Rheumatoid arthritis: How helpful are low-dose corticosteroids against flares?

Corticosteroid medications have a bad reputation for adverse effects. But when taken in low doses for a short time they have fewer adverse effects and they can help reduce painful arthritis flares.

Arthritis is a chronic inflammation of the joints. Its causes are still unknown, but it is typical of the disease that the defense cells of the immune system move to the joint capsules of the fingers, knees and elbows. These inflammations can cause joints to become swollen and very painful. Phases of less joint pain often alternate with phases of more intense inflammation. These intense phases are called flares. Sometimes arthritis leads after many years to a joint becoming completely stiff or damaged.

So-called corticosteroids (or glucocorticoids) can be used to treat arthritis. They are similar to the body’s anti-inflammatory hormones and are part of a group of hormones that can also be called “cortisone” or “steroids”. Synthetic corticosteroids such as prednisone and prednisolone are strong drugs that also have many adverse effects if they are used in high doses for long periods of time. One of these adverse effects is that they can slow bone metabolism so much that the risk of breaking a bone increases by a lot.

Because of adverse effects like this, people with arthritis often use so-called non-steroidal anti-inflammatory drugs (NSAIDs) instead of corticosteroids. This group relieves symptoms in a different way and includes drugs such as diclofenac, ibuprofen and indomethacin. These drugs can also cause adverse effects, particularly affecting the stomach.

In order to see which of these groups of medicines is more effective and better tolerated, researchers from the Cochrane Collaboration gathered and analyzed the results of 11 trials involving a total of 462 people with severe forms of rheumatoid arthritis that tested steroids and non-steroidal drugs. They focused on trials in which corticosteroids were taken only in lower doses, and for less than 1 month. They wanted to find out whether this type of short-term use could reduce symptoms mostly for people who were not helped by other medications, and whether severe adverse effects could be avoided at the same time. Most of the people in the trials were using the corticosteroids to relieve flares.

One of the results they found was that even in lower doses prednisolone or prednisone led to a greater reduction in pain than other anti-inflammatory drugs. This could be seen, for example, in the number of painful joints. People who had taken low-dose steroids had fewer painful joints than the people on non-steroidal anti-inflammatory drugs.

To get a better picture of the range of adverse effects, the researchers also analyzed results of trials in people who took steroids for many months or some years. Those studies showed that the risk of bone breaks increases noticeably only after long-term use of steroids.

You can find information about more treatment options for arthritis here.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)