RESEARCH - Lack of radiological and clinical benefit over two years of low dose prednisolone for RA

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Ann Rheum Dis. 2004 Jul;63(7):797-803.

Lack of radiological and clinical benefit over two years of low dose

prednisolone for rheumatoid arthritis: results of a randomised controlled

trial.

Capell HA, Madhok R, Hunter JA, Porter D, on E, Larkin J, Thomson EA,

Hampson R, Poon FW.

Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow

University NHS Trust, Castle St, Glasgow G40SF, UK.

.Capell@...

BACKGROUND: Evidence for disease modifying activity of low dose

corticosteroid treatment in rheumatoid arthritis is contradictory. Studies

showing radiological benefit suggest that continued treatment is required to

sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral

prednisolone in early rheumatoid arthritis on disease activity over two

years. DESIGN: Double blind placebo controlled trial. METHODS: Patients with

rheumatoid arthritis, duration <3 years (n = 167), were started on a disease

modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by

stratified randomisation to prednisolone 7 mg/day or placebo. Primary

outcome measure was radiological damage, assessed by the modified Sharp

method. Clinical benefit was a secondary outcome. A proactive approach to

identifying and treating corticosteroid adverse events was adopted. Patients

who discontinued sulphasalazine were offered an alternative DMARD. RESULTS:

90 of 257 patients eligible for the study refused to participate (more women

than men). Of those enrolled, 84% were seropositive for rheumatoid factor,

median age 56 years, median disease duration 12 months, female to male ratio

1.8:1. Prednisolone was given to 84 patients; of these 73% continued

prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on

placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were

no significant differences in radiological score or clinical and laboratory

measures at 0 and 2 years.

CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical

benefit on patients maintained on a DMARD over two years. Low dose

corticosteroids have no role in the routine management of rheumatoid

arthritis treated with conventional disease modifying drugs.

PMID: 15194574

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15194574 & itool=iconabstr

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