The British Journal of Rheumatology, Vol 37, 930-936, Copyright © 1998 by British Society for Rheumatology
P Hickling, RK Jacoby and JR Kirwan
OBJECTIVE: Prednisolone reduced the progression of joint destruction over 2
yr in early, active rheumatoid arthritis. The response to discontinuation
of prednisolone under double-blind conditions is now reported. METHODS: A
randomized, double-blind, placebo-controlled trial of prednisolone 7.5 mg
daily in addition to routine medication over 2 yr in 128 patients with
early rheumatoid arthritis, using radiological progression (changes in the
Larsen score) and the development of erosions as primary outcome measures.
Study medication was blindly discontinued and follow-up maintained for a
further year. Other assessments included disability, joint inflammation,
pain and the acute- phase response. RESULTS: Similar results were obtained
when all available radiographs were included for each year of assessment
(maximum 114) and when only patients with radiographs at all time points
were included (75 patients). In these 75, the mean progression in the
prednisolone group was 0.21 Larsen units in year 1, 0.04 units in year 2
and 1.01 units in year 3 (P = 0.587, 0.913 and 0.039 for change within each
year, respectively). The equivalent placebo group means were 2.34, 1.00 and
1.63 Larsen units (P = 0.001, 0.111 and 0.012; difference between groups:
2.13, 0.96 and 0.67 units, P = 0.082, 0.02 and 0.622). The percentage of
hands which had erosions at each time point was: prednisolone group: 27.8,
29.2, 34.7 and 39.2; placebo group: 28.2, 48.7, 59.0 and 66.5. There was
little evidence for a flare in clinical symptoms after discontinuation of
prednisolone. CONCLUSION: Joint destruction resumed after discontinuation
of prednisolone. This corroborates the previously reported therapeutic
effect and challenges current concepts of disease pathogenesis.
ORIGINAL PAPERS
Joint destruction after glucocorticoids are withdrawn in early rheumatoid arthritis. Arthritis and Rheumatism Council Low Dose Glucocorticoid Study Group
Mount Gould Hospital, Plymouth.
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