A Cochrane review (abstract , review ) included 11 studies with a total of 462 subjects to determine whether short-term (i.e. as recorded within the first month of therapy), oral low-dose corticosteroids (corresponding to a maximum of 15 mg prednisolone daily) is superior to placebo and non-steroidal, anti-inflammatory drugs in patients with rheumatoid arthritis.
Two placebo-controlled trials had adequate allocation concealment: for joint tenderness, the standardised mean difference was -0.52 (95%CI -1.01 to -0.03; 2 studies, n=182), for pain it was -0.6 (95% CI -1.58 to 0.23; 2 studies, n=182), and for grip strength 0.22 (95% CI -0.40 to 0.84; 1 study, n=40). The estimates were considerably larger if all trials were included: for joint tenderness, the standardised mean difference was -1.16 (95% CI -1.69 to -0.64; 8 studies, n=392), for pain it was -1.51 (95% CI -2.31 to -0.71; 7 studies, n=416), and for grip strength 0.41 (95% CI 0.13 to 0.69; 6 studies, n=208). Prednisolone also had a greater effect than non-steroidal, anti-inflammatory drugs on joint tenderness (-0.63, 95% CI -1.16 to -0.11; 4 studies, n=144) and pain (-1.25, 95% CI -2.24 to -0.26; 3 studies, n=153), whereas the difference in grip strength was not significant (0.31, 95% CI -0.02 to 0.64; 4 studies, n=142). The main harms in long-term treatment were vertebral fractures and infections.
Comment: Prednisolone in low doses may be used intermittently in patients with rheumatoid arthritis, particularly if the disease cannot be controlled by other means.