Re: RESEARCH - Lack of benefit over 2 years of low dose prednisolone for RA

[Guest guest]

I have been on prednisone for over 10 years- the dose has varied but drug has

been part of my treatment repertoire. Would I rather not be on it- sure. It has

caused problems and it has alleviated problems. While it does not modify the

disease long term- it does help with inflammation and pain. Sometimes it is the

only thing that does. It often keeps people mobile until the right drug

combination works. It has its place in a treatment program - and should be

discontinued- if possible- when possible.

-------------- Original message ----------------------

From: " " <Matsumura_Clan@...>

>

> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>

>

> Lack of radiological and clinical benefit over two years of low dose

> prednisolone for rheumatoid arthritis: results of a randomised controlled

> trial.

>

>

> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson EA,

> Hampson R, Poon FW.

>

> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> University NHS Trust, Castle St, Glasgow G40SF, UK.

> .Capell@...

>

> BACKGROUND: Evidence for disease modifying activity of low dose

> corticosteroid treatment in rheumatoid arthritis is contradictory. Studies

> showing radiological benefit suggest that continued treatment is required to

> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> prednisolone in early rheumatoid arthritis on disease activity over two

> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients with

> rheumatoid arthritis, duration <3 years (n = 167), were started on a disease

> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> outcome measure was radiological damage, assessed by the modified Sharp

> method. Clinical benefit was a secondary outcome. A proactive approach to

> identifying and treating corticosteroid adverse events was adopted. Patients

> who discontinued sulphasalazine were offered an alternative DMARD. RESULTS:

> 90 of 257 patients eligible for the study refused to participate (more women

> than men). Of those enrolled, 84% were seropositive for rheumatoid factor,

> median age 56 years, median disease duration 12 months, female to male ratio

> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were

> no significant differences in radiological score or clinical and laboratory

> measures at 0 and 2 years.

>

> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

> benefit on patients maintained on a DMARD over two years. Low dose

> corticosteroids have no role in the routine management of rheumatoid

> arthritis treated with conventional disease modifying drugs.

>

>

> PMID: 15194574

>

>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra

> ct & list_uids=15194574 & itool=iconabstr

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

>

[Guest guest]

I have been on prednisone for over 10 years- the dose has varied but drug has

been part of my treatment repertoire. Would I rather not be on it- sure. It has

caused problems and it has alleviated problems. While it does not modify the

disease long term- it does help with inflammation and pain. Sometimes it is the

only thing that does. It often keeps people mobile until the right drug

combination works. It has its place in a treatment program - and should be

discontinued- if possible- when possible.

-------------- Original message ----------------------

From: " " <Matsumura_Clan@...>

>

> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>

>

> Lack of radiological and clinical benefit over two years of low dose

> prednisolone for rheumatoid arthritis: results of a randomised controlled

> trial.

>

>

> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson EA,

> Hampson R, Poon FW.

>

> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> University NHS Trust, Castle St, Glasgow G40SF, UK.

> .Capell@...

>

> BACKGROUND: Evidence for disease modifying activity of low dose

> corticosteroid treatment in rheumatoid arthritis is contradictory. Studies

> showing radiological benefit suggest that continued treatment is required to

> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> prednisolone in early rheumatoid arthritis on disease activity over two

> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients with

> rheumatoid arthritis, duration <3 years (n = 167), were started on a disease

> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> outcome measure was radiological damage, assessed by the modified Sharp

> method. Clinical benefit was a secondary outcome. A proactive approach to

> identifying and treating corticosteroid adverse events was adopted. Patients

> who discontinued sulphasalazine were offered an alternative DMARD. RESULTS:

> 90 of 257 patients eligible for the study refused to participate (more women

> than men). Of those enrolled, 84% were seropositive for rheumatoid factor,

> median age 56 years, median disease duration 12 months, female to male ratio

> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were

> no significant differences in radiological score or clinical and laboratory

> measures at 0 and 2 years.

>

> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

> benefit on patients maintained on a DMARD over two years. Low dose

> corticosteroids have no role in the routine management of rheumatoid

> arthritis treated with conventional disease modifying drugs.

>

>

> PMID: 15194574

>

>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra

> ct & list_uids=15194574 & itool=iconabstr

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

>

[Guest guest]

, I'm not trying to induce anxiety in anyone here who cannot

discontinue prednisone. And it's true that, for many people, it is very good

for rapidly relieving pain and inflammation in the early stages of RA while

they are waiting for DMARDs to work. It's also true that some people use it

at a low dose for years without major problems.

BUT since we can't predict who will be able to discontinue prednisone, and

since we can't predict who will suffer multiple and serious adverse effects

from prednisone, and since the data generally doesn't support long-term

clinical or radiological benefits of prednisone in RA, and since there are

so many new and effective treatment options now for pain and RA itself, I

can't recommend that newbies start it (or resume it).

In fact, there are some researchers and physicians who are looking at the

feasibility of using the biologics immediately with, for example, MTX. As

prednisone does, biologics work very quickly, but, unlike prednisone, they

can be easily discontinued if need be. Not only that, it is possible that,

if biologics are started early enough in the disease process, they may be

able to induce the sort of control, or even remission, that might maintained

with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> I have been on prednisone for over 10 years- the dose has varied but drug

> has been part of my treatment repertoire. Would I rather not be on it-

> sure. It has caused problems and it has alleviated problems. While it does

> not modify the disease long term- it does help with inflammation and pain.

> Sometimes it is the only thing that does. It often keeps people mobile

> until the right drug combination works. It has its place in a treatment

> program - and should be discontinued- if possible- when possible.

>

>

> -------------- Original message ----------------------

> From: " " <Matsumura_Clan@...>

>>

>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>>

>>

>> Lack of radiological and clinical benefit over two years of low dose

>> prednisolone for rheumatoid arthritis: results of a randomised controlled

>> trial.

>>

>>

>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

>> EA,

>> Hampson R, Poon FW.

>>

>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

>> University NHS Trust, Castle St, Glasgow G40SF, UK.

>> .Capell@...

>>

>> BACKGROUND: Evidence for disease modifying activity of low dose

>> corticosteroid treatment in rheumatoid arthritis is contradictory.

>> Studies

>> showing radiological benefit suggest that continued treatment is required

>> to

>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

>> prednisolone in early rheumatoid arthritis on disease activity over two

>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

>> with

>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

>> disease

>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

>> outcome measure was radiological damage, assessed by the modified Sharp

>> method. Clinical benefit was a secondary outcome. A proactive approach to

>> identifying and treating corticosteroid adverse events was adopted.

>> Patients

>> who discontinued sulphasalazine were offered an alternative DMARD.

>> RESULTS:

>> 90 of 257 patients eligible for the study refused to participate (more

>> women

>> than men). Of those enrolled, 84% were seropositive for rheumatoid

>> factor,

>> median age 56 years, median disease duration 12 months, female to male

>> ratio

>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

>> were

>> no significant differences in radiological score or clinical and

>> laboratory

>> measures at 0 and 2 years.

>>

>> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

>> benefit on patients maintained on a DMARD over two years. Low dose

>> corticosteroids have no role in the routine management of rheumatoid

>> arthritis treated with conventional disease modifying drugs.

>>

>>

>> PMID: 15194574

>>

>>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra

>> ct & list_uids=15194574 & itool=iconabstr

>>

>>

>>

>>

>>

>> I'll tell you where to go!

>>

>> Mayo Clinic in Rochester

>> http://www.mayoclinic.org/rochester

>>

>> s Hopkins Medicine

>> http://www.hopkinsmedicine.org

>>

[Guest guest]

, I'm not trying to induce anxiety in anyone here who cannot

discontinue prednisone. And it's true that, for many people, it is very good

for rapidly relieving pain and inflammation in the early stages of RA while

they are waiting for DMARDs to work. It's also true that some people use it

at a low dose for years without major problems.

BUT since we can't predict who will be able to discontinue prednisone, and

since we can't predict who will suffer multiple and serious adverse effects

from prednisone, and since the data generally doesn't support long-term

clinical or radiological benefits of prednisone in RA, and since there are

so many new and effective treatment options now for pain and RA itself, I

can't recommend that newbies start it (or resume it).

In fact, there are some researchers and physicians who are looking at the

feasibility of using the biologics immediately with, for example, MTX. As

prednisone does, biologics work very quickly, but, unlike prednisone, they

can be easily discontinued if need be. Not only that, it is possible that,

if biologics are started early enough in the disease process, they may be

able to induce the sort of control, or even remission, that might maintained

with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> I have been on prednisone for over 10 years- the dose has varied but drug

> has been part of my treatment repertoire. Would I rather not be on it-

> sure. It has caused problems and it has alleviated problems. While it does

> not modify the disease long term- it does help with inflammation and pain.

> Sometimes it is the only thing that does. It often keeps people mobile

> until the right drug combination works. It has its place in a treatment

> program - and should be discontinued- if possible- when possible.

>

>

> -------------- Original message ----------------------

> From: " " <Matsumura_Clan@...>

>>

>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>>

>>

>> Lack of radiological and clinical benefit over two years of low dose

>> prednisolone for rheumatoid arthritis: results of a randomised controlled

>> trial.

>>

>>

>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

>> EA,

>> Hampson R, Poon FW.

>>

>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

>> University NHS Trust, Castle St, Glasgow G40SF, UK.

>> .Capell@...

>>

>> BACKGROUND: Evidence for disease modifying activity of low dose

>> corticosteroid treatment in rheumatoid arthritis is contradictory.

>> Studies

>> showing radiological benefit suggest that continued treatment is required

>> to

>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

>> prednisolone in early rheumatoid arthritis on disease activity over two

>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

>> with

>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

>> disease

>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

>> outcome measure was radiological damage, assessed by the modified Sharp

>> method. Clinical benefit was a secondary outcome. A proactive approach to

>> identifying and treating corticosteroid adverse events was adopted.

>> Patients

>> who discontinued sulphasalazine were offered an alternative DMARD.

>> RESULTS:

>> 90 of 257 patients eligible for the study refused to participate (more

>> women

>> than men). Of those enrolled, 84% were seropositive for rheumatoid

>> factor,

>> median age 56 years, median disease duration 12 months, female to male

>> ratio

>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

>> were

>> no significant differences in radiological score or clinical and

>> laboratory

>> measures at 0 and 2 years.

>>

>> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

>> benefit on patients maintained on a DMARD over two years. Low dose

>> corticosteroids have no role in the routine management of rheumatoid

>> arthritis treated with conventional disease modifying drugs.

>>

>>

>> PMID: 15194574

>>

>>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra

>> ct & list_uids=15194574 & itool=iconabstr

>>

>>

>>

>>

>>

>> I'll tell you where to go!

>>

>> Mayo Clinic in Rochester

>> http://www.mayoclinic.org/rochester

>>

>> s Hopkins Medicine

>> http://www.hopkinsmedicine.org

>>

[Guest guest]

, don't you think that cost is a major consideration for not

starting biologics earlier? Some insurance companies (mine for one) are

reluctant to spend that much money if they can avoid it. My rheumy

Fellow who worked to get me approved for Enbrel with my insurance

company said there were two companies they did not like to work with,

and mine was one of them. They have paid for Enbrel for almost two

years, but in January they did raise the co-pay from $25 to $40 for a

28-day supply. I still consider that a real bargain, LOL. Sue

On Friday, March 4, 2005, at 06:25 PM, wrote:

>

> In fact, there are some researchers and physicians who are looking at

> the

> feasibility of using the biologics immediately with, for example, MTX.

> As

> prednisone does, biologics work very quickly, but, unlike prednisone,

> they

> can be easily discontinued if need be. Not only that, it is possible

> that,

> if biologics are started early enough in the disease process, they may

> be

> able to induce the sort of control, or even remission, that might

> maintained

> with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

[Guest guest]

, don't you think that cost is a major consideration for not

starting biologics earlier? Some insurance companies (mine for one) are

reluctant to spend that much money if they can avoid it. My rheumy

Fellow who worked to get me approved for Enbrel with my insurance

company said there were two companies they did not like to work with,

and mine was one of them. They have paid for Enbrel for almost two

years, but in January they did raise the co-pay from $25 to $40 for a

28-day supply. I still consider that a real bargain, LOL. Sue

On Friday, March 4, 2005, at 06:25 PM, wrote:

>

> In fact, there are some researchers and physicians who are looking at

> the

> feasibility of using the biologics immediately with, for example, MTX.

> As

> prednisone does, biologics work very quickly, but, unlike prednisone,

> they

> can be easily discontinued if need be. Not only that, it is possible

> that,

> if biologics are started early enough in the disease process, they may

> be

> able to induce the sort of control, or even remission, that might

> maintained

> with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

[Guest guest]

Yes, Sue, cost is most definitely a huge consideration. But, let's say that

you could start Enbrel and MTX immediately upon diagnosis and phase out the

Enbrel after two or three months while phasing in Plaquenil (keeping the MTX

all along) to maintain control.

They're experimenting with that sort of approach - one that doesn't let the

disease spiral out of control (which is much harder to calm down). In the

long run, this kind of treatment could be cheaper and better for the

patient, too.

Prednisone is cheap, but its side effects can be expensive - and not just in

terms of money.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> , don't you think that cost is a major consideration for not

> starting biologics earlier? Some insurance companies (mine for one) are

> reluctant to spend that much money if they can avoid it. My rheumy

> Fellow who worked to get me approved for Enbrel with my insurance

> company said there were two companies they did not like to work with,

> and mine was one of them. They have paid for Enbrel for almost two

> years, but in January they did raise the co-pay from $25 to $40 for a

> 28-day supply. I still consider that a real bargain, LOL. Sue

>

> On Friday, March 4, 2005, at 06:25 PM, wrote:

>>

>> In fact, there are some researchers and physicians who are looking at

>> the

>> feasibility of using the biologics immediately with, for example, MTX.

>> As

>> prednisone does, biologics work very quickly, but, unlike prednisone,

>> they

>> can be easily discontinued if need be. Not only that, it is possible

>> that,

>> if biologics are started early enough in the disease process, they may

>> be

>> able to induce the sort of control, or even remission, that might

>> maintained

>> with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

[Guest guest]

Yes, Sue, cost is most definitely a huge consideration. But, let's say that

you could start Enbrel and MTX immediately upon diagnosis and phase out the

Enbrel after two or three months while phasing in Plaquenil (keeping the MTX

all along) to maintain control.

They're experimenting with that sort of approach - one that doesn't let the

disease spiral out of control (which is much harder to calm down). In the

long run, this kind of treatment could be cheaper and better for the

patient, too.

Prednisone is cheap, but its side effects can be expensive - and not just in

terms of money.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

> , don't you think that cost is a major consideration for not

> starting biologics earlier? Some insurance companies (mine for one) are

> reluctant to spend that much money if they can avoid it. My rheumy

> Fellow who worked to get me approved for Enbrel with my insurance

> company said there were two companies they did not like to work with,

> and mine was one of them. They have paid for Enbrel for almost two

> years, but in January they did raise the co-pay from $25 to $40 for a

> 28-day supply. I still consider that a real bargain, LOL. Sue

>

> On Friday, March 4, 2005, at 06:25 PM, wrote:

>>

>> In fact, there are some researchers and physicians who are looking at

>> the

>> feasibility of using the biologics immediately with, for example, MTX.

>> As

>> prednisone does, biologics work very quickly, but, unlike prednisone,

>> they

>> can be easily discontinued if need be. Not only that, it is possible

>> that,

>> if biologics are started early enough in the disease process, they may

>> be

>> able to induce the sort of control, or even remission, that might

>> maintained

>> with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

[Guest guest]

But it does cause anxiety. My point is - prednisone can be an effective drug

and has been an effective drug for me and a number of people on the site -

who cannot easily or completely discontinue it for any number of reasons. My

rheumatologist gave me prednisone - because I was having major mobility

problems- and many of the other drugs she had available in her arsenal -

were not good choices for me at the time. I remained mobile and working

because of that choice. I was made aware of the side effects and made a

choice. I am not sure it is our position to recommend or discourage any

specific drug or drug treatment. Sharing our good and bad experiences of a

drug is helpful. Providing research showing side effects is helpful. Members

of the site can use that information - and discuss drug treatment and side

effects with their doctors. Doctors should be making treatment

recommendations and providing options.

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

>, I'm not trying to induce anxiety in anyone here who cannot

>discontinue prednisone. And it's true that, for many people, it is very

good

>for rapidly relieving pain and inflammation in the early stages of RA while

>they are waiting for DMARDs to work. It's also true that some people use it

>at a low dose for years without major problems.

>

>BUT since we can't predict who will be able to discontinue prednisone, and

>since we can't predict who will suffer multiple and serious adverse effects

>from prednisone, and since the data generally doesn't support long-term

>clinical or radiological benefits of prednisone in RA, and since there are

>so many new and effective treatment options now for pain and RA itself, I

>can't recommend that newbies start it (or resume it).

>

>In fact, there are some researchers and physicians who are looking at the

>feasibility of using the biologics immediately with, for example, MTX. As

>prednisone does, biologics work very quickly, but, unlike prednisone, they

>can be easily discontinued if need be. Not only that, it is possible that,

>if biologics are started early enough in the disease process, they may be

>able to induce the sort of control, or even remission, that might

maintained

>with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

>

>

>

>

>I'll tell you where to go!

>

>Mayo Clinic in Rochester

>http://www.mayoclinic.org/rochester

>

>s Hopkins Medicine

>http://www.hopkinsmedicine.org

>

>

> Re: [ ] RESEARCH - Lack of benefit over 2 years of low

>dose prednisolone for RA

>

>

>>

>> I have been on prednisone for over 10 years- the dose has varied but drug

>> has been part of my treatment repertoire. Would I rather not be on it-

>> sure. It has caused problems and it has alleviated problems. While it

does

>> not modify the disease long term- it does help with inflammation and

pain.

>> Sometimes it is the only thing that does. It often keeps people mobile

>> until the right drug combination works. It has its place in a treatment

>> program - and should be discontinued- if possible- when possible.

>>

>>

>> -------------- Original message ----------------------

>> From: " " <Matsumura_Clan@...>

>>>

>>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>>>

>>>

>>> Lack of radiological and clinical benefit over two years of low dose

>>> prednisolone for rheumatoid arthritis: results of a randomised

controlled

>>> trial.

>>>

>>>

>>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

>>> EA,

>>> Hampson R, Poon FW.

>>>

>>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

>>> University NHS Trust, Castle St, Glasgow G40SF, UK.

>>> .Capell@...

>>>

>>> BACKGROUND: Evidence for disease modifying activity of low dose

>>> corticosteroid treatment in rheumatoid arthritis is contradictory.

>>> Studies

>>> showing radiological benefit suggest that continued treatment is

required

>>> to

>>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

>>> prednisolone in early rheumatoid arthritis on disease activity over two

>>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

>>> with

>>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

>>> disease

>>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

>>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

>>> outcome measure was radiological damage, assessed by the modified Sharp

>>> method. Clinical benefit was a secondary outcome. A proactive approach

to

>>> identifying and treating corticosteroid adverse events was adopted.

>>> Patients

>>> who discontinued sulphasalazine were offered an alternative DMARD.

>>> RESULTS:

>>> 90 of 257 patients eligible for the study refused to participate (more

>>> women

>>> than men). Of those enrolled, 84% were seropositive for rheumatoid

>>> factor,

>>> median age 56 years, median disease duration 12 months, female to male

>>> ratio

>>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

>>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

>>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

>>> were

>>> no significant differences in radiological score or clinical and

>>> laboratory

>>> measures at 0 and 2 years.

>>>

>>> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

>>> benefit on patients maintained on a DMARD over two years. Low dose

>>> corticosteroids have no role in the routine management of rheumatoid

>>> arthritis treated with conventional disease modifying drugs.

>>>

>>>

>>> PMID: 15194574

>>>

>>>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

stra

>>> ct & list_uids=15194574 & itool=iconabstr

>>>

>>>

>>>

>>>

>>>

>>> I'll tell you where to go!

>>>

>>> Mayo Clinic in Rochester

>>> http://www.mayoclinic.org/rochester

>>>

>>> s Hopkins Medicine

>>> http://www.hopkinsmedicine.org

>>>

>

>

>

>

[Guest guest]

But it does cause anxiety. My point is - prednisone can be an effective drug

and has been an effective drug for me and a number of people on the site -

who cannot easily or completely discontinue it for any number of reasons. My

rheumatologist gave me prednisone - because I was having major mobility

problems- and many of the other drugs she had available in her arsenal -

were not good choices for me at the time. I remained mobile and working

because of that choice. I was made aware of the side effects and made a

choice. I am not sure it is our position to recommend or discourage any

specific drug or drug treatment. Sharing our good and bad experiences of a

drug is helpful. Providing research showing side effects is helpful. Members

of the site can use that information - and discuss drug treatment and side

effects with their doctors. Doctors should be making treatment

recommendations and providing options.

Re: [ ] RESEARCH - Lack of benefit over 2 years of low

dose prednisolone for RA

>

>, I'm not trying to induce anxiety in anyone here who cannot

>discontinue prednisone. And it's true that, for many people, it is very

good

>for rapidly relieving pain and inflammation in the early stages of RA while

>they are waiting for DMARDs to work. It's also true that some people use it

>at a low dose for years without major problems.

>

>BUT since we can't predict who will be able to discontinue prednisone, and

>since we can't predict who will suffer multiple and serious adverse effects

>from prednisone, and since the data generally doesn't support long-term

>clinical or radiological benefits of prednisone in RA, and since there are

>so many new and effective treatment options now for pain and RA itself, I

>can't recommend that newbies start it (or resume it).

>

>In fact, there are some researchers and physicians who are looking at the

>feasibility of using the biologics immediately with, for example, MTX. As

>prednisone does, biologics work very quickly, but, unlike prednisone, they

>can be easily discontinued if need be. Not only that, it is possible that,

>if biologics are started early enough in the disease process, they may be

>able to induce the sort of control, or even remission, that might

maintained

>with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

>

>

>

>

>I'll tell you where to go!

>

>Mayo Clinic in Rochester

>http://www.mayoclinic.org/rochester

>

>s Hopkins Medicine

>http://www.hopkinsmedicine.org

>

>

> Re: [ ] RESEARCH - Lack of benefit over 2 years of low

>dose prednisolone for RA

>

>

>>

>> I have been on prednisone for over 10 years- the dose has varied but drug

>> has been part of my treatment repertoire. Would I rather not be on it-

>> sure. It has caused problems and it has alleviated problems. While it

does

>> not modify the disease long term- it does help with inflammation and

pain.

>> Sometimes it is the only thing that does. It often keeps people mobile

>> until the right drug combination works. It has its place in a treatment

>> program - and should be discontinued- if possible- when possible.

>>

>>

>> -------------- Original message ----------------------

>> From: " " <Matsumura_Clan@...>

>>>

>>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

>>>

>>>

>>> Lack of radiological and clinical benefit over two years of low dose

>>> prednisolone for rheumatoid arthritis: results of a randomised

controlled

>>> trial.

>>>

>>>

>>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

>>> EA,

>>> Hampson R, Poon FW.

>>>

>>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

>>> University NHS Trust, Castle St, Glasgow G40SF, UK.

>>> .Capell@...

>>>

>>> BACKGROUND: Evidence for disease modifying activity of low dose

>>> corticosteroid treatment in rheumatoid arthritis is contradictory.

>>> Studies

>>> showing radiological benefit suggest that continued treatment is

required

>>> to

>>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

>>> prednisolone in early rheumatoid arthritis on disease activity over two

>>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

>>> with

>>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

>>> disease

>>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

>>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

>>> outcome measure was radiological damage, assessed by the modified Sharp

>>> method. Clinical benefit was a secondary outcome. A proactive approach

to

>>> identifying and treating corticosteroid adverse events was adopted.

>>> Patients

>>> who discontinued sulphasalazine were offered an alternative DMARD.

>>> RESULTS:

>>> 90 of 257 patients eligible for the study refused to participate (more

>>> women

>>> than men). Of those enrolled, 84% were seropositive for rheumatoid

>>> factor,

>>> median age 56 years, median disease duration 12 months, female to male

>>> ratio

>>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

>>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

>>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

>>> were

>>> no significant differences in radiological score or clinical and

>>> laboratory

>>> measures at 0 and 2 years.

>>>

>>> CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

>>> benefit on patients maintained on a DMARD over two years. Low dose

>>> corticosteroids have no role in the routine management of rheumatoid

>>> arthritis treated with conventional disease modifying drugs.

>>>

>>>

>>> PMID: 15194574

>>>

>>>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

stra

>>> ct & list_uids=15194574 & itool=iconabstr

>>>

>>>

>>>

>>>

>>>

>>> I'll tell you where to go!

>>>

>>> Mayo Clinic in Rochester

>>> http://www.mayoclinic.org/rochester

>>>

>>> s Hopkins Medicine

>>> http://www.hopkinsmedicine.org

>>>

>

>

>

>

[Guest guest]

Yes, I am sure cost is a consideration. That's why here in France there is a

protocol which the rheumies have to follow and whereby you have to have failed

on other conventional treatments before you qualify. If you do not respond to a

biologic within 6 months, it has to be doiscontinued. Fortunately, Enbrel is

working very well for me.

n

France

Re: [ ] RESEARCH - Lack of benefit over 2 years of low dose

prednisolone for RA

, don't you think that cost is a major consideration for not

starting biologics earlier? Some insurance companies (mine for one) are

reluctant to spend that much money if they can avoid it. My rheumy

Fellow who worked to get me approved for Enbrel with my insurance

company said there were two companies they did not like to work with,

and mine was one of them. They have paid for Enbrel for almost two

years, but in January they did raise the co-pay from $25 to $40 for a

28-day supply. I still consider that a real bargain, LOL. Sue

[Guest guest]

Yes, I am sure cost is a consideration. That's why here in France there is a

protocol which the rheumies have to follow and whereby you have to have failed

on other conventional treatments before you qualify. If you do not respond to a

biologic within 6 months, it has to be doiscontinued. Fortunately, Enbrel is

working very well for me.

n

France

Re: [ ] RESEARCH - Lack of benefit over 2 years of low dose

prednisolone for RA

, don't you think that cost is a major consideration for not

starting biologics earlier? Some insurance companies (mine for one) are

reluctant to spend that much money if they can avoid it. My rheumy

Fellow who worked to get me approved for Enbrel with my insurance

company said there were two companies they did not like to work with,

and mine was one of them. They have paid for Enbrel for almost two

years, but in January they did raise the co-pay from $25 to $40 for a

28-day supply. I still consider that a real bargain, LOL. Sue

[Guest guest]

I agree entirely with . I was on steroids for 7 years and almost died as a

result. I took me ages to get off them. My first rheumy was quite happy for me

to take steroids. I ended up ditching him - should have done it much earlier.

My second rheumy was totally against them and worked with me to get off them.

After 7 or 8 years on MTX, this latter stopped working for me - back to codeine,

etc. I did take the occasional 10 mg of prednisolone for temporary relief, but

never again took it regularly. Last September I 'qualified' for Enbrel and

everything is hunky-dory.

Be careful of the prednisolone - it's a wolf in lamb's clothing. It can make

you feel good while doing you serious damage.

n

France

[Guest guest]

I agree entirely with . I was on steroids for 7 years and almost died as a

result. I took me ages to get off them. My first rheumy was quite happy for me

to take steroids. I ended up ditching him - should have done it much earlier.

My second rheumy was totally against them and worked with me to get off them.

After 7 or 8 years on MTX, this latter stopped working for me - back to codeine,

etc. I did take the occasional 10 mg of prednisolone for temporary relief, but

never again took it regularly. Last September I 'qualified' for Enbrel and

everything is hunky-dory.

Be careful of the prednisolone - it's a wolf in lamb's clothing. It can make

you feel good while doing you serious damage.

n

France

[Guest guest]

Unfortunately, some insurance companies don't see it that way,

. I have seen many instances of this, working in the hospital.

It is unfortunate that insurance companies get to decide how a

person should be treated for their particular ailment rather than

letting the doctor, who treats that person, actually SEES that

person, and has the experience to make those decisions, treat the

person. Prednison also has it's long term problems as well. It may

be cheaper to treat the problem with it now, but later it will have

its toll--osteoporosis, cataracts, ect. I also use prednison. I

was on 100mg a day at one point. I decided that I needed to get off

of them and use them only as needed. I did it, it wasn't easy with

the flares that insued. Now, however, I ony use it when a flare

won't go away on its own. It is a wonderful, yet frighting,

medication. I feel sooo much better when I am taking it because it

brings the pain down to a tolerable roar. But, I also am acutely

aware of the potential problems to follow with its use.

But, on the flip side, low dosing prednison may have a befnifit not

mentioned. It could be said to prevent DVT's or pneumonia because

when it is taken, appropriately, it allows the user freedom of

movement with less pain. The first reaction to pain is to not

move. The less you move, the more problems that are surely to

arise. DVT's are one example. Pneumonia can also set it if the pain

leaves you bedridden. Treatment and long term affects can be costly

there as well!!

Now, if I could only find that magic wand!! Alas, the insurance

company would probably deny its use anyway. Saying first you have

to have this procedure first, and that medication next, before it

would even CONSIDER the cure!!! LOL.....Marina

[Guest guest]

Unfortunately, some insurance companies don't see it that way,

. I have seen many instances of this, working in the hospital.

It is unfortunate that insurance companies get to decide how a

person should be treated for their particular ailment rather than

letting the doctor, who treats that person, actually SEES that

person, and has the experience to make those decisions, treat the

person. Prednison also has it's long term problems as well. It may

be cheaper to treat the problem with it now, but later it will have

its toll--osteoporosis, cataracts, ect. I also use prednison. I

was on 100mg a day at one point. I decided that I needed to get off

of them and use them only as needed. I did it, it wasn't easy with

the flares that insued. Now, however, I ony use it when a flare

won't go away on its own. It is a wonderful, yet frighting,

medication. I feel sooo much better when I am taking it because it

brings the pain down to a tolerable roar. But, I also am acutely

aware of the potential problems to follow with its use.

But, on the flip side, low dosing prednison may have a befnifit not

mentioned. It could be said to prevent DVT's or pneumonia because

when it is taken, appropriately, it allows the user freedom of

movement with less pain. The first reaction to pain is to not

move. The less you move, the more problems that are surely to

arise. DVT's are one example. Pneumonia can also set it if the pain

leaves you bedridden. Treatment and long term affects can be costly

there as well!!

Now, if I could only find that magic wand!! Alas, the insurance

company would probably deny its use anyway. Saying first you have

to have this procedure first, and that medication next, before it

would even CONSIDER the cure!!! LOL.....Marina

[Guest guest]

This brings up a question for me. I really can't take Prednisone. I have been

on it in the past for only short periods, and invariably I get a very strong

rage reaction on it. This is odd, because I am not a rageful person. It also

has been very frightening. Additionally, I am not willing to take Prednisone

because I also have an autoimmune thyroid disorder, and I am not willing to take

any drug that has weight gain as a side effect. And, I have had a friend, and

also now my husband, who have been on Prednisone because of transplants (kidney

for friend, bone marrow for husband). So, I have seen the effects it has on

people over time. Literally, my life would have to depend on taking it for me

to agree to take it.

How difficult is it going to be to get good RA treatment without being willing

to take Prednisone? I have good insurance, not an HMO, so they are willing to

pay for some better medicine.

---------------------------------

Celebrate 's 10th Birthday!

Netrospective: 100 Moments of the Web

[Guest guest]

This brings up a question for me. I really can't take Prednisone. I have been

on it in the past for only short periods, and invariably I get a very strong

rage reaction on it. This is odd, because I am not a rageful person. It also

has been very frightening. Additionally, I am not willing to take Prednisone

because I also have an autoimmune thyroid disorder, and I am not willing to take

any drug that has weight gain as a side effect. And, I have had a friend, and

also now my husband, who have been on Prednisone because of transplants (kidney

for friend, bone marrow for husband). So, I have seen the effects it has on

people over time. Literally, my life would have to depend on taking it for me

to agree to take it.

How difficult is it going to be to get good RA treatment without being willing

to take Prednisone? I have good insurance, not an HMO, so they are willing to

pay for some better medicine.

---------------------------------

Celebrate 's 10th Birthday!

Netrospective: 100 Moments of the Web

[Guest guest]

I don't think any rheumatologist in his right mind would prescribe

prednisone to you, knowing that you have such a bad reaction to it. If

so, I would change doctors.

Sue

On Saturday, March 5, 2005, at 03:44 PM, wrote:

> How difficult is it going to be to get good RA treatment without being

> willing to take Prednisone? I have good insurance, not an HMO, so

> they are willing to pay for some better medicine.

[Guest guest]

I don't think any rheumatologist in his right mind would prescribe

prednisone to you, knowing that you have such a bad reaction to it. If

so, I would change doctors.

Sue

On Saturday, March 5, 2005, at 03:44 PM, wrote:

> How difficult is it going to be to get good RA treatment without being

> willing to take Prednisone? I have good insurance, not an HMO, so

> they are willing to pay for some better medicine.

[Guest guest]

psycosis or psycotic episodes can be a potential side effect. it is

frightening. it happened to me once. i got so enraged, i knew i

was enraged, but couldn't figure out why or what triggered such a

reaction. then it dawned on me, i forgot to take my dose of

prednison. i was on a pretty high dose at the time. not everyone

reacts the same, not everyone has the same benefit. for me it

helped get things under control until the ra meds could kick in. i

let the ra go too long without treatment so it took big guns to work

for me. now i just use it for sever flares....marina

>

> This brings up a question for me. I really can't take

Prednisone. I have been on it in the past for only short periods,

and invariably I get a very strong rage reaction on it. This is

odd, because I am not a rageful person. It also has been very

frightening. Additionally, I am not willing to take Prednisone

because I also have an autoimmune thyroid disorder, and I am not

willing to take any drug that has weight gain as a side effect.

And, I have had a friend, and also now my husband, who have been on

Prednisone because of transplants (kidney for friend, bone marrow

for husband). So, I have seen the effects it has on people over

time. Literally, my life would have to depend on taking it for me

to agree to take it.

>

> How difficult is it going to be to get good RA treatment without

being willing to take Prednisone? I have good insurance, not an

HMO, so they are willing to pay for some better medicine.

>

>

>

>

> ---------------------------------

> Celebrate 's 10th Birthday!

> Netrospective: 100 Moments of the Web

>

>

[Guest guest]

psycosis or psycotic episodes can be a potential side effect. it is

frightening. it happened to me once. i got so enraged, i knew i

was enraged, but couldn't figure out why or what triggered such a

reaction. then it dawned on me, i forgot to take my dose of

prednison. i was on a pretty high dose at the time. not everyone

reacts the same, not everyone has the same benefit. for me it

helped get things under control until the ra meds could kick in. i

let the ra go too long without treatment so it took big guns to work

for me. now i just use it for sever flares....marina

>

> This brings up a question for me. I really can't take

Prednisone. I have been on it in the past for only short periods,

and invariably I get a very strong rage reaction on it. This is

odd, because I am not a rageful person. It also has been very

frightening. Additionally, I am not willing to take Prednisone

because I also have an autoimmune thyroid disorder, and I am not

willing to take any drug that has weight gain as a side effect.

And, I have had a friend, and also now my husband, who have been on

Prednisone because of transplants (kidney for friend, bone marrow

for husband). So, I have seen the effects it has on people over

time. Literally, my life would have to depend on taking it for me

to agree to take it.

>

> How difficult is it going to be to get good RA treatment without

being willing to take Prednisone? I have good insurance, not an

HMO, so they are willing to pay for some better medicine.

>

>

>

>

> ---------------------------------

> Celebrate 's 10th Birthday!

> Netrospective: 100 Moments of the Web

>

>

[Guest guest]

,

I am very thankful that my physiology teacher discussed the effect

long term steroids have on our body. If it weren't for him, I would

have taken steroids early in my disease. Because of the knowledge I

gained in nursing school, I spared myself the agony of being stuck on

steroids for life along with all the serious health problems they

pose. My very first rheumy tried prescribing them, and I refused.

When the vioxx articles started coming out, I discussed the risks with

my rheumy. He was not at all concerned about it and wanted me to

continue taking it. Since it elevated my blood pressure so much, I

stopped taking them in spite of my rheumy's opinion. I'm very glad I

did. I may have spared myself cardiac side effects.

Every time I read about a side effect of Enbrel, I cringe. But I

weigh the pros and cons and I continue taking it in spite of the

potential side effects. But I will still post these informative posts

so that readers can educate themselves and make the decision to take

or not to take it.

No one here recommends or discourages a specific treatment. We are

not doctors and can't advise anyone what meds to take. We simply

provide the published data so that readers can educate themselves and

then discuss options with their doctors.

We have many members that will be on prednisone for life. I wonder

how many of them knew this when they started taking it? I wonder how

many of them knew when they started, the serious side effects that

can result from long term steroid use? I wonder how many of them

would have refused had they known? New members here have the right to

know that some meds can cause more harm than good. Sure, not everyone

will have serious side effects, but they still have the right to know

that the possibility exists.

I'm glad you have a doctor that discussed the side effects with you

before you started taking it.

Unfortunately not all doctors take the time nor do all doctors keep up

with current research.

a

On Sat, 5 Mar 2005 03:15:24 -0500, Choate

<k.j.choate@...> wrote:

> But it does cause anxiety. My point is - prednisone can be an effective

> drug

> and has been an effective drug for me and a number of people on the site -

> who cannot easily or completely discontinue it for any number of reasons.

> My

> rheumatologist gave me prednisone - because I was having major mobility

> problems- and many of the other drugs she had available in her arsenal -

> were not good choices for me at the time. I remained mobile and working

> because of that choice. I was made aware of the side effects and made a

> choice. I am not sure it is our position to recommend or discourage any

> specific drug or drug treatment. Sharing our good and bad experiences of a

> drug is helpful. Providing research showing side effects is helpful.

> Members

> of the site can use that information - and discuss drug treatment and side

> effects with their doctors. Doctors should be making treatment

> recommendations and providing options.

>

>

>

> Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> dose prednisolone for RA

>

>

> >

> >, I'm not trying to induce anxiety in anyone here who cannot

> >discontinue prednisone. And it's true that, for many people, it is very

> good

> >for rapidly relieving pain and inflammation in the early stages of RA

> while

> >they are waiting for DMARDs to work. It's also true that some people use

> it

> >at a low dose for years without major problems.

> >

> >BUT since we can't predict who will be able to discontinue prednisone, and

> >since we can't predict who will suffer multiple and serious adverse

> effects

> >from prednisone, and since the data generally doesn't support long-term

> >clinical or radiological benefits of prednisone in RA, and since there are

> >so many new and effective treatment options now for pain and RA itself, I

> >can't recommend that newbies start it (or resume it).

> >

> >In fact, there are some researchers and physicians who are looking at the

> >feasibility of using the biologics immediately with, for example, MTX. As

> >prednisone does, biologics work very quickly, but, unlike prednisone, they

> >can be easily discontinued if need be. Not only that, it is possible that,

> >if biologics are started early enough in the disease process, they may be

> >able to induce the sort of control, or even remission, that might

> maintained

> >with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

> >

> >

> >

> >

> >I'll tell you where to go!

> >

> >Mayo Clinic in Rochester

> >http://www.mayoclinic.org/rochester

> >

> >s Hopkins Medicine

> >http://www.hopkinsmedicine.org

> >

> >

> > Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> >dose prednisolone for RA

> >

> >

> >>

> >> I have been on prednisone for over 10 years- the dose has varied but

> drug

> >> has been part of my treatment repertoire. Would I rather not be on it-

> >> sure. It has caused problems and it has alleviated problems. While it

> does

> >> not modify the disease long term- it does help with inflammation and

> pain.

> >> Sometimes it is the only thing that does. It often keeps people mobile

> >> until the right drug combination works. It has its place in a treatment

> >> program - and should be discontinued- if possible- when possible.

> >>

> >>

> >> -------------- Original message ----------------------

> >> From: " " <Matsumura_Clan@...>

> >>>

> >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> >>>

> >>>

> >>> Lack of radiological and clinical benefit over two years of low dose

> >>> prednisolone for rheumatoid arthritis: results of a randomised

> controlled

> >>> trial.

> >>>

> >>>

> >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

> >>> EA,

> >>> Hampson R, Poon FW.

> >>>

> >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> >>> .Capell@...

> >>>

> >>> BACKGROUND: Evidence for disease modifying activity of low dose

> >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> >>> Studies

> >>> showing radiological benefit suggest that continued treatment is

> required

> >>> to

> >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> >>> prednisolone in early rheumatoid arthritis on disease activity over two

> >>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

> >>> with

> >>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

> >>> disease

> >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> >>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> >>> outcome measure was radiological damage, assessed by the modified Sharp

> >>> method. Clinical benefit was a secondary outcome. A proactive approach

> to

> >>> identifying and treating corticosteroid adverse events was adopted.

> >>> Patients

> >>> who discontinued sulphasalazine were offered an alternative DMARD.

> >>> RESULTS:

> >>> 90 of 257 patients eligible for the study refused to participate (more

> >>> women

> >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> >>> factor,

> >>> median age 56 years, median disease duration 12 months, female to male

> >>> ratio

> >>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

> >>> were

> >>> no significant differences in radiological score or clinical and

> >>> laboratory

> >>> measures at 0 and 2 years.

> >>>

> >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> clinical

> >>> benefit on patients maintained on a DMARD over two years. Low dose

> >>> corticosteroids have no role in the routine management of rheumatoid

> >>> arthritis treated with conventional disease modifying drugs.

> >>>

> >>>

> >>> PMID: 15194574

> >>>

> >>>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> stra

> >>> ct & list_uids=15194574 & itool=iconabstr

> >>>

> >>>

> >>>

> >>>

> >>>

> >>> I'll tell you where to go!

> >>>

> >>> Mayo Clinic in Rochester

> >>> http://www.mayoclinic.org/rochester

> >>>

> >>> s Hopkins Medicine

> >>> http://www.hopkinsmedicine.org

> >>>

> >

> >

> >

> >

[Guest guest]

,

I am very thankful that my physiology teacher discussed the effect

long term steroids have on our body. If it weren't for him, I would

have taken steroids early in my disease. Because of the knowledge I

gained in nursing school, I spared myself the agony of being stuck on

steroids for life along with all the serious health problems they

pose. My very first rheumy tried prescribing them, and I refused.

When the vioxx articles started coming out, I discussed the risks with

my rheumy. He was not at all concerned about it and wanted me to

continue taking it. Since it elevated my blood pressure so much, I

stopped taking them in spite of my rheumy's opinion. I'm very glad I

did. I may have spared myself cardiac side effects.

Every time I read about a side effect of Enbrel, I cringe. But I

weigh the pros and cons and I continue taking it in spite of the

potential side effects. But I will still post these informative posts

so that readers can educate themselves and make the decision to take

or not to take it.

No one here recommends or discourages a specific treatment. We are

not doctors and can't advise anyone what meds to take. We simply

provide the published data so that readers can educate themselves and

then discuss options with their doctors.

We have many members that will be on prednisone for life. I wonder

how many of them knew this when they started taking it? I wonder how

many of them knew when they started, the serious side effects that

can result from long term steroid use? I wonder how many of them

would have refused had they known? New members here have the right to

know that some meds can cause more harm than good. Sure, not everyone

will have serious side effects, but they still have the right to know

that the possibility exists.

I'm glad you have a doctor that discussed the side effects with you

before you started taking it.

Unfortunately not all doctors take the time nor do all doctors keep up

with current research.

a

On Sat, 5 Mar 2005 03:15:24 -0500, Choate

<k.j.choate@...> wrote:

> But it does cause anxiety. My point is - prednisone can be an effective

> drug

> and has been an effective drug for me and a number of people on the site -

> who cannot easily or completely discontinue it for any number of reasons.

> My

> rheumatologist gave me prednisone - because I was having major mobility

> problems- and many of the other drugs she had available in her arsenal -

> were not good choices for me at the time. I remained mobile and working

> because of that choice. I was made aware of the side effects and made a

> choice. I am not sure it is our position to recommend or discourage any

> specific drug or drug treatment. Sharing our good and bad experiences of a

> drug is helpful. Providing research showing side effects is helpful.

> Members

> of the site can use that information - and discuss drug treatment and side

> effects with their doctors. Doctors should be making treatment

> recommendations and providing options.

>

>

>

> Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> dose prednisolone for RA

>

>

> >

> >, I'm not trying to induce anxiety in anyone here who cannot

> >discontinue prednisone. And it's true that, for many people, it is very

> good

> >for rapidly relieving pain and inflammation in the early stages of RA

> while

> >they are waiting for DMARDs to work. It's also true that some people use

> it

> >at a low dose for years without major problems.

> >

> >BUT since we can't predict who will be able to discontinue prednisone, and

> >since we can't predict who will suffer multiple and serious adverse

> effects

> >from prednisone, and since the data generally doesn't support long-term

> >clinical or radiological benefits of prednisone in RA, and since there are

> >so many new and effective treatment options now for pain and RA itself, I

> >can't recommend that newbies start it (or resume it).

> >

> >In fact, there are some researchers and physicians who are looking at the

> >feasibility of using the biologics immediately with, for example, MTX. As

> >prednisone does, biologics work very quickly, but, unlike prednisone, they

> >can be easily discontinued if need be. Not only that, it is possible that,

> >if biologics are started early enough in the disease process, they may be

> >able to induce the sort of control, or even remission, that might

> maintained

> >with less expensive, well-known drugs (MTX, Plaquenil, Azulfidine).

> >

> >

> >

> >

> >I'll tell you where to go!

> >

> >Mayo Clinic in Rochester

> >http://www.mayoclinic.org/rochester

> >

> >s Hopkins Medicine

> >http://www.hopkinsmedicine.org

> >

> >

> > Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> >dose prednisolone for RA

> >

> >

> >>

> >> I have been on prednisone for over 10 years- the dose has varied but

> drug

> >> has been part of my treatment repertoire. Would I rather not be on it-

> >> sure. It has caused problems and it has alleviated problems. While it

> does

> >> not modify the disease long term- it does help with inflammation and

> pain.

> >> Sometimes it is the only thing that does. It often keeps people mobile

> >> until the right drug combination works. It has its place in a treatment

> >> program - and should be discontinued- if possible- when possible.

> >>

> >>

> >> -------------- Original message ----------------------

> >> From: " " <Matsumura_Clan@...>

> >>>

> >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> >>>

> >>>

> >>> Lack of radiological and clinical benefit over two years of low dose

> >>> prednisolone for rheumatoid arthritis: results of a randomised

> controlled

> >>> trial.

> >>>

> >>>

> >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

> >>> EA,

> >>> Hampson R, Poon FW.

> >>>

> >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> >>> .Capell@...

> >>>

> >>> BACKGROUND: Evidence for disease modifying activity of low dose

> >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> >>> Studies

> >>> showing radiological benefit suggest that continued treatment is

> required

> >>> to

> >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> >>> prednisolone in early rheumatoid arthritis on disease activity over two

> >>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

> >>> with

> >>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

> >>> disease

> >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> >>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> >>> outcome measure was radiological damage, assessed by the modified Sharp

> >>> method. Clinical benefit was a secondary outcome. A proactive approach

> to

> >>> identifying and treating corticosteroid adverse events was adopted.

> >>> Patients

> >>> who discontinued sulphasalazine were offered an alternative DMARD.

> >>> RESULTS:

> >>> 90 of 257 patients eligible for the study refused to participate (more

> >>> women

> >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> >>> factor,

> >>> median age 56 years, median disease duration 12 months, female to male

> >>> ratio

> >>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

> >>> were

> >>> no significant differences in radiological score or clinical and

> >>> laboratory

> >>> measures at 0 and 2 years.

> >>>

> >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> clinical

> >>> benefit on patients maintained on a DMARD over two years. Low dose

> >>> corticosteroids have no role in the routine management of rheumatoid

> >>> arthritis treated with conventional disease modifying drugs.

> >>>

> >>>

> >>> PMID: 15194574

> >>>

> >>>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> stra

> >>> ct & list_uids=15194574 & itool=iconabstr

> >>>

> >>>

> >>>

> >>>

> >>>

> >>> I'll tell you where to go!

> >>>

> >>> Mayo Clinic in Rochester

> >>> http://www.mayoclinic.org/rochester

> >>>

> >>> s Hopkins Medicine

> >>> http://www.hopkinsmedicine.org

> >>>

> >

> >

> >

> >

[Guest guest]

a-

You miss my point. I am aware of the side effects of prednisone. I am also aware

that had I not taken prednisone when it was first prescribed I would not have

been able to walk.My RA responded to nothing else at the time. I did not want to

take pred- but I wanted to walk. There have been many breakthroughs and changing

philosophies on treatment- since I had to make that choice. I am currently on a

combo of Remicade, MTX and yes, prednisone. There have been no drugs that have

been miracle drugs where I have been concerned- but I am mobile and the pain I

live with is tolerable. I have suffered from side effects also- that I would not

wish on anyone here.I would hate to think,however, someone here - whose disease

and symptoms of disease was similarly unresponsive- would forego a drug

treatment recommended by a doctor because someone here- could not recommend

it-or were frightened out of taking it. The decision whether or not to take

prednisone or any corticosteroid is serious decision -question the hell out of

a doctor who recommends it. IT IS A DECISION HOWEVER THAT SHOULD BE MADE BY AND

BETWEEN A DOCTOR AND A PATIENT- period. I have really attempted to be diplomatic

in my responses to the posts to date.We should be sharing research. We should be

sharing personal stories and decisions. I don't disagree with any of that. You

have,however, said we do not make recommendations here. Unfortunately while that

should be true- it isn't true. I would not have responded if I had not read in a

post " I could not in good conscience recommend the use of prednisone.... " The

person was not a doctor- nor am I aware- had the person taken prednisone. The

research shared was fine- the recommendation was not. We are not doctors and

should not be dispensing medical advice- no matter how well intentioned. Enough.

-

--------- Re: [ ] RESEARCH - Lack of benefit over 2 years of low

> > >dose prednisolone for RA

> > >

> > >

> > >>

> > >> I have been on prednisone for over 10 years- the dose has varied but

> > drug

> > >> has been part of my treatment repertoire. Would I rather not be on it-

> > >> sure. It has caused problems and it has alleviated problems. While it

> > does

> > >> not modify the disease long term- it does help with inflammation and

> > pain.

> > >> Sometimes it is the only thing that does. It often keeps people mobile

> > >> until the right drug combination works. It has its place in a treatment

> > >> program - and should be discontinued- if possible- when possible.

> > >>

> > >>

> > >> -------------- Original message ----------------------

> > >> From: " "

> > >>>

> > >>> Ann Rheum Dis. 2004 Jul;63(7):797-803.

> > >>>

> > >>>

> > >>> Lack of radiological and clinical benefit over two years of low dose

> > >>> prednisolone for rheumatoid arthritis: results of a randomised

> > controlled

> > >>> trial.

> > >>>

> > >>>

> > >>> Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson

> > >>> EA,

> > >>> Hampson R, Poon FW.

> > >>>

> > >>> Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

> > >>> University NHS Trust, Castle St, Glasgow G40SF, UK.

> > >>> .Capell@...

> > >>>

> > >>> BACKGROUND: Evidence for disease modifying activity of low dose

> > >>> corticosteroid treatment in rheumatoid arthritis is contradictory.

> > >>> Studies

> > >>> showing radiological benefit suggest that continued treatment is

> > required

> > >>> to

> > >>> sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

> > >>> prednisolone in early rheumatoid arthritis on disease activity over two

> > >>> years. DESIGN: Double blind placebo controlled trial. METHODS: Patients

> > >>> with

> > >>> rheumatoid arthritis, duration <3 years (n = 167), were started on a

> > >>> disease

> > >>> modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

> > >>> stratified randomisation to prednisolone 7 mg/day or placebo. Primary

> > >>> outcome measure was radiological damage, assessed by the modified Sharp

> > >>> method. Clinical benefit was a secondary outcome. A proactive approach

> > to

> > >>> identifying and treating corticosteroid adverse events was adopted.

> > >>> Patients

> > >>> who discontinued sulphasalazine were offered an alternative DMARD.

> > >>> RESULTS:

> > >>> 90 of 257 patients eligible for the study refused to participate (more

> > >>> women

> > >>> than men). Of those enrolled, 84% were seropositive for rheumatoid

> > >>> factor,

> > >>> median age 56 years, median disease duration 12 months, female to male

> > >>> ratio

> > >>> 1.8:1. Prednisolone was given to 84 patients; of these 73% continued

> > >>> prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

> > >>> placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There

> > >>> were

> > >>> no significant differences in radiological score or clinical and

> > >>> laboratory

> > >>> measures at 0 and 2 years.

> > >>>

> > >>> CONCLUSIONS: Low dose prednisolone conferred no radiological or

> > clinical

> > >>> benefit on patients maintained on a DMARD over two years. Low dose

> > >>> corticosteroids have no role in the routine management of rheumatoid

> > >>> arthritis treated with conventional disease modifying drugs.

> > >>>

> > >>>

> > >>> PMID: 15194574

> > >>>

> > >>>

> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

> > stra

> > >>> ct & list_uids=15194574 & itool=iconabstr

> > >>>

> > >>>

> > >>>

> > >>>

> > >>>

> > >>> I'll tell you where to go!

> > >>>

> > >>> Mayo Clinic in Rochester

> > >>> http://www.mayoclinic.org/rochester

> > >>>

> > >>> s Hopkins Medicine

> > >>> http://www.hopkinsmedicine.org

> > >>>

> > >

> > >

> > >

> > >