RA Treatment - Low Dose Glucocorticoids
Abstract 1204 Low Dose Glucocorticoids in Early RA Inhibit Radiological Joint Damage
AA van Everdingen, JWG Jacobs, DR van Reesma, JWJ Bilsma The Netherlands
Eighty-one patients with early RA of less than 1-year duration were randomized to receive prednisone 10 mg daily (41 patients) or placebo (40 patients) and followed for 2 years. NSAIDs were allowed but no DMARDs were allowed until 6 months at which time sulfasalazine 2 g daily could be added at the discretion of the investigators. Radiographic changes were assessed every 6 months by modified Sharp scoring of x-rays of the hands and feet. At the 24 month time point, investigators found significant inhibition of x-ray progression in the prednisone group by comparison with the placebo arm (modified Sharp score 45 vs 20).
Editorial Comment: Despite its small sample size, this study is important additional evidence that low dose prednisone therapy can have disease modifying effects. In prior studies, low dose prednisone has already been shown to inhibit radiographic progression when added to DMARD agents. Given the mounting evidence supporting DMARD use in early RA, studies such this one which delays DMARD use may be hard to replicate in the future for ethical reasons. It is surprising that 65% of both the placebo and prednisone groups were not started on sulfasalazine by 2 years, suggesting a relatively mild patient population. This study supports the use of low dose prednisone in early RA, however consideration must still be given to the morbidity associated with chronic steroid therapy.
