Study: Adding prednisone to rheumatoid arthritis treatment improves symptoms

Patients’ rheumatoid arthritis (RA) symptoms improved after adding prednisone at the start of a methotrexate-based treatment strategy, according to research published in the March 6 issue of the Annals of Internal Medicine.

The study was conducted by several health facilities on behalf of the Utrecht Rheumatoid Arthritis Cohort Study Group.

Researchers conducted a 2-year prospective, randomized, multicenter trial at 7 hospitals in The Netherlands, enrolling 236 patients with early RA (less than a year).

Patients were randomly assigned to a methotrexate-based, tight-control strategy, starting with either methotrexate and 10 mg/d of prednisone or methotrexate and placebo. Erosive joint damage after 2 years was limited and less in the group receiving methotrexate and prednisone than in the group receiving methotrexate and placebo.

According to researchers, the methotrexate and prednisone strategy was also more effective in reducing disease activity and physical disability and achieving sustained remission.

The need for additional treatment such as cyclosporine or adalimumab in the methotrexate and prednisone group was significantly less than that in the methotrexate and placebo group, according to the researchers.

The reduced need for additional treatments, along with better physical functioning and quality of life, could affect cost-effectiveness of treating RA in the future, the researchers wrote.

“On the basis of these data, a cost-effectiveness trial comparing a tight control strategy of methotrexate and prednisone with a strategy directly starting with a biologic agent seems justified,” the researchers stated.