title: Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial.
abstract: BACKGROUND
  Treatment strategies for tight control of early rheumatoid arthritis (RA) are highly effective but can be improved.
  
  
  OBJECTIVE
  To investigate whether adding prednisone, 10 mg/d, at the start of a methotrexate (MTX)-based treatment strategy for tight control in early RA increases its effectiveness.
  
  
  METHODS
  A 2-year, prospective, randomized, placebo-controlled, double-blind, multicenter trial (CAMERA-II [Computer Assisted Management in Early Rheumatoid Arthritis trial-II]). (International Standard Randomised Controlled Trial Number: ISRCTN 70365169)
  
  
  METHODS
  7 hospitals in the Netherlands.
  
  
  METHODS
  236 patients with early RA (duration <1 year).
  
  
  METHODS
  Patients were randomly assigned to an MTX-based, tight control strategy starting with either MTX and prednisone or MTX and placebo. Methotrexate treatment was tailored to the individual patient at monthly visits on the basis of predefined response criteria aiming for remission.
  
  
  METHODS
  The primary outcome was radiographic erosive joint damage after 2 years. Secondary outcomes included response criteria, remission, and the need to add cyclosporine or a biologic agent to the treatment.
  
  
  RESULTS
  Erosive joint damage after 2 years was limited and less in the group receiving MTX and prednisone (n = 117) than in the group receiving MTX and placebo (n = 119). The MTX and prednisone strategy was also more effective in reducing disease activity and physical disability, achieving sustained remission, and avoiding the addition of cyclosporine or biologic treatment. Adverse events were similar in both groups, but some occurred less in the MTX and prednisone group.
  
  
  CONCLUSIONS
  A tight control strategy for RA implies monthly visits to an outpatient clinic, which is not always feasible.
  
  
  CONCLUSIONS
  Inclusion of low-dose prednisone in an MTX-based treatment strategy for tight control in early RA improves patient outcomes.
  
  
  BACKGROUND
  Catharijne Foundation.
authors.affiliation: Department of Rheumatology and Clinical Immunology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, and Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: Marije F
authors.initials: MF
authors.lastname: Bakker
authors.forename: Johannes W G
authors.initials: JW
authors.lastname: Jacobs
authors.forename: Paco M J
authors.initials: PM
authors.lastname: Welsing
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: Janneke
authors.initials: J
authors.lastname: Tekstra
authors.forename: Evelien
authors.initials: E
authors.lastname: Ton
authors.forename: Monique A W
authors.initials: MA
authors.lastname: Geurts
authors.forename: Jacobine H
authors.initials: JH
authors.lastname: van der Werf
authors.forename: Grietje A
authors.initials: GA
authors.lastname: van Albada-Kuipers
authors.forename: Zalima N
authors.initials: ZN
authors.lastname: Jahangier-de Veen
authors.forename: Maaike J
authors.initials: MJ
authors.lastname: van der Veen
authors.forename: Catharina M
authors.initials: CM
authors.lastname: Verhoef
authors.forename: Floris P J G
authors.initials: FP
authors.lastname: Lafeber
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011241:Prednisone; D008727:Methotrexate