50# 莲的心事
激素对RA的疗效有不同德说法，
1。小剂量激素加上其它抗关节炎药可以减少关节损坏。我们应对激素多一些尊重(不要太敏感)。 问题是观察时间太短(1-2)年
Low-dose steroids (i.e. glucocorticoids such as prednisone) can inhibit joint damage when prescribed early in the course of rheumatoid arthritis. The evidence appears in The Cochrane Library, a publication of The Cochrane Collaboration, and is based on a review of 15 studies which involved 1,414 patients. Patients were treated with low doses of glucocorticoid pills and DMARDs (disease-modifying anti-rheumatic drugs) for one to two years.
rheumatologist Scott J. Zashin, M.D., said "Now, we have to give steroids a little more respect."
http://arthritis.about.com/b/2007/01/25/low-dose-steroids-reduce-joint-damage-associated-with-rheumatoid-arthritis.htm
2。日本的4年， 214 例 分析 发表在最权威的RA 杂志， 2008 年。 激素可以降低关节炎活动度(不痛)，但长时间HAQ(综合健康评估)比不用激素者差。
Rheumatology 2008;47:519–521
Concise Report Low disease activity state with corticosteroid may not represent ‘true’ low disease activity state in patients with rheumatoid arthritis 214 RA patients whose disease activity score (DAS) 28 and HAQ were available consecutively from October 2000 to October 2004. All 214 patients had average DAS 28 <3.2, meaning only those who had well-controlled RA disease activity were chosen as subjects. The subjects were divided into steroid users who received continuous corticosteroids every month and non-steroid users who did not receive consecutive corticosteroids continuously every month. Results. Fifty-five patients (25.7%) were corticosteroid users and 159 (74.3%) were non-users. Average prednisolone for the former group was 4.2 mg/day. No significant differences were observed among baseline variables and RA disease activity variables. However, for steroid users, HAQ progressively worsened with time and for non-steroid users, HAQ progressively improved. Conclusions. Although DAS 28 and other variables may suggest well-controlled RA disease activity, functional capacity of patients on lowdose corticosteroids deteriorated. Thus, low disease activity state with corticosteroid may not represent the ‘true’ low disease activity state. Along with the achievement of a low disease activity state, long-term efficacy, prognosis, and the quality of remission need to be also considered in the tight control of RA activity. KEY WORDS: RA, Corticosteroids, Disease activity score 28, HAQ, Epidemiology. E-mail: iikuni@ior.twmu.ac.jp
假如长期用，常查骨密度 。
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