title: Low-dose prednisolone in rheumatoid arthritis: adverse effects of various disease modifying antirheumatic drugs.
abstract: OBJECTIVE
  To assess the incidence and severity of disease modifying antirheumatic drug (DMARD)-induced adverse effects (AE) in patients with rheumatoid arthritis (RA) taking/not taking glucocorticoids (GC). More specifically, we tested whether GC can prolong the survival time of DMARD in patients receiving combination therapy.
  
  
  METHODS
  In a retrospective study of 154 patients with RA, data were examined for DMARD therapy and duration of low-dose GC ((3/4) 7.5 mg prednisone equivalent/day). Patients were followed for 2-62 months, and AE were graded following WHO criteria.
  
  
  RESULTS
  GC therapy significantly increased the duration of therapy with sulfasalazine (SSZ) from 10.4 +/- 2.3 to 22.5 +/- 1.9 months and for methotrexate (MTX) from 21.8 +/- 2.9 to 43.3 +/- 2.7 months. Stratifying the withdrawal of DMARD for occurrence of AE and loss of efficacy revealed that GC comedication significantly increased the time until AE for users of MTX (3.0 +/- 0.6 vs 18.8 +/- 1.3 mo; p < 0.05), hydroxychloroquine (HCQ; 34.5 +/- 4.6 vs 54.4 +/- 5.1 mo; p < 0.05), and gold (6.6 +/- 0.9 vs 10.5 +/- 0.9 mo; p < 0.05). In patients taking SSZ the time until cessation due to loss of efficacy increased significantly under GC comedication (16.8 +/- 1.2 vs 31.3 +/- 2.9 mo; p < 0.05). However, in patients taking azathioprine (AZA) the duration of therapy decreased from 44.4 +/- 2.6 to 22.3 +/- 1.6 months under GC due to both time until AE and loss of efficacy. Patients under comedication of MTX + GC, HCQ + GC, and AZA + GC experienced significantly more AE compared to the respective DMARD monotherapy. A highly significant reduction was observed in the frequency of erosive RA in patients with GC comedication (n = 30; 49.1%) compared to patients without low-dose GC (n = 81, 80.4%; OR 4.05, 95% CI 1.91-8.66, p < 0.0001).
  
  
  CONCLUSIONS
  Low-dose GC retard radiological progression of RA and exhibit a differential effect on survival of DMARD and degree of AE due to DMARD. Further studies are warranted to address safety and interactions of chronic low-dose GC in RA patients treated with DMARD.
authors.affiliation: Medical Clinic and Polyclinic IV, University Hospital, Leipzig, Germany. Olga.Malysheva@medizin.uni-leipzig.de
authors.forename: Olga A
authors.initials: OA
authors.lastname: Malysheva
authors.forename: Matthias
authors.initials: M
authors.lastname: Wahle
authors.forename: Ulf
authors.initials: U
authors.lastname: Wagner
authors.forename: Matthias
authors.initials: M
authors.lastname: Pierer
authors.forename: Sybille
authors.initials: S
authors.lastname: Arnold
authors.forename: Holm
authors.initials: H
authors.lastname: Häntzschel
authors.forename: Cristoph G O
authors.initials: CG
authors.lastname: Baerwald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D012189:Retrospective Studies; D012460:Sulfasalazine / Q000009:adverse effects
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D011239:Prednisolone; D008727:Methotrexate