title: The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis.
abstract: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.
  
  
  
  Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.
  
  
  
  In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.
  
  
  
  Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.
  
  
  
  ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center n.konijn@vumc.nl.
authors.forename: Nicole P C
authors.initials: NP
authors.lastname: Konijn
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center.
authors.forename: Lilian H D
authors.initials: LH
authors.lastname: van Tuyl
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center Department of Epidemiology & Biostatistics, VU University Medical Center.
authors.forename: Maarten
authors.initials: M
authors.lastname: Boers
authors.affiliation: Department of Epidemiology & Biostatistics, VU University Medical Center.
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center.
authors.forename: Debby
authors.initials: D
authors.lastname: den Uyl
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center Department of Epidemiology & Biostatistics, VU University Medical Center.
authors.forename: Marieke M
authors.initials: MM
authors.lastname: Ter Wee
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam Department of Rheumatology, Westfriesgasthuis, Hoorn.
authors.forename: Pit
authors.initials: P
authors.lastname: Kerstens
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center.
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Voskuyl
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dirkjan
authors.initials: D
authors.lastname: van Schaardenburg
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.affiliation: Department of Rheumatology, Amsterdam Rheumatology and immunology Center Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001823:Body Composition / Q000187:drug effects*; D015992:Body Mass Index; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D050177:Overweight / Q000150:complications / Q000503:physiopathology; D011239:Prednisolone / Q000008:administration & dosage*
chemical_list: D018501:Antirheumatic Agents; D011239:Prednisolone
keywords: body composition; cardiovascular disease; cobra light; glucocorticoids; log-ratio analysis; rheumatoid arthritis