Background/Purpose:

To describe the longitudinal changes in the number of swollen and tender joints and HAQ scores in 345 African Americans with early RA and to assess factors influencing improvement and side effects of medications.

Methods:

This is a prospective observational cohort study of African American RA patients with early disease (<2 years) taken from the CLEAR1 registry who were followed longitudinally for up to 5 years after diagnosis.  A total of 626 clinical visits were performed on 345 subjects (~54% of subjects had the 5 year disease duration visit).  Clinical outcome data (number of tender and swollen joints based on 28 joints and HAQ scores) were subjected to repeated measures analysis.  The statistical models were adjusted simultaneously for 7 baseline covariates (gender, age, BMI, family history of RA, smoking status, poverty and education level) and 5 time-dependent covariates ( prednisone therapy divided daily and single daily, methotrexate treatment, diabetes, hypertension and osteopenia/osteoporosis).

Results:

The mean age at enrollment was 51 years, 82% of the cohort was female, and the mean disease duration at enrollment was 12 months.  The prevalence of low dose oral prednisone use at baseline was 77% (265/345) and median prednisone dose at baseline was 10 mg/day.  AA with early RA had significant reduction during follow-up in number of swollen joints, tender joints and in HAQ scores (all p <0.001, univariable analyses).  At baseline, 18% of patients had diabetes mellitus, 56% hypertension, 45% osteopenia and 5% osteoporosis.  During follow-up approximately 5% of the patients developed diabetes mellitus, hypertension or new osteoporosis.

Multivariable analyses indicated  similar improvement in number of swollen joints and HAQ scores for patients on divided daily low dose oral prednisone (n=x) or single daily low dose oral prednisone (n=y).  However, the adjusted mean tender joint count was lower for patients on a divided daily dose of prednisone (covariate-adjusted mean= 7.1) compared to a single daily dose of prednisone (covariate-adjusted mean= 9.6) with a mean difference (divided daily minus single daily) in number of tender joints=-2.5 joints (95% Cl: -2.8 to -2.2; P < 0.01).  The adjusted mean number of tender joints for patients not on prednisone was approximately 9 tender joints.

Conclusion:

During the 5 years of follow-up, clinical outcomes improved in AA patients with early RA.  Reduced number of tender joints appears to be associated with divided daily low dose prednisone treatment.  The development of new diabetes mellitus, hypertension and osteoporosis was uncommon and not related to prednisone use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-daily-low-dose-prednisone-divided-daily-versus-single-daily-dose-in-the-treatment-of-african-americans-aa-with-early-rheumatoid-arthritis-ra/