FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 333:142-147 July 20, 1995 Number 3 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Oral glucocorticoids are widely used to treat patients with rheumatoid arthritis, but their effect on joint destruction, as assessed radiologically, is uncertain.

Methods We conducted a randomized, double-blind trial comparing oral prednisolone (7.5 mg daily for two years) with placebo in 128 adults with active rheumatoid arthritis of less than two years' duration. Except for systemic corticosteroids, other treatments could be prescribed. The primary outcome variables were the progression of damage as seen on radiographs of the hand after one and two years, as measured by the Larsen index, and the appearance of erosions in hands that had no erosions at base line. The radiographs were viewed jointly by a radiologist and a rheumatologist who were unaware of the treatment assignment and the time point at which the films were obtained.

Results The statistical analysis of radiologically detected changes was based on 106 patients for whom there were films obtained at base line and two years later. After two years, the Larsen scores increased by a mean of 0.72 unit in the prednisolone group, indicating very little change, and by 5.37 units in the placebo group, indicating substantial joint destruction (P = 0.004). Of the 212 hands of these patients, 147 (69.3 percent) had no erosions at the start of the study. At two years, 15 of the 68 such hands in the prednisolone group (22.1 percent) and 36 of the 79 such hands in the placebo group (45.6 percent) had acquired erosions (difference, 23.5 percentage points; 95 percent confidence interval, 5.9 to 40.7; P = 0.007). The patients in the prednisolone group had greater reductions than the patients in the placebo group in scores on an articular index and for pain and disability at 3 months; for pain at 6 months; and for disability at 6, 12, and 15 months (all P<0.05). There was no difference between groups in standardized scores for the acute-phase response. The adverse events were typical of those encountered with antirheumatoid drugs.

Conclusions In patients with early, active rheumatoid arthritis, prednisolone (7.5 mg daily) given for two years in addition to other treatments substantially reduced the rate of radiologically detected progression of disease.

Source Information

Address reprint requests to Dr. Kirwan at the University Department of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.

Full Text of this Article

Related Letters:

Glucocorticoids and Joint Destruction in Rheumatoid Arthritis
Fries J. F., Singh G., Porter D., Deodhar A.A., Woolf A.D., Kirwan J. R.
Extract | Full Text  
N Engl J Med 1995; 333:1569-1570, Dec 7, 1995. Correspondence

This article has been cited by other articles:

• Hoes, J N, Jacobs, J W G, Verstappen, S M M, Bijlsma, J W J, Van der Heijden, G J M G (2009). Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis 68: 1833-1838 [Abstract] [Full Text]  
• Pincus, T, Swearingen, C J, Luta, G, Sokka, T (2009). Efficacy of prednisone 1-4 mg/day in patients with rheumatoid arthritis: a randomised, double-blind, placebo controlled withdrawal clinical trial. Ann Rheum Dis 68: 1715-1720 [Abstract] [Full Text]  
• Huscher, D, Thiele, K, Gromnica-Ihle, E, Hein, G, Demary, W, Dreher, R, Zink, A, Buttgereit, F (2009). Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68: 1119-1124 [Abstract] [Full Text]  
• Ravindran, V., Rachapalli, S., Choy, E. H. (2009). Safety of medium- to long-term glucocorticoid therapy in rheumatoid arthritis: a meta-analysis. Rheumatology (Oxford) 48: 807-811 [Abstract] [Full Text]  
• Hardy, R, Cooper, M S (2009). Bone loss in inflammatory disorders. J Endocrinol 201: 309-320 [Abstract] [Full Text]  
• Hafstrom, I, Albertsson, K, Boonen, A, van der Heijde, D, Landewe, R, Svensson, B, for the BARFOT Study Group, (2009). Remission achieved after 2 years treatment with low-dose prednisolone in addition to disease-modifying anti-rheumatic drugs in early rheumatoid arthritis is associated with reduced joint destruction still present after 4 years: an open 2-year continuation study. Ann Rheum Dis 68: 508-513 [Abstract] [Full Text]  
• Keystone, E, Emery, P, Peterfy, C G, Tak, P P, Cohen, S, Genovese, M C, Dougados, M, Burmester, G R, Greenwald, M, Kvien, T K, Williams, S, Hagerty, D, Cravets, M W, Shaw, T (2009). Rituximab inhibits structural joint damage in patients with rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitor therapies. Ann Rheum Dis 68: 216-221 [Abstract] [Full Text]  
• Choy, E H S, Smith, C M, Farewell, V, Walker, D, Hassell, A, Chau, L, Scott, D L, for the CARDERA (Combination Anti-Rheumatic Drugs, (2008). Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis. Ann Rheum Dis 67: 656-663 [Abstract] [Full Text]  
• Iikuni, N., Inoue, E., Tanaka, E., Hara, M., Tomatsu, T., Kamatani, N., Yamanaka, H. (2008). Low disease activity state with corticosteroid may not represent 'true' low disease activity state in patients with rheumatoid arthritis. Rheumatology (Oxford) 47: 519-521 [Abstract] [Full Text]  
• Aletaha, D, Strand, V, Smolen, J S, Ward, M M (2008). Treatment-related improvement in physical function varies with duration of rheumatoid arthritis: a pooled analysis of clinical trial results. Ann Rheum Dis 67: 238-243 [Abstract] [Full Text]  
• Panoulas, V. F., Douglas, K. M. J., Stavropoulos-Kalinoglou, A., Metsios, G. S., Nightingale, P., Kita, M. D., Elisaf, M. S., Kitas, G. D. (2008). Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis. Rheumatology (Oxford) 47: 72-75 [Abstract] [Full Text]  
• Wasko, M. C. M., Hubert, H. B., Lingala, V. B., Elliott, J. R., Luggen, M. E., Fries, J. F., Ward, M. M. (2007). Risk of Diabetes in Patients With Rheumatoid Arthritis Taking Hydroxychloroquine Reply. JAMA 298: 2369-2370 [Full Text]  
• Biswal, S., Resnick, D. L., Hoffman, J. M., Gambhir, S. S. (2007). Molecular Imaging: Integration of Molecular Imaging into the Musculoskeletal Imaging Practice. Radiology 244: 651-671 [Abstract] [Full Text]  
• Scholz-Ahrens, K. E., Delling, G., Stampa, B., Helfenstein, A., Hahne, H.-J., Acil, Y., Timm, W., Barkmann, R., Hassenpflug, J., Schrezenmeir, J., Gluer, C.-C. (2007). Glucocorticosteroid-induced osteoporosis in adult primiparous Gottingen miniature pigs: effects on bone mineral and mineral metabolism. Am. J. Physiol. Endocrinol. Metab. 293: E385-E395 [Abstract] [Full Text]  
• Scott, D. L. (2007). Early rheumatoid arthritis. Br Med Bull 0: ldm011v1-18 [Abstract] [Full Text]  
• Baron, G., Boutron, I., Giraudeau, B., Ravaud, P. (2007). Reporting of radiographic methods in randomised controlled trials assessing structural outcomes in rheumatoid arthritis. Ann Rheum Dis 66: 651-657 [Abstract] [Full Text]  
• Mancini, L., Paul-Clark, M. J., Rosignoli, G., Hannon, R., Martin, J. E., Macintyre, I., Perretti, M. (2007). Calcitonin and Prednisolone Display Antagonistic Actions on Bone and Have Synergistic Effects in Experimental Arthritis. Am. J. Pathol. 170: 1018-1027 [Abstract] [Full Text]  
• Park, G. S., Weng Kee Wong, , Oh, M., Khanna, D., Gold, R. H., Sharp, J. T., Paulus, H. E. (2007). Classifying radiographic progression status in early rheumatoid arthritis patients using propensity scores to adjust for baseline differences. Stat Methods Med Res 16: 13-29 [Abstract]  
• Combe, B, Landewe, R, Lukas, C, Bolosiu, H D, Breedveld, F, Dougados, M, Emery, P, Ferraccioli, G, Hazes, J M W, Klareskog, L, Machold, K, Martin-Mola, E, Nielsen, H, Silman, A, Smolen, J, Yazici, H (2007). EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66: 34-45 [Abstract] [Full Text]  
• Gaffo, A., Saag, K. G., Curtis, J. R. (2006). Treatment of rheumatoid arthritis. Am J Health Syst Pharm 63: 2451-2465 [Abstract] [Full Text]  
• (2006). Combination therapy for early rheumatoid arthritis. DTB 44: 81-85 [Abstract] [Full Text]  
• Getting, S. J., Lam, C. W., Chen, A. S., Grieco, P., Perretti, M. (2006). Melanocortin 3 receptors control crystal-induced inflammation. FASEB J. 20: 2234-2241 [Abstract] [Full Text]  
• Verstappen, S M M, Hoes, J N, ter Borg, E J, Bijlsma, J W J, Blaauw, A A M, van Albada-Kuipers, G A, van Booma-Frankfort, C, Jacobs, J W G, on behalf of the Utrecht Rheumatoid Arthritis Coho, (2006). Joint surgery in the Utrecht Rheumatoid Arthritis Cohort: the effect of treatment strategy. Ann Rheum Dis 65: 1506-1511 [Abstract] [Full Text]  
• Jahangier, Z N, Jacobs, K M G, Bijlsma, J W J, Lafeber, F P J G (2006). Radiation synovectomy with yttrium-90 for persisting arthritis has direct harmful effects on human cartilage that cannot be prevented by co-administration of glucocorticoids: an in vitro study. Ann Rheum Dis 65: 1384-1389 [Abstract] [Full Text]  
• Morrison, E., Capell, H. A. (2006). Corticosteroids in the management of early and established rheumatoid disease. Rheumatology (Oxford) 45: 1058-1061 [Full Text]  
• Schattner, A. (2006). Prednisolone plus a disease modifying antirheumatic drug improved outcomes in early rheumatoid arthritis. Evid. Based Med. 11: 79-79 [Full Text]  
• Da Silva, J A P, Jacobs, J W G, Kirwan, J R, Boers, M, Saag, K G, Ines, L B S, de Koning, E J P, Buttgereit, F, Cutolo, M, Capell, H, Rau, R, Bijlsma, J W J (2006). Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 65: 285-293 [Abstract] [Full Text]  
• Aletaha, D, Ward, M M (2006). Duration of rheumatoid arthritis influences the degree of functional improvement in clinical trials. Ann Rheum Dis 65: 227-233 [Abstract] [Full Text]  
• Choy, E. H. S., Smith, C., Dore, C. J., Scott, D. L. (2005). A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology (Oxford) 44: 1414-1421 [Abstract] [Full Text]  
• Del Rosso, A., Cinelli, M., Guiducci, S., Pignone, A., Fibbi, G., Margheri, F., Gabrielli, A., Giacomelli, R., Coppini, A., Del Rosso, M., Matucci Cerinic, M. (2005). Deflazacort modulates the fibrinolytic pattern and reduces uPA-dependent chemioinvasion and proliferation in rheumatoid arthritis synoviocytes. Rheumatology (Oxford) 44: 1255-1262 [Abstract] [Full Text]  
• Choy, E H, Kingsley, G H, Khoshaba, B, Pipitone, N, Scott, D L, the Intramuscular Methylprednisolone Study Group, (2005). A two year randomised controlled trial of intramuscular depot steroids in patients with established rheumatoid arthritis who have shown an incomplete response to disease modifying antirheumatic drugs. Ann Rheum Dis 64: 1288-1293 [Abstract] [Full Text]  
• Suresh, E, Lambert, C M (2005). Combination treatment strategies in early rheumatoid arthritis. Ann Rheum Dis 64: 1252-1256 [Abstract] [Full Text]  
• Higaki, M, Ishihara, T, Izumo, N, Takatsu, M, Mizushima, Y (2005). Treatment of experimental arthritis with poly(D, L-lactic/glycolic acid) nanoparticles encapsulating betamethasone sodium phosphate. Ann Rheum Dis 64: 1132-1136 [Abstract] [Full Text]  
• Doan, T., Massarotti, E. (2005). Rheumatoid Arthritis: An Overview of New and Emerging Therapies. J Clin Pharmacol 45: 751-762 [Abstract] [Full Text]  
• Haugeberg, G., Strand, A., Kvien, T. K., Kirwan, J. R. (2005). Reduced Loss of Hand Bone Density With Prednisolone in Early Rheumatoid Arthritis: Results From a Randomized Placebo-Controlled Trial. Arch Intern Med 165: 1293-1297 [Abstract] [Full Text]  
• Pisu, M., James, N., Sampsel, S., Saag, K. G. (2005). The cost of glucocorticoid-associated adverse events in rheumatoid arthritis. Rheumatology (Oxford) 44: 781-788 [Abstract] [Full Text]  
• Lee, S J, Kavanaugh, A (2004). A need for greater reporting of socioeconomic status and race in clinical trials. Ann Rheum Dis 63: 1700-1701 [Full Text]  
• Kirwan, J, Boers, M, Capell, H, Hunter, J, Madhok, R, Morrison, E, Larkin, J, on behalf of the WOSERACT group, (2004). Low dose prednisolone for treatment of RA * Authors' reply. Ann Rheum Dis 63: 1533-1534 [Full Text]  
• Souverein, P C, Berard, A, Van Staa, T P, Cooper, C, Egberts, A C G, Leufkens, H G M, Walker, B R (2004). Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart 90: 859-865 [Abstract] [Full Text]  
• Capell, H A, Madhok, R, Hunter, J A, Porter, D, Morrison, E, Larkin, J, Thomson, E A, Hampson, R, Poon, F W (2004). Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis 63: 797-803 [Abstract] [Full Text]  
• O'Dell, J. R. (2004). Therapeutic Strategies for Rheumatoid Arthritis. NEJM 350: 2591-2602 [Full Text]  
• Kirwan, J R, Hallgren, R, Mielants, H, Wollheim, F, Bjorck, E, Persson, T, Book, C, Bowman, S, Byron, M, Cox, N, Field, M, Kanerud, L, Leirisalo-Repo, M, Malaise, M, Mohammad, A, Palmer, R, Petersson, I F, Ringertz, B, Sheldon, P, Simonsson, M, Snowden, N, Van den Bosch, F (2004). A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis. Ann Rheum Dis 63: 688-695 [Abstract] [Full Text]  
• Matteson, E. L., Weyand, C. M., Fulbright, J. W., Christianson, T. J. H., McClelland, R. L., Goronzy, J. J. (2004). How aggressive should initial therapy for rheumatoid arthritis be? Factors associated with response to 'non-aggressive' DMARD treatment and perspective from a 2-yr open label trial. Rheumatology (Oxford) 43: 619-625 [Abstract] [Full Text]  
• Jensen, T, Klarlund, M, Hansen, M, Jensen, K E, Podenphant, J, Hansen, T M, Skjodt, H, Hyldstrup, L (2004). Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome. Ann Rheum Dis 63: 15-22 [Abstract] [Full Text]  
• Bijlsma, J W J, Boers, M, Saag, K G, Furst, D E (2003). Glucocorticoids in the treatment of early and late RA. Ann Rheum Dis 62: 1033-1037 [Full Text]  
• Morrison, E., Crosbie, D., Capell, H. A. (2003). Attitude of rheumatoid arthritis patients to treatment with oral corticosteroids. Rheumatology (Oxford) 42: 1247-1250 [Abstract] [Full Text]  
• Forsblad d'Elia, H, Larsen, A, Waltbrand, E, Kvist, G, Mellstrom, D, Saxne, T, Ohlsson, C, Nordborg, E, Carlsten, H (2003). Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis. Ann Rheum Dis 62: 617-623 [Abstract] [Full Text]  
• Aletaha, D, Kapral, T, Smolen, J S (2003). Toxicity profiles of traditional disease modifying antirheumatic drugs for rheumatoid arthritis. Ann Rheum Dis 62: 482-486 [Abstract] [Full Text]  
• Gause, A. (2003). Progress in the treatment of rheumatic disease. Nephrol Dial Transplant 18: 13-16 [Full Text]  
• Jones, G., Halbert, J., Crotty, M., Shanahan, E. M., Batterham, M., Ahern, M. (2003). The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials. Rheumatology (Oxford) 42: 6-13 [Abstract] [Full Text]  
• Bae, S.-C., Corzillius, M., Kuntz, K. M., Liang, M. H. (2003). Cost-effectiveness of low dose corticosteroids versus non-steroidal anti-inflammatory drugs and COX-2 specific inhibitors in the long-term treatment of rheumatoid arthritis. Rheumatology (Oxford) 42: 46-53 [Abstract] [Full Text]  
• Pincus, T., Ferraccioli, G., Sokka, T., Larsen, A., Rau, R., Kushner, I., Wolfe, F. (2002). Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review. Rheumatology (Oxford) 41: 1346-1356 [Abstract] [Full Text]  
• Buttgereit, F, Da Silva, J A P, Boers, M, Burmester, G-R, Cutolo, M, Jacobs, J, Kirwan, J, Kohler, L, van Riel, P, Vischer, T, Bijlsma, J W J (2002). Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 61: 718-722 [Abstract] [Full Text]  
• Ferraccioli, G. F., Gremese, E., Tomietto, P., Favret, G., Damato, R., Di Poi, E. (2002). Analysis of improvements, full responses, remission and toxicity in rheumatoid patients treated with step-up combination therapy (methotrexate, cyclosporin A, sulphasalazine) or monotherapy for three years. Rheumatology (Oxford) 41: 892-898 [Abstract] [Full Text]  
• Weisman, M H (2002). Newly diagnosed rheumatoid arthritis. Ann Rheum Dis 61: 287-289 [Full Text]  
• Rau, R., Wassenberg, S., Kirwan, J., Byron, M., Watt, I. (2002). The relationship between soft tissue swelling, joint space narrowing and erosive damage in hand X-rays of patients with rheumatoid arthritis. Rheumatology (Oxford) 41: 350-352 [Full Text]  
• van Everdingen, A. A., Jacobs, J. W.G., Siewertsz van Reesema, D. R., Bijlsma, J. W.J. (2002). Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. ANN INTERN MED 136: 1-12 [Abstract] [Full Text]  
• Pincus, T., Sokka, T., Stein, C. M. (2002). Are Long-Term Very Low Doses of Prednisone for Patients with Rheumatoid Arthritis as Helpful as High Doses Are Harmful?. ANN INTERN MED 136: 76-78 [Full Text]  
• Machein, U., Buss, B., Spiller, I., Braun, J., Rudwaleit, M., Faerber, L., Sieper, J. (2002). Effective treatment of early rheumatoid arthritis with a combination of methotrexate, prednisolone and cyclosporin. Rheumatology (Oxford) 41: 110-111 [Full Text]  
• Pisetsky, D. S., St.Clair, E. W. (2001). Progress in the Treatment of Rheumatoid Arthritis. JAMA 286: 2787-2790 [Full Text]  
• Quinn, M. A., Conaghan, P. G., Emery, P. (2001). The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence?. Rheumatology (Oxford) 40: 1211-1220 [Abstract] [Full Text]  
• Verhoeven, A. C., Boers, M., te Koppele, J. M., van der Laan, W. H., Markusse, H. M., Geusens, P., van der Linden, S. (2001). Bone turnover, joint damage and bone mineral density in early rheumatoid arthritis treated with combination therapy including high-dose prednisolone. Rheumatology (Oxford) 40: 1231-1237 [Abstract] [Full Text]  
• Merlino, L. A., Bagchi, I., Taylor, T. N., Utrie, P., Chrischilles, E., Sumner, W. II, Mudano, A., Saag, K. G. (2001). Preferences for Fractures and Other Glucocorticoid-Associated Adverse Effects among Rheumatoid Arthritis Patients. Med Decis Making 21: 122-132 [Abstract]  
• Kirwan, J., Byron, M., Watt, I. (2001). The relationship between soft tissue swelling, joint space narrowing and erosive damage in hand X-rays of patients with rheumatoid arthritis. Rheumatology (Oxford) 40: 297-301 [Abstract] [Full Text]  
• Jacobs, J W G, Geenen, R, Evers, A W M, van Jaarsveld, C H M, Kraaimaat, F W, Bijlsma, J W J (2001). Short term effects of corticosteroid pulse treatment on disease activity and the wellbeing of patients with active rheumatoid arthritis. Ann Rheum Dis 60: 61-64 [Abstract] [Full Text]  
• Madhok, R., Kerr, H., Capell, H. A (2000). Recent advances: Rheumatology. BMJ 321: 882-885 [Full Text]  
• Wong, P., Cuello, C., Bertouch, J. V., Roberts-Thomson, P. J., Ahern, M. J., Smith, M. D., Youssef, P. P. (2000). The effects of pulse methylprednisolone on matrix metalloproteinase and tissue inhibitor of metalloproteinase-1 expression in rheumatoid arthritis. Rheumatology (Oxford) 39: 1067-1073 [Abstract] [Full Text]  
• Lacaille, D. (2000). Rheumatology: 8. Advanced therapy. CMAJ 163: 721-728 [Full Text]  
• Harrison, B., Symmons, D. (2000). Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years. Rheumatology (Oxford) 39: 939-949 [Full Text]  
• Byron, M. (2000). The ARC steroid trial and its effects on clinical practice. Rheumatology (Oxford) 39: 340-340 [Full Text]  
• Goldring, S. R. (2000). A 55-Year-Old Woman With Rheumatoid Arthritis. JAMA 283: 524-531 [Full Text]  
• Torsteinsdottir, I., Hakansson, L., Hallgren, R., Gudbjornsson, B., Arvidson, N.-G., Venge, P. (1999). Serum lysozyme: a potential marker of monocyte/macrophage activity in rheumatoid arthritis. Rheumatology (Oxford) 38: 1249-1254 [Abstract] [Full Text]  
• Hansen, M., Pødenphant, J., Florescu, A., Stoltenberg, M., Borch, A., Kluger, E., Sørensen, S. F., Hansen, T. M. (1999). A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects. Ann Rheum Dis 58: 713-718 [Abstract] [Full Text]  
• Mcgeoch, P., Butler, R. (1999). The ARC steroid trial and its effect on clinical practice. Rheumatology (Oxford) 38: 905-906 [Full Text]  
• Krasner, A. S. (1999). Glucocorticoid-Induced Adrenal Insufficiency. JAMA 282: 671-676 [Full Text]  
• Gelmon, K. A., Eisenhauer, E. A., Harris, A. L., Ratain, M. J., Workman, P. (1999). Anticancer Agents Targeting Signaling Molecules and Cancer Cell Environment: Challenges for Drug Development?. JNCI J Natl Cancer Inst 91: 1281-1287 [Full Text]  
• McQueen, F. M, Stewart, N., Crabbe, J., Robinson, E., Yeoman, S., Tan, P. L J, McLean, L. (1999). Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 58: 156-163 [Abstract] [Full Text]  
• Rehman, H U, Walton, C, Atkin, S (1999). Cushing's disease masking coincidental steroid-responsive diseases. Postgrad. Med. J. 75: 43-45 [Abstract] [Full Text]  
• Brooks, P. (1998). Recent advances: Rheumatology. BMJ 316: 1810-1812 [Full Text]  
• Nakashima, T., Sasaki, H., Tsuboi, M., Kawakami, A., Fujiyama, K., Kiriyama, T., Eguchi, K., Ichikawa, M., Nagataki, S. (1998). Inhibitory Effect of Glucocorticoid for Osteoblast Apoptosis Induced by Activated Peripheral Blood Mononuclear Cells. Endocrinology 139: 2032-2040 [Abstract] [Full Text]  
• Gøtzsche, P. C, Johansen, H. K. (1998). Meta-analysis of short term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis. BMJ 316: 811-818 [Abstract] [Full Text]  
• (1998). Modifying disease in rheumatoid arthritis. DTB 36: 3-6 [Abstract] [Full Text]  
• Guyatt, G. H., Naylor, C. D., Juniper, E., Heyland, D. K., Jaeschke, R., Cook, D. J. (1997). Users' Guides to the Medical Literature: XII. How to Use Articles About Health-Related Quality of Life. JAMA 277: 1232-1237 [Abstract]  
• MASI, A. T, CHROUSOS, G. P (1997). Dilemmas of low dosage glucocorticoid treatment in rheumatoid arthritis: considerations of timing. Ann Rheum Dis 56: 1-4 [Full Text]  
• Arvidson, N. G., Gudbjörnsson, B., Larsson, A., Hällgren, R. (1997). The timing of glucocorticoid administration in rheumatoid arthritis. Ann Rheum Dis 56: 27-31 [Abstract] [Full Text]  
• Brennan, P., Harrison, B., Barrett, E., Chakravarty, K., Scott, D., Silman, A., Symmons, D. (1996). A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study. BMJ 313: 471-476 [Abstract] [Full Text]  
• Fries, J. F., Singh, G., Porter, D., Deodhar, A.A., Woolf, A.D., Kirwan, J. R. (1995). Glucocorticoids and Joint Destruction in Rheumatoid Arthritis. NEJM 333: 1569-1570 [Full Text]  
• (1995). Cyclosporine and Corticosteroids for Rheumatoid Arthritis. Journal Watch Dermatology 1995: 18-18 [Full Text]  
• (1995). CYCLOSPORINE AND CORTICOSTEROIDS FOR RHEUMATOID ARTHRITIS. JWatch General 1995: 1-1 [Full Text]  
• Breedveld, F. C. (1995). New Perspectives on Treating Rheumatoid Arthritis. NEJM 333: 183-184 [Full Text]  
• Paul-Clark, M. J., Mancini, L., Del Soldato, P., Flower, R. J., Perretti, M. (2002). Potent antiarthritic properties of a glucocorticoid derivative, NCX-1015, in an experimental model of arthritis. Proc. Natl. Acad. Sci. USA 99: 1677-1682 [Abstract] [Full Text]