TITLE:
Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis
AUTHORS:
Doyt L. Conn
KEYWORDS:
Prednisone; Rheumatoid Arthritis; Rayos
JOURNAL NAME:
Health,
Vol.5 No.8A,
August
12,
2013
ABSTRACT:
This is a review of
the evolution of the use prednisone in the treatment of rheumatoid arthritis
(RA). Cortisone was introduced in 1949 and shortly thereafter, the Mayo
investigators found that low divided doses with slow tapering were effective
and caused fewer side effects. In 1959, a British double blind 2 year study of
prednisolone treatment in early RA demonstrated effectiveness and reduced
bony erosions. This experience was lost over time and empiricism and efforts
to reduce side effects dominated practice for the next 35 years. Since 1995, a
number of controlled studies of low single daily doses of prednisone in early
RA have been reported by European investigators. They have shown clinical
improvement, reduced bony erosions, augmentation of the effect of dmards and
few side effects. During the last 25 years, the molecular actions of glucocorticoids
have been elucidated. The time relationship of the dose to the biologic and
clinical effects has been established. As a result of the information on the diurnal
effect of glucocorticoids and the documentation of the effect occurring 5-6
hours after the dose and dissipating by 24 hours, a delayed release preparation
of prednisone has been developed. With the rediscovery of the effectiveness of
low single daily morning dose of prednisone in early RA by controlled studies
and the demonstration of the onset and duration of the clinical effect of low
dose of prednisone, it is now possible to use low doses of prednisone
rationally and effectively in the treatment of RA. It remains to be determined
whether a single morning, single evening or a twice a day low dose is the most
effective and safe. It is doubtful if the new delayed release prednisone is any
more effective than the usual immediate release prednisone if given at the same
time.