Background In RA, synthetic glucocorticoids (steroids) are often used as “bridge therapy” to rapidly control symptoms while allowing slower-acting DMARDs time to reduce disease activity. Whether early use of steroids in conjunction with conventional DMARDs has an added benefit for achieving early remission is unknown.
Objectives To describe the frequency of early steroid use in a national observational cohort of ERA patients seen by rheumatologists in routine clinical practice and to estimate the extent to which early use of steroids is associated with achieving early remission at 6 months.
Methods We analyzed baseline and 6-month follow up data from the prospective multi-center Canadian early ArThritis CoHort (CATCH). The study sample included participants meeting 1987 or 2010 ACR/EULAR criteria for RA, symptom duration ≤12 months, with DAS28 moderate-high disease activity at enrolment and medication information and follow-up DAS28 scores at 6 months. Mixed-effects logistic regression was used to estimate independent effects of early steroid use on remission status at 6 months after adjusting for sociodemographics (age, sex, education, comorbidities, smoking), and RA characteristics (symptom duration; presence of erosions, DAS28 and HAQ at baseline) including treatment at enrolment. A random effect for study center was specified to appropriately account for dependencies in the data.
Results The analytic sample included 1170 CATCH participants and was mostly female (n=855; 73%) with a mean [SD] age of 54  and symptom duration of 6  months. At entry, 640 (55%) used steroids (oral only 264 [23%]; parental only 295 [25%]; both: 81 [7%]). Patients receiving steroids were older, male, had shorter symptom duration, a higher DAS28, and more swollen and tender joints (p<0.003). Steroids were most commonly used with MTX (frequency [%]: 513 [80%]; MTX mono: 194 [30%]; MTX combo; 319 [50%]; biologics: 10 [2%]; other treatment strategies: 117 [18%]). At 6 months, 393 (34%) were in DAS28 remission. After adjusting for treatment and other covariates, neither oral not parenteral steroids were independently associated with remission status at 6 months, though there was a trend (p=.07) for patients receiving both oral and parenteral steroids to have a lower odds of being in remission (see table).
Conclusions Findings from this large national ERA cohort showed that steroids were commonly used as early adjunctive therapy in routine practice and that patients receiving steroids were more likely to be older, male, have higher disease activity and more affected joints. Early steroid use (oral or parenteral) was not independent associated with early remission at 6 months, although use of both may be a negative prognostic indicator.
Disclosure of Interest None declared
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