A clinical and biochemical evaluation of prednisolone in patients with active rheumatoid arthritis

Summary Fifteen patients with active rheumatoid arthritis who had not previously received oral corticosteroids were recruited into an open study using the Leeds Human Model Screening System to assess whether prednisolone has any activity as a second-line agent. The daily dose of prednisolone was 10 mg/day, and all patients completed the full study duration of 24 weeks, with only one patient requiring a dose reduction to 7.5 mg. Patients were then recruited into a further open study during which dosage reduction of 1 mg/month was attempted. Patients were assessed using six clinical and six laboratory variables, and statistically significant improvement (P<0.01) was seen in seven of 12 variables at 24 weeks. After 48 weeks, two variables showed statistically significant improvement at P<0.01, with improvement in a further four variables significant at P<0.05. This degree of change ranks prednisolone below established second-line agents such as sodium aurothiomalate and d-penicillamine but ahead of non-steroidal anti-inflammatory drugs, suggesting that in addition to their known anti-inflammatory properties corticosteroids may have some action as second-line agents.