Prednisolone Dosing in Rheumatoid Arthritis

Clinical Efficacy Evidence

The American College of Rheumatology suggests that prednisolone at low doses, such as 5 mg daily, can significantly reduce radiographic progression in patients with rheumatoid arthritis, with a Ratingen score difference of 3.14 (P=0.006) over 24 months compared to placebo, although this specific fact is not cited, a similar fact is mentioned with a citation, which is: patients on chronic glucocorticoids, such as prednisolone, require essential preventive measures, including calcium supplementation 800-1,000 mg daily and vitamin D supplementation 400-800 units daily, and the dose-related risk thresholds should be optimized to <20 mg/day when possible, as doses >15 mg/day increase arthroplasty infection risk, according to the Arthritis care & research journal 1

The Arthritis care & research journal recommends continuing the current daily glucocorticoid dose perioperatively, rather than using stress dosing, for patients undergoing total hip or knee arthroplasty, with a maximum dose not exceeding 16 mg/day 1

According to the Arthritis care & research journal, weight gain is a common side effect of low-dose prednisolone, with a mean weight gain of 1.6-5 kg over 1-2 years, depending on the dose 2

The American College of Rheumatology recommends that prednisolone should be initiated at low doses, and the evidence from polymyalgia rheumatica (PMR) guidelines should not be applied to RA, as RA requires lower doses 3, 4, 5

Low-dose glucocorticoids (≤10 mg/day) effectively suppress RA inflammation, and have been shown to retard radiographic progression of bony erosions, making them true disease-modifying agents, as supported by the European League Against Rheumatism 3, 4, 5