What role do corticosteroids play in the treatment of rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Corticosteroids are potent anti-inflammatory drugs that are commonly used in patients with RA to bridge the time until treatment with DMARDs is effective. [5, 128] These agents are effective adjuncts to DMARD or NSAID therapy. Timely dose reductions and cessation are important because of the adverse effects associated with long-term steroid use. Corticosteroids can be administered by oral, IV, or intra-articular routes.

When Buttgereit et al studied circadian rhythms in 288 patients with active RA, half of whom were randomly assigned to a modified-release (MR) prednisone tablet and the other half to an immediate-release (IR) prednisone tablet, there was a clinically relevant reduction of morning stiffness of the joints with the MR product as compared with the IR product. [129]

A 9-month extension of the same study showed that the MR prednisone taken at bedtime was well tolerated and provided a sustained improvement. [130] A third study that added low-dose MR prednisone to existing DMARD treatment also showed improvements in RA signs and symptoms, including a reduction in morning stiffness as compared with baseline (35% vs 55%). [131]

A comparison of high-dose IV steroids with infliximab in the 18-month randomized, double-blind IDEA study found similar rates of remission induction and sustained remission, as well as the time to sustained remission, with the two agents. [132, 133] The study, which included 112 patients with new-onset DMARD-naïve RA, compared the efficacy of infliximab and IV steroid therapy, both in combination with methotrexate, as remission induction in early RA, followed by a treat-to-target approach.


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