• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Johns Hopkins Arthritis Center

Show Search
Hide Search
  • Disease Information
    • Rheumatoid Arthritis
    • Psoriatic Arthritis
    • Ankylosing Spondylitis
    • Osteoarthritis
    • Gout
    • Osteoporosis
  • Patient Corner
    • Drug Information Sheets
    • Managing Your Arthritis
    • RheumTV – Patient Education Video Library
  • Our Research
    • Patient-Centered Outcomes Research
    • Current Research Studies
    • The Camille Julia Morgan Arthritis Research and Education Fund
  • About Us
    • Appointment Information
    • Contact Us
    • Our Faculty
    • Our Staff
    • Rheumatology Specialty Centers
  • Donate
Home / Arthritis News / Low-Dose Prednisone Can Slow Joint Damage in Rheumatoid Arthritis

Low-Dose Prednisone Can Slow Joint Damage in Rheumatoid Arthritis

April 13, 2005 By Arthritis Center

Low-dose prednisone is widely used for the treatment of rheumatoid arthritis (RA). When used in conjunction with disease-modifying antirheumatic drugs (DMARDs), it has been shown to retard radiologic damage in RA. However, few data are available on the efficacy of prednisone alone in this regard, or its safety. To address this question, van Everdingen, et al (Ann Intern Med 2002; 136:1-12) conducted a two year trial comparing low dose prednisone alone versus placebo for the treatment of early RA.

Methods:

In a two year, randomized, double-blinded study the efficacy of 10 mg prednisone vs. placebo was examined in 81 subjects. All subjects had been diagnosed with rheumatoid arthritis within the past year and had active disease (>3 tender joints, >3 swollen joints, ESR > 28 mm/hr, > 30 minutes morning stiffness). No subjects had been exposed any DMARD prior to the study.

Patients were randomized to receive either placebo or prednisone 10 mg every morning with 500 mg supplemental calcium. Acetaminophen and NSAID use was allowed as were intraarticular steroid injections. Sulfasalazine was allowed as a rescue medication after six months if the investigator deemed the disease active.

Results:

Thirty-five of 41 placebo subjects and 36 of 40 prednisone subjects completed the study. No subject dropped due to lack of efficacy or side effects, despite restrictions on DMARD therapy within the first six months. At baseline, there were no statistically significant differences in the demographic characteristics or disease activity parameters between the two groups, although there were some trends towards greater severity in the placebo group. After 6 months, 39 of 71 completers (20 placebo, 19 prednisone) received sulfasalazine.

At 12 and 24 months, there was statistically significant less radiographic progression in the prednisone group compared to the control group. Prednisone patients progressed at a rate of approximately 8 radiographic (Sharp) units per year, while placebo patients progressed at approximately 15 units per year. Overall, improvements in clinical efficacy parameters were not significantly different between the groups except for grip strength and 28-joint tender score (better in the prednisone group). However, prednisone treated patients took significantly less daily NSAID and acetaminophen, and had significantly fewer steroid articular injections, than the placebo treated subjects. This may have obscured any potential differences in the clinical parameters between the prednisone and placebo groups. Patients receiving prednisone experienced weight gain (77 to 80 kg, p=0.001) and an increase in mean serum glucose levels (5.1 to 5.9 mmol/L, p=0.01), while placebo patients did not. Prednisone treated patients also had an increased number of new vertebral bone fractures than placebo treated patients (5 versus 2).

Conclusions:

Low-dose prednisone provides relief from rheumatoid arthritis symptoms particularly within the first six months and substantially inhibits progression of erosive joint damage in patients nave to other DMARD therapies. However, as the authors note, because of its limited disease modifying properties, prednisone should be prescribed in conjunction with other DMARDs.

Editorial Comment:

There are several important notations to make about this study. As the authors duly note, a placebo-controlled study design would not likely be approved now by human subjects or ethics committees. But, when it was initiated in the early 1990s, it was state-of-the-art and clearly yielded valuable information. Without the confounding addition of DMARDs, this study clearly demonstrates the disease modifying potential of low dose steroids. However, subjects receiving 10 mg prednisone daily still progressed at 8 Sharp units/yr. While this was lower than the placebo rate of 15 units/yr, it is much higher than the rates observed in recent studies in patients treated with methotrexate, etanercept, infliximab + methotrexate, or leflunomide. With these DMARDs, rates of progression are in the range of 0-2 units/yr. Each Sharp unit represents the equivalent of one erosion (or worsening of one erosion) or progression in joint space narrowing in one joint. Eight erosions, or progression of narrowing of eight joints, per year as demonstrated on prednisone treated subjects in this study, would not be acceptable given the higher superiority of the DMARDs listed above. Thus, the recommendation by the authors that prednisone should be adjunctive, rather than monotherapy, is appropriate.

The efficacy of prednisone must also be balanced against its potential long-term side effects. In this study, there was a tendency towards hyperglycemia and weight gain. Insofar as active RA can cause weight loss, some of the weight gain in prednisone patients could conceivably have been due to better control of disease activity and return to pre-RA weight rather than purely a side effect of prednisone. The increase in vertebral fractures is particularly concerning, however, and consistent with a recent report that even nasally administered corticosteroids are associated with decreases in bone density. (see report)

Finally, it would have been interesting to see how the addition of sulfasalazine altered the rates of progression in the two groups. Insofar as equivalent numbers of both treatment groups were started on sulfasalazine, its effect is probably equally distributed among the two groups. However, the subset in both treatment groups who received sulfasalazine might be expected to exhibit a slower rate of progression from 6-12 months than they had in the period of 0-6 months.

Receive the Latest News from Johns Hopkins Rheumatology

Receive the Latest News from Johns Hopkins Rheumatology

Join our mailing list to receive the latest news and updates from Johns Hopkins Rheumatology.

Interested In

You have Successfully Subscribed!

Arthritis Center

Founded in 1998, the Arthritis Center at Johns Hopkins is dedicated to providing quality education to patients and healthcare providers alike.

Use of this Site

All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Primary Sidebar

Recent News

Exercise Tips for Arthritis Patients

How Does Exercise Affect my Joints? How Frequently Should I Be Exercising? Should I Lose Weight for Exercise to be

Risks and Benefits of Biologic Medications

Victoria Ruffing, RN, BC, Director of Patient Education at the Johns Hopkins Arthritis Center, shares the risks and benefits of biologic for

How to Manage Rheumatoid Arthritis Flares

Through research, doctors have a clearer understanding of how flares can impact a patient on a personal and emotional level. Dr. Uzma Haque

Complementary & Alternative Medicines for Psoriatic Arthritis

There are many complementary & alternative medicines and practices that have been found to be beneficial in curbing arthritis pain,

I can’t be a runner because I have Rheumatoid Arthritis (RA), right?

Dr. Manno discusses running and Rheumatoid Arthritis. Is it an option for the RA patient?

News Categories

  • Ankylosing Spondylitis News
  • Fibromyalgia News
  • Gout News
  • Lupus News
  • Osteoarthritis News
  • Osteoporosis News
  • Psoriatic Arthritis News
  • Rheumatoid Arthritis News
RheumTV Logo

Rheum.TV is an informational platform created to educate patients living with a rheumatic disease. With over 100 disease education videos produced by the team at Johns Hopkins Rheumatology.

Visit Rheum.TV

Footer

Johns Hopkins Rheumatology

  • Johns Hopkins Rheumatology
  • Johns Hopkins Lupus Center
  • Johns Hopkins Lyme Disease Research Center
  • Johns Hopkins Myositis Center
  • Johns Hopkins Scleroderma Center
  • Johns Hopkins Sjögren’s Syndrome Center
  • Johns Hopkins Vasculitis Center

Connect With Us

  • Facebook
  • Twitter
  • YouTube

Johns Hopkins Medicine

© 2023 Johns Hopkins Arthritis Center
Patient Privacy