Background Glucocorticoid (GC) therapy for rheumatoid arthritis patients improves joint inflammation and destruction; however, it is associated with risk of complications such as osteoporosis, diabetes (DM), and cardiovascular (CV) disease. Although EULAR recommends that low-dose GC should be administered for up to 6 months, the ideal dose and duration of GC use remain unresolved.
Objectives To investigate the efficacy and safety of low-dose GC therapy in addition to other disease-modifying antirheumatic drugs (DMARDs) for maximum 1 year in Japanese early RA patients.
Methods Ninety-six Japanese RA patients with disease duration of <2 years were included. Patients were treated with a T2T strategy; if disease activity did not improve within 3 months, their DMARDs were replaced with alternatives or additional DMARDs were added. We excluded patients with a history of prior complications, including CV disease, DM, or vertebral fracture. We classified patients into two groups, one was group treated with DMARDs alone (N group; 35 females and 10 males) and the other with maximum 5 mg of GC for maximum 1 year along with DMARDs (GC group; 40 females and 11 males). The mean ages of the N and GC groups were 56.3 and 60.9 years, respectively. Thirty-four percent of patients were treated with MTX monotherapy, 20.9% were treated with combined conventional synthetic DMARD with MTX, and 31.3% were treated with a biological agent. Regarding MTX or biological agent use rates, no significant statistical differences were observed between the groups. We evaluated the change of DAS28-CRP scores for 3 years, bone metabolism makers [urine type I collagen cross-linked N-telopeptide (NTX), serum tartrate-resistant acid phosphatase 5b (TRACP5b), serum bone-specific alkaline phosphatase (BAP), and serum osteocalcin (OC)], bone mineral density (BMD) of lumber spine (L-spine) and femoral neck (FN) and the rate of new complications. Comparisons of BMD and the rate of new complications were made at baseline and 3 years after initiating GC treatment.
Results There were no significant differences in DAS28-CRP scores at baseline. In the GC group, the mean GC dose was 2.46 mg/day. At 1 month after treatment, there was a significant difference in the improvement rate of DAS28-CRP scores in the GC group compared with the N group. However, no significant difference was observed between the two groups at 3 months or more post-treatment (Fig.1). None of the bone metabolism makers and BMD deteriorated in the GC group and there were no statistical differences between both groups (Table.1, Fig.2). New complications occurred in four cases in the N group (one, vertebra fracture; one, CVD; and two, high HbA1c levels) and four cases in the GC group (two, vertebrae fractures and two, high HbA1c levels). There were no significant differences in the rate of new complications between both groups.
Conclusions The treatment of early rheumatoid arthritis by low-dose GC for maximum one year enables earlier improvement of disease activity and does not worsen bone metabolism status or the rate of new complications. The therapy does not pose a problem in the middle term. This study confirms that use of GC in RA patients leads to patient satisfaction.
Disclosure of Interest None declared