RESEARCH - Remission achieved after 2 years treatment with low dose prednisolone in addition to DMARDs in early RA is associated with reduced joint destruction

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Ann Rheum Dis. Published Online First: 17 April 2008.

doi:10.1136/ard.2008.087833

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Extended Report

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

Ingiäld Hafström 1*, a Albertsson 1, Annelies Boonen 2, Desirée

MFM van der Heijde 3, RBM Landewé 4 and Bjorn Svensson 5

1 Karolinska Institute, Sweden

2 University Hospital Maastricht, Netherlands

3 Leiden University Medical Center, Netherlands

4 University of Maastricht, Netherlands

5 University of Lund, Sweden, Sweden

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.

http://ard.bmj.com/cgi/content/abstract/ard.2008.087833v1?

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