Rheumatology Unit, University of Bristol Division of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, UK
Sir, McGeoch and Butler [1] examined the effect of the ARC glucocorticoid study in rheumatoid arthritis (RA) [2] and suggested that more patients were being prescribed prednisolone by general practitioners (GPs) and rheumatologists after the publicity about the study than before. However, within McGeoch and Butler's data is another interesting fact concerning the effect on clinical practice of the ARC trial. The data suggest that as well as an effect on numbers of patients prescribed glucocorticoids, the trial results and the following publicity seem to have had a significant effect on the doses prescribed.
Using the data from their table [1], prior to the trial publication and publicity, 58% (7/12) of patients prescribed prednisolone were given more than 7.5 mg daily. Subsequently this fell to 15% (4/26), a significant reduction (2 = 5.32, P < 0.05, with Yates' correction). This may go some way to alleviate concerns that the ARC study would encourage the use of excessive doses of prednisolone.
Some rheumatologists expressed reservations about the initial results of the ARC study and were wary of its conclusions. It is worth noting that both a follow-up to the original study [3] and a substantial study from The Netherlands [4] have confirmed that in patients with early disease treated with prednisolone in addition to their second-line therapy, radiological progression is almost completely prevented. Slowly but surely we are finding a strategy for corticosteroid therapy in RA.
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