Corticosteroids in rheumatoid arthritis: Is a trial of their 'disease modifying' potential feasible?

After three decades of experience the use of corticosteroids to treat rheumatoid arthritis (RA) remains a matter of personal taste and generates much debate. Although their role in life threatening complications is apparently acceptable, one standard text suggests that less than 5% of patients with predominantly articular disease will require them, and in a recent survey British rheumatologists reported using corticosteroids only 'occassionally' or 'very infrequently'. However, when making clinical decisions a physician's opinion does not necessarily reflect his clinical practice. Recent studies have found that 24 of 100 consecutive RA patients seen lat one British hospital were taking a mean daily dose of 5.6 mg of prednisolone² and that 15% of outpatients seen at a Dutch clinic were also receiving steroid treatment.