Is the addition of low-dose prednisolone more beneficial than harmful to older patients with rheumatoid arthritis?

This study assessed the effectiveness and safety of daily administered prednisolone (Prelone) at a dose of 5 mg, as an add-on to the standard of care (SOC) in older patients with rheumatoid arthritis (RA). The authors concluded that low-dose prednisolone added to SOC had long-term benefits in these patients with a favorable balance of benefit and harm.

RA is a chronic, painful, inflammatory disease affecting the lining of joints. This progressive disease results in bone erosions (bone loss), joint damage, deformities, and disabilities. A common treatment approach for RA involves the long-term use of low-dose glucocorticoids (GCs).

GCs such as prednisolone are steroid hormones with anti-inflammatory effects. Although chronic use of low-dose GCs can reduce RA disease activity and slow joint damage progression, it may be associated with long-term harmful effects. These include increases in blood pressure, blood glucose, reduced bone density and an increased risk of fractures.

Older patients (aged 65 or older) are more likely to have two or more diseases or medical conditions at the same time. Therefore, they may be at higher risk for possible long-term harmful effects. However, the balance of benefit and harm based on long-term administration of low-dose GCs remains unclear, especially for older patients with RA.

This study included 451 patients with RA, aged 65 and above. 226 patients were randomly assigned to a prednisolone 5mg daily treatment group. 225 patients were given a placebo. All patients were given SOC anti-rheumatic treatment. The benefit was determined using the disease activity score in 28 joints (DAS28). The Sharp/van der Heijde score was used for measuring joint damage. Patients were followed for 2 years.

63% of patients that received prednisolone completed the trial compared to 61% of those that were given a placebo. Patients that received prednisolone had significantly lower disease activity scores and joint damage progression compared to the placebo group.

There was a 24% increase in the occurrence of harm in patients that received prednisolone. The majority of side effects experienced by patients were non-severe and involved mild to moderate infections.

The study suggested that the addition of low-dose prednisolone to SOC in older patients with RA provided beneficial long-term benefits with a 24% increase in the occurrence of side effects that were mainly non-severe.

The study duration of 2 years was relatively short for RA which is a chronic disease. Missing data towards the end of the study may have affected the interpretation of the results.