Low-Dose Prednisone Improves Symptom Severity in Patients with Newly Diagnosed Rheumatoid Arthritis

Short-term, low-dose prednisone was shown to improve clinical severity and induce remission in patients with newly diagnosed rheumatoid arthritis (RA), according to a study published in BMC.¹

“RA-associated morbidity is directly correlated with the amount of time patients spend in a state of severe disease activity,” investigators stated. “Therefore, early intervention and optimal management is paramount to limiting long-term complications.”

In this retrospective study, investigators analyzed patients with newly diagnosed RA, defined as a duration of symptoms less than 12 months, to determine if short-term (up to 6 months), low doses (< 10 mg/day) of prednisone would help improve the Disease Activity Score-28 erythrocyte sedimentation rate (DAS28-ESR) score according to the European Alliance of Associations for Rheumatology (EULAR) response criteria. Medical records were evaluated using data from January 1, 2005 and September 1, 2018 at the Community Health Center in North Dakota.

Patients were excluded if they were previously treated with disease-modifying antirheumatic drugs (DMARDs) or if they were already receiving glucocorticoid treatment.

Demographics, such as age, gender, and race were collected, as well as prednisone dosage, treatment duration, other medications, tender and swollen joint counts, C-reactive protein (CRP), hemoglobin, and platelets.

Patients’ response to prednisone was calculated using baseline and 6-week post-treatment DAS28-ESR data. Severity was defined as remission (<2.6), minimal (> 2.6 to < 3.2), moderate (>3.2 to 5.1), and severe (> 5.1).

A total of 201 patients were included in the study, with a mean age of 55.1 years, 65.7% female, and 91.5% were White. The average prednisone dosage was 8 mg/day and treatment duration was 42.2 days.

Disease activity improved from baseline in tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001) and swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001). Visual analog pain scores went from 4.8 ± 2.6 at baseline to 2.1 ± 2.5 (P < 0.001) at the 6-week follow-up. Inflammation improved from baseline to follow-up, with ESR decreasing from 33.7 ± 22.6 to 19.9 ± 16.0 (P < 0.001) and CRP levels decreasing from 2.5 ± 3.2 t0 1.2 ± 1.3 (P < 0.001).

Additionally, the DAS28-ESR score improved from 5.1 ± 1.2 to 2.7 ± 1.3; (P < 0.001) for both seropositive (5.2 ± 1.1 vs. 2.7 ± 1.3 (P < 0.001) and seronegative patients 4.9 ± 1.2 vs. 2.6 ± 1.1 (P < 0.001).

Regarding EULAR response criteria, nearly 70% of patients had a good response to low-dose prednisone treatment, 20.4% had a moderate response, and 10% had no response. In total, 95% of patients reported severe or moderate disease activity at baseline, according to DAS28-ESR scores. After 6 weeks of treatment, 54.2% of patients were in remission and 16.9% had low disease activity. Only 5% of patients were still in a severe disease state at follow-up.

Limitations included the retrospective nature of the study, which may have impacted results and created selection bias due to missing data. Further, generalizability was hindered as most of the patients were White.

“These findings may assist clinicians in selecting the appropriate prednisone dosage and duration of use, as a first line monotherapy, for newly diagnosed RA patients,” investigators concluded. “More research needs to be done to perform side effects of induction with low dose GC monotherapy vs. alternative therapies and the long-term consequences of both therapies for matched treatment groups.”

Reference:

Stacy JM, Greenmyer JR, Beal JR, Sahmoun AE, Diri E. The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients. Adv Rheumatol. 2021;61(1):50. Published 2021 Aug 9. doi:10.1186/s42358-021-00205-4