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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

Svensson, Björn LU ; Boonen, A; Albertsson, K; van der Heijde, D; Keller, C and Hafstrom, I (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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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Arthritis and Rheumatism
volume
52
issue
11
pages
3360 - 3370
publisher
John Wiley & Sons
external identifiers
  • pmid:16255010
  • wos:000233285400007
  • scopus:27744466694
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
2007-08-16 16:10:51
date last changed
2017-10-22 03:37:20
@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 &lt;= 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 &lt; 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},
  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},
  volume       = {52},
  year         = {2005},
}