Randomized withdrawal of long-term prednisolone treatment in rheumatoid arthritis:: Effects on inflammation and bone mineral density

Objective: Short- term, low- dose glucocorticoid ( GC) treatment has anti- inflammatory and disease- modifying effects in rheumatoid arthritis ( RA). However, scientific support for long- term, low- dose GC treatment, although widespread, is poor, and information on the effects on bone density is scarce. The aim of this study was to investigate how long- term GC treatment in RA affects inflammation as well as bone density, and also to investigate the feasibility of withdrawal of GC. Patients and methods: Fifty- eight patients with RA treated with 5 - 7.5 mg prednisolone daily for at least 2 years were randomized either to withdraw or to continue GC treatment. The patients were followed prospectively for 2 years with respect to disease activity [ using the Disease Activity Score calculated for 28 joints, ( DAS28)], functional ability [ using the Health Assessment Questionnaire ( HAQ) score] and bone mineral density ( BMD) of the lumbar spine and hip. Results: Only 11 patients out of 26 randomized to stop GC treatment and available for outcome measures succeeded in stopping the GC medication within 1 year. Fifteen patients failed withdrawal of GC because of increased joint symptoms. A higher mean DAS28 during the study was associated with loss of bone mass in the trochanter. The group that continued with unchanged GC treatment did not deteriorate in BMD during the 2 years but in fact Z- scores improved significantly. Conclusion: Our results indicate that low- dose GC treatment after several years has persisting anti- inflammatory effects in RA and no further negative impact on BMD. It thus seems to be more important to control disease activity than withdraw low- dose GC treatment in this population considering bone health.