- About 18 million people worldwide have rheumatoid arthritis.
- There are various medications — including steroids — used to treat symptoms, all with potential side effects.
- Researchers from Charite – Universitätsmedizin Berlin report that the use of low-dose glucocorticoids to treat people with rheumatoid arthritis does not cause substantial weight gain or high blood pressure.
There is currently no cure for rheumatoid arthritis. A rheumatologist can prescribe treatments to help ease the symptoms of the condition to help prevent damage to the body’s joints or other affected areas.
There are a variety of different drugs available to help with rheumatoid arthritis, including nonsteroidal anti-inflammatory drugs (NSAIDs), conventional and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), biologic treatments, and steroids.
Now researchers from Charite – Universitätsmedizin Berlin in Berlin, Germany, are reporting that the use of low-dose glucocorticoids — a type of steroid hormone — to treat people with rheumatoid arthritis does not cause substantial weight gain or high blood pressure.
This study was recently published in the journal Annals of Internal Medicine.
Rheumatoid arthritis is a chronic inflammatory condition in which the body’s immune system mistakes its own tissues for foreign bodies.
Symptoms of rheumatoid arthritis may not be as apparent at first but may worsen over time.
A person with the condition normally goes through periods of time where symptoms peak in what is known as a flare.
As the symptoms lessen due to treatment or other reasons, they enter remission. Most people with rheumatoid arthritis will experience cycles of flares and remission throughout their lives.
Glucocorticoids are a type of steroid used to work with your immune system to treat inflammation.
The body naturally makes glucocorticoids through the adrenal gland. However, sometimes a person may need to take synthetic glucocorticoids to treat an autoimmune disease, inflammatory disorders, allergies, or asthma.
Types of glucocorticoid drugs include:
Depending on the person and their symptom severity, the dose of a glucocorticoid drug a doctor prescribes will vary.
In this study, researchers from Charite – Universitätsmedizin Berlin focused on studying the use of low-dose glucocorticoids for the management of rheumatoid arthritis.
The researchers noted that while the adverse effects are known from high-dose glucocorticoids, there is still more to learn about the side effects of low-dose glucocorticoids.
The scientists analyzed data from five randomized controlled trials with two-year interventions to see how the low-dose glucocorticoid treatment affected people with rheumatoid arthritis.
A total of 1,112 participants with rheumatoid arthritis from 12 European countries were included.
During the two-year follow-up, the researchers reported that participants receiving low-dose glucocorticoid gained only gained about 2 pounds more in body weight than participants receiving the placebo.
Additionally, they reported no significant difference in blood pressure between the two groups.
After reviewing this study, Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California, told Medical News Today he thought it was a good and encouraging study.
“A lot of people, when you talk about long-term use of steroids for treatment of an autoimmune disease (like) rheumatoid arthritis, they tend to shy away (and) get scared,” he explained. “There’s definitely bad media about steroids that it’s going to make you gain weight and change a lot of your physiology.”
“Showing that over 1,000 patients in 12 different European countries with the net result versus placebo gaining only an average over the two years of 2 pounds or 2.5 pounds and very minor changes or nothing of significance as far as blood pressure is a good encouraging point,” Mikhael added.
Medical News Today also spoke with Dr. David R. Karp, a professor and chief of the Rheumatic Diseases Division at UT Southwestern Medical Center in Dallas. He said there are pros and cons to this study’s approach, but it was reassuring to see that the effects of prednisone on weight and blood pressure were small.
“However, there was still more weight gain in people taking 7.5 mg of prednisone per day compared to taking only 5 mg per day,” he noted. “This bears out most rheumatologists’ feeling that the lowest dose of prednisone that a patient needs to control their symptoms is better and probably it is best to be off prednisone entirely if other drugs are working. Most rheumatologists would not treat their patients with prednisone alone because of possible side effects not measured in this study.”
Karp said he would like to see this study repeated in more diverse populations.
“These were all Western European patients who tend to be mainly white individuals,” he explained. “We should know whether the same results are seen in Black patients or Hispanic patients, for example.”
“More importantly, we need to know the effects of low-dose prednisone over longer periods of time than two years and we need to know about other side effects like osteoporosis, infection risk, diabetes, and eye disease, for example,” Karp added.
Mikhael said he would like to see studies that compare low-dose glucocorticoids to other rheumatoid arthritis therapies.
“Instead of (a) comparison versus placebo, (compare) low-dose glucocorticoids versus non-biologic modifying antirheumatic agents like methotrexate or Plaquenil … to see effectiveness, prevention of disease progression, and then comparing side effects for long-term use,” he said. “That would be also very informative and very helpful to do a comparison like that.”