Steroids may help arthritis sufferers

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The Independent Online

Medical Editor

Thousands of people who suffer severely from rheumatoid arthritis are set to benefit from a drug treatment, abandoned 30 years ago, which can halt their disease.

Researchers are confident that a regular low dose of steroids can stop the progression of the disease in the joints and may even prevent damage from starting.

The dramatic results of a two-year study on bone-damage prevention were given yesterday by Dr John Kirwan of Bristol University's Rheumatology Unit in a key paper at the annual meeting of the British Society of Rheumatology in Glasgow.

Dr Kirwan and Dr Margaret Byron, of Stoke Mandeville Hospital, developed a strategy of low-dose corticosteroids after a review of steroid treatments over the past 40 years.

Dr Kirwan said yesterday that while there were treatments to ease pain from rheumatoid arthritis - inflammation and swelling of the joints - there was no cure. There is nothing to help the underlying disease, which, in about half of patients, goes on to destroy the lining in the joints causing great pain and leading to osteoarthritis.

In the Fifties, doctors began to use steroids to treat the symptoms of rheumatoid arthritis, but, increasingly, high doses were needed over the months, which themselves caused unacceptable side effects. The treatment was abandoned.

In these early studies, X-rays were taken to monitor the patients' disease. When Dr Kirwan looked again at the X-rays and re-analysed the data, he found that steroids slowed the progression of the disease in the joints.

"These doctors were not looking at preventing the disease, but for methods of relieving the symptoms. What we have done is to establish a low fixed dose of steroids, which gives relief from pain in the first few months."

Then, instead of increasing the dose when the steroids no long give pain relief, the doctors treat patients with established drugs to give relief from pain while the fixed-dose steroids continue to prevent damage in the joints.

Most of the 128 patients in the trial, aged 18 to 70, had advanced disease in their joints which X-rays now show has been halted. But a small number were still at the stage of inflammation. During the two-year trial, the patients have not gone on to the joint damage which would have been expected.

Dr Kirwan said they had been discussing the success of the trial in recent months with colleagues internationally, and Swedish doctors are about to launch a trial using an even lower dose of steroids.

While high doses of steroids can cause heart disease, diabetes, obesity and thin bones, low doses can cause thinning of the skin which makes people bruise easily.

"There have been some side effects, but these have been minimal." Dr Kirwan said he believed the low-dose steroid treatment would be adopted around the world. About one in 50 people suffer from rheumatoid arthritis in Britain.