title: Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold. A randomized double-blind placebo-controlled trial.
abstract: The efficacy of oral prednisone as bridge therapy in rheumatoid arthritis (RA) was studied. Forty patients starting aurothioglucose were randomized to receive either prednisone or placebo for 18 weeks. The dose was 10 mg/day in the first 12 weeks, 7.5 mg/day in weeks 13 and 14, 5 mg/day in weeks 15 and 16, and 2.5 mg/day in weeks 17 and 18. Patients were followed for 44 weeks. We found that disease activity was significantly lower in the prednisone group as early as week 1 and continued up to week 12. Response to prednisone was noticed in 60% of the patients. After tapering prednisone, a rebound deterioration was noticed at weeks 20 and 24 in 58% of the responders. No significant differences in X-ray progression were found between the two groups. We concluded that oral prednisone (10 mg/day) significantly reduces short-term disease activity in 60% of patients with active RA. The rebound deterioration after tapering the dose means that bridge therapy with prednisone using this dose-reduction scheme is not recommended.
authors.affiliation: Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: van Gestel
authors.forename: R F
authors.initials: RF
authors.lastname: Laan
authors.forename: C J
authors.initials: CJ
authors.lastname: Haagsma
authors.forename: L B
authors.initials: LB
authors.lastname: van de Putte
authors.forename: P L
authors.initials: PL
authors.lastname: van Riel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006051:Aurothioglucose / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011241:Prednisone / Q000627:therapeutic use*; D011859:Radiography
chemical_list: D010919:Placebos; D006051:Aurothioglucose; D011241:Prednisone