Metabolic effects of high-dose prednisolone treatment in early rheumatoid arthritis: Diabetogenic effects and inflammation reduction on the balance.

Author(s): den Uyl D, van Raalte DH, Nurmohamed MT, Lems WF, Bijlsma JW, Hoes JN, Dijkmans BA, Diamant M

Affiliation(s): University Medical Center, Department of Rheumatology, Utrecht, The Netherlands.

Publication date & source: 2011-09-27, Arthritis Rheum., [Epub ahead of print]

OBJECTIVE: To investigate dose-related effects of glucocorticoid (GC) treatment on glucose tolerance, beta-cell function and insulin sensitivity in patients with early active rheumatoid arthritis (RA). METHODS: A randomized controlled, single-blind trial was conducted in 41 drug-naive patients with early active RA. Patients were randomized to receive prednisolone 60mg q.d. (PRED60) or prednisolone 30mg q.d. (PRED30). Before and at 1 week of treatment, a frequently-sampled oral glucose tolerance test was performed. The area under glucose curve (AUC(G) ) was calculated. In addition, beta-cell function and insulin sensitivity parameters were computed. RESULTS.: Patients (age: 55+/-13 years, BMI: 25.0+/-4.1 kg/m(2) ) had active disease: DAS44 score: 4.0+/-0.8 and C-reactive protein (CRP): 17 (5-37) mg/L. At baseline, 56% of the patients had impaired glucose tolerance and 7% unknown type 2 diabetes mellitus (T2DM). ESR and CRP levels were associated with AUC(G) (beta=2.430; 95%CI 0.179-4.681, P=0.04) and (beta=2.358; 95%CI 0.210-4.506, P=0.03 respectively). Treatment with both prednisolone dosages reduced CRP levels significantly. T2DM incidence increased to 24% (P<0.001), evenly distributed across the groups. Mean AUC(G) did not change in both arms. Beta-cell function improved during PRED60 treatment (P=0.02), and PRED30 treatment (P=0.04). Disease duration was associated with changes in AUC(G) (beta=3.626; 95% CI 1.077-6.174, P=0.007) and with deterioration of the glucose state (OR=1.068; 95%CI 1.017-1.122, p=0.009). CONCLUSION: Short-term exposure to 60 or 30 mg PRED q.d. improved disease activity without deterioration of glucose tolerance in patients with active RA. However, due to individual differences monitoring is recommended. (c) 2011 American College of Rheumatology. Copyright (c) 2011 by the American College of Rheumatology.