Background Corticosteroids have been in and out of fashion as treatment in rheumatoid arthritis (RA) since their introduction in the 1940s. Current EULAR recommendations suggest using oral prednisolone at initiation and then for up to 6 months (1). However, studies suggest up to 30% of RA patients remain on prednisolone for much longer periods (2). We were interested in the characteristics of these long term current prednisolone users, and aimed to compare them to a cohort of RA patients not currently using oral prednisolone using data from our regional audit group.
Objectives To describe the characteristics of RA patients currently taking oral prednisolone for more than 12 months (COP), and to compare to them to a cohort of RA patients not taking prednisolone (NOP).
Methods 7 centres in our regional audit network submitted consecutive RA patients until we had achieved 100 patients in each group. We analysed demographics, duration of RA, use of second line medication, total number of medications, co-morbidities (ischaemic heart disease, hypertension and type 2 diabetes), bone density and RA activity measures.
Results The table below shows key results. The mean daily steroid dose in the COP group was 6.6mg and the mean duration of current steroid use was 4.9 years. Similar numbers of patients in the COP and NOP groups were also using a conventional DMARD and/or biologic (85% and 86% respectively). 39% of both groups had one or more of the 3 comorbidities we looked for. 4% of the COP group had all 3 comorbidities compared to none of the NOP group and 5% of the COP group had 2 out of 3 comorbidities compared to 8% in the NOP group. DEXA scans were available for 61% of COP and 31% of NOP patients. The mean T score in the COP group was -1.2 compared to -1.05 in the NOP group.
Conclusions This study provides a snapshot of an important group of 'real world' steroid-using RA patients who are perhaps under-represented in the literature. In our audit RA patients on long term prednisolone tended to be a little older, have a longer duration of RA, greater polypharmacy and greater disease activity. Interestingly, the prednisolone users were taking at least as much other second line medication as the non users, suggesting prolonged steroid use may suggest difficult to control RA rather than avoidance of polypharmacy. Co-morbidities seemed similar between groups. The relatively long duration of prednisolone treatment suggests that RA patients on steroids for more than one year are likely to stay on steroids longer term.
Ann Rheum Dis doi:10.1136/annrheumdis-2013-204573
Caplan L, Wolfe F, Russell AS, Michaud K.Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. J Rheumatol. 2007;34(4):696.
Acknowledgement We are grateful for the support of all our colleagues in the South Thames Regional Audit Group
Disclosure of Interest None declared