Abstract

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.