Zirkadiane versus ultradiane Glukokortikoid-Gabe bei der rheumatoiden Arthritis

Alten, Rieke; Nolte, M.; Döring, Gerd; Werder, K. Von

doi:10.1055/s-0029-1243618

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…Delayed release prednisolone gave similar pain improvement to standard release after 12 weeks of night-time dosing in the CAPRA-1 study [ 75 ]. Six weeks of ultradian dosing gave similar results to circadian dosing of prednisolone in one trial [ 80 ]. Additionally, dosing at 2 a.m. with 7.5 mg prednisolone yielded greater pain improvements than 7.30 a.m. doses (25 mm difference on 100 mm VAS) in one study [ 81 ].…”

Section: Resultsmentioning

confidence: 99%

The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis

et al. 2021

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Objectives Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain. Methods A systematic literature review of randomised controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences (MDs) were meta-analysed. Heterogeneity (I2, tau statistics) and bias (funnel plot, Eggers test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562). Results 18903 titles, 880 abstracts and 226 full texts were assessed. Thirty three RCTs suitable for the meta-analysis included 2658 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD= -0.65 (15 studies, 95% CI, -0.82, -0.49, p< 0.001) with significant heterogeneity (I2=56%, p= 0.0002). Efficacy displayed time-related decreases after GC initiation. Mean difference VAS pain was -12mm (95% CI, -14mm to -9mm) greater improvement in GC than control at ≤ 3 months, -8mm (95% CI, -12mm, -3mm) at > 3–6 months, and -6mm (95% CI, -10mm, -2mm) at > 6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from 5 RCTs suggested improvement also in fatigue during GC treatment. Conclusion Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.

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Section: Resultsmentioning

confidence: 99%