According to a Cochrane review , very few studies assessed the effectiveness of corticosteroids for RA treatment and many were or poor methodologic quality. Only seven of 34 studies identified by our search met criteria for inclusion. Our results indicated that corticosteroids were significantly more effctive than placebo controls for four of six outcomes assessed (standardized mean difference for tender joints -0.37 (95% CI -0.59 to -0.14), swollen joints -0.41 (95% CI -0.67 to -0.16), pain -0.43 (95% CI -0.74 to -0.12), and functional status -0.57 (95% CI -0.92 to -0.22). Trials comparing prednisone to aspirin and to chloroquine found no differences between the drugs.
Another systematic review including 9 studies with a total of 472 subjects treated with corticosteroids for at least 3 monhts was abstracted in DARE. The patients received prednisolone at the mean dose of 15 mg/day or less. For the number of tender joints, the effect size was 0.60 (95% CI -0.31 to 1.51). For the number of swollen joints the mean effect size was 0.71 (95% CI -0.41 to 1.83). For ESR, effect size 0.72 (95% CI -0.17 to 1.61). Relative effectiveness of prednisolone to second-line agents commonly used for the treatment of RA: unadjusted combined effect size for corticosteroid arm 0.82. For placebo-controlled studies effect size 0.86.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).