Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis. Results of a 12 month open-label randomized study. Arthritis Research & Therapy, 05/17/2012

Montecucco C et al. – In early rheumatoid arthritis (RA), despite a similar response rate in terms of low disease activity (LDA), low–dose oral prednisone (PDN) co–medication led to a higher proportion of clinical remission and power Doppler (PD) negativity compared to methotrexate (MTX) monotherapy, thus ensuring a better disease activity control.

• Two hundred and twenty (220) patients with early RA (<1 year from clinical onset) were treated according to a low disease activity (LDA) targeted step–up protocol including methotrexate (MTX) and, in the active treatment arm, low–dose (6.25 mg/d) oral PDN over 12 months.
• Clinical disease activity measures were collected at baseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months.
• Grey–scale (GS) and power Doppler (PD) synovitis were scored (0 to 3) for each joint.
• At 12 months, clinical remission, according to disease activity score 28 (DAS28), was defined as clinical outcome, and total joint PD score=0 (PD negativity) as imaging outcome.

• Each group included 110 patients with comparable demographic, clinical, laboratory and US characteristics.
• At 12 months, LDA rate was similar in the 2 groups, whilst clinical remission rate (RR 1.61 [95%CI 1.08, 2.04]) and PD negativity rate (RR 1.31 [95%CI 1.04, 1.64]) were significantly higher in MTX+PDN group.