Background/Purpose:

Glucocorticoids (GCs) are commonly used in RA patients as remission induction monotherapy or as bridging therapy when starting DMARD/biologic therapy.  Despite the ubiquity of GC use in RA treatment, agreed upon standard dosages, particularly for remission induction in newly diagnosed patients, remain elusive. Past studies indicated that the well-known long term adverse effects of GCs are directly related to cumulative dose. Therefore, identification of the lowest GC dose that reproducibly induces remission is imperative. The purpose of our study was to assess the response of newly diagnosed RA patients to low dose prednisone monotherapy (defined as less than or equal to 10 mg/day).

Methods: We conducted a chart review for new diagnoses of RA (ICD-9 714) from January 1, 2005 to September 1, 2018 at Trinity Health Group in Minot, ND. Patients treated with < 10 mg prednisone daily for at least six weeks were included. Those previously treated with a DMARD or already started on a GC upon referral were excluded. Disease severity was calculated using the Disease Activity Score (DAS28-ESR).  Response to treatment was determined based on the change in the DAS28-ESR score before and after treatment.  The European League Against Rheumatism (EULAR) response criteria was used to categorize response to therapy as good, moderate, or no response.  

Results: A total of 1386 patients were screened and 201 of them met inclusion and exclusion criteria. The average dose of prednisone was 8 mg daily, ranging between 5 and 10 mg, for an average of 42.2 days. Average age at presentation was 55.1. Majority of them were female (65.7%) and white (91.5%).  The average DAS28-ESR score among our entire cohort dropped from 5.1 ± 1.1 at presentation to 2.7 ± 1.3 after 6 weeks of treatment with low dose prednisone (p < 0.001).  The average DAS28-ESR of our seropositive patients (n=134) dropped from 5.2 ± 1.1 to 2.7 ± 1.3 (p< 0.001), and that of our seronegative patients (n=67) dropped from 4.9 ± 1.2 to 2.6 ± 1.1 (p< 0.001). As defined by the EULAR response criteria, 69.7% of patients showed a good response to treatment, 20.4% showed a moderate response, and only 10% showed no response. At presentation, 50.2% of the total cohort qualified as having either severe disease according to DAS28-ESR score. After treatment, only 5% qualified for severe disease, and 54.2% had reached remission.

Conclusion: Low dose prednisone monotherapy leads to statistically significant improvement in clinical severity of RA in newly diagnosed patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-efficacy-of-low-dose-prednisone-for-remission-induction-in-newly-diagnosed-rheumatoid-arthritis-patients/