Background While the 2013 EULAR recommendations for the management of rheumatoid arthritis (RA) mention that low-dose corticosteroids (CS) should be considered as part of the initial treatment strategy in association with DMARDs and should be tapered as soon as possible (1), the 2015 ACR Guidelines for the treatment of RA recommend CS for early RA (ERA) patients only if the disease flares (2).
Objectives The aim of this study is to determine what forms of CS are used for patients with ERA and if the use of CS influences the outcome of this patients.
Methods We have evaluated data obtained from patients with early arthritis (duration of less than 12 months), either ERA or early undifferentiated arthritis not classifiable as other disease, referred to the Early Arthritis Research Center of “Dr. I. Cantacuzino” between 2010 and 2014. Patients were treated according to the current guidelines. Parameters were evaluated at baseline and after 1 year of follow up.
Results 73 patients were enrolled in this study and 60.3% were female. The mean age was 49.81±15.93 years. The mean duration of symptoms was 3.39±3.42 months. The parameters evaluated at baseline and after 1 year of follow up (median value and interquartile range) are described in Table 1.
61.7% of patients received treatment with DMARDs and 56.2% of patients received CS, associated with DMARDs. The types of CS used at baseline and the percent of patients who received each type were: Prednisone (42.5%), Dexamethasone i.m. (4.1%), Betamethasone administered intra-articularly (8.2%) and pulse therapy with Methylprednisolone (1.4%). At 12 months only 10 patients (13.7%) still received CS and the only form of CS used was low-dose Prednisone. The number of patients who required CS decreased significantly during the study (p<0.001 – Wilcoxon test). All the parameters evaluated decreased significantly during the study (p<0.001 – Wilcoxon test), but CS didn't influence any of them (p>0.05 – linear regression) regardless of dose or mode of administration.
Conclusions In a relatively small cohort of patients with early arthritis, there was no significant influence of CS treatment on the variation of parameters reflecting disease activity at 12 months. The doses and modes of administration at baseline varied, but that didn't influence the outcomes. On short-term, patients who receive CS, at baseline, have an subjective improvement of symptoms assessed by VAS, but at 12 months there is no significant difference between those who received at baseline DMARDs associated with CS and those who received DMARDs monotherapy. The number of patients who required treatment with CS decreased significantly during the follow up period and the few patients who still required CS at 12 months were receiving only low-dose Prednisone.
Smolen JS et al. Ann Rheum Dis. 2014;73:492–509
Singh JA et al. Arthritis&Rheumatology; 2016;68(1):1–26
Disclosure of Interest None declared