Low dose steroid use not associated with substantial weight gain or hypertension in patients with rheumatoid arthritis

An analysis of randomized controlled trials has found that the use of low-dose glucocorticoids was not associated with substantial weight gain or hypertension in patients being treated for rheumatoid arthritis. The analysis is published in Annals of Internal Medicine.

Glucocorticoids are often used in the management of rheumatoid arthritis (RA). Weight gain and hypertension are well known adverse effects of treatment with high-dose glucocorticoids. However, little is known about the adverse effects of low-dose steroids, which are commonly used to treat RA.

Researchers from Charite—Universitätsmedizin Berlin, Berlin, Germany conducted a pooled analysis of five randomized controlled trials with two-year interventions to evaluate the effects of low-dose glucocorticoid treatment in RA. The researchers found that use of low-dose glucocorticoids was associated with a 1.1 kilogram weight increase compared to a control. They observed no significant differences in blood pressure between groups.

An accompanying editorial by David Fernandez, MD, Ph.D. of the Hospital for Special Surgery, New York, New York says that the risks of low-dose glucocorticoid therapy may be smaller and more manageable than they may appear based on observational studies.

He notes that the two-year timespan of the studies may not fully evaluate the effect of weight gain and hypertension because those effects may manifest over decades. However, the findings provide a more quantifiable assessment of the potential adverse effects of steroid therapy than had existed previously and will be helpful to providers and patients as they decide on the relative risks and benefits of glucocorticoids as part of their therapy plan.