Small Doses of Prednisolone in the Management of Rheumatoid Arthritis

Abstract

In many patients with rheumatoid arthritis a single dose of 5 mg. prednisolone taken at bedtime markedly reduced morning stiffness. Among the patients able to detect a difference in the effect of 5 mg. prednisolone taken in the morning as compared with the same dose taken at night, the majority favoured the evening dose. Adverse effects of treatment with prednisolone were compared in patients treated with a total daily dose of 5 to 7.5 mg. and in those receiving higher doses. Severe adverse effects from low doses were mainly gastro-intestinal and occurred in the early stages of treatment. After patients suffering such effects had been discovered and their treatment stopped, prolongation of therapy in the remainder rarely produced fresh major adverse effects, though the incidence of purpura and bruising continued to increase. By contrast, the major adverse effects of higher doses of corticosteroid occurred at any time but more often when treatment was prolonged. Pituitary-adrenocortical reserve was found to be present in all of ten patients who had taken 5 mg. prednisolone daily for up to 3 1/2 years. If doses of prednisolone in the range 5 to 7.5 mg. are not exceeded, treatment with corticosteroids is justifiable in relatively early and mild cases of rheumatoid arthritis. The clinical response is better if such doses have not been preceded by a period of higher dosage. No claim is made that low doses produce other than symptomatic benefit.