title: Glucocorticoids in the treatment of rheumatoid arthritis: still used after 65 years.
abstract: Glucocorticoids (GCs) have been used for over 65 years in the treatment of rheumatoid arthritis (RA). There is by now good evidence for their disease-modifying effects, especially in early RA. When used in a dosage of 5-10 mg, most adverse effects can adequately be monitored, though accurate monitoring and awareness for infections are important. In this paper, the Utrecht and computer-assisted management in early rheumatoid arthritis (CAMERA) studies are discussed; the Utrecht study was the first of these studies in which 10 mg prednisone daily was compared to placebo in patients with early RA. A clear disease-modifying effect was shown. In the CAMERA II study, patients with early RA were treated with a tight-control scheme of climbing dosages of methotrexate plus either 10 mg prednisone daily or placebo. After 2 years, 70% of the patients treated with a tight-control strategy without GCs had no erosions versus 82% of the patients treated with additional prednisone. Remission was reached more often and earlier on in the strategy with prednisone compared to the strategy with placebo.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Johannes W G
authors.initials: JW
authors.lastname: Jacobs
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011241:Prednisone; D008727:Methotrexate
keywords: disease-modifying antirheumatic drugs; glucocorticoids; methotrexate; rheumatoid arthritis; tight control