CATABOLIC EFFECTS OF HIGH-DOSE CORTICOSTEROIDS PERSIST DESPITE THERAPEUTIC BENEFIT IN RHEUMATOID-ARTHRITIS

Although corticosteroids (CS) cause nitrogen wasting in healthy humans, it is not known whether the salutary antiinflammatory and appetite-stimulating effects of CS in inflammatory diseases mitigate this effect. We measured nitrogen balance before, during, and after 3 d of high-dose methylprednisolone therapy in nine patients with flare-ups of rheumatoid arthritis. There was evidence of preexisting somatic protein and fat depletion in seven of nine subjects. Patients were allowed to eat freely on a metabolic ward. Nitrogen balances were -0.89 ± 1.38 g/d (x̄ ± SEM) before CS therapy, -5.77 ± 1.30 g/d during therapy (P < 0.001), and -3.54 ± 1.38 g/d after therapy (P < 0.01) despite increased energy and nitrogen intake and clinical resolution of inflammation during and after the pulse therapy. We conclude that patients with rheumatoid arthritis are often cachectic and high-dose CS cause nitrogen wasting in these patients despite an antiinflammatory and appetite-stimulatory benefit.