A Cochrane review [Abstract] 1 included 15 studies with a total of 1414 subjects. The majority of trials studied early RA (disease duration up to 2 yrs), and the mean cumulative dose of glucocorticoid was 2,300 mg prednisone equivalent (range 270 mg - 5,800 mg) over the first year, added to other disease-modifying anti-rheumatoid drug. The standardised mean difference in progression was 0.40 in favour of glucocorticoids (95% CI 0.27, 0.54). In studies lasting 2 years (806 patients included), the SMD in progression in favour of glucocorticoids at 1 year was 0.45 (0.24, 0.66) and at 2 years was 0.42 (0.30, 0.55). All studies except one showed a numerical treatment effect in favour of glucocorticoids.
EULAR 2022 recommendations for the management of rheumatoid arthritis 2 states that short-term (not more than 3 months) glucocorticoids should be considered when initiating or changing csDMARDs (conventional synthetic disease-modifying antirheumatic drugs), in different dose regimens and routes of administration, but should be tapered and discontinued as rapidly as clinically feasible. It is specifically mentioned that chronic use of glucocorticoids is neither meant nor suggested by this recommendation.
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