Metabolic effects of high‐dose prednisolone treatment in early rheumatoid arthritis: Balance between diabetogenic effects and inflammation reduction

Abstract

Objective. To investigate the dose-related effects of glucocorticoid treatment on glucose tolerance, beta cell function, and insulin sensitivity in patients with early active rheumatoid arthritis (RA).Methods. A randomized, controlled, single-blind trial was conducted in 41 patients with early active RA. At the beginning of the trial patients had not been treated for their RA, and were randomized to begin treatment with prednisolone at 60 mg/day or 30 mg/day. Before and at the end of 1 week of treatment, a frequently sampled oral glucose tolerance test was performed. The glucose area under the curve (AUC G ) was calculated. In addition, beta cell function and insulin sensitivity parameters were computed.Results Conclusion. In this study, short-term treatment with prednisolone 60 mg or 30 mg per day improved disease activity without deterioration of glucose tolerance in patients with active RA. However, due to individual differences, monitoring is recommended.

The current relevance and use of prednisone in rheumatoid arthritis

“…In a recent trial by den Uyl et al [94], not even medium to high doses of prednisone, given for 1 week, did have an impact on glucose tolerance, even if tolerance was previously impaired. Latest data are therefore suggesting that even a short-term medium to high dose of GC is not necessarily impairing glucose tolerance or b-cell function, which is just in line with the evidence outlined for long-term use of low-dose GC above.…”

“…Obviously, RA itself is not only interfering with bone metabolism but also influences glucose metabolism; as a matter of fact, insulin sensitivity decreases with increasing disease activity [85,94]. In a recent trial by den Uyl et al [94], not even medium to high doses of prednisone, given for 1 week, did have an impact on glucose tolerance, even if tolerance was previously impaired.…”

New Guidelines for the Management of Rheumatoid Arthritis (Eular, 2013): The Place of Glucocorticoids

“…Однако короткий курс ГК в средних/высоких [87] или низких [88] дозах не приводит к нарушению толерантности к глюкозе, что не исключает необходимости тщательного мониторин-га гликемии на фоне лечения ГК. Полагают также, что прибавка массы тела, наблюдаемая на фоне лечения ГК, может быть связана не столько с метаболическими эффек-тами ГК, сколько со снижением активности воспаления, которое, как известно, приводит к потере массы тела (рев-матоидная кахексия) у пациентов с РА [89].…”

Diabetes mellitus and hyperglycemia in patients with rheumatoid arthritis

“…Этот факт можно объяснить усилением синтеза и базальной секреции инсулина под действием ГК, что наблюдали и D. Den Uyl и соавт. [19] при кратковремен-ном назначении высоких доз преднизолона.…”