Prednisone treatment of elderly‐onset rheumatoid arthritis

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 ≥ 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.