Osteoarthritis Treatment Guidelines American College Rheumatology

By | June 7, 2017

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whats a safe dose of prednisone

A spirited debate was published in the Rheumatologist,a magazine I get. The topic was the use of prednisone in rheumatoid arthritis. Recentguidelines produced by the American College of Rheumatology regarding treatment of rheumatoidarthritis omitted the use of prednisone. John Kirwan, a professor at the Universityof Bristol, who wrote several papers showing that prednisone had diseasemodifying effectsand held back the destructive processes of rheumatoid arthritis (RA) made his pitch.He advocated the use of prednisone in combination therapy for this condition. Theodore Pincus, a professor at NYU, advocated the use of low dose prednisone (less thanor equal to 5 mgs a day). He provided evidence

that it was safe and effective at that dose. Anthony S. Russell, a professor at the University of Alberta issued the counterpoint.He provided historical data showing that prednisone had long term toxicity without significantbenefit (in his opinion.) With all due respect to Russell, muchof the data he cited was old data when higher doses of prednisone were used. He also contendedthat primary care s would be tempted to use prednisone if they saw rheumatologistsusing it. My opinion is this. I use low dose prednisonea lot in my practice. By low dose, I mean 5 mgs or less. I think it is effective asan add on therapy. It is also a great quot;bridgequot;

if the patient is transitioning therapies.I have seen very little long term toxicity associated with this low dose approach. AndI think the benefits derived from improved activities of daily living far outweigh thenegatives. I do think that doses higher than 5 mgs should be avoided if possible. I alsodon't think the primary care issue is that big a deal although I admit. I have seensome indiscriminate use in my community.

Apremilast useful in psoriatic arthritis

Apremilast useful in psoriatic arthritis Phoebe Starr writing in Valuebased Care inrheumatology reported an investigational oral drug, apremilast, was found to be effectivein a phase 3 al trial the PALACE1 study. It was effective in combination withdisease modifying antirheumatic drugs but was even more effective as a single agent.The drug inhibits phosphodiestarase 4 and blocks inflammatory proteins while increasingthe amount of antiinflammatory proteins. Safety was also acceptable. Both the 20 mgand the 30 mg dose were statistically superior to placebo.

Comment: Encouraging data for a drug thatappears to be specific for psoriatic arthritis.

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