RESEARCH - Remission achieved after 2 years treatment with low-dose prednisolone in addition to DMARDs in early RA

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Ann Rheum Dis. 2009 Apr;68(4):508-13. Epub 2008 Apr 17.

Remission achieved after 2 years treatment with low-dose prednisolone

in addition to disease-modifying anti-rheumatic drugs in early

rheumatoid arthritis is associated with reduced joint destruction

still present after 4 years: an open 2-year continuation study.

Hafström I, Albertsson K, Boonen A, van der Heijde D, Landewé R,

Svensson B; BARFOT Study Group.

The Rheumatology Unit, Karolinska Institute, Karolinska University

Hospital, Huddinge, Stockholm, 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 a sustained effect on radiological

damage for a total of 4 years.

METHODS: A total of 150 of 211 eligible patients with RA who had been

randomised to the 7.5 mg prednisolone group (P) or no prednisolone

group (NoP) in addition to the initial disease-modifying antirheumatic

drugs were included. Radiographs of hands and feet were scored using

the Sharp-van der Heijde scoring method. A patient was considered to

be in remission if the 28-joint count disease activity score was <2.6.

RESULTS: Mean (SD) age was 53 (14) and 57 (12) years for the patients

in the P and NoP groups, respectively. 64% were female, 64% rheumatoid

factor 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,

compared with those not in remission, had 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 4 years did not

differ between those in remission and those with active disease, and

were similar in the two treatment groups.

CONCLUSIONS: Prednisolone 7.5 mg daily in addition to

disease-modifying anti-rheumatic drugs increases the rate of remission

in patients with early RA, which has a beneficial and sustained effect

on radiological damage.

PMID: 18420939

http://www.ncbi.nlm.nih.gov/pubmed/18420939

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