Objective. To clarify whether increase of body weight in patients with early rheumatoid arthritis (RA) upon administration of prednisone is a side effect of prednisone or a result of better control of disease activity, we examined the association of prednisone and disease activity with a subsequent change in body mass index (BMI). Methods. In the Computer Assisted Management in Early Rheumatoid Arthritis Trial-II, patients ages >18 years with early RA (disease duration <1 year and no prior use of disease-modifying antirheumatic drugs) had been randomized to a methotrexate (MTX)-based tight control strategy with either 10 mg of prednisone (MTX ؉ prednisone) or placebo (MTX ؉ placebo). The MTX ؉ prednisone group had lower disease activity, but gained more weight than the MTX ؉ placebo group (mean ؎ SD 2.9 ؎ 4.2 kg versus 1.3 ؎ 5.3 kg; P ؍ 0.03). Data from patients with monthly measurements of disease activity (Disease Activity Score in 28 joints [DAS28]) and BMI were analyzed with a longitudinal regression (mixed model) analysis with BMI as the dependent variable and treatment strategy and DAS28 as the independent variables, correcting for baseline BMI and possible confounders (sex, age, and rheumatoid factor status). Results. There was no independent association of glucocorticoid therapy with a change in BMI, but a lower DAS28 was associated with an increased BMI 6 months later. The association of the DAS28 with BMI was most strongly present in postmenopausal women. Clinical cutoff points showed a clear association between DAS28 level and the change in BMI 6 months later. Conclusion. Weight gain during treatment with prednisone seems attributable to a reduction of disease activity and is probably, at least partly, regained weight.
In particular, costs for devices/adaptations and for medication changed during follow-up. The latter was probably due to an increase in the use of biological agents. Hopefully a decrease in direct costs and a reduced percentage of patients getting work disabled by better disease control will outweigh the high costs of biological drugs in the future.
SUMMARYThis double‐blind one‐year study compares the long‐term efficacy and safety of nimesulide with naproxen in patients with osteoarthritis (OA) of the knee or hip. Patients were randomised to nimesulide 100 mg twice daily (n=183) or naproxen 250 mg morning, 500 mg evening (n=187). The primary efficacy variable was change in pain intensity (WOMAC A scale) at 6 months. Nimesulide tablets showed at least equivalent efficacy to naproxen tablets in reducing pain intensity at 6 and 12 months (nimesulide ‐22.5% at 6 and 12 months; naproxen ‐22.4% at 6 months, ‐19.9% at 12 months; non‐inferiority proven). At 6 months the investigator assessed efficacy as ‘good’ or ‘excellent’ in 59.3% of nimesulide and 56.4% of naproxen‐treated patients, with corresponding values for patient assessment of 57% and 52.7%. Both treatments were well tolerated, with fewer related gastrointestinal adverse events reported with nimesulide (77 cases, 47.5%) than with naproxen (96 cases, 54.5%). This study shows nimesulide to be as effective as naproxen in the long‐term treatment of OA and to be associated with fewer gastrointestinal side‐effects.
Background In the Computer Assisted Management of Early RA trial-II (CAMERA-II),patients aged ≥18 years with early RA (disease duration <1 year and no prior use of DMARDs) were included and randomized to an MTX-based tight control strategy with either 10 mg of Prednisone (MTX+pred) or placebo (MTX+plac)[1]. The MTX+predgroup had lower disease activity, disability and less erosive joint damage, compared to the MTX+plac group, but gained significantly more in weight than the MTX+plac group: mean 2.9 kg (standard deviation, SD 4.2) versus 1.3 kg (SD 5.3), p=0.03. Objectives To examine the association of glucocorticoids and disease activity with subsequent changes in body mass index (BMI). Furthermore the effect of BMI on disease activity was investigated. Methods Data from 224 patients of the CAMERA-II trial with monthly measurements of disease activity (DAS28) and BMI were used. Longitudinal regression (mixed model) analysis with BMI as dependent variable and DAS28 and treatment strategy as independent variables correcting for possible confounders (age, gender, rheumatoid factor, baseline BMI) was used. Separately, a longitudinal regression analysis with DAS28 as dependent variable and BMI and treatment strategy as independent variables, correcting for possible confounders was performed. To study the associations between disease activity and BMI several time lags between these variables were tested and the best fitting model was selected. To further focus on the longitudinal associations within patients an autoregressive model was used. Results There was no independent association of glucocorticoid therapy with changes in BMI. A decrease in DAS28 resulted in an increase in BMI 6 months later; also a rise in BMI was associated with a rise in DAS28 6 months later. Conclusions The higher BMI in the MTX+pred group seems (at least partly) attributable to a reduction of disease activity. A rise in BMI is associated with a rise in disease activity. References Bakker MF, Jacobs JWG, et al. Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis. A Randomized Trial. Ann Intern Med 2012; 156: 329-39 Disclosure of Interest None Declared
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