Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis

Letters21 August 2012Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid ArthritisTheodore Pincus, MD, Isabel Castrejon, MD, and Yusuf Yazici, MDTheodore Pincus, MDFrom New York University Hospital for Joint Diseases, New York, NY 10003., Isabel Castrejon, MDFrom New York University Hospital for Joint Diseases, New York, NY 10003., and Yusuf Yazici, MDFrom New York University Hospital for Joint Diseases, New York, NY 10003.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-4-201208210-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The article by Bakker and colleagues (1) presents impressive control of disease activity in patients with rheumatoid arthritis (RA), which ironically may have attenuated the apparent treatment effect of prednisone. Overall, 67% of patients who received no prednisone had no erosions—only 11% fewer than the 78% of patients treated with 10 mg/d of prednisone for 2 years, albeit a statistically significant difference. The strongest treatment effects that were maintained over 2 years involved patient functional status, which generally is more significant than laboratory and radiographic data to predict work disability and mortality in patients with RA (2).... References1. Bakker MF, Jacobs JW, Welsing PM, Verstappen SM, Tekstra J, Ton E, et al; Utrecht Rheumatoid Arthritis Cohort Study Group. Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med. 2012;156:329-39. [PMID: 22393128] LinkGoogle Scholar2. Pincus T, Bijlsma JW, Braun J, Buttgereit F, Cutolo M. Low-dose glucocorticoids in rheumatic diseases: introduction. Clin Exp Rheumatol. 2011;29:S2-4. [PMID: 22018176] MedlineGoogle Scholar3. Wassenberg S, Rau R, Steinfeld P, Zeidler H. Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:3371-80. [PMID: 16255011] CrossrefMedlineGoogle Scholar4. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004;141:764-70. [PMID: 15545676] LinkGoogle Scholar5. Pincus T, Sokka T, Stein CM. Are long-term very low doses of prednisone for patients with rheumatoid arthritis as helpful as high doses are harmful? [Editorial]. Ann Intern Med. 2002;136:76-8. [PMID: 11777366] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From New York University Hospital for Joint Diseases, New York, NY 10003.Disclosures: Dr. Pincus: Consultancy: Bristol-Myers Squibb, Genentech, UCB. Dr. Yazici: Consultancy: Abbott, Bristol-Myers Squibb, Genentech, Pfizer, Horizon, UCB; Grants/grants pending: Bristol-Myers Squibb, Genentech, Janssen. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis Marije F. Bakker , Johannes W.G. Jacobs , Paco M.J. Welsing , Suzanne M.M. Verstappen , Janneke Tekstra , Evelien Ton , Monique A.W. Geurts , Jacobine H. van der Werf , Grietje A. van Albada-Kuipers , Zalima N. Jahangier-de Veen , Maaike J. van der Veen , Catharina M. Verhoef , Floris P.J.G. Lafeber , Johannes W.J. Bijlsma , and Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis Athanase D. Protogerou , Evangelia Zampeli , and Petros P. Sfikakis Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis Johannes W.G. Jacobs , Marije F. Bakker , and Johannes W.J. Bijlsma Metrics Cited ByInteractions among Low Dose of Methotrexate and Drugs Used in the Treatment of Rheumatoid Arthritis 21 August 2012Volume 157, Issue 4Page: 299KeywordsClinical trial reportingDrugsHypertensionMethotrexateOsteoporosisResearch laboratoriesRheumatoid arthritis ePublished: 21 August 2012 Issue Published: 21 August 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...