0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Amalia A. van Everdingen, MD; Johannes W.G. Jacobs, MD, PhD; Dirk R. Siewertsz van Reesema, MD; and Johannes W.J. Bijlsma, MD, PhD
[+] Article and Author Information

From University Medical Center Utrecht, Utrecht; Deventer Hospital, Deventer; and Zutphen Hospital, Zutphen, the Netherlands.


Acknowledgments: The authors thank H.H. Nuver-Zwart, rheumatologist, for patient inclusion and support and B.G. Ziedzes des Plantes, radiologist, for advice; E.M.J. Brouwers-Kuyper, radiologist, and D.M. Hofman, rheumatologist, for scoring the radiographs; the Deventer Hospital pharmacists for preparation, randomization, and distribution of the study medication; and A.W.J.M. Jacobs-van Bree for data management.

Grant Support: By the Dutch League against Rheumatism (Het Nationaal Reumafonds) (no. 541).

Requests for Single Reprints: Johannes W.G. Jacobs, MD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Box 85500, 3508 GA Utrecht, the Netherlands; e-mail, j.w.g.jacobs@azu.nl.

Current Author Addresses: Dr. van Everdingen: Department of Rheumatology, Deventer Hospital, Box 5001, 7400 GC Deventer, the Netherlands.

Dr. Jacobs: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Box 85500, 3508 GA Utrecht, the Netherlands.

Dr. Siewertsz van Reesema: Department of Rheumatology, Deventer Hospital, Box 5001, 7400 GC Deventer, the Netherlands.

Dr. Bijlsma: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, F02.127, Box 85500, 3508 GA Utrecht, the Netherlands.

Author Contributions: Conception and design: A.A. van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema, J.W.J. Bijlsma.

Analysis and interpretation of the data: A.A. van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema, J.W.J. Bijlsma.

Drafting of the article: A.A. van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema.

Critical revision of the article for important intellectual content: A.A. van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema, J.W.J. Bijlsma.

Final approval of the article: A.A. van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema, J.W.J. Bijlsma.

Provision of study materials or patients: A.A. van Everdingen, J.W.G. Jacobs.

Statistical expertise: A.A. van Everdingen, J.W.G. Jacobs.

Obtaining of funding: A.A. van Everdingen, J.W.J. Bijlsma.

Administrative, technical, or logistic support: A.A. van Everdingen, J.W.G. Jacobs, J.W.J. Bijlsma.

Collection and assembly of data: A.A. van Everdingen, J.W.G. Jacobs.


Ann Intern Med. 2002;136(1):1-12. doi:10.7326/0003-4819-136-1-200201010-00006
Text Size: A A A

Drug treatment for rheumatoid arthritis usually consists of a combination of a nonsteroidal anti-inflammatory drug (NSAID) and a disease-modifying antirheumatic drug (for example, sulfasalazine, methotrexate, gold salt, or a combination). New biological agents, such as tumor necrosis factor-α blocking agents and interleukin-1 receptor antagonists, appear promising (12). Glucocorticoids have had a special place in the treatment of rheumatoid arthritis since the publication of the report by Hench and coworkers showing that cortisone dramatically alleviated the symptoms of rheumatoid arthritis by inhibiting inflammation (3). This period of enthusiasm in the 1950s was followed by a long period in which glucocorticoids were applied cautiously for rheumatoid arthritis because of their many side effects and the recognition that inhibition of inflammation is not necessarily associated with retardation of joint damage (4).

First Page Preview

View Large
/>
First page PDF preview

Figures

Grahic Jump Location
Figure 2.
Cumulative mean use of nonsteroidal anti-inflammatory drugsNSAIDs) in units.P

( One unit = 1000 mg of naproxen or the equivalent dose of another NSAID. At follow-up at all points in time, statistically significant differences were seen between the two groups ( < 0.001 [Mann–Whitney U-test]). The solid line indicates the prednisone group; the dotted line indicates the placebo group. Error bars represent the standard error.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Radiologic scores over time for both erosions and joint space narrowing in hands and feet (top), erosions alone (middle), and joint space narrowing alone (bottom).(10, 11)PP

All scores are means and are based on the van der Heijde modification of the Sharp method . Solid lines indicate the prednisone group; dotted lines indicate the placebo group. Error bars represent the standard error. * = 0.04; † = 0.02.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Prednisone for Rheumatoid Arthritis

The summary below is from the full report titled “Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects. A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” It is in the 1 January 2002 issue of Annals of Internal Medicine (volume 136, pages 1-12). The authors are AA van Everdingen, JWG Jacobs, DR Siewertsz van Reesema, and JWJ Bijlsma.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)