Oral Glucocorticoids Reduce Pain in Patients With Rheumatoid Arthritis

In patients with rheumatoid arthritis (RA), oral glucocorticoid treatments reduce pain but may not do so substantially for more than 3 months, according to the results of a recent meta-analysis.

British researchers conducted a systematic literature review of randomized controlled trials (RCTs) in patients with RA and compared oral glucocorticoids with inactive treatment. They extracted data on spontaneous pain and evoked pain outcomes from 3 databases, meta-analyzed standardized mean differences and mean differences in this data, assessed heterogeneity with I2 and tau statistics, and assessed bias via funnel plot and Egger test.

The researchers assessed nearly 19,000 titles, 880 abstracts, and 226 full texts, which uncovered 33 RCTs—together including more than 3000 participants for meta-analysis.

Results of the meta-analysis indicated that pain scores decreased in participants who received oral glucocorticoids. The researchers found a standard mean difference of -0.65 (15 RCTs, 95% CI, -0.82 to -0.49; P < .001) and significant heterogeneity (I2 = 56%, P = .0002).

In addition, time-related decreases in efficacy were found after glucocorticoid initiation. More specifically, at equal to or less than 3 months, the mean difference in pain measured with a visual analog scale was -15 mm more with glucocorticoid treatment than with control; at greater than 3 to 6 months, it was -8 mm more, and at greater than 6 months, it was -7 mm more. Analysis of evoked pain outcomes produced similar results.

In addition to these findings on improvement in pain, improvement in fatigue with glucocorticoid treatment was suggested by data from 5 RCTs.

“Oral [glucocorticoids] are analgesic in RA,” the researchers concluded. “The benefit is greatest shortly after initiation and [glucocorticoids] might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory [glucocorticoids] should be considered to reduce the long-term burden of pain in RA.”

—Ellen Kurek

Reference:

McWilliams DF, Thankaraj D, Jones-Diette J, Morgan R, Ifesemen OS, Shenker NG, Walsh DA. The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis. Rheumatology. 2022;61(1):76-89. doi:10.1093/rheumatology/keab503