Effectiveness and safety of oral corticosteroids in the treatment of rheumatoid arthritis: a systematic review

Objective: This systematic review analyzed the effectiveness and the safety of oral corticosteroids in the treatment of rheumatoid arthritis. Method: The search sources were Cochrane (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, among other; in order to identify randomized controlled trials (RCT) that compared the oral use of corticosteroids to placebo or other treatments in adults. Reviewers, in pairs and independently, selected studies, performed data extraction and assessed the risk of bias. Narrative synthesis of data was performed. Results: Thirteen RCT were selected (n=2,393 patients) and more than 50% of them had some risk of bias. Prednisone 5mg and prednisolone 7.5mg seem to improve pain. Physical function improved with the use of prednisone 5mg, 10mg plus methotrexate (MTX) and 30mg plus MTX; and use of prednisolone 5mg, 7.5mg plus disease modifying anti-rheumatic drugs (DMARD). Prednisone 10mg and prednisolone 5mg, 7.5mg, 30mg and 60mg (alone or with DMARD) seems to improve radiological imaging. Prednisone 5mg and prednisolone 7.5mg reduced morning stiffness. Prednisone 5mg and 10mg (plus aurothioglucose), and prednisolone 7.5mg, budesonide 9mg seem to reduce the number swollen joints. Prednisone 5mg and 10mg, prednisolone 5mg and 7.5mg, and budesonide 9mg reduced the number tender joints. Prednisone 10mg and prednisolone 5mg improved grip strength. Prednisone 5mg, prednisolone (plus MTX and ciclosporin) and prednisolone 7.5mg improved quality of life. Prednisolone and budesonide showed larger numbers of common and serious adverse events. Conclusion: Prednisone 5mg and 10mg and prednisolone 5mg and 7.5mg seems to be effective, while prednisone appears to be safer anti-inflammatory to the treatment of rheumatoid arthritis. However, methodological limitations and the combination of different drugs and doses, contributed to limiting the conclusions on these findings.