Effects of glucocorticoids on radiological progression in rheumatoid arthritis.

摘要: Background Glucocorticoid use in rheumatoid arthritis (RA) is widespread. Two Cochrane Reviews have been published examining the short term clinical benefit of low dose glucocorticoids compared to non-steroidal anti-inflammatory drugs and demonstrate good medium benefits. The possibility that may a fundamental 'disease modifying' effect RA, which would be seen by reduction rate radiological progression, has raised several authors. Objectives To perform systematic review studies evaluating glucocorticoid efficacy inhibiting progression damage arthritis. Search methods A search MEDLINE (from 1966 22 February 2005) Central Register Controlled Trials was undertaken, using terms 'corticosteroids' 'rheumatoid arthritis' expanded according Collaboration recommendations. Identified abstracts were reviewed appropriate reports obtained full. Additional identified from reference lists expert knowledge. Selection criteria Randomized controlled or cross-over trials adults with diagnosis prednisone similar preparation either placebo controls active (i.e. comparative studies) where there evaluation radiographs hands, hands feet, feet any standardised technique. Eligible had at least one treatment arm without glucocorticoids. Data collection analysis Standardised data extraction mean standard deviation (SD) change erosion scores over 1 year 2 years. (Where SD for not given conservative estimate taken baseline data.) At two authors selected extracted data. Radiographic expressed as percentage maximum possible score method used. results pooled after weighting random effects model provide difference (SMD). Main results The initial produced 217 citations, 15 added experts, lists. Authors 4 being prepared publication (and subsequently published) kindly shared their After application eligibility criteria 1,414 patients included. majority studied early RA (disease duration up years), cumulative 2,300 mg equivalent (range 270 - 5,800 mg) first year. Glucocorticoids mostly other disease modifying anti-rheumatoid drug (DMARD) treatment. 0.40 favour (95% CI 0.27, 0.54). In lasting years (806 included), 0.45 (0.24, 0.66) 0.42 (0.30, 0.55). All except showed numerical glucocorticoids. beneficial generally achieved when used conjunction DMARD treatment. Authors' conclusions Even most estimate, evidence addition therapy can substantially reduce convincing. There remains concern about potential long-term adverse reactions therapy, such increased cardiovascular risk, this issue requires further research.