Low-dose steroid reduces bone loss in hand RA

Daily prednisolone use leads to significantly better bone density at two years compared with placebo.

Treatment with low doses of a steroid can help reduce disease-related bone loss in early rheumatoid arthritis patients, a new analysis of previously published data shows.

Glen Haugeberg, MD, PhD, and colleagues at the Diakonhjemmet Hospital in Oslo, Norway, and at the Bristol Royal Infirmary in Bristol, England, reviewed data from a prospective, randomized and placebo-controlled study published in The New England Journal of Medicine in 1995. In that study, the researchers had evaluated the effect of daily treatment with 7.5 mg doses of prednisolone on joint destruction in 128 RA patients.

The new analysis included 95 patients with at least two radiographs available from baseline out to two years follow-up. Both prednisolone and placebo groups had no significant differences at the start of the study, the authors said. Both groups also had similar improvements in clinical status during the course of follow-up, they noted.

However, patients treated with daily prednisolone in addition to their routine RA therapy showed a significant improvement in Health Assessment Questionnaire Disability Index score at one year follow-up. These patients also had significantly less progression in Larson score, according to the study.

At one year, prednisolone-treated patients had a mean 0.6 progression in Larson score compared with a mean 2.8 progression for placebo-treated patients. At two years, Larson score had progressed by a mean of 1.0 for the prednisolone group and by a mean of 4.5 for the placebo group.

In addition, prednisolone-treated patients had significantly less inflammation-related bone loss at both one and two years follow-up, the authors note.

At one year, prednisolone patients had a mean 0.011 g/cm² reduction in bone density compared with a mean reduction of 0.022 g/cm² for placebo patients (P=.005). At two years, prednisolone patients had a mean 0.026 g/cm² bone density reduction compared with a mean 0.039 g/cm² reduction for placebo patients (P=.03), according to the study.

“The main finding in this placebo-controlled study is that low-dose prednisolone reduces inflammatory-related hand bone loss in patients with early rheumatoid arthritis,” the authors said. “[It] is possible to retard or suppress disease-related hand or periarticular bone loss in rheumatoid arthritis.”

“However, use of glucocorticoids may have a negative overall effect on generalized bone loss, leading to increased fracture risk,” they added.

For more information:
Haugeberg G, Strand A, Kvien TK, Kirwan JR. Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis. Arch Intern Med. 2005;165:1293-1297.
Kirwan JR, et. al. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med. 1995;333:142-146.