Editorials

Corticosteroids in rheumatoid arthritis

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7134.789 (Published 14 March 1998) Cite this as: BMJ 1998;316:789

Effective anti-inflammatory agents but doubts about safety remain

  1. Elaine M Dennison, Wellcome training research fellow,
  2. Cyrus Cooper, Professor of rheumatology
  1. MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton S016 6YD

    Papers p 811

    The millennium brings with it the 50th anniversary of Hench's discovery that corticosteroids might be used to treat rheumatoid arthritis.1 Attitudes towards such use have waxed and waned since then. Initial hope that steroids might dramatically alter the long term course of the disorder gave way to a recognition of the serious adverse effects that accompany high dose treatment. As a result the use of low dose corticosteroids in arthritis remains highly controversial.

    Corticosteroids are used widely in medicine today. A recent survey in general practice found that 1.4% of patients aged over 54 were using corticosteroids at a mean dose of 8 mg daily2: rheumatoid arthritis was the indication in 23% of cases. Although rheumatologists claim to use steroids relatively infrequently, audits of patients attending outpatient departments suggest a high prevalence of use (as great as 80%). 3 4 What, then, is the quality of the evidence to support the use of corticosteroids in rheumatoid arthritis?

    This question is best answered by considering the balance between the risks and benefits of steroid use for short periods (two to three months), with the objective …

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