Treat Arthritis, Battle Diabetes Risk

Prednisolone for rheumatoid arthritis has safe impact on blood sugar

March 20, 2012 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Steroids used to treat rheumatoid arthritis have been linked to the development of diabetes. Now, scientists may have pinpointed a steroid dose that treats arthritis without increasing the risk of diabetes.

Rheumatoid arthritis patients who took high doses of prednisolone (a formulation of corticosteroids used in many different diseases to treat severe inflammation) for a short period of time had improved arthritis without a decline in glucose tolerance. That is, short-term treatment with high doses of prednisolone appears to be a safe treatment for rheumatoid arthritis without increasing the risk of diabetes.

"Watch your blood sugar if you are taking steroids."

Even though past studies have found links between prednisolone and conditions that lead to diabetes, the impact of these drugs on blood sugar remains unclear.

In a recent study, Michael T. Nurmohamed, M.D., Ph.D., of VU University Medical Center in Amsterdam, and colleagues wanted to find out how different doses of prednisolone affected glucose tolerance (how quickly sugar is removed from the blood), function of beta cells (cells involved in insulin production), and insulin sensitivity (responsiveness to insulin, the hormone that removes sugar from the blood).

Glucose tolerance, beta cell function, and insulin sensitivity all play a key role in the development of type 2 diabetes.

Dr. Nurmohamed and colleagues wanted to see if there is a dosage of prednisolone that would reduce the inflammation of rheumatoid arthritis while not increasing the risk for diabetes.

"In this study, short-term treatment with prednisolone 60 mg or 30 mg per day improved disease activity without deterioration of glucose tolerance in patients with active [rheumatoid arthritis]," the authors write.

In other words, patients who took 60 mg or 30 mg of prednisolone for one week had improved rheumatoid arthritis without weakening glucose tolerance.

For their study, the researchers recruited 41 patients with early active rheumatoid arthritis. When the study started, none of the patients had been treated for rheumatoid arthritis.

Patients were randomly assigned to take either 60 mg or 30 mg of prednisolone per day for one week. At the beginning and end of the week, participants took an oral glucose tolerance test. The researchers also measured beta cell function and insulin sensitivity.

At the beginning of the study, 56 percent of participants had impaired glucose metabolism (problems ridding the blood of sugar), and seven percent were diagnosed with type 2 diabetes.

After being treated with prednisolone, patients had much lower levels of C-reactive protein - a blood marker for inflammation that is thought to play a role in diabetes and other chronic diseases.

Patients who took 60 mg of prednisolone per day had improved beta cell function.

While this study was small, its findings suggest that short-term, high-dose exposure to prednisolone may be safe for many rheumatoid arthritis patients. However, since steroid treatment affected patients in different ways, the authors recommend that doctors continue to monitor patients taking prednisolone.

The results of this randomized, controlled, single-blind trial are published in the journal Arthritis & Rheumatism.