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Prednisone/prednisolone does not affect bone mineral density in rheumatoid arthritis

01 Aug 2018

Prednisone/prednisolone does not seem to significantly affect bone mineral density (BMD) in patients with early and active rheumatoid arthritis (RA), a recent meta-analysis has found.

Pooled analysis of six randomized comparisons including 979 patients showed that the prednisone/prednisolone intervention did not significantly affect BMD at the lumbar spine at 24 months (standardized mean difference [SMD] change, –0.02; 95 percent CI, –0.16 to 0.12; p=0.74). Excluding a study where antiosteoporotic treatment was different between groups did not change the results (SMD, –0.03; –0.17 to 0.12).

Since studies differed by sites of measurement of hip BMD, researchers reported BMD at the hip collectively. They found no significant difference in BMD between control and intervention groups (SMD, –0.11; –0.25 to 0.02; p=0.10). The finding was also robust to sensitivity analysis (SMD, –0.18; –0.35 to –0.02).

In contrast, prednisone/prednisolone treatment improved RA activity as measured by the RA Disease Activity Score (DAS28). Findings were inconclusive when the Health Assessment Questionnaire scores were used. Radiographic progression was significantly less pronounced in patients who received the intervention as compared with controls.

“These results suggest that in a population with early and active RA, at least through 24 months, the effects of glucocorticoids on dampening systemic inflammation may counterbalance their adverse effects on bone formation and resorption,” said researchers.

For the present study, researchers accessed the databases of CENTRAL, PubMed and Embase. Studies eligible for inclusion were randomized, double-blinded placebo-controlled studies of oral prednisone/prednisolone on RA patients.

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