Although oral glucocorticosteroids are analgesic in rheumatoid arthritis (RA), the benefits are short-lived and may not provide clinically relevant pain relief for more than 3 months of use, according to findings from a systematic review published in Rheumatology.

A team of UK-based researchers conducted a systematic literature review and meta-analysis (PROSPERO Number: CRD42019111562) to quantify the efficacy of systemic glucocorticosteroids use on RA-related pain.

A total of 33 randomized controlled trials (27 for spontaneous pain and 24 for evoked pain measures) were included in the meta-analysis, which included 2658 participants (68{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} women; mean age, 54 years); 23 of the studies reported oral glucocorticosteroids dosing, 4 studies used intramuscular treatment, 5 studies used intravenous treatment, and 1 study used iontophoresis to administer treatment.

In the meta-analysis for spontaneous pain, oral glucocorticosteroids alone, which were examined in 15 studies, were significantly associated with a significant reduction in spontaneous pain, with a standardized mean difference of -0.65 (95{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc} CI, -0.82 to -0.49; P <.001) with significant heterogeneity between studies (I2=56{d847ba2f23daf15c773bda6cb71ac33aa9166b9578a171d654c6e3c528a0b6bc}; P =.0045).


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In subgroup analyses that assessed the time course of oral glucocorticosteroids effects on spontaneous pain, efficacy was associated with a time-related decrease after glucocorticosteroids initiation. Among patients who were treated with glucocorticosteroids for 3 months or less, the mean difference in visual analog scale (VAS) for pain resulted in a better improvement (-12 mm). Mean difference in VAS pain for more than 3 months and more than 6 months also improved for patients treated with glucocorticosteroids (-8 mm and -7 mm, respectively). In addition, improvements in fatigue were noted in 5 randomized clinical trials among patients treated with glucocorticosteroids.

“The current use of [glucocorticosteroids] to treat RA pain appears to be largely guided by clinical experience rather than robust evidence from [randomized] controlled trials,” the authors noted.

Study authors noted that additional research is required to understand which patients would most benefit from systemic glucocorticosteroids so clinicians can provide more personalized treatments, and to better understand the potential risks and benefits association with withdrawal in patients who are already using long-term systemic glucocorticosteroids.

“The evidence from this review suggests systemic [glucocorticosteroids] are not a complete solution to RA pain and additional analgesic strategies are urgently needed,” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

McWilliams DF, Thankaraj D, Jones-Diette J, et al. The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis. Rheumatology. Published online July 2, 2021. doi:10.1093/rheumatology/keab503

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