Low dose prednisolone therapy (LDPT) retards radiographically detectable destruction in early rheumatoid arthritis

Journal/Book: Z Rheumatol 1999; 58: 308-309. 1999;

Abstract: S. Wassenberg; Rheumaklinik Evangelisches Fachkrankenhaus Ratingen Objective: To test if continuous LDPT decreases radiographically detectable joint destruction in early RA. Methods: Patients with active RA (duration <2 yrs) were treated with prednisolone 5 mg daily or placebo 2 yrs in a double blind randomized multicenter study. All patients were set on either gold sodium thiomalat (GSTM) or methotrexate (MTX) and had to switch to the other in case of inefficacy or side effects. Radiographs of hands and forefeet were taken at baseline and after 6 12 and 24 mo. All radiographs were evaluated by one observer (SW) with known time sequence but unaware of the patients status using van der Heijdes modification of Sharp's method. Results: Of 196 patients (pts) included we report the results of the 76 pts who completed the study according to the protocol. 34 were treated with prednisolone 42 with placebo 48 initially with GSTM 28 with MTX. 17 pts switched from GSTM to MTX 1 from MTX to GSTM. The mean values of the radiographic scores of the prednisolone treated patients (pred) and the controls (placebo) are given in the table. The increase in score values was much greater in the first than in the second year of treatment (1 % of the TS vs. 0.1 % in the pred group 2.3 % of the TS vs. 0.3 % in the placebo group). It was also greater between baseline and 24 mo in the placebo group (2.6 %) compared to the pred group (1.1 %). Conclusion: In addition to conventional DMARD-therapy with MTX or GSTM continuous low dose prednisolone treatment with 5 mg daily over two yrs decreases radiographic progression in early RA. ... le

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