Background/Purpose

Anti-inflammatory and disease-modifying properties of glucocorticoids (GCs) have been demonstrated in patients with rheumatoid arthritis (RA). Better outcomes in trials by combinations of synthetic DMARDs plus GCs versus DMARD monotherapy might be due GC. Since GCs are associated with adverse events, tapering of GCs is recommended in guidelines. There is almost no information on the benefits of GC in early arthritis outside the limitations of a clinical study

To analyse whether initial GC therapy influences the course of the disease in early arthritis patients

Methods

We included all patients from the Swiss RA registry SCQM with recent onset arthritis, (disease duration ≤1 year). Patients were categorized into two groups depending on their initial GC use. The primary outcome of this study was RA disease progression, as assessed by the evolution of disease activity (DAS28), radiographic erosion (Ratingen score) and HAQ-DI as a patient cantered outcome. The baseline disease characteristics were compared using standard descriptive statistics. The effect of initial glucocorticoid use on DAS 28 and HAQ-DI scores during follow up was estimated using linear mixed models with random slope and random intercept, and adjusted for various baseline factors in a univariate fashion. Slopes were compared between groups using the Mann-Whitney U-test

Results

A total of 592 patients (pts) with early disease were available. Of these, 363 pts were initially treated with GC and 228 pts without (no-GC). DAS 28 (4.6 vs. 4.3, p = 0.011) and the HAQ-DI (0.94 vs. 0.82, p = 0.0122) were higher at the inclusion visit in GC patients, whereas average levels of CRP, swollen/tender joint counts, and erosion scores (Ratingen), presence of ACPA or rheumatoid factor at disease onset were not statistically different. Neither DAS 28, nor HAQ-DI, or the development of joint erosions differed between the two groups during follow up. Initial GC treatment was stopped in 201 patients during follow up after 680 days (mean). In parallel, GC treatment was initiated in 48 of the initial no-GC patients after 662 days (mean). Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p = 0.0097). No differences in the number or kind of concomitant diseases were found

We examined the probability of taking GC on the basis of baseline, parameters in a propensity score analysis. Even after adjusting for this propensity score, patients with and without use of GC did not have statistically significantly different DAS 28 (difference 0.04 on average, p = 0.67), erosion (0.75 higher Ratingen score with GC, p = 0.29), or HAQ-DI (0.03 higher with GC, p = 0.47)

Conclusion

It could be argued that initial GC use is not necessary in early RA patients, since disease progression, patient centred outcome, and the radiographic progression were comparable during follow up. Is has to be taken into consideration, however, that the patients with initial GC treatment had bad prognostic factors for the further disease course. Therefore we conclude that the treating rheumatologists have counterbalanced these factors by earlier and more frequent use of GC and subsequently by biologics

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-corticosteroid-therapy-at-disease-onset-influence-disease-progression-of-ra-results-from-the-swiss-prospective-observational-cohort/