Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial

• Published in: Annals of the rheumatic diseases 2004-11, Vol.63 (11), p.1460-1469
• Main Authors: Buchbinder, R, Hoving, J L, Green, S, Hall, S, Forbes, A, Nash, P
• Format: Article
• Language: English
• Subjects: adhesive capsulitis; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Bursitis - drug therapy; Bursitis - physiopathology; Confidence intervals; DASH; disabilities arm shoulder and hand; Diseases of the osteoarticular system; Double-Blind Method; Extended Report; Female; Follow-Up Studies; frozen shoulder; HAQ; health assessment questionnaire; Humans; Juxtaarticular diseases. Extraarticular rhumatism; Male; Medical sciences; Middle Aged; Movement; Pain; prednisolone; Prednisolone - therapeutic use; SF-36; short form 36 item health survey; Shoulder; Shoulder Joint - physiopathology; Shoulder Pain - drug therapy; Shoulder Pain - physiopathology; shoulder pain and disability index; SPADI; Statistical analysis; Steroids; Studies; Treatment Outcome
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2003.018218

Objective: To determine whether a short course of prednisolone is superior to placebo for improving pain, function, and range of motion in adhesive capsulitis. Design: Double blind, randomised, placebo controlled trial. Setting: Community based rheumatology practice in Australia. Participants: 50 participants (24 active, 26 placebo); 46 completed the 12 week protocol. Entry criteria were age ⩾18 years, pain and stiffness in predominantly one shoulder for ⩾3 weeks, and restriction of passive motion by >30° in two or more planes. Interventions: 30 mg oral prednisolone/day for three weeks or placebo. Main outcome measures: Overall, night, and activity related pain, SPADI, Croft shoulder disability questionnaire, DASH, HAQ, SF-36, participant rated improvement, and range of active motion measured at baseline and at 3, 6, and 12 weeks. Results: At 3 weeks, there was greater improvement in overall pain in the prednisolone group than in the placebo group (mean (SD) change from baseline, 4.1 (2.3) v 1.4 (2.3); adjusted difference in mean change between the two groups, 2.4 (95% CI, 1.1 to 3.8)). There was also greater improvement in disability, range of active motion, and participant rated improvement (marked or moderate overall improvement in 22/23 v 11/23; RR = 2 (1.3 to 3.1), p = 0.001). At 6 weeks the analysis favoured the prednisolone group for most outcomes but none of the differences was significant. At 12 weeks, the analysis tended to favour the placebo group. Conclusions: A three week course of 30 mg prednisolone daily is of significant short term benefit in adhesive capsulitis but benefits are not maintained beyond six weeks.