A recent study suggest that steroid use may be associated with fractures in early rheumatoid arthritis (RA). Researchers looked at the impact of systemic glucocorticoid exposure on fracture risk among new-onset rheumatoid arthritis by looking at administrative claims data between 2005-2012. The data provided detailed information about the treatments and outcomes of 42, 127 newly diagnosed RA patients.
From the data, researchers concluded that 85% of RA patients were exposed to steroids. Rheum Now summarised the research findings as follow: “Although exposed and unexposed patients were demographically similar, fracture risk was significantly higher at doses <15mg/day (5 to 9 per 1000 person-years), ≥15 mg/day (16 per 1000 PY), and with cumulative doses ≥5400 mg (13.4 per 1000 PY). Adjusted fracture risk was approximately 2-fold higher at highest dose levels compared with 0 mg/day current daily dose and <675 mg cumulative dose, respectively.”
The patients who discontinued the use of steroids after 2-6 months showed a lower fracture risk of 29% when compared to the patients who continued to use steroids. Among younger, new-onset RA patients, fracture risk increased if daily and cumulative steroid dose was high. To learn more about the study, please click here.
Steroids in the treatment of arthritis
Steroids help to treat the symptoms of arthritis; it does not treat the underlying disease. Steroids such as glucocorticoids can be given by mouth, intravenous infusion (for life or organ-threatening disease), intramuscular injection, and injection directly into a joint or tendon sheath (when there is local inflammation). It is commonly used to treat inflammation caused by rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic lupus erythematosus (SLE), and vasculitis.
The use of steroid is considered to be a good bridge therapy before disease-modifying anti-rheumatic drugs take full effect. It is unlikely that glucocorticoids will slow down the joint damage caused by the diseases mentioned above, but glucocorticoids are often used to treat life-threatening or organ-threatening complications from these diseases, such as RA lung inflammation, RA eye disease, RA vasculitis, SLE nephritis, SLE brain disease, dermatomyositis, and vasculitis.