eMedinewS Editorial

Health Care 122 Comments

Very low dose steroids

The efficacy of prednisone at doses below 5 mg/day in rheumatoid arthritis has been shown in a trial in which 31 patients on stable medication regimens, including disease–modifying antirheumatioid drugs (DMARDs), were randomly assigned to continued maintenance therapy of 1- 4 mg/day of prednisone or to slow dose reduction at the rate of 1 mg every four weeks.

Withdrawal from the study for lack of efficacy was significantly less frequent in patients maintained on their initial stable prednisone dose.

Steroids should be used as a bridge between the initiation and therapeutic effect of DMARDs and/or the treatment of acute synovitis. They may be used at lower doses in combination with traditional DMARDs and biologic agents to maintain function and prevent degradation of joints in patients with rheumatoid arthritis.

When deciding whether to initiate steroid therapy, the following clinical features that increase the risk of toxicity must be considered.

  • Established hypertension or diabetes mellitus
  • Pre-existing cataract(s) or glaucoma
  • Significant risk factors for osteoporosis

Most adverse effects of chronic steroid therapy are typically seen at doses of 10 mg/day or higher, with risk of bone loss at lower doses. Dose of steroids should be tapered as quickly as possible to the lowest effective dose, usually 1–5 mg/day of prednisone or its equivalent when chronic use is anticipated. To minimize interference with the normal diurnal hormonal pattern, they are best administered in the morning.


  1. Pincus T, Swearingen CJ, Luta G, et al. Efficacy of prednisone 1-4 mg/day in patients with rheumatoid arthritis: a randomised, double-blind, placebo controlled withdrawal clinical trial. Ann Rheum Dis 2009;68:1715.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor