A review of the effectiveness of glucocorticosteroid treatments for painful rheumatoid arthritis
Study: The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: A systematic literature review and meta-analysis.
Daniel F McWilliams1, Divya Thankaraj1, Julie Jones-Diette1, Rheinallt Morgan2, Onosi S Ifesemen1, Nicholas G Shenker3, David A Walsh1,4
https://doi.org/10.1093/rheumatology/keab503
- Division of ROD, Pain Centre Versus Arthritis, NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK.
- Nottingham University Hospitals NHS Trust, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
A review of the effectiveness of glucocorticosteroid treatments for painful rheumatoid arthritis
Pain is one of the main problems for people with active rheumatoid arthritis (RA), and glucocorticosteroids (GCs) are often used to treat this. The commonest GC is prednisolone, and others include dexamethasone, betamethasone and cortisone. GCs can be used to affect the whole body; which normally means taking a daily tablet, but can also be by intravenous infusion or injection into a muscle (these are known as systemic administration). It is currently believed that GCs relieve pain by reducing inflammation and joint swelling in people with RA. Treatment with GCs needs to carefully managed by rheumatologists, as there are well-known side effects that have to be balanced against benefits. Therefore it is important to know the magnitude of pain relief that comes from systemic GCs, and also about how long people with RA can expect to see benefits.
This study analysed pain data from all of the randomised controlled trials testing systemic GCs in people with RA. A similar study, from more than 10 years ago, had concluded that GCs helped with RA pain, but had only looked at GC tablets taken for a few weeks. In this study, we were able to use extra data from more recent studies and we also looked at longer treatments and different routes of administration.
We found 33 trials that had published suitable data for our analysis. We found that pain was reduced when people with RA were given systemic GC treatment for 12 weeks or less; and the average level of pain relief could be classed as “moderate”. However, when GCs were used for more than 12 weeks, the average amount of pain relief tailed off to almost nothing. When GCs were used for over 6 months, it is possible that most people with RA were not experiencing pain relief from them.
We also found that giving GCs by tablet, infusion and injection into the muscle seemed to have similar effects to each other. Additionally, GCs had a small benefit on the fatigue of RA.
We conclude that systemic GCs are most effective for pain during the first 3 months of treatment, and treatments of longer than 6 months might have very little benefit indeed. Systemic GC treatments provided for pain should be time-limited, which is in line with current guidance.
Future research should examine which individuals will benefit most from the anti-inflammatory effects of systemic glucocorticosteroids. Other treatments than GCs are required to improve long-term pain in people with RA.