RESEARCH - Low disease activity state with steroids may not represent true low disease activity state in RA

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Rheumatology 2008 47(4):519-521; doi:10.1093/rheumatology/ken047

Low disease activity state with corticosteroid may not represent

'true' low disease activity state in patients with rheumatoid

arthritis

N. Iikuni, E. Inoue, E. Tanaka, M. Hara, T. Tomatsu, N. Kamatani and

H. Yamanaka

Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.

Abstract

Objective. Corticosteroids constitute one of the most common

treatments of RA. The purpose of this study is to investigate whether

long-term corticosteroid use suppresses the progression of disability

in RA patients with low disease activity state.

Methods. Data collected from a large observational cohort of RA

patients at our institution were analysed for 214 RA patients whose

disease activity score (DAS) 28 and HAQ were available consecutively

from October 2000 to October 2004. All 214 patients had average DAS 28

<3.2, meaning only those who had well-controlled RA disease activity

were chosen as subjects. The subjects were divided into steroid users

who received continuous corticosteroids every month and non-steroid

users who did not receive consecutive corticosteroids continuously

every month.

Results. Fifty-five patients (25.7%) were corticosteroid users and 159

(74.3%) were non-users. Average prednisolone for the former group was

4.2 mg/day. No significant differences were observed among baseline

variables and RA disease activity variables. However, for steroid

users, HAQ progressively worsened with time and for non-steroid users,

HAQ progressively improved.

Conclusions. Although DAS 28 and other variables may suggest

well-controlled RA disease activity, functional capacity of patients

on low-dose corticosteroids deteriorated. Thus, low disease activity

state with corticosteroid may not represent the 'true' low disease

activity state. Along with the achievement of a low disease activity

state, long-term efficacy, prognosis, and the quality of remission

need to be also considered in the tight control of RA activity.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/4/519?etoc

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