Worried about rheumatoid arthritis, ‘osteoporosis’ during steroid treatment?

Ajou University Professor Changhee Seo · Research Assistant Professor Jiwon Kim

Treatment below the equivalent dose of ‘Prednisolone 2.5mg’, suggesting an appropriate dose

A study result was published that solves the concerns about steroid treatment in rheumatoid arthritis patients.

Steroids are administered to control inflammation in the early stages of rheumatoid arthritis or when symptoms worsen. This steroid inhibits bone formation and interferes with intestinal calcium absorption, which increases the risk of osteoporosis.

However, according to a study published by Professor Seo Chang-hee and Research Assistant Professor Kim Ji-won of the Department of Rheumatology at Ajou University Hospital, it was confirmed that low-dose steroids did not significantly affect the decrease in bone density.

In addition, as a result of analyzing changes in bone density according to steroid dose, ultra-low dose steroid treatment of prednisolone 2.5 mg or less is the most appropriate dose that does not adversely affect bone density while maintaining a state of remission of rheumatoid arthritis, that is, a state in which symptoms have completely subsided. Confirmed.

The research team retrospectively analyzed clinical data from 833 patients taking steroids and 100 control groups not taking steroids among patients treated for rheumatoid arthritis at Ajou University Hospital from January 1999 to June 2020. The control group was patients who had not taken steroids for at least 1 year before the bone density test.

As a result, there was no difference in the annual rate of change of bone density between the two groups and the rate of newly developed osteoporosis and fractures during the follow-up period. In other words, it was confirmed that steroid treatment did not significantly adversely affect bone density. The mean follow-up period for both the patient group and the control group was 9 years and 3 months.

In addition, as a result of multiple linear regression analysis, it was confirmed that the only factor affecting the change in bone density was ‘DAS28-ESR’, the disease activity of rheumatoid arthritis. Rather, it was confirmed that bone loss can be prevented only by lowering the disease activity of rheumatoid arthritis through inflammatory treatment such as steroid treatment.

However, in addition to osteoporosis and fractures, steroids cause various side effects such as the endocrine system and skin, so it is recommended to administer the minimum dose, the research team explained.

Research assistant professor Kim Ji-won said, “This study is meaningful in that it is possible to treat inflammation with low-dose steroid treatment in rheumatoid arthritis patients, confirming that it does not adversely affect osteoporosis, and also identifies risk factors affecting bone density.” Because there is a difference, the use of steroids must be done under the judgment of an expert.”

Professor Seo Chang-hee said, “Because rheumatoid arthritis patients have reduced activity due to pain, and inflammatory mediators secreted in the body adversely affect bone metabolism, increasing the risk of osteoporosis. It is essential to prevent osteoporosis and fractures through physical exercise,” he added.

Meanwhile, the results of this study were published in the June issue of the SCI international journal Journal of Clinical Medicine, ‘Anti-Inflammatory Effects of Low-Dose Glucocorticoids Compensate for Their Detrimental Effects on Bone Mineral Density in Patients with Rheumatoid Arthritis. The anti-inflammatory effect of steroids compensates for the detrimental effect on bone density).