Background Anti-inflammatory and disease-modifying properties of glucocorticoids (GCs) have been demonstrated in patients with rheumatoid arthritis (RA). Better outcomes in trials by combinations of synthetic DMARDs plus GCs versus DMARD monotherapy might be due GC. Since GCs are associated with adverse events, tapering of GCs is recommended in guidelines. There is almost no information on the benefits of GC in early arthritis outside the limitations of a clinical study.
Objectives To analyse whether initial GC therapy influences the long-term course of the disease in early arthritis patients.
Methods We included all patients from the Swiss RA registry SCQM with recent onset arthritis (disease duration ≤1 year). The exposure of interest was initial GC use. The primary outcome was clinical and radiographic disease progression, as assessed by the disease activity (DAS28), function (HAQ-DI) and structural joint damage (Ratingen erosion score). The baseline disease characteristics were compared using standard descriptive statistics. The effects of initial GC use on disease progression during follow up was estimated using linear mixed models with random slope and random intercept and adjusted for potential confounders. In a sensitivity analysis, we adjusted for differences in baseline parameters between the two groups using propensity score.
Results In total, 592 patients (pts) with early disease and 4.3 years of follow-up (average) were available. Of these, 363 pts were initially treated with glucocorticoids (GC patients) and 228 pts without (no-GC patients). DAS 28 (4.6 vs. 4.3, p=0.01) and the HAQ-DI (0.94 vs. 0.82, p=0.01) were higher at baseline in GC patients, while other prognostic factors were balanced at disease onset. Neither the evolution of DAS 28, nor HAQ-DI, or the development of joint erosions differed between the two groups during follow up. Even after adjusting for this propensity score, patients with and without use of GCs did not show statistically significantly different disease activity (DAS 28) at one year. Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p<0.01).
Conclusions These results suggest that the long-term evolution of disease activity and radiographic damage are not significantly modified by initial GC use
Disclosure of Interest None declared