Glucocorticoids in the treatment of rheumatoid arthritis: still used after 65 years.

Glucocorticoids (GCs) have been used for over 65 years in the treatment of rheumatoid arthritis (RA). There is by now good evidence for their disease-modifying effects, especially in early RA. When used in a dosage of 5-10 mg, most adverse effects can adequately be monitored, though accurate monitoring and awareness for infections are important. In this paper, the Utrecht and computer-assisted management in early rheumatoid arthritis (CAMERA) studies are discussed; the Utrecht study was the first of these studies in which 10 mg prednisone daily was compared to placebo in patients with early RA. A clear disease-modifying effect was shown. In the CAMERA II study, patients with early RA were treated with a tight-control scheme of climbing dosages of methotrexate plus either 10 mg prednisone daily or placebo. After 2 years, 70% of the patients treated with a tight-control strategy without GCs had no erosions versus 82% of the patients treated with additional prednisone. Remission was reached more often and earlier on in the strategy with prednisone compared to the strategy with placebo.