Low-dose corticosteroid therapy in rheumatoid arthritis: balancing the evidence

Corticosteroid (steroid) use is common but controversial in rheumatoid arthritis (RA). Some observational studies suggest that mortality might be increased with steroid use, and several large retrospective reviews indicate that long-term low-dose steroid use is a significant independent predictor of numerous, potentially serious adverse events. Both cumulative and average steroid dose are independent important adverse-event predictors. There is a lack of long-term data on the efficacy of steroid therapy, since few studies exceed 1 year in follow-up. Most of the short- and medium-term steroid studies reveal similar or improved disease activity when compared with control therapy. A meta-analysis of the few randomized studies available showed that steroids were equivalent or slightly better than placebo and active controls in improving RA disease activity. Studies of disease-modifying effects have not produced definitive results.