Is tapering glucocorticoids safe in rheumatoid arthritis after achieving low disease activity?

This study investigated tapering glucocorticoids (GCs) in rheumatoid arthritis (RA) patients who have achieved low disease activity (LDA). They found that continuing GCs at a low dose was more effective at sustaining LDA. 

Rheumatoid arthritis (RA) is a chronic condition. Excess inflammation causes painful swelling in the joints. Over time this leads to joint damage and disability. RA is treated with drugs to reduce inflammation. They are called disease-modifying anti-rheumatic drugs (DMARDs). One commonly used drug type is glucocorticoids (GC).  

GCs are usually used for short periods of time. This is because they can cause side effects. His includes osteoporosis, high blood sugar, and heart complications. GCs are also used in combination with other DMARDs. Some doctors think GC doses should be reduced in patients with low disease activity (LDA) or remission. This is called tapering. However, tapering GCs could result in an increase in DA. It is unclear if GC tapering is safe and effective in RA patients with LDA/remission.

This study included 259 RA patients with LDA/remission. All patients were taking a biological DMARD called tocilizumab (Actemra). Patients were also taking a GC called prednisone (PDN; Deltasone). Patients were randomly assigned to take the same dose of PDN (5 mg) or reduce it (0 mg) over 16 weeks. The total treatment time lasted 24 weeks. DA was measured using the DAS28-ESR score.

At 24 weeks, DA increased in patients in the tapering PDN group, while it decreased in the continued PDN group. More patients in the continued PDN group had maintained LDA and had no RA flares (77%) than the tapering PDN group (65%).

Patients in the continued PDN group had greater improvements in health-related quality of life tests. This included disability and pain scores. Side effects related to treatment were reported in 61% of the tapering group compared to 50% of the continued PDN group.

The authors concluded that continuing GCs at a low dose was more effective at sustaining LDA in patients with RA who achieved LDA/remission.

Some patient details were not available to the authors. The duration or dose of previous GC treatment was not available. The long-term safety of tapering is still unclear. Follow-up studies are needed. 

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