Unexpectedly, the investigators found that the rate of growth of children in the short-term high-dose strategy group was about centimeters per year less than the rate for children in the low-dose strategy group, even though the high-dose treatments were given only about two weeks per year on average. While the growth difference was small, the finding echoes previous studies showing that children who take inhaled corticosteroids for asthma may experience a small negative impact on their growth rate. More frequent or prolonged high-dose steroid use in children might increase this adverse effect, the researchers caution.
The best treatment for an individual patient is best discussed between the patient and their doctor. A few people develop serious complications to their rheumatoid arthritis, which means that, in spite of the risks, it is still best for them to take even quite high doses of glucocorticoid. Patients who need rapid short-term control of symptoms might be given glucocorticoids by injection (which can be given into the muscle or directly into an affected joint) or as tablets for a few weeks or months. Patients who develop new rheumatoid arthritis are often offered prednisolone either at a low dose of mg daily, or sometimes at a high dose (60mg daily) quickly reducing to the low dose over a few weeks, and then continue low dose treatment to control the joint destruction. The length of time that patients will remain on steroid treatment will vary between patients (and rheumatologists). Some patients may only be given low-dose oral steroids for the first few months following diagnosis, while others may stay on steroids for longer. There is evidence to suggest that patients can experience a continued reduction in the progression of the disease from steroids for 1 to 2 years, but this will not be appropriate for everyone, so the decision will be made on an individual basis. These patients can also get symptom improvement for a year or two as a kind of 'beneficial side effect'.