EFFECTS OF LOW-DOSE CORTICOSTEROIDS ON THE BONE-MINERAL DENSITY OF PATIENTS WITH RHEUMATOID-ARTHRITIS

Objective. To assess the effect of low doses of corticosteroids on the bone mineral density (BMD) of patients with rheumatoid arthritis (RA). Methods. A cross sectional study of BMD as measured by dual photon x-ray of the femoral neck and lumbar spine (lateral view) in 139 patients with RA followed in a university setting. Results. The mean daily dose of prednisone taken by the study group was 4.15 mg/day. Patients receiving daily doses of prednisone between 1 and 4 mg/day had similar BMD to patients who were not receiving corticosteroids, but patients taking 5-9 mg/day and those taking > 10 mg/day had significantly lower BMD of the lumbar spine (84.28 and 80.51% of controls, respectively) than patients who received 1-4 mg/day (99.16% of controls). The effect of corticosteroids remained significant when other risk factors such as disease severity, disease duration, functional class, and activity level were controlled for. No significant relationship between prednisone dose and BMD of the femoral neck was seen at the low doses studied. Conclusion. Low dose corticosteroid use has a significant effect on BMD of the lumbar spine.