Why Oral Corticosteroids Should Not be Used in Patients with Rheumatoid Arthritis

As my colleagues and I once observed, “the decision to institute steroid therapy emanates in part from a simple desire to rapidly alleviate patients’ symptoms.”¹⁹ This “quick fix” can prove misleading to both patient and doctor regarding the need for longer-term DMARD control of the RA. The published guidelines of the ACR recommend DMARD therapy if active disease is present.²⁰ A patient whose PCP recently prescribed steroids for early RA—permitted in the guidelines—could have their disease activity inappropriately masked so they are not started on DMARDs—or even worse, not referred to a rheumatologist until damage is done.

In summary, we are using a drug with impressive long-term toxicity and without demonstrable symptomatic benefit after one year of use even at 10 mg per day. All of this for a demonstrated benefit of four Sharp score units at four years!

I am reminded of a quote from Lewis Carroll’s Through the Looking Glass: “I didn’t say it was good for you,” the king replied. “I said that there was nothing like it.”

Dr. Russell is professor of medicine at the University of Alberta in Edmonton.

References

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