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The beneficial effects of a 3 week course of intramuscular glucocorticoid injections in patients with very early inflammatory polyarthritis: Results of the STIVEA trial
Annals of Rheumatic Diseases, 10/23/09

Verstappen SMM et al. – Treatment of patients with very early IP with IM methylprednisolone-acetate appears to postpone the prescription of DMARDs and prevent one in ten patients from progressing into RA.

• Patients with very early IP (4-10 weeks duration) randomised to receive 3 injections of either 80 mg IM methylprednisolone-acetate or placebo, given at weekly intervals
• Assessments monthly until 6 months after first injection, and then concluded at 12 months
• Primary outcome was need to start DMARDs by 6 month assessment
• Secondary outcomes included disease activity and final clinical diagnosis by rheumatologist at 12 months

• Patients in placebo group (76%) more likely to need DMARDs during the first 6 months of trial than patients in glucocorticoid group
• Disease activity did not differ between 2 groups at 12 months, probably because many patients in placebo group started DMARDs early in study
• After 12 months, arthritis had resolved without need for DMARDs in 9.9% (11/111) of patients in placebo group and 19.8% (22/111) in glucocorticoid treated group

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