IN RESPONSE:
Both the activity of the inflammatory process and the functional impairments that are the consequence of rheumatoid arthritis contribute independently to bone loss [1]. We have presented evidence that low-dose glucocorticoids can cause rapid and marked trabecular bone loss despite an improvement in disease activity and functional capacity [2]. We also showed that this effect may be reversed after discontinuing therapy. After correcting for possibly confounding factors, other [3, 4] have found long-term use of prednisone to be associated with decreased bone mass in the spine and forearm.
We certainly agree that glucocorticoids are necessary for the management of some patients with rheumatoid arthritis. We suggest that the use of prednisone be limited to short periods as much as possible and that strategies to prevent bone loss be considered from the beginning and throughout glucocorticoid treatment.
1. Laan RF, Buijs WC, Verbeek AI, Draad MP, Corstens FH, van de Putte LB, et al. Bone mineral density in patients with recent onset rheumatoid arthritis: influence of disease activity and functional capacity. Ann Rheum Dis. 1993; 52:21-6.
2. Laan RF, van Riel PL, van de Putte LB, van Erning LJ, van't Hof MA, Lemmens JA. Low-dose prednisone induced rapid reversible axial bone loss in patients with rheumatoid arthritis. A randomized, controlled study. Ann Intern Med. 1993; 119:963-8.
3. Laan RF, van Riel PL, van Erning LJ, Lemmens JA, Ruijs SH, Putte LB. Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisone therapy. Br J Rheumatol. 1992; 31:91-6.
4. Laan RF, Buijs WC, van Erning LJ, Lemmens JA, Corstens FH, Ruijs SH, et al. Differential effects of glucocorticoids on cortical appendicular and cortical vertebral bone mineral content. Calcif Tissue Int. 1993; 52:5-9.
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