The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis

McWilliams, Daniel F; Thankaraj, Divya; Jones-Diette, Julie; Morgan, Rheinallt; Ifesemen, Onosi S; Shenker, Nicholas G; Walsh, David A

Abstract

Background: Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.
Methods: A systematic literature review of randomised controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences (MDs) were meta-analysed. Heterogeneity (I², tau statistics) and bias (funnel plot, Eggers test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562).
Results: 18903 titles, 880 abstracts and 226 full texts were assessed. Thirty three RCTs suitable for the meta-analysis included 2658 participants.
Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD= -0.65 (15 studies, 95% CI, -0.82, -0.49, p3 to 6 months, and -6mm (95% CI, -10mm, -2mm) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from 5 RCTs suggested improvement also in fatigue during GC treatment.
Discussion. Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.

Citation

McWilliams, D. F., Thankaraj, D., Jones-Diette, J., Morgan, R., Ifesemen, O. S., Shenker, N. G., & Walsh, D. A. (2021). The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis. Rheumatology, 61(1), 76-89. https://doi.org/10.1093/rheumatology/keab503

• Journal Article Type: Article
• Acceptance Date: Jun 1, 2021
• Online Publication Date: Jul 2, 2021
• Publication Date: Dec 24, 2021
• Deposit Date: Jun 10, 2021
• Publicly Available Date: Jul 3, 2022
• Journal: Rheumatology
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 61
• Issue: 1
• Article Number: keab503
• Pages: 76-89
• DOI: https://doi.org/10.1093/rheumatology/keab503
• Keywords: Pharmacology (medical); Rheumatology
• Public URL: https://nottingham-repository.worktribe.com/output/5422135
• Publisher URL: https://academic.oup.com/rheumatology/article/61/1/76/6313178