[Effect of small-dose glucocorticoids on the course of early rheumatic arthritis]

Abstract

The study was undertaken to evaluate the effect of small-dose glucocorticoids (GCs) in combination with essential drugs used in early rheumatic arthritis (RA) on the clinical and laboratory activity and progression of joint destruction. Sixty-two patients aged 18-63 years who had active RA (its history being 1.5 to 24 months) and had not received basic therapy before were given methotrexate (MT) in a dose of 7.5-10.0 mg/week. Prednisolone (P) was randomly used in a dose equal or more than 10 mg/day). The efficiency of treatment was evaluated every 3 months by the ACR criteria 20/50/70. X-ray study of the hand and foot joints (the Larsen procedure by erosion calculations) was performed and the serum levels of C-reactive protein (C-RP) and interleukin-6 (IL-6) were measured before and 12 months after therapy. In the MT group, the patients' mean age was 52.0 +/- 10.5 years, the history of RA was 8.4 +/- 6.8 months; 82% of the patients were seropositive in terms of rheumatoid factor; the DAS 28 index was 5.2 +/- 0.8; in the P+MT group, the above parameters were 51.9 +/- 11. 7 years, 9.1 +/- 6.0 months, 83%, and 5.4 +/- 0.8, respectively (p > 0.05). Throughout one-year follow-up, the patients whose parameters corresponded to ACR 70 were more in the P+MT group than in the MT group (p < 0.05). The level of IL-6 and C-RP significantly decreased only in the P+MT group. There was a significant in the Larsen scores in both groups. A much fewer number of new erosions was revealed in the P+MT group than that in the MT group. According to the ACR 70 criteria, the efficiency of treatment with small-dose GCs was much higher than that in MT monotherapy. The small doses of GCs significantly lowered the laboratory activity of RA (C-RP, IL-6) and the occurrence of erosions.