Background Several studies have shown structural and clinical benefit of corticotherapy (CT) for 1 to 2 years treatment of recent-onset rheumatoid arthritis (RA). However, because of its numerous adverse effects (AE), CT prescription is still under debate.
Objectives The aim of this study is to evaluate the tolerance to CT for early RA
Methods We carried out a systematic literature review on PubMed, EMBASE and Cochrane library until July 2013. The research was manually completed by the analysis of all references identified and of all abstracts presented at ACR and EULAR conferences of the past 2 years. All randomised placebo-controlled trials conducted on adult patients recently diagnosed (<3 years) with RA were selected. Data regarding AE, serious AE, arterial hypertension (HTN), diabetes, gastrointestinal AE, cephalgia, osteoporotic fractures and ophthalmic complications within 2 years of treatment were collected. Discontinuations due to treatment intolerance were also taken into account. Pooled Odds-Ratios were calculated by meta-analysis using the Mantel-Haensen method. In case of significant heterogeneity, a random-effects model was used. Sensitivity analyses were based on the dose used (low-dose ≤10mg/day of equivalent prednisone and high-dose) and duration of treatment.
Results Out of 1367 selected articles 16 were analysed. These were based on 12 randomised controlled trails involving a total of 2481 patients (mean age=54 years, 67% of women, mean of RA progression=5.3 months). Eight studies were based on low-dose CT and 4 on high-dose CT. A significant higher number of epigastralgia but not ulcers were reported in the CT group compared to placebo. No other significant difference could be observed in terms of AE (see table).
Conclusions CT associated with background treatment is well tolerated in recent-onset RA, with only an increase of epigastralgia events in the first two years of treatment. Although patients included in clinical trials are selected and subject to long term AE, a low-dose may be recommended for early RA.
Disclosure of Interest : None declared
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