[Prednisone for rheumatoid arthritis: the detriment of the doubt]

Physicians pride themselves on practicing evidence-based medicine. However, these principles appear not to apply in the case of glucocorticoid therapy for rheumatoid arthritis (RA). Despite a sizable body of evidence, glucocorticoids are underutilised in the treatment of RA. Hench's 1950 acceptance speech for the Nobel Prize (which he shared with Kendall and Reichstein for the discovery of glucocorticoids) illustrated his awareness of the benefits and risks of these agents. Although glucocorticoids have proved beneficial in randomized trials from 1955 onwards, only a perception of harm has endured. The recently published CAMERA-2 trial data could be the final piece of evidence added to the substantial body of literature proving that prednisone 10 mg/d given for 2 years in early RA, in addition to high-dose methotrexate, is better than methotrexate alone in inducing remission and preventing joint damage, and is accompanied by fewer side effects. Existing treatment guidelines need to be urgently updated to reflect these findings.