Background In the Computer Assisted Management in Early RA trial-II (CAMERA II), addition of 10 mg prednisone (versus placebo) to an MTX-based tight control treatment strategy resulted in lower disease activity and disability, a higher proportion of patients achieving sustained remission and less joint damage.However, glucocorticoids might also influence different domains of quality of life like psychological functioning.
Objectives To investigate the effects of the added prednisone on different domains of quality of life over 2 years.
Methods Data from the CAMERA II study was used. The questionnaire Impact of Rheumatic diseases on General Health and Lifestyle (IRGL, based on the AIMS) was used to measure quality of life (Qol) domains, including physical functioning (Mobility, Self-Care and Pain) psychological functioning (depressed mood, cheerful mood and anxiety) and social functioning (Nr. of Neighbours, Nr. of Friends, Perceived Support, Actual Support and Mutual Visit), plus 1 scale assessing the influence of the disease on daily life. Changes from baseline and either 1 or 2 years were compared between the treatment arms. Linear regression analyses were performed, correcting for demographic and prognostic variables (age, gender, baseline values), and, to study the influence of treatment independent from the effect on disease activity, for changes in disease activity.
Results Changes in disease activity were clearly related to almost all domains of physical and psychological functioning and influence on daily life, showing that a lower disease activity related to an improvement in QoL. Without corrections, changes in “Self Care” over 2 years were in favour of the strategy with prednisone, butchanges in “Perceived Support” over 1 year were in favour of the strategy without prednisone. After correcting for baseline values and changes in disease activity, improvements in “Self Care” over 2 years and “Influence on Relationships” over 1 year were significantly higher in the strategy with prednisone, p=0.027 and p=0.036, respectively.
Conclusions Disease activity was correlated with most domains of quality of life. Corrected for disease activity changes, prednisone exerted minor and not consistent effects on different domains of quality of life.
Bakker MF, Jacobs JWG, et al. Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis. A Randomized Trial. Ann Intern Med 2012; 156: 329-39
Disclosure of Interest None Declared
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