Low‐dose prednisolone in addition to the initial disease‐modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: A two‐year randomized trial

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Abstract
Objective: To assess the efficacy of low‐dose prednisolone on joint damage and disease activity in patients with early rheumatoid arthritis (RA).Methods: At the start of their initial treatment with a disease‐modifying antirheumatic drug (DMARD), patients with early (duration ≤1 year) active RA were randomly assigned to receive either 7.5 mg/day prednisolone or no prednisolone for 2 years. Radiographs of the hands and feet were obtained at baseline and after 1 and 2 years and scored according to the Sharp score as modified by van der Heijde. Remission was defined as a Disease Activity Score in 28 joints of P= 0.019). In the prednisolone group, there were fewer newly eroded joints per patient after 2 years (median 0.5 [IQR 0–2] versus 1.25 [IQR 0–3.25];P= 0.007). In the prednisolone group, 25.9% of patients had radiographic progression beyond the smallest detectable difference compared with 39.3% of patients in the no‐prednisolone group (P= 0.033). At 2 years, 55.5% of patients in the prednisolone group had achieved disease remission, compared with 32.8% of patients in the no‐prednisolone group (P= 0.0005). There were few adverse events that led to withdrawal. Bone loss during the 2‐year study was similar in the 2 treatment groups.Conclusion: Prednisolone at 7.5 mg/day added to the initial DMARD retarded the progression of radiographic damage after 2 years in patients with early RA, provided a high remission rate, and was well tolerated. Therefore, the data support the use of low‐dose prednisolone as an adjunct to DMARDs in early active RA.