JOINT DESTRUCTION AFTER GLUCOCORTICOIDS ARE WITHDRAWN IN EARLY RHEUMATOID-ARTHRITIS

Objective. Prednisolone reduced the progression of joint destruction o ver 2 yr in early, active rheumatoid arthritis. The response to discon tinuation of prednisolone under double-blind conditions is:now reporte d. Methods. A randomized, double-blind, placebo-controlled trial of pr ednisolone 7.5 mg daily in addition to routine medication over 2 yr in 128 patients with early rheumatoid arthritis, using radiological prog ression (changes in the Larsen score) and the development of erosions as primary outcome measures;: Study medication was blindly discontinue d and follow-up maintained for a further year. Other assessments inclu ded 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 patien ts). 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 yea r 3 (P = 0.587, 0.913 and 0.039 for change within each year, respectiv ely). The equivalent placebo group means were 2.34, 1.00 and 1.63 Lars en 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 ha nds 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. The re was little evidence-for a flare in clinical symptoms after disconti nuation of prednisolone. Conclusion. Joint destruction resumed after d iscontinuation of prednisolone. This corroborates the previously repor ted therapeutic effect and challenges current concepts of disease path ogenesis.