Background/Purpose: Focus on early aggressive treatment in patients with rheumatoid arthritis (RA) has increased during the past decade. There is evidence for the efficacy of prednisolone as bridging therapy awaiting the therapeutic effect of DMARDs as well as evidence for a disease-modifying effect of glucocorticoids. Our objective was to investigate pattern in prednisolone use in RA patients in the past decade.

Methods: Data for this study were provided by the NOR-DMARD register, including adult patients with inflammatory arthropathies starting a new DMARD regimen at 5 Norwegian centers. These analyses included Methotrexate (MTX) naïve RA patients starting MTX mono and biologics naïve RA patients starting TNF inhibitor (TNFi) + MTX between 2000 and 2010. Each group was divided into 2-year intervals according to date of treatment start. The proportion using prednisolone, and mean prednisolone doses at baseline and at 6 months were assessed. Comparisons between first vs. last time period were made by Chi²-test and two-sample t-test. Possible linear effects of time were assessed by logistic and linear regression with year of treatment start as a continuous variable. 6-month DAS28 remission rates were calculated.

Results: 2573 pts were included – MTX mono n=1866 [70% female, 62% RF+, mean (SD) age 56.0 (13.7) years, time from diagnosis 3.6 (7.7) years] and TNFi+MTX n=707 [70% female, 75% RF+, age 52.1 (13.2) years, time from diagnosis 9.1 (9.3) years]. In patients starting MTX mono the proportion of patients using prednisolone at baseline increased over the years, while the proportion still using prednisolone at 6 months decreased (table). The differences between the first and the last period were statistically significant, but the effect of time was not linear. In the TNFi+MTX group the proportion of patients using prednisolone at baseline was stable during the decade, but the proportion at 6 months was significantly lower in the last vs. the first time period. The mean doses of prednisolone were stable throughout the decade in both groups. Proportions of patients reaching 6-month DAS28 remission increased gradually over the years in both groups (table).

* chi² –test first vs. last period, ** two sample t-test first vs. last period.

Conclusion: A higher proportion of RA patients used prednisolone when starting MTX in the recent years, and an increasing proportion of patients tapered and discontinued prednisolone. The observed increases in DAS28 remission rates likely reflects the implementation of modern DMARD treatment strategies including treatment earlier in the disease course and at lower levels of disease activity, but the changes in the use of prednisolone may be a contributing factor.