Background Glucocorticoids (GC) are very commonly used in the rheumatoid arthritis (RA) treatment; however their potential risks warrants a rational use. ^1,2

Objectives Evaluate the impact of biological therapies on GC use in RA in the clinical daily practice.

Methods Descriptive study by reviewing clinical histories of the RA patients (January 2008-December 2010). Patients on GC treatment starting biological therapy were included. Demographic variables, disease variables (duration, RF/ACPA, radiographic erosions, DMARD treatment, previous TNFi or biological treatment) and starting biological, were collected. At baseline (T0), 3 months (T3) and at 1 year (T12), disease activity (DAS28, SDAI), level of functional capacity (HAQ) and the medium dose of GC (prednisone equivalent mg/day) were registered.

At T12, GC medium and cumulative dose for the year was calculated and remission by DAS28, SDAI and the new ACR/EULAR 2011 criteria were evaluated. The GC dose were compared between the group in remission and not in remission.

Results:

71 patients (84.5% women), medium age 46.1±13.7 and with a disease duration of 9.8±6 years starting biological therapy were included. 70.4% were RF positive, 71.8% were ACPA positive and the 83.1% had radiographic erosions. New biological treatment (ETN 39.4%, ADA 31%, TCZ 25.4%, RTX 1.4%, ABT 2.8%) was associated with DMARD in 87.3% of patients.

The GC medium dose showed a sadistically reduction from T0 to T3 and T12, from 9.9±5.9mg to 4.9±5.5mg and 2.9±3.5mg respectively. The GC were stopped in 33 patients (46.5%), reduced in 23 patients (32.4%) and remained stable in 11 patients, only 4 patients required and increase of GC. Disease activity decreased significantly in T3 and T12 and an improvement in functional capacity was observed.

A positively, significantly correlation between the GC medium dose and the disease activity by DAS28 was found in T0 (r=0.391; p=0.001), T3 (r=0.398; p=0.001) and T12 (r=0.549; p<0.001) and by SDAI (T0 (r=0.443; p<0.001; T3 (r=0.441; p<0.001; T12 (r=0.663; p<0.001)).

At T12 patients in remission (63.3% by DAS28, 50.7% by SDAI and 33.8% by the ACR/EULAR 2011 criteria) showed less GC treatment with significant differences compared to patients not in remission (table 1).

Conclusions In our series, 78.9% of the patients reduced or even stopped GC treatment in the first year of biological therapy. The reduction in the GC dose was higher in the first 3 months and in those patients who achieved remission at 1 year. The GC medium dose correlated with disease activity. However, in daily practice 20.8-37.8% of the patients in remision, remained on GC treatment.

1. Gorter SL, Bijlsma JW, Cutolo M, et al. Current evidence of rheumatoid arthritis with glucocorticoids: a systemic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2010; 69 (6): 1010-1014

2. Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugsAnn Rheum Dis 2010; 69(6): 964-75

Disclosure of Interest None Declared