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NEW YORK (Reuters Health) - Low-dose prednisone started when symptoms of rheumatoid arthritis first show up inhibits the radiological progression of the disease over 2 years, according to a report in The Cochrane Library, published online on January 24.

Previous reviews have provided good evidence that steroid use for up to 7 months provides clinical benefit, lead author Dr. John R. Kirwan, from Liverpool Women's Hospital in England, and colleagues note.

To address the potential "disease-modifying" effect of low-dose steroids, their current meta-analysis included 15 studies and 1,414 patients, published between 1955 and 2005.

Most subjects had been diagnosed with rheumatoid arthritis for < 2 years. Mean cumulative dose of glucocorticoid was 2,300 mg prednisone equivalent (6.3 mg/day). The steroid was usually added along with other disease-modifying antirheumatic drugs. Progression was measured by degree of joint erosions and joint narrowing over time, documented by radiography of patients' hands and feet.

Daily steroid use slowed the progression of erosions by roughly 60%, compared with controls. The authors also noted significant reductions in joint space narrowing.

"There were statistically significant reductions in the progression of erosions over 1 year and over 2 years in all subgroup analyses, irrespective of concomitant medication and length of study," Dr. Kirwan and his associates maintain.

With regard to complications, the team cites a previously published review that states, "Few of the commonly held beliefs about their incidence, prevalence, and impact are supported by clear scientific evidence."

Dr. Kirwan's team made similar findings, and they stress that "the most immediate concern, reduced bone mineral density, can also now be readily treated."

They conclude that low-dose steroid treatment should be offered to patients, but that the potential for long-term complications warrants further research.

The Cochrane Library 2007;1.