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Adding Low-Dose Prednisone to Methotrexate Therapy for Early Rheumatoid Arthritis FREE

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The full report is titled “Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis.

A Randomized Trial.” It is in the 6 March 2012 issue of Annals of Internal Medicine (volume 156, pages 329-339). The authors are M.F. Bakker, J.W.G. Jacobs, P.M.J. Welsing, S.M.M. Verstappen, J. Tekstra, E. Ton, M.A.W. Geurts, J.H. van der Werf, G.A. van Albada-Kuipers, Z.N. Jahangier-de Veen, M.J. van der Veen, C.M. Verhoef, F.P.J.G. Lafeber, and J.W.J. Bijlsma, on behalf of the Utrecht Rheumatoid Arthritis Cohort Study Group.

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Ann Intern Med. 2012;156(5):I-18. doi:10.7326/0003-4819-156-5-201203060-00001
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What is the problem and what is known about it so far?

Rheumatoid arthritis (RA) is a serious disease that can lead to permanent disability from joint destruction. Methotrexate is the most common drug now used to initially treat moderate to severe RA. Additional drugs, such as cyclosporine or “biologic” treatments, are often added to control the disease as soon and as completely as possible. They may be given with methotrexate from the beginning of treatment and then decreased when the disease is under control or may be added to methotrexate later if improvement is incomplete or slow. These additional drugs are effective but have their own side effects, are costly, and add to the complexity of treatment for patients.

Why did the researchers do this particular study?

To see whether adding low doses of prednisone to methotrexate from the beginning of therapy would be more effective than first giving methotrexate alone and would decrease the likelihood that patients would need to later receive cyclosporine or biologic drugs in addition to their treatment regimen. Prednisone is an anti-inflammatory drug that has been used for approximately 60 years to treat RA, is generally safe and well-tolerated when given in low doses, and is inexpensive.

Who was studied?

Adult patients who had RA for 1 year or less and had not been treated with methotrexate, prednisone, cyclosporine, or biologic treatments.

What did the researchers find?

Giving both methotrexate and low-dose prednisone from the beginning of treatment for RA resulted in less joint damage and improved disease control and measures of function than giving methotrexate alone. Patients who received both methotrexate and low-dose prednisone from the beginning were less likely to need to have cyclosporine or biologic drugs added later to control RA. The patients who received methotrexate and prednisone for initial therapy had fewer side effects than those who received methotrexate alone for initial therapy.

What were the limitations of the study?

Some patients who received prednisone along with methotrexate from the beginning still needed to have additional drugs added later. The number of patients studied was not large enough to determine whether unusual or rare side effects were more likely to occur with one approach or the other.

What are the implications of the study?

Giving low-dose prednisone along with methotrexate from the beginning of treatment for RA may improve patient outcomes compared with giving methotrexate alone and, in some cases, will “spare” patients the need to later receive cyclosporine or biologic drugs in addition to methotrexate.





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