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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)

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Abstract

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.

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Acknowledgments

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 www.scqm.ch/institutions.

Contributorship

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.

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Authors and Affiliations

  1. Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland

    Ruediger B. Mueller, Nazim Reshiti, Toni Kaegi & Johannes von Kempis

  2. Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland

    Axel Finckh

  3. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    Sarah R. Haile

  4. Rheumaeinheit, Medizinische Klinik IV, Klinikum der Universität München, Pettenkoferstr. 8a, 80336, Munich, Germany

    Hendrik Schulze-Koops

  5. University of Colorado, Denver, CO, USA

    Michael Schiff

  6. Spital Linth, Uznach, Switzerland

    Michael Spaeth

Authors
  1. Ruediger B. Mueller
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  2. Nazim Reshiti
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  3. Toni Kaegi
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  4. Axel Finckh
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  5. Sarah R. Haile
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  6. Hendrik Schulze-Koops
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  7. Michael Schiff
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  8. Michael Spaeth
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  9. Johannes von Kempis
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Consortia

on behalf of the SCQM physicians

Corresponding author

Correspondence to Ruediger B. Mueller.

Ethics declarations

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).

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Disclosures

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Additional information

Key message: The use of GC in early arthritis may compensate unfavourable prognostic factors.

Significance and innovation

•GC use may have a beneficial role in patients with unfavourable prognostic factors.

-Patients with initial GC treatment had more unfavourable prognostic factors than those without.

-Early-RA patients with and without initial GC use demonstrated similar clinical and radiographic development during follow-up.

•In our opinion, in the absence of contraindications, GCs should always be considered as bridging therapy in early disease and used, in particular, if unfavourable prognostic factors are present.

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Mueller, R.B., Reshiti, N., Kaegi, T. et al. 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). Clin Rheumatol 36, 59–66 (2017). https://doi.org/10.1007/s10067-016-3468-6

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  • DOI: https://doi.org/10.1007/s10067-016-3468-6

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