Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis

Abstract

BackgroundThe e ect of low dose corticosteroids, equivalent to 15 mg prednisolone daily or less, in patients with rheumatoid arthritis has been questioned. We reviewed the trials that compared corticosteroids with placebo or non-steroidal, anti-inflammatory drugs. ObjectivesTo determine whether short-term (i.e. as recorded within the first month of therapy), oral low-dose corticosteroids (corresponding to a maximum of 15 mg prednisolone daily) is superior to placebo and non-steroidal, anti-inflammatory drugs in patients with rheumatoid arthritis. Search methodsPubMed, the Cochrane Central Register of Controlled Trials, reference lists and a personal archive. Date of last search Nov 2007. Selection criteriaAll randomised trials comparing an oral corticosteroid (not exceeding an equivalent of 15 mg prednisolone daily) with placebo or a nonsteroidal, anti-inflammatory drug were eligible if they reported clinical outcomes within one month a er start of therapy. For adverse e ects, long-term trials were also selected. Data collection and analysisDecisions on which trials to include were made independently by two observers based on the methods sections of the trials. Standardised mean di erence (random e ects model) was used for the statistical analyses. Main resultsEleven trials, involving 462 patients, were included. Two placebo-controlled trials had adequate allocation concealment. For joint tenderness, the standardised mean di erence was -0.52, 95% confidence interval (CI) -1.01 to -0.03, for pain it was -0.67, 95% CI -1.58 to 0.23, and for grip strength, 0.22, 95% CI -0.40 to 0.84. The estimates for the other trials were considerably larger.Prednisolone also had a greater e ect than non-steroidal, anti-inflammatory drugs on joint tenderness (-0.63, 95% CI -1.16 to -0.11) and pain (-1.25, 95% CI -2.24 to -0.26), whereas the di erence in grip strength was not significant (0.31, 95% CI -0.02 to 0.64). The main harms in long-term treatment were vertebral fractures and infections. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis (Review)

Anti-Inflammatory Effect of Wasp Venom in BV-2 Microglial Cells in Comparison with Bee Venom

“…Prednisolone is the most frequently used glucocorticoid owing to its anti-inflammatory and immunosuppressive activities [ 62 , 63 , 64 ]. Considering the anti-inflammatory mechanisms of prednisolone [ 65 , 66 , 67 , 68 ] and BV [ 23 , 42 , 69 ], it was assumed that the suppressive activities of WV on NO production and cytokine release would be mediated through the NF-κB pathway.…”

Anti-Inflammatory Effect of Wasp Venom in BV-2 Microglial Cells in Comparison with Bee Venom

“…Prednisolone is the most frequently used glucocorticoid owing to its anti-inflammatory and immunosuppressive activities [ 62 , 63 , 64 ]. Considering the anti-inflammatory mechanisms of prednisolone [ 65 , 66 , 67 , 68 ] and BV [ 23 , 42 , 69 ], it was assumed that the suppressive activities of WV on NO production and cytokine release would be mediated through the NF-κB pathway.…”

Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis

“…Systematic review showed that prednisolone administrated orally at low doses (maximum of 15 mg/day) was more effective than placebo and NSAIDs at decreasing joint tenderness and pain, but the quality of the evidence was not assessed by the authors [ 23 ]. According to older evidences, after six months, the effects of prednisolone (maximum 15 mg/day) were significantly better compared to placebo for number of painful joints, number of swollen joints, pain and physical function [ 21 ].…”

Implications of long-term medication of oral steroids and antimalarial drugs in primary Sjögren's syndrome

“…Although associated with significant adverse effects (reviewed in [23]), low-dose prednisolone has been used in the management of rheumatoid arthritis for decades, especially to relieve symptoms of early morning stiffness [24]. Important mechanisms underlying the anti-inflammatory effects of corticosteroids include the blocking of the effect of macrophage migration inhibitory factor and inhibition of neutrophil and monocyte-macrophage adherence to endothelial cells in the inflamed area (Summary of Product Characterisation, SPC [25]).…”

Anti-Inflammatory Effect of Wasp Venom in BV-2 Microglial Cells in Comparison with Bee Venom

“…Prednisolone is the most frequently used glucocorticoid owing to its anti-inflammatory and immunosuppressive activities [ 62 , 63 , 64 ]. Considering the anti-inflammatory mechanisms of prednisolone [ 65 , 66 , 67 , 68 ] and BV [ 23 , 42 , 69 ], it was assumed that the suppressive activities of WV on NO production and cytokine release would be mediated through the NF-κB pathway.…”

Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis

“…Systematic review showed that prednisolone administrated orally at low doses (maximum of 15 mg/day) was more effective than placebo and NSAIDs at decreasing joint tenderness and pain, but the quality of the evidence was not assessed by the authors [ 23 ]. According to older evidences, after six months, the effects of prednisolone (maximum 15 mg/day) were significantly better compared to placebo for number of painful joints, number of swollen joints, pain and physical function [ 21 ].…”

Implications of long-term medication of oral steroids and antimalarial drugs in primary Sjögren's syndrome

“…Although associated with significant adverse effects (reviewed in [23]), low-dose prednisolone has been used in the management of rheumatoid arthritis for decades, especially to relieve symptoms of early morning stiffness [24]. Important mechanisms underlying the anti-inflammatory effects of corticosteroids include the blocking of the effect of macrophage migration inhibitory factor and inhibition of neutrophil and monocyte-macrophage adherence to endothelial cells in the inflamed area (Summary of Product Characterisation, SPC [25]).…”

Anti-Inflammatory Effect of Wasp Venom in BV-2 Microglial Cells in Comparison with Bee Venom

“…Prednisolone is the most frequently used glucocorticoid owing to its anti-inflammatory and immunosuppressive activities [ 62 , 63 , 64 ]. Considering the anti-inflammatory mechanisms of prednisolone [ 65 , 66 , 67 , 68 ] and BV [ 23 , 42 , 69 ], it was assumed that the suppressive activities of WV on NO production and cytokine release would be mediated through the NF-κB pathway.…”

Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis

“…Systematic review showed that prednisolone administrated orally at low doses (maximum of 15 mg/day) was more effective than placebo and NSAIDs at decreasing joint tenderness and pain, but the quality of the evidence was not assessed by the authors [ 23 ]. According to older evidences, after six months, the effects of prednisolone (maximum 15 mg/day) were significantly better compared to placebo for number of painful joints, number of swollen joints, pain and physical function [ 21 ].…”

Implications of long-term medication of oral steroids and antimalarial drugs in primary Sjögren's syndrome

“…Although associated with significant adverse effects (reviewed in [23]), low-dose prednisolone has been used in the management of rheumatoid arthritis for decades, especially to relieve symptoms of early morning stiffness [24]. Important mechanisms underlying the anti-inflammatory effects of corticosteroids include the blocking of the effect of macrophage migration inhibitory factor and inhibition of neutrophil and monocyte-macrophage adherence to endothelial cells in the inflamed area (Summary of Product Characterisation, SPC [25]).…”