Low-Dose Corticosteroids for RA
NSAIDS, novel biologics and glucocorticoids (GCs) are frequently prescribed in the treatment of rheumatoid arthritis (RA), although the optimal treatment regimen is evolving as new data come to light. Glucocorticoids have a pivotal role in the pharmacologic management of RA and other conditions, due to their anti-inflammatory and immunosuppressive properties. In recent years, the use of low-dose GCs (below 7.5mg/day) has become an accepted treatment paradigm in order to minimize steroid side effects. Based on high-quality evidence, low-dose chronotherapy with modified-release (MR) prednisone has demonstrated superior efficacy, compared with conventional prednisone treatment, thereby further improving the benefit-risk ratio of GC therapy.

The MR tablet is taken at bedtime and releases prednisone four hours after ingestion. GC release is therefore synchronized to the circadian rhythms of the disease. The improved efficacy of prednisone chronotherapy permitted effective treatment with a very low-dose of prednisone. The resulting favorable safety profile was almost comparable to placebo. It appears that MR prednisone, at low doses, is a safe and effective treatment option for the management of active RA.

After completing this video-based activity, in which experts discuss the 2010 meeting of the European League Against Rheumatism, participants should be better able to consider re-evaluation of glucocorticoids in the use of early and longstanding RA and to recognize suboptimal or refractory responses to pharmacologic interventions and modify treatment plans accordingly. » Go to this activity

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