Should we use glucocorticoids in early rheumatoid arthritis? Results at 5 years from the early RA UCLouvain Brussels cohort

Abstract

Objectives To evaluate the proportion of patients with ERA who have initiated or not GC, to analyse the baseline characteristics, and to assess the clinical benefit and side effects of GC during 5 years of follow-up. Methods We included patients with ERA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classification criteria and were naïve to cDMARDs. We retrospectively collected patient characteristics prior to the introduction of cDMARDs with or without GC. Efficiency and serious adverse events were analysed at 6, 12, 36 and 60 months. Results Data from 474 eligible ERA patients were collected. 180 patients initiated GC compared with 294 who did not. At baseline, the increased CRP is the main factor that favors the initiation of GC followed by smoking, absence of ACPA, prescription of methotrexate as a monotherapy and age. 5 years follow-up of DAS28-CRP, HAQ or VAS pain values did not differ between the two groups. We also analysed a subgroup of 139 patients who received >1 g of prednisolone during the 5 years period. We confirmed the same baseline differences and observed in addition more males and higher DAS-28CRP values. During the 5 years follow up, DAS-28CRP, VAS pain and HAQ remained significantly higher in this subgroup. More severe infections were also reported. Conclusion In our ERA cohort, the initiation of GC treatment does not bring additional benefit for the short and long-term control of the disease. GC was more prescribed in seronegative RA patients with a higher level of inflammation. Disclosure statement the authors declare no conflicts of interest. Ethics statement authors declare that the study complies with the Declaration of Helsinki.

Short-term glucocorticoids reduce risk of chronic NSAID and analgesic use in early methotrexate-treated rheumatoid arthritis patients with favourable prognosis: subanalysis of the CareRA randomised controlled trial

“…RMD Open RMD Open RMD Open recommending as first treatment strategy the initiation of disease-modifying antirheumatic drug (DMARD) such as methotrexate (MTX) with a short-term glucocorticoid (GC) course, 2 it is debated if this intensive approach is also necessary in patients lacking classical markers of poor prognosis. 3 In the Care in early RA (CareRA) trial, we demonstrated that also in patients without erosions, seronegative or with low disease activity, the speed of response was more rapid when treated with MTX plus a step-down-bridge GC scheme compared with MTX therapy without GC, while long-term treat-to-target results were comparable. [4][5][6] However, the potential advantage of intensive therapy on patient important outcomes such as pain and the concomitant use of non-steroidal antiinflammatory drugs (NSAIDs) and analgesics deserves more detailed study in relation to the clinical response to a treat-to-target approach, taking into account the cumulative need but also the evolution over time.…”

Incidence of severe infection in patients with rheumatoid arthritis taking biologic agents: a systematic review

“…The infection rate was available for patients in 39 studies with 48 cohorts who were administered TNF-α inhibitors; however, only 2 studies reported the infection rate for all 5 types of TNF-α inhibitor drugs, 17,65 and most of the studies reported information for a couple of TNF-α inhibitor drugs.…”