title: Decline of mean initial prednisone dosage from 10.3 to 3.6 mg/day to treat rheumatoid arthritis between 1980 and 2004 in one clinical setting, with long-term effectiveness of dosages less than 5 mg/day.
abstract: OBJECTIVE
  To analyze prednisone treatment from 1980-2004 in 308 patients with rheumatoid arthritis (RA), including 75 monitored over 4-8 years and 73 monitored over >8 years, for initial dose, long-term doses and effectiveness, and adverse events.
  
  
  METHODS
  A database of all patients of a single rheumatologist included medications and Multidimensional Health Assessment Questionnaire (MDHAQ) scores at each visit. Proportions of patients whose initial prednisone dosages were >5, 5, or <5 mg/day were computed in 5-year periods: 1980-1984, 1985-1989, 1990-1994, 1995-1999, and 2000-2004. Mean changes in MDHAQ function, pain, and Routine Assessment of Patient Index Data 3 (RAPID3) scores were compared in patients treated with <5 versus ≥5 mg/day of prednisone; scores and adverse events were analyzed in quartiles by treatment duration of ≤1, 1.1-4, 4.1-8, and >8 years.
  
  
  RESULTS
  In the respective 5-year periods, the mean initial prednisone dosages were 10.3, 6.5, 5.1, 4.1, and 3.6 mg/day, with >5 mg/day in 49%, 16%, 7%, 7%, and 3% of patients, 5 mg/day in 51%, 80%, 70%, 26%, and 10% of patients, and <5 mg/day in 0%, 4%, 23%, 67%, and 86% of patients. Most patients received early concomitant methotrexate after 1990, and prednisone <5 mg/day was maintained indefinitely. Patients treated with prednisone ≥5 mg/day had poorer clinical status as baseline and followup. MDHAQ scores improved similarly in patients treated with <5 or ≥5 mg/day. Primary adverse events were skin thinning and bruising. New hypertension, diabetes mellitus, and cataracts occurred in <10% of all patients, and <13% of those treated longer than 8 years.
  
  
  CONCLUSIONS
  The data suggest that many patients with RA might be treated effectively with initial and long-term prednisone <5 mg/day, although further research and observational data are needed to characterize more fully effectiveness and safety.
authors.affiliation: Department of Rheumatology, Room 1608, NYU-Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. tedpincus@gmail.com
authors.forename: Theodore
authors.initials: T
authors.lastname: Pincus
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
authors.forename: Isabel
authors.initials: I
authors.lastname: Castrejón
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
mesh_terms: D000046:Academic Medical Centers / Q000639:trends*; D000553:Ambulatory Care / Q000639:trends*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D016208:Databases, Factual / Q000639:trends; D004305:Dose-Response Relationship, Drug; D006801:Humans; D011241:Prednisone / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone