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Are Long-Term Very Low Doses of Prednisone for Patients with Rheumatoid Arthritis as Helpful as High Doses Are Harmful?

Theodore Pincus, MD; Tuulikki Sokka, MD, PhD; and C. Michael Stein, MD
[+] Article, Author, and Disclosure Information

Vanderbilt University Medical Center Nashville, TN 37232

Acknowledgment: The authors thank John P. Bilezikian, Stanley B. Cohen, Doyt L. Conn, Harris Dienstfrey, Max I. Hamburger, Roger M. Reynolds, Anthony S. Russell, Kenneth G. Saag, Arthur L. Weaver, Michael H. Weisman, and Frederick Wolfe for critical comments.

Requests for Single Reprints: Theodore Pincus, MD, Vanderbilt University Medical Center, 203 Oxford House, Nashville, TN 37232; e-mail, theodore.pincus@vanderbilt.edu.

Current Author Addresses: Drs. Pincus and Sokka: Vanderbilt University Medical Center, 203 Oxford House, Nashville, TN 37232.

Dr. Stein: Vanderbilt University Medical Center, Nashville, TN 37232.

Ann Intern Med. 2002;136(1):76-78. doi:10.7326/0003-4819-136-1-200201010-00013
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Treatment of rheumatoid arthritis with corticosteroids has evoked controversy for half a century. Extremely successful initial clinical results (1) led to the awarding of the 1950 Nobel Prize in Medicine to Kendall, Reichstein, and Hench. Some early clinical trials indicated that corticosteroids had “disease-modifying” properties in retarding radiographic progression (2). However, it was soon recognized that severe toxicities associated with the long-term pharmacologic doses of prednisone used at that time (20 to 40 mg) almost invariably outweighed any benefits (3). By the late 1950s, clinicians were taught that while occasional corticosteroids might be needed for acute life-threatening rheumatoid vasculitis or severe disease flares, long-term corticosteroid treatment had no place in the management of most patients with rheumatoid arthritis.

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