Progression of radiographic joint erosion during low dose corticosteroid treatment of rheumatoid arthritis

Objective, The reported prevention of joint damage during treatment with pr ednisolone 7.5 mg daily in patients with early rheumatoid arthritis (RA)(3) may have important implications for management of RA. We evaluated this ob servation in another patient population. Methods. Radiographic progression rates in paired hand radiographs were ana lyzed in 824 patients with RA who participated in a 3 year prospective, ran domized clinical trial comparing the nonsteroidal antiinflammatory drugs (N SAID) etodolac (150 or 500 mg bid) and ibuprofen (600 mg qid). Disease modi fying antirheumatic drugs (DMARD) were not permitted. Prednisone less than or equal to 5 mg daily was continued by 197 patients (mean dose 4.37 mg dai ly) who had started prednisone therapy at least 6 mo before study entry, bu t new prednisone starts were not allowed. Standardized hand/wrist radiograp hs were done yearly and at dropout; joint erosion and narrowing scores of 3 readers were averaged and progression rates were compared. Results. Mean duration of RA was 3.6 years (range 1-7); patients' ages were 21-78 years; 71% were women. Among the 824 patients, those taking predniso ne were more likely to have had previous DMARD, and at study entry had high er radiographic scores for joint erosion and joint space narrowing and slig htly higher swollen joint counts, C-reactive protein values, and rheumatoid factor titers than those not taking prednisone. However, for the subgroup of 252 patients with RA duration of 12-24 months, prestudy radiographic sco res were not different in those taking or not taking prednisone. The mean ( +/- SD) monthly rate of increase in erosion scores was 0.228 +/- 0.37 for t he prednisone patients and 0.206 +/- 0.35 for patients not taking prednison e (p = 0.994 by ANCOVA), The subgroup with 12 to 24 months' disease duratio n at. entry also showed no significant effect of prednisone treatment on er osion progression. Conclusion. Clinically indicated low dose prednisone did not prevent progre ssive radiographic damage in 197 NSAID treated patients whose physicians ha d initiated 7.5 mg daily before study entry. The risk/benefit ratio of chro nic low dose prednisone in early RA remains uncertain.