Objectives To determine the long term effects of initial glucocorticoid therapy on joint damage in patients with early rheumatoid arthritis (RA).
Methods Randomised controlled trials assessing the efficacy of glucocorticoid treatment during one or two years in RA including follow up measurements after the original study duration were identified. Lead authors of these studies were invited to provide data on patient characteristics, disease activity, co treatment, and (erosive) joint damage. A comprehensive dataset with individual patient data was created and used for analyses, and data up to five years after the start of trials was analysed.
Results Original study data and follow up measurements after the trial duration were shared by authors from five studies. Of the 838 patients entering these studies, 413 had been allocated to a treatment strategy including glucocorticoids. In total, 79% percent of the patients had at least one follow up radiograph scored between 3 and 5 years follow up after start of the original trial. Radiological progression over five years was significantly lower in glucocorticoid users (p=0.001). When analysing exclusively the time period after trials, initial glucocorticoid users and controls showed similar radiological progression rates.
Conclusions Addition of glucocorticoid therapy to treatment in early RA is effective in decreasing radiological damage. This beneficial effect can still be identified after five years of follow up, mainly reflecting the initially obtained advantage.
Disclosure of Interest None declared