Clinical Rheumatology

, Volume 36, Issue 1, pp 59–66 | Cite as

Does addition of glucocorticoids to the initial therapy influence the later course of the disease in patients with early RA? Results from the Swiss prospective observational registry (SCQM)

  • Ruediger B. Mueller
  • Nazim Reshiti
  • Toni Kaegi
  • Axel Finckh
  • Sarah R. Haile
  • Hendrik Schulze-Koops
  • Michael Schiff
  • Michael Spaeth
  • Johannes von Kempis
  • on behalf of the SCQM physicians
Original Article


The main goal of this study was to analyse whether initial addition of glucocorticoid to DMARD therapy influences the long-term course of the disease in patients with early rheumatoid arthritis. All patients from the Swiss RA cohort SCQM with recent-onset arthritis (disease duration ≤1 year) were analysed. The exposure of interest was the use of glucocorticoids (GCs) at baseline. As primary outcome, we considered clinical and radiographic disease progression, assessed by the disease activity (disease activity score, DAS-28), function (health assessment questionnaire disability index, HAQ-DI) and structural joint damage (Ratingen erosion score). The baseline disease characteristics were compared using standard descriptive statistics. The effects of initial GC use on disease progression during follow-up were estimated using linear mixed models with random slope and random intercept, adjusted for potential confounders. In total, 592 patients with early disease were available, with 4.3 years of follow-up (average). Of these, 363 were initially treated with glucocorticoids (GC patients) and 228 were not (no-GC patients). DAS-28 (4.6 vs. 4.3, p = 0.01) and the HAQ-DI (0.94 vs. 0.82, p = 0.01) were higher at baseline in GC patients, while other prognostic factors were balanced at baseline. Neither the change of DAS-28, of HAQ-DI nor of the development of joint erosions differed between the two groups during follow-up. Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p < 0.01). In this cohort, patients with early RA initially treated with GCs had higher measures of disease activity at baseline in comparison to no-GC patients. Despite a similar course of the disease in GC versus non-GC patients, the higher escalation rate to biologic agents in GC patients may reflect a disease less responsive to therapy in these patients. These data suggest that GC use as part of the initial therapeutic strategy in early RA may prevent a more severe course of the disease in patients with higher clinical disease measures at the start of therapy.


Disease progression Early disease Glucocorticoids Rheumatoid arthritis 



The authors acknowledge the SCQM-RA staff maintaining the registry and the rheumatologists including the patients. A list of contributing institutions can be found under


RM: setup of the study, interpretation of data and writing of the manuscript

NR: interpretation of data and writing of the manuscript

TK: interpretation of data and writing of the manuscript

AF: interpretation of data and writing of the manuscript

SH: interpretation of data and writing of the manuscript

HS: interpretation of data and writing of the manuscript

MSch: interpretation of data and writing of the manuscript

MSp: interpretation of data and writing of the manuscript

JK: setup of the study, interpretation of data and writing of the manuscript

All authors read and approved the manuscript.

Compliance with ethical standards

Ethics approval

Ethics approval for the collection of patient data for the SCQM cohort was given by the regional review boards. Compliance with ethical standards was obtained throughout the study.

Informed consent

Informed consent was obtained from all patients before inclusion in the SCQM cohort.

Financial disclosures/funding

The study was conducted without special funding. SCQM has received grants from the Swiss health authorities (BAG), the Swiss Academy for Medical Sciences (SAMW) and private companies (Pfizer, AbbVie, MSD, Aventis, Bristol-Myers, Mepha, Merck, Novartis and Roche).

Financial support





  1. 1.
    van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW (2002) Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 136(1):1–12CrossRefPubMedGoogle Scholar
  2. 2.
    Kirwan JR (1995) The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The arthritis and rheumatism council low-dose glucocorticoid study group. N Engl J Med 333(3):142–146CrossRefPubMedGoogle Scholar
  3. 3.
    Kirwan JR, Quilty B (1997) Prognostic criteria in rheumatoid arthritis: can we predict which patients will require specific anti-rheumatoid treatment? Clin Exp Rheumatol 15(Suppl 17):S15–S25PubMedGoogle Scholar
  4. 4.
    Svensson B, Boonen A, Albertsson K, van der Heijde D, Keller C, Hafstrom I (2005) Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum 52(11):3360–3370CrossRefPubMedGoogle Scholar
  5. 5.
    Wassenberg S, Rau R, Steinfeld P, Zeidler H (2005) Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum 52(11):3371–3380CrossRefPubMedGoogle Scholar
  6. 6.
    Mottonen T, Hannonen P, Leirisalo-Repo M, Nissila M, Kautiainen H, Korpela M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo trial group. Lancet 353(9164):1568–1573CrossRefPubMedGoogle Scholar
  7. 7.
    Boers M, Verhoeven AC, Markusse HM, van de Laar MA, Westhovens R, van Denderen JC et al (1997) Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 350(9074):309–318CrossRefPubMedGoogle Scholar
  8. 8.
    Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM et al (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 52(11):3381–3390CrossRefPubMedGoogle Scholar
  9. 9.
    den Uyl D, ter Wee M, Boers M, Kerstens P, Voskuyl A, Nurmohamed M et al (2014) A non-inferiority trial of an attenuated combination strategy (‘COBRA-light’) compared to the original COBRA strategy: clinical results after 26 weeks. Ann Rheum Dis 73(6):1071–1078CrossRefGoogle Scholar
  10. 10.
    Hoes JN, Jacobs JW, Verstappen SM, Bijlsma JW, Van der Heijden GJ (2009) Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis 68(12):1833–1838CrossRefPubMedGoogle Scholar
  11. 11.
    Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73(3):492–509CrossRefPubMedGoogle Scholar
  12. 12.
    Finckh A, Liang MH, van Herckenrode CM, de Pablo P (2006) Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Rheum 55(6):864–872CrossRefPubMedGoogle Scholar
  13. 13.
    Uitz E, Fransen J, Langenegger T, Stucki G (2000) Clinical quality management in rheumatoid arthritis: putting theory into practice. Swiss Clinical Quality Management in Rheumatoid Arthritis. Rheumatology 39(5):542–549CrossRefPubMedGoogle Scholar
  14. 14.
    Mueller RB, Kaegi T, Finckh A, Haile SR, Schulze-Koops H, von Kempis J et al (2014) Is radiographic progression of late-onset rheumatoid arthritis different from young-onset rheumatoid arthritis? Results from the Swiss prospective observational cohort. Rheumatology (Oxford) 53(4):671–677CrossRefGoogle Scholar
  15. 15.
    Mueller RB, Schiff M, Kaegi T, Finckh A, Haile SR, Schulze-Koops H et al (2015) The new 2010 ACR/EULAR criteria as predictor of clinical and radiographic response in patients with early arthritis. Clin Rheumatol 34(1):51–59CrossRefPubMedGoogle Scholar
  16. 16.
    Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 26(11):1346–1353CrossRefPubMedGoogle Scholar
  17. 17.
    Rau R, Wassenberg S, Herborn G, Stucki G, Gebler A (1998) A new method of scoring radiographic change in rheumatoid arthritis. J Rheumatol 25(11):2094–2107PubMedGoogle Scholar
  18. 18.
    Detert J, Bastian H, Listing J, Weiss A, Wassenberg S, Liebhaber A et al (2013) Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann Rheum Dis 72(6):844–850CrossRefPubMedGoogle Scholar
  19. 19.
    de Jong PH, Hazes JM, Han HK, Huisman M, van Zeben D, van der Lubbe PA et al (2014) Randomised comparison of initial triple DMARD therapy with methotrexate monotherapy in combination with low-dose glucocorticoid bridging therapy; 1-year data of the tREACH trial. Ann Rheum Dis 73(7):1331–1339CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou JF et al (2003) Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 30(11):2344–2349PubMedGoogle Scholar
  21. 21.
    Dixey J, Solymossy C, Young A, Early RAS (2004) Is it possible to predict radiological damage in early rheumatoid arthritis (RA)? A report on the occurrence, progression, and prognostic factors of radiological erosions over the first 3 years in 866 patients from the Early RA Study (ERAS). J Rheumatol Suppl 69:48–54PubMedGoogle Scholar
  22. 22.
    Atzeni F, Antivalle M, Pallavicini FB, Caporali R, Bazzani C, Gorla R et al (2009) Predicting response to anti-TNF treatment in rheumatoid arthritis patients. Autoimmun Rev 8(5):431–437CrossRefPubMedGoogle Scholar
  23. 23.
    de Jong PH, Hazes JM, Barendregt PJ, Huisman M, van Zeben D, van der Lubbe PA et al (2013) Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann Rheum Dis 72(1):72–78CrossRefPubMedGoogle Scholar
  24. 24.
    Bakker MF, Jacobs JW, Welsing PM, Verstappen SM, Tekstra J, Ton E et al (2012) Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med 156(5):329–339CrossRefPubMedGoogle Scholar
  25. 25.
    Moreland LW, O'Dell JR, Paulus HE, Curtis JR, Bathon JM, St Clair EW et al (2012) A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: the treatment of early aggressive rheumatoid arthritis trial. Arthritis Rheum 64(9):2824–2835CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Fiehn C, Belke-Voss E, Krause D, Wassenberg S, Rau R (2013) Improved radiological outcome of rheumatoid arthritis: the importance of early treatment with methotrexate in the era of biological drugs. Clin Rheumatol 32(12):1735–1742CrossRefPubMedGoogle Scholar
  27. 27.
    Laan RF, Jansen TL, van Riel PL (1999) Glucocorticosteroids in the management of rheumatoid arthritis. Rheumatology (Oxford) 38(1):6–12CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2016

Authors and Affiliations

  • Ruediger B. Mueller
    • 1
  • Nazim Reshiti
    • 1
  • Toni Kaegi
    • 1
  • Axel Finckh
    • 2
  • Sarah R. Haile
    • 3
  • Hendrik Schulze-Koops
    • 4
  • Michael Schiff
    • 5
  • Michael Spaeth
    • 6
  • Johannes von Kempis
    • 1
  • on behalf of the SCQM physicians
  1. 1.Division of Rheumatology, Immunology and RehabilitationKantonsspital St. GallenSt. GallenSwitzerland
  2. 2.Division of RheumatologyUniversity Hospital of GenevaGenevaSwitzerland
  3. 3.Epidemiology, Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland
  4. 4.Rheumaeinheit, Medizinische Klinik IVKlinikum der Universität MünchenMunichGermany
  5. 5.University of ColoradoDenverUSA
  6. 6.Spital LinthUznachSwitzerland

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