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Early initial
intensive therapy should include glucocorticoid
(GC) bridging in rheumatoid arthritis (RA) patients likely
to have a favourable prognosis.
As per the subanalysis of the CareRA randomized controlled trial, initial oral glucocorticoid bridging reduced chronic non-steroidal anti-inflammatory drug (NSAID) and analgesic intake in patients with RA considered to have favourable prognosis.
The study researchers investigated NSAIDs and analgesics intake in early RA (less than or equal to 1 year) with a favourable risk profile (no erosions, negative for the presence of rheumatoid factor and anti-citrullinated protein antibodies or low disease activity) commencing methotrexate (MTX) with or without GC bridging.
Participants were randomized to MTX 15 mg with a step-down GC plan (COBRA Slim) (n=43), or MTX without oral GCs i.e. Tight-Step-Up plan (TSU) (n=47). The frequency, start/end date and indication associated with analgesics were noted down. Intake of NSAIDs for ≥90 days, acetaminophen, opioids plus tramadol and antidepressants indicated for musculoskeletal pain were taken into consideration.
Prior to the study, more patients in the COBRA Slim used analgesics. During the trial, patients used 67 and 107 NSAID and analgesics in COBRA Slim and TSU group (details in table 1):
Overall, the number
of patients on NSAID and analgesics at any time during the study and chronically considerably varied between the
groups. Also, the number of patients on
daily chronically NSAIDs was markedly different.
RMD Open
Short-term glucocorticoids reduce risk of chronic NSAID and analgesic use in early methotrexate-treated rheumatoid arthritis patients with favourable prognosis: subanalysis of the CareRA randomised controlled trial
Sofia Pazmino et al.
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