Meta-analysis of short term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis

La polyarthrite rhumatoïde du sujet âgé

“…Les recommandations de l'Afssaps contre indiquent les AINS sélectifs ou non sélectifs en cas d'ulcère évolutif ou de saignement gastro-intestinal, d'antécédents de saignement digestif ou de perforation survenus sous AINS, d'insuffisance cardiaque [26]. Elles contre-indiquent les coxibs en cas de cardiopathie ischémique avérée, d'artériopathie périphérique, d'antécédent d'accident vasculaire cérébral constitué ou d'accident ischémique transitoire [28]. Elles déconseillent la prescription d'AINS sélectifs ou non sélectifs chez un patient qui présente un risque d'insuffisance rénale fonctionnelle (sujet âgé, hypovolémique, traité par inhibiteur de l'enzyme de conversion ou antagonistes des récepteurs de l'angiotensine 2).…”

Glucocorticoid use in rheumatoid arthritis

“…In an effort to define improvement in disease activity, interventional studies have compared glucocorticoid preparations with placebo, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and less potent second-line anti-rheumatic drugs. Pooling these studies in a Cochrane Library meta-analysis, Gotzsche and Johansen [13] confirmed short-term efficacy (outcomes measured closest to 1 week) based on superior improvement in joint tenderness and pain in comparison with NSAIDs.…”

Effects of long-term corticosteroid usage on functional disability in patients with early rheumatoid arthritis, regardless of controlled disease activity

“…The use of steroids for RA patients remains controversial. However, several recent randomized trials [21-23] and some meta-analysis reports [24][25][26][27][28] suggested that short-term use of corticosteroids is effective for retarding radiographic joint destructions in patients with early RA (of at least 2 years). Based on these data, Bijlsma et al [54,55] insisted that corticosteroids have DMARD-like activity in retarding the progression of joint damage.…”

“…In addition, recent randomized trials have indicated that short-term usage of low-dose corticosteroids was able to prevent radiographic progression in patients with early RA [21][22][23], and some meta-analysis reports have also supported the short-term effectiveness of corticosteroids [24][25][26][27][28], while other studies of RA patients using 7.5 mg/day failed to confirm these kinds of benefits [29][30][31]. Iikuni et al [32] showed that corticosteroid usage even at low dosage significantly deteriorated functional capacity in patients with low disease activity state, although most patients in their study were established RA (average RA disease duration 8.4 years).…”