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Remission achieved after 2 years treatment with low dose prednisolone in addition to DMARDs in early RA is associated with reduced joint destruction still present after 4 years: an open two year continuation study
  1. Ingiäld Hafström (ingiald.hafstrom{at}
  1. Karolinska Institute, Sweden
    1. Kristina Albertsson (kristina.albertsson{at}
    1. Karolinska Institute, Sweden
      1. Annelies Boonen (aboo{at}
      1. University Hospital Maastricht, Netherlands
        1. Desirée MFM van der Heijde (d.vanderheijde{at}
        1. Leiden University Medical Center, Netherlands
          1. RBM Landewé (rlan{at}
          1. University of Maastricht, Netherlands
            1. Bjorn Svensson (bjosve{at}
            1. University of Lund, Sweden, Sweden


              Objective: To evaluate if remission induced by low-dose prednisolone during the first 2 years of rheumatoid arthritis (RA) in the BARFOT glucocorticoid (GC) study had sustained effect on radiological damage for a total of 4 years.

              Methods: A total of 150 of 211 eligible RA patients who had been randomized to 7.5 mg prednisolone (P-group) or no prednisolone (NoP-group) in addition to the initial disease-modifying drug (DMARD) were included. Radiographs of hands and feet were scored using the Sharp van der Heijde scoring method. Remission was defined as DAS28 below 2.6.

              Results: Mean(SD) age was 53(14) and 57(12) years for the P and NoP patients, respectively. 64% were female, 64% RF positive and disease duration at baseline was 6 months. At 2 years the proportion of patients in remission in the P and NoP groups was 55 vs 30%, p=0.003. Longitudinal analysis showed that over the entire course of the disease, patients on prednisolone had a higher probability of being in remission. Patients in remission at 2 years had, compared with those not in remission, significantly lower total Sharp score, erosion score and joint space narrowing score at 2 and 4 years. The changes in bone mineral density during the four years did not differ between those in remission and those not and were similar in the two treatment groups.

              Conclusion: Prednisolone 7.5 mg daily in addition to DMARD increases the rate of remission in patients with early RA, which has a beneficial and sustained effect on radiological damage.

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