Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis: results of a 12-month open-label randomised study Report as inadecuate




Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis: results of a 12-month open-label randomised study - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 14:R112

First Online: 14 May 2012Received: 17 October 2011Revised: 05 April 2012Accepted: 14 May 2012

Abstract

IntroductionIn early rheumatoid arthritis RA, low-dose oral prednisone PDN co-medication yields better clinical results than monotherapy with disease-modifying anti-rheumatic drugs DMARDs. In addition, ultrasonography US evaluation reveals rapid and significant effects of glucocorticosteroids on subclinical synovitis. No data currently exist that examine the clinical and US results offered by glucocorticoid co-medication over DMARD monotherapy in early RA patients.

MethodsTwo hundred and twenty patients with early RA < 1 year from clinical onset were treated according to a low disease activity LDA targeted step-up protocol including methotrexate MTX and, in the active treatment arm, low-dose 6.25 mg-day oral PDN over 12 months. Clinical disease activity measures were collected at baseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months. Grey-scale and power Doppler PD synovitis were scored 0 to 3 for each joint. At 12 months, clinical remission according to the disease activity score among 28 joints was defined as the clinical outcome, and a total joint PD score of 0 PD negativity as the imaging outcome.

ResultsEach group included 110 patients with comparable demographic, clinical, laboratory and US characteristics. At 12 months, the LDA rate was similar in the two groups, whilst the clinical remission rate risk ratio = 1.61 95% confidence interval = 1.08, 2.04 and PD negativity rate risk ratio = 1.31 95% confidence interval = 1.04, 1.64 were significantly higher in the MTX+PDN group.

ConclusionIn early RA, despite a similar response rate in terms of LDA, low-dose oral PDN co-medication led to a higher proportion of clinical remission and PD negativity compared with MTX monotherapy, thus ensuring a better disease activity control.

Trial registration numberCurrent Controlled Trials ISRCTN2486111

AbbreviationsDAS28disease activity score among 28 joints

DMARDdisease-modifying anti-rheumatic drug

GCglucocorticoids

GSgrey-scale

LDAlow disease activity

MDmean or median difference from baseline

MTXmethotrexate

PDpower Doppler

PDNprednisone

RArheumatoid arthritis

RRrisk ratio

SDAISimplified Disease Activity Index

TNFtumour necrosis factor

USultrasonography

VASvisual analogue scale.

Electronic supplementary materialThe online version of this article doi:10.1186-ar3838 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Author: Carlomaurizio Montecucco - Monica Todoerti - Garifallia Sakellariou - Carlo Alberto Scirè - Roberto Caporali

Source: https://link.springer.com/



DOWNLOAD PDF




Related documents