Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The Role of Low-Dose Oral Prednisone Treatment in Early Rheumatoid Arthritis: Effects on Clinical and Ultrasonographic Remission and Functional Outcome.
Sakellariou1, Garifallia, Todoerti2, Monica, Scire2, Carlo A., Bugatti2, Serena, Montecucco2, Carlomaurizio, Caporali2, Roberto
Chair and Division of Rheumatology, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
Chair and Division of Rheumatology, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Glucocorticoids are widely used in treating patients with rheumatoid arthritis (RA), providing rapid clinical improvement, reduction of radiographic progression and higher rates of clinical remission. Nevertheless, there is evidence of persistent subclinical synovitis even in clinical remission, and ultrasonography (US) is considered a sensitive tool to detect it. In this study we investigated the effect of low-dose oral prednisone co-medication on the occurrence of clinical and US remission, and the impact of these statuses on the development of future disability in a cohort of patients with early RA.
210 patients with early RA (symptom duration<1 year) were assigned to receive (P) or not (no-P) low-dose oral prednisone in association with a DAS-driven DMARD therapeutic protocol. Patients started with a dosage of 12.5 mg/day of prednisone, tapered to 6.25 mg/day after two weeks. Disease Activity Score 28 (DAS28) was assessed at the beginning of the study and after 12 months. A DAS28<2.6 identified patients in clinical remission. The US assessment of patients included 12 joints (MCPs and wrists). A single operator unaware of the clinical findings carried out all scans with a GE Logiq 9 scanner, using a multi-frequency linear array transducer (815MHz), under standardized settings. Grey-scale (GS) and power Doppler (PD) synovitis were subjectively scored (0 to 3) for each joint. US remission was defined as absence of intra-articular PD signal (PD grade 0). Health Assessment Questionnaire (HAQ) was completed at the beginning of the study, at 12 and 24 months; disability (mild) was defined as a value of HAQ>0.5. Patients with complete data both on clinical and US variables were included in the analyses.
Out of 210 patients, 105 were on prednisone plus DMARDs (P) and 105 on DMARDs alone (no-P). Age, disease duration, DAS28, HAQ, ESR, CRP, US findings did not differ between P and no-P at baseline. At 12 months, 44% of P patients, and only 28% of no-P patients were in DAS28 remission (p=0.018). US remission occurred in 71.2% of P patients, and in only 55.4% of no-P patients (p=0.041). At 24 months, the odds ratio of progression to disability in patients who were in DAS 28 remission, compared to those with active disease, was 0.18 (95% confidence interval, CI, 0.0630.55, p=0.001). In this subgroup, patients who were also in PD remission carried the lowest risk of development of disability (OR 0.16, 95% CI 0.010.62, p=0.008).
low-dose oral prednisone co-medication gave an advantage over DMARD monotherapy in terms of higher rates of clinical and US remission. Patients in clinical and US remission showed the lowest rate of progression to disability at two years. These findings suggest a more complete suppression of joint inflammation in patients with early RA receiving glucocorticoids, resulting in a positive influence on functional outcome.
To cite this abstract, please use the following information:
Sakellariou, Garifallia, Todoerti, Monica, Scire, Carlo A., Bugatti, Serena, Montecucco, Carlomaurizio, Caporali, Roberto; The Role of Low-Dose Oral Prednisone Treatment in Early Rheumatoid Arthritis: Effects on Clinical and Ultrasonographic Remission and Functional Outcome. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1397