Low-dose daily oral therapy
Non-steroidal anti-inflammatory drugs (NSAIDs) provide rapid symptomatic relief in RA. However, they do not prevent the development of bony erosions. When the diagnosis of RA is established, a disease-modifying anti-rheumatic drug (DMARD) should be introduced to try to prevent the development of bony erosions and to induce disease remission. However, most of these drugs, e.g. sulfasalazine, take a minimum of 6 weeks, and in some cases up to 6 months, to take effect. Patients may require oral corticosteroids for symptomatic relief if NSAIDs produce an inadequate response. This may bridge the gap until DMARDs take effect. The corticosteroid dose can then be tapered off.
In patients who cannot tolerate NSAIDs or in whom the use of DMARDs has proven to be problematic, e.g. adverse effects, monitoring difficulties or poor compliance, the use of a low-dose corticosteroid e.g. prednisolone 5-10 mg/day, may provide good control of symptoms and improved function.
Importantly, with regard to the use of low-dose corticosteroids, a recent placebo controlled trial has shown that prednisolone 7.5 mg/day has a disease-modifying effect by preventing the development of bony erosions.2