Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2014 Oct;66(10):1482-8.
doi: 10.1002/acr.22365.

Time trends in glucocorticoid use in rheumatoid arthritis: results from a population-based inception cohort, 1980-1994 versus 1995-2007

Ashima Makol  1 , John M Davis 3rd, Cynthia S Crowson, Terry M Therneau, Sherine E Gabriel, Eric L Matteson
Affiliations
Observational Study

Time trends in glucocorticoid use in rheumatoid arthritis: results from a population-based inception cohort, 1980-1994 versus 1995-2007

Ashima Makol et al. Arthritis Care Res (Hoboken). 2014 Oct.

Abstract

Objective: To examine trends in glucocorticoid (GC) use and dosing among patients diagnosed with rheumatoid arthritis (RA) over time.

Methods: A population-based inception cohort of RA patients diagnosed during 1980-2007 was followed longitudinally through their medical records until death, migration, or December 31, 2008. GC start and stop dates were collected, along with doses in prednisone equivalents.

Results: The study population comprised 349 patients (68% women) diagnosed in 1980-1994 and 464 (69% women) diagnosed in 1995-2007, with a median followup of 15.3 and 5.7 years, respectively. A higher proportion of patients started GCs in their first year of disease in 1995-2007 (68% versus 36%; P < 0.001), but the starting dose (mean 8.7 versus 10.3 mg; P = 0.08) and cumulative dose in the first year of use (mean 1.8g [mean daily dose 4.9 mg] versus 2.1 gm [mean daily dose 5.8 mg]; P = 0.48) were not different. A higher proportion also discontinued GCs in their first year of disease in the 1995-2007 cohort (P < 0.001). These differences in GC initiation and discontinuation persisted throughout followup. Prevalence of GC use was higher in the 1995-2007 cohort for the first 3 years of disease.

Conclusion: More patients are starting GCs early in their disease course now compared to previously, which is consistent with established treatment guidelines. A higher proportion are also discontinuing GCs, but the proportion of patients taking GCs at any given point of disease during the first 4 years is higher now than previously. Despite early addition of a disease-modifying antirheumatic drug, some patients may not be able to discontinue GCs over the long term.

PubMed Disclaimer

Conflict of interest statement

Disclosure of Interests

None of the authors have any relevant financial or other conflicts of interests to disclose relevant to this manuscript.

Figures

Figure 1
Figure 1
Cumulative incidence of start of glucocorticoids according to time period of rheumatoid arthritis (RA) incidence - 1980–1994 (dashed line) vs. 1995–2007 (solid line), p<0.001.
Figure 2
Figure 2
Cumulative incidence of discontinuation of glucocorticoids for at least 90 days according to time period of rheumatoid arthritis incidence: 1980–1994 (dashed line) vs. 1995–2007 (solid line), (p<0.001).
Figure 3
Figure 3
A. Current prevalence of glucocorticoid (GC) use by rheumatoid arthritis (RA) duration, according to time period of RA incidence: 1980–1994 (dashed line; n=394) vs. 1995–2007 (solid line; n=464). B. Patients who started a disease modifying antirheumatic drug in the first 6 months of RA (red line; 1980–94 n=164, 1995–2007 n=356) vs those who did not (black line; 1980–1994 n=185, 1995–2007 n=108).
See this image and copyright information in PMC

References

    1. Hillier SG. Diamonds are forever: the cortisone legacy. J Endocrinol. 2007;195(1):1–6. - PubMed
    1. Bakker MF, Jacobs JW, Welsing PM, Verstappen SM, Tekstra J, Ton E, et al. Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med. 2012;156(5):329–339. - PubMed
    1. Kirwan JR, Bijlsma JW, Boers M, Shea BJ. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev. 2007;(1) CD006356. - PMC - PubMed
    1. van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002;136(1):1–12. - PubMed
    1. Caplan L, Wolfe F, Russell AS, Michaud K. Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. J Rheumatol. 2007;34(4):696–705. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources