Background/Purpose:

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which causes significant pain and swelling in the joints. The early treatment of the disease mainly rests on two groups of agents; Disease modifying drugs and Corticosteroids. Steroids are very effective for the treatment of early disease, acutely controlling the disease activity and reducing the long-term damage  They are used both as systemically (Oral or Intramuscular) or locally, however there is no consensus on the required dose, route of administration or duration of use in this condition.

The published data about adverse events of steroid usage in this situation is not clear and there is suggestion that quick aggressive control of inflammatory disease may actually outweigh the risk of damage. 

Methods:

A questionnaire was sent by post to all consultant Rheumatologists in England under ‘Freedom of Information act (FOI)’ to 131 NHS trusts.  Questions were aimed to enquire about the initial steroid regime used by consultant rheumatologists in adult cases (≥ 18 yrs) of confirmed RA.   The responses were received back by post and analysed.

Results:

Total response received were 130 (92 % response rate), with 82.4 % agreeing on the early routine use of steroids in their practice.  53.6% used the Oral route, 48% used the intramuscular (IM) route and 45.6% of Consultants used the intra-articular route (either alone or in combination with other routes). 

For those who used oral Prednisolone, the initial starting dose varied from 60mg (6.3%) to 7.5 mg (11.1% responses) per day with the majority using an initial dose of 15 mg (25.3%) or 20mg (23.8%) daily.

The duration of oral steroid use varied from 1 month (4.2%) to 2 yrs (4.2%) with the majority being for 4-6 months (72.3%).

The dose of IM Depomedrone varied from 40mg – 160 mg, with majority using 120 mg (86.2%), for a total duration that again varied from 2 months to 2 years, with the majority being 6 months (52.2%). 

The dose of intraarticular injection for large joint also varied from 20 mg to 60 mg of Depomedrone with 40 mg used by majority (92%) of rheumatologist.

Conclusion:

Majority of Rheumatologist use steroids for initial treatment of early Rheumatoid Arthritis.  There is a wide variability in the use of steroids including its route, dose and duration of use.  There is therefore an urgent need of scientifically proved guidelines on their initial use.

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« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-wide-variation-in-corticosteroid-use-in-early-rheumatoid-arthritis-there-is-need-for-guidelines/