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Prednisone in Managing Rheumatoid Arthritis
- Roland F. J. M. Laan, MD;
- Piet L. C. M. van Riel, MD; and
- Levinus B. A. van de Putte, MD
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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.
Roland F. J. M. Laan, MD
Piet L. C. M. van Riel, MD
Levinus B. A. van de Putte, MD
University Hospital Nijmegen; 6500 HB Nijmegen; The Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
