Are low-dose glucocorticoids safe and effective in combination with methotrexate and hydroxychloroquine in early rheumatoid arthritis?

This study investigated the use of low dose (LD) glucocorticoids (GC) combined with methotrexate (MTX; Otrexup) and hydroxychloroquine (HCQ; Plaquenil).in early rheumatoid arthritis (RA).

They found that LD-GCs improved disease activity (DA) combined with MTX and HCQ in these patients.

Rheumatoid arthritis (RA) is a chronic immune condition. It is caused by excessive inflammation. RA is treated with drugs that reduce inflammation. They are called disease-modifying anti-rheumatic drugs (DMARDs). The aim of RA treatment is to reduce disease activity (DA). There are many types of DMARDs. 

Glucocorticoids (GCs) such as prednisone (PDN; Deltasone) are one type of drugs used to treat RA. GCs are effective at reducing inflammation. However, they can be taken for short periods. This is to reduce side effects. Some studies suggest low dose GCs (LD-GCs) can also be effective in early RA. LD-GCs improved DA in combination with another drug, methotrexate (MTX). MTX targets multiple cellular pathways involved in inflammation. Hydroxychloroquine (HCQ) is another drug used to treat RA. It also reduces the immune response. It is unclear If LD-GGs are safe and effective in combination with MTX and HCQ in patients with early RA

This study included 80 patients with early RA that have never received RA treatment before. Patients were randomly assigned to receive LD-GC or placebo (inactive drug) treatment. All patients were also treated with MTX + HCQ. DA was measured used the ACR20 response. This describes how many patients had a 20% reduction in symptoms. The DAS28 score was also used to measure DA. 

Significantly more patients in the LD-GC group (55%) had an ACR20 response in the first month compared to placebo (20%). This effect was observed at all time points up to 12 months (90% vs 72.5%). DAS28 scores were reduced in the LD-GC group for up to 6 months. Joint damage was significantly improved by LD-GC treatment. Bone erosion progressed in placebo (MTX + HCQ) patients only. Similar side effects were seen in both groups. 

The authors concluded that LD-GCs improved DA combined with MTX and HCQ in patients with early RA.

The number of patients in this study was low. The safety of LD-GCs after 1 year is still not clear. Larger, long-term studies are needed. 

If you have any concerns regarding RA management, please discuss with your doctor.