Glucocorticoid use in RA treatment more prevalent

Dr Matteson

Consistent with treatment guidelines, more rheumatoid arthritis (RA) patients are starting glucocorticoids early in their disease course, according to a study published online in Arthritis Care & Research.

“A higher share are also discontinuing glucocorticoids, but the proportion of patients on them at any given disease point during the first 4 years after diagnosis is higher than it used to be,” according to senior author Eric Matteson, MD, who is chair of rheumatology at Mayo Clinic in Rochester, Minn.

“Corticosteroids are commonly used, even in the modern era of rheumatoid arthritis therapeutics,” Dr Matteson said. “Even in more recent years, they appear to be used early, very likely as a measure to get the disease under control in the initial phase of the disease. “

Dr Matteson and colleagues used resources from the Rochester Epidemiology Project to retrospectively study a population-based cohort of 349 adults diagnosed with rheumatoid arthritis between January 1, 1980, and December 31, 2007. They followed them through their complete medical records or death, migration or December 31, 2008. All generic and trade names of glucocorticoid medications were used to identify exposures documented in the medical records.

According to the authors, a greater proportion of patients started glucocorticoids in their first year of disease in 1995 to 2007 (68% vs 36%, P<.001), but the starting dose and cumulative dose in the first year of use were not different. A higher proportion also discontinued glucocorticoids in their first year of disease in the 1995-2007 cohort (P<.001).

"These differences in GC [glucocorticoid] initiation and discontinuation persisted throughout followup. Prevalence of GC [glucocorticoid] use was higher in the 1995-2007 cohort for the first 3 years of disease," the authors wrote

“We wanted to examine trends in glucocorticoid use to determine whether they have changed as RA therapeutics and treatment practices have changed,” said Dr Matteson. “Prednisone is here to stay.”