Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate - A two-year randomized trial
(2005) In Arthritis and Rheumatism 52(11). p.3360-3370- Abstract
- Objective. To assess the efficacy of low-dose prednisolone on joint damage and disease activity in patients with early rheumatoid arthritis (RA). Methods. At the start of their initial treatment with a disease-modifying antirheumatic drug (DMARD), patients with early (duration <= 1 year) active RA were randomly assigned to receive either 7.5 mg/day prednisolone or no prednisolone for 2 years. Radiographs of the hands and feet were obtained at baseline and after 1 and 2 years and scored according to the Sharp score as modified by van der Heijde. Remission was defined as a Disease Activity Score in 28 joints of < 2.6. Bone mineral density was measured by dual x-ray absorptiometry at baseline and after 2 years. Results. Of the 250... (More)
- Objective. To assess the efficacy of low-dose prednisolone on joint damage and disease activity in patients with early rheumatoid arthritis (RA). Methods. At the start of their initial treatment with a disease-modifying antirheumatic drug (DMARD), patients with early (duration <= 1 year) active RA were randomly assigned to receive either 7.5 mg/day prednisolone or no prednisolone for 2 years. Radiographs of the hands and feet were obtained at baseline and after 1 and 2 years and scored according to the Sharp score as modified by van der Heijde. Remission was defined as a Disease Activity Score in 28 joints of < 2.6. Bone mineral density was measured by dual x-ray absorptiometry at baseline and after 2 years. Results. Of the 250 patients included, 242 completed the study and 225 had radiographs available both at baseline and at 2 years. At 2 years, the median and interquartile range (IQR) change in total Sharp score was lower in the prednisolone group than in the no-prednisolone group (1.8 [IQR 0.5-6.0] versus 3.5 [IQR 0.5-10]; P = 0.019). In the prednisolone group, there were fewer newly eroded joints per patient after 2 years (median 0.5 [IQR 0-2] versus 1.25 [IQR 0-3.25]; P = 0.007). In the prednisolone group, 25.9% of patients had radiographic progression beyond the smallest detectable difference compared with 39.3% of patients in the no-prednisolone group (P = 0.033). At 2 years, 55.5% of patients in the prednisolone group had achieved disease remission, compared with 32.8% of patients in the no-prednisolone group (P = 0.0005). There were few adverse events that led to withdrawal. Bone loss during the 2-year study was similar in the 2 treatment groups. Conclusion. Prednisolone at 7.5 mg/day added to the initial DMARD retarded the progression of radiographic damage after 2 years in patients with early RA, provided a high remission rate, and was well tolerated. Therefore, the data support the use of low-dose prednisolone as an adjunct to DMARDs in early active RA. (Less)
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https://lup.lub.lu.se/record/213337
- author
- Svensson, Björn LU ; Boonen, A ; Albertsson, K ; van der Heijde, D ; Keller, C and Hafstrom, I
- organization
- publishing date
- 2005
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Arthritis and Rheumatism
- volume
- 52
- issue
- 11
- pages
- 3360 - 3370
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:16255010
- wos:000233285400007
- scopus:27744466694
- pmid:16255010
- ISSN
- 1529-0131
- DOI
- 10.1002/art.21298
- language
- English
- LU publication?
- yes
- id
- dc2f4589-3455-4240-af06-fbdc3d131499 (old id 213337)
- date added to LUP
- 2016-04-01 11:45:36
- date last changed
- 2022-04-05 04:39:10
@article{dc2f4589-3455-4240-af06-fbdc3d131499, abstract = {{Objective. To assess the efficacy of low-dose prednisolone on joint damage and disease activity in patients with early rheumatoid arthritis (RA). Methods. At the start of their initial treatment with a disease-modifying antirheumatic drug (DMARD), patients with early (duration <= 1 year) active RA were randomly assigned to receive either 7.5 mg/day prednisolone or no prednisolone for 2 years. Radiographs of the hands and feet were obtained at baseline and after 1 and 2 years and scored according to the Sharp score as modified by van der Heijde. Remission was defined as a Disease Activity Score in 28 joints of < 2.6. Bone mineral density was measured by dual x-ray absorptiometry at baseline and after 2 years. Results. Of the 250 patients included, 242 completed the study and 225 had radiographs available both at baseline and at 2 years. At 2 years, the median and interquartile range (IQR) change in total Sharp score was lower in the prednisolone group than in the no-prednisolone group (1.8 [IQR 0.5-6.0] versus 3.5 [IQR 0.5-10]; P = 0.019). In the prednisolone group, there were fewer newly eroded joints per patient after 2 years (median 0.5 [IQR 0-2] versus 1.25 [IQR 0-3.25]; P = 0.007). In the prednisolone group, 25.9% of patients had radiographic progression beyond the smallest detectable difference compared with 39.3% of patients in the no-prednisolone group (P = 0.033). At 2 years, 55.5% of patients in the prednisolone group had achieved disease remission, compared with 32.8% of patients in the no-prednisolone group (P = 0.0005). There were few adverse events that led to withdrawal. Bone loss during the 2-year study was similar in the 2 treatment groups. Conclusion. Prednisolone at 7.5 mg/day added to the initial DMARD retarded the progression of radiographic damage after 2 years in patients with early RA, provided a high remission rate, and was well tolerated. Therefore, the data support the use of low-dose prednisolone as an adjunct to DMARDs in early active RA.}}, author = {{Svensson, Björn and Boonen, A and Albertsson, K and van der Heijde, D and Keller, C and Hafstrom, I}}, issn = {{1529-0131}}, language = {{eng}}, number = {{11}}, pages = {{3360--3370}}, publisher = {{John Wiley & Sons Inc.}}, series = {{Arthritis and Rheumatism}}, title = {{Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate - A two-year randomized trial}}, url = {{http://dx.doi.org/10.1002/art.21298}}, doi = {{10.1002/art.21298}}, volume = {{52}}, year = {{2005}}, }