Prednisone treatment of elderly-onset rheumatoid arthritis. Disease activity and bone mass in comparison with chloroquine treatment

Arthritis Rheum. 1995 Mar;38(3):334-42. doi: 10.1002/art.1780380307.

Abstract

Objective: Prednisone is frequently used in the treatment of elderly-onset rheumatoid arthritis (RA), but the balance between efficacy and toxicity, including the effect on bone mass, has not been investigated in long-term studies. This prospective, randomized study was undertaken to compare disease activity and bone mass during long-term treatment with prednisone versus chloroquine in this patient population.

Methods: Patients with active RA diagnosed at age > or = 60 were randomized to receive prednisone (15 mg/day for 1 month, with the dosage tapered as low as possible thereafter) (n = 28) or chloroquine (n = 28). Patients who did not show a response received other second-line drugs as an adjunct to prednisone or as a replacement for chloroquine. Bone mass was measured by dual-energy x-ray absorptiometry. The study duration was 2 years.

Results: During the 2 years, treatment with other second-line drugs was needed for 12 patients in the prednisone group (43%) and 8 in the chloroquine group (29%). Functional capacity and disease activity improved significantly in both groups and did not differ significantly between the groups, except for a greater improvement in the prednisone group at 1 month. Radiographic scores for joint destruction progressed similarly in both groups. There was a nonsignificant excess bone loss of 1.8% in the spine and 1.5% in the hip in the prednisone group, compared with the chloroquine group.

Conclusion: Neither treatment was entirely satisfactory since a significant number of patients needed an additional second-line drug over the 2-year period.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / metabolism
  • Bone Density / drug effects*
  • Bone Remodeling / drug effects
  • Chloroquine / adverse effects
  • Chloroquine / therapeutic use*
  • Elbow / injuries
  • Female
  • Fractures, Bone / etiology
  • Hip Fractures / etiology
  • Humans
  • Male
  • Middle Aged
  • Prednisone / adverse effects
  • Prednisone / therapeutic use*
  • Prospective Studies
  • Radiography
  • Thoracic Vertebrae / injuries
  • Treatment Outcome

Substances

  • Chloroquine
  • Prednisone