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Meta-analysis of short term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7134.811 (Published 14 March 1998) Cite this as: BMJ 1998;316:811
  1. Peter C Gøtzsche, director (p.c.gotzsche{at}cochrane.dk),
  2. Helle Krogh Johansen, senior researcher
  1. Nordic Cochrane Centre, Rigshospitalet, Department 7112, Tagensvej 18 B, DK-2200 Copenhagen N, Denmark
  1. Correspondence to: Dr Gøtzsche
  • Accepted 18 November 1997

Abstract

Objective: To determine whether short term, oral low dose prednisolone (⩽15 mg daily) is superior to placebo and non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis.

Design: Meta-analysis of randomised trials of oral corticosteroids compared with placebo or a non-steroidal anti-inflammatory drug.

Setting: Trials conducted anywhere in the world.

Subjects: Patients with rheumatoid arthritis.

Main outcome measures: Joint tenderness, pain, and grip strength. Outcomes measured on different scales were combined by using the standardised effect size (difference in effect divided by SD of the measurements).

Results: Ten studies were included in the meta-analysis. Prednisolone had a marked effect over placebo on joint tenderness (standardised effect size 1.31; 95% confidence interval 0.78 to 1.83), pain (1.75; 0.87 to 2.64), and grip strength (0.41; 0.13 to 0.69). Measured in the original units the differences were 12 (6 to 18) tender joints and 22 mm Hg (5 mm Hg to 40 mm Hg) for grip strength. Prednisolone also had a greater effect than non-steroidal anti-inflammatory drugs on joint tenderness (0.63; 0.11 to 1.16) and pain (1.25; 0.26 to 2.24), whereas the difference in grip strength was not significant (0.31; −0.02 to 0.64). Measured in the original units the differences were 9 (5 to 12) tender joints and 12 mm Hg (−6 mm Hg to 31 mm Hg). The risk of adverse effects during moderate and long term use seemed acceptable.

Conclusion: Prednisolone in low doses (⩽15 mg daily) may be used intermittently in patients with rheumatoid arthritis, particularly if the disease cannot be controlled by other means.

Key messages

  • Prednisolone in low doses—that is, no more than 15 mg daily—is highly effective in patients with rheumatoid arthritis

  • The risk of adverse effects is acceptable in short, moderate, or long term use

  • Oral low dose prednisolone may be used intermittently in patients with rheumatoid arthritis, particularly if the disease cannot be controlled by other means

  • Further short term placebo controlled trials to study the clinical effect of prednisolone or other oral corticosteroids are no longer necessary

Footnotes

    • Accepted 18 November 1997
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