Treatment with prednisone/prednisolone was not associated with significant change in bone mass density (BMD) compared with placebo in patients with early and active rheumatoid arthritis (RA), according to a study published in the journal Bone.
The role of glucocorticoids in the treatment of rheumatoid arthritis (RA) has always remained a matter of discussion.
ABG Blavnsfeld and his associates conducted a study to assess the effect of prednisolone/prednisone on bone mineral density (BMD) in patients with RA analyzed in randomized, controlled trials.
The authors performed a systematic literature search and identified randomized, double-blinded placebo-controlled studies including patients with RA and using prednisolone or prednisone as the intervention. The authors selected studies that measured BMD by DXA at baseline and at least once thereafter. The primary endpoint was mean change in BMD from baseline to follow-up. Secondary endpoints included radiographic scores, RA disease activity indices, and fractures.
The authors identified 7 studies and included previously unpublished data. Studies were similar regarding study population and intervention. A standard mean difference (SMD) in the change in BMD from 0 to 24 months was −0.02 at the lumbar spine and −0.11 at the hip (both high-quality evidence) between patients treated with prednisolone/prednisone or not.
The study found that
- Oral glucocorticoids for 2 years did not reduce BMD in early and active RA.
- Neither hip BMD nor lumbar BMD decreased in response to oral glucocorticoids.
- Anti-inflammatory effects of glucocorticoids may counterbalance negative effects on bone.
- Fracture data are few and insufficient for conclusions.
The study concluded that in patients with early and active RA, no difference was seen in the change in BMD between patients treated with prednisone/prednisolone versus placebo, suggesting that at least through 24 months, the suppression of inflammation by glucocorticoids may counterbalance their adverse effects on bone remodeling.
Rheumatoid arthritis is an autoimmune disorder which occurs when that immune system attacks one’s own body’s tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
For more reference log on to https://doi.org/10.1016/j.bone.2018.06.008