Low-dose prednisone for RA patients might be effective initially, long term

Many patients with rheumatoid arthritis might be treated effectively with an initial and long-term prednisone dose of less than 5 mg daily, according to study results.

Researchers evaluated 308 patients with rheumatoid arthritis (RA) who received prednisone from 1980 to 2004. Medications and multidimensional health assessment questionnaire (MDHAQ) scores from each visit were included in the patient database. Initial prednisone doses of more than 5 mg/day, 5 mg/day or less than 5 mg/day were computed by proportion of patients in 5-year periods: 1980-1984, 1985-1989, 1990-1994, 1995-1999 and 2000-2004.

Changes in mean scores between patients treated with less than 5 mg/day vs. those treated with at least 5 mg/day were compared for MDHAQ function, pain and routine assessment of patient index data 3.

The mean initial daily prednisone doses in milligrams during the 5-year periods were 10.3, 6.5, 5.1, 4.1 and 3.6, respectively. Proportion of patients receiving more than 5 mg/day initially were 49%, 16%, 7%, 7% and 3%. Proportion treated with 5 mg/day were 51%, 80%, 70%, 26% and 10%, and proportion treated with less than 5 mg/day were 0%, 4%, 23%, 67% and 86%. After 1990, the majority of patients also received methotrexate, while prednisone treatment at less than 5 mg/day was maintained indefinitely.

“Patients treated with 5 mg/day or more had poorer clinical status,” the researchers reported. “MDHAQ scores were improved similarly in patients treated with less than 5 mg/day or 5 mg/day or more.”

Skin-thinning and bruising were primary adverse effects, with less than 10% of patients experiencing newly developed hypertension, diabetes and cataracts.

“The data indicate a decline in initial prednisone dose … between 1980 and 2004 from 10.3 mg/day to 3.6 mg/day,” the researchers reported. “The proportion of patients who were taking methotrexate was increased from 10% in 1985 to 77% in 2000, which may explain in part reduction of prednisone … . Prednisone at initial and long-term doses less than 5 mg/day with indefinite continuation appeared effective for most patients with RA, with few adverse effects.”