Iannuzzi L P
Ohio Permanente Medical Group, Parma 44130.
Postgrad Med. 1987 Oct;82(5):295-8, 300-1. doi: 10.1080/00325481.1987.11700016.
Although low-dose oral corticosteroid therapy cannot be considered remittive, it has earned a place in the therapeutic armamentarium for rheumatoid arthritis. Major clinical trials of a group using corticosteroid compared with a control group have not been done since the 1950s. One of these three large trials showed some slowing of the destructive joint changes of rheumatoid arthritis with use of low doses of corticosteroid. However, these agents have well-known side effects, especially when used long-term. Elderly patients or those who have features of the disease that indicate progression (eg, multiple joint involvement, elevated ESR, early evidence of erosion on x-ray films) are likely to benefit from carefully controlled doses of a corticosteroid. Because these drugs diminish bone formation and arthritis itself accelerates osteoporosis, supplemental calcium and vitamin D are useful adjuncts. A remittive agent and aspirin-like drug should be prescribed along with the corticosteroid. Abrupt withdrawal of even a very low dose of corticosteroids in rheumatoid arthritis patients causes a flare.
尽管低剂量口服皮质类固醇疗法不能被视为缓解性疗法，但它在类风湿关节炎的治疗手段中已占有一席之地。自20世纪50年代以来，尚未进行过一组使用皮质类固醇与对照组比较的大型临床试验。这三项大型试验中的一项显示，使用低剂量皮质类固醇可使类风湿关节炎的破坏性关节变化有所减缓。然而，这些药物有众所周知的副作用，尤其是长期使用时。老年患者或那些具有疾病进展特征（如多关节受累、血沉升高、X线片早期有侵蚀迹象）的患者可能会从精心控制剂量的皮质类固醇中获益。由于这些药物会减少骨形成，而关节炎本身会加速骨质疏松，补充钙和维生素D是有用的辅助措施。应与皮质类固醇一起开一种缓解性药物和一种阿司匹林样药物。类风湿关节炎患者即使突然停用极低剂量的皮质类固醇也会导致病情复发。
