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 side effects and they can help reduce painful arthritis flares.

Arthritis is a disease that affects the joints, such as those in the fingers, knees and elbows. The causes of arthritis are not completely understood. But when a joint is affected by arthritis, parts of the joint become inflamed (red, hot and swollen) as a result of a reaction in the immune system.

People with arthritis have phases where there is less joint pain, alternating with very severe episodes of pain caused by this inflammation. These episodes are called flares or exacerbations. Eventually, arthritis also causes parts of the joints to become damaged and wear thin.

Corticosteroids are also called glucocorticoids or steroids. They are strong drugs such as prednisolone that can reduce inflammation. However, when they are used in high doses and for long periods of time, they can cause side effects such as osteoporosis. Osteoporosis affects the bones, which leads to fractures or broken bones.

Because of the risk of serious side effects like this, people usually use so-called non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the inflammation and pain during arthritis flares. These include drugs such as diclofenac, ibuprofen and indomethacin. These drugs also can cause adverse effects, particularly affecting the stomach.

In order to see which of these groups of medicines is more effective and tolerable, researchers from the Cochrane Collaboration gathered and analysed the results of trials which tested steroids and non-steroidal drugs in people with severe forms of rheumatoid arthritis. They concentrated on on lower doses of steroids, taken for less than one month. Most of the people in the trials were using the steroids to relieve flares.

One of the results they found was that prednisolone or prednison in lower doses 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 spectrum of adverse effects, the researchers also analysed results of trials in people who took steroids for many months or some years. Those studies showed that the risk of bone breaks increases after longterm use of steroids.

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