The clinical effect of glucocorticoids in patients with rheumatoid arthritis may be masked by decreased use of additional therapies.

Autor: van Everdingen AA; University Medical Center, Utrecht, The Netherlands. everdiva@dz.nl, Siewertsz van Reesema DR, Jacobs JW, Bijlsma JW
Jazyk: angličtina
Zdroj: Arthritis and rheumatism [Arthritis Rheum] 2004 Apr 15; Vol. 51 (2), pp. 233-8.
DOI: 10.1002/art.20251
Abstrakt: Objective: Our previous analysis of patients with early active rheumatoid arthritis (RA) treated with prednisone or placebo revealed the following discrepancy: although a significant retardation of joint damage was observed in the prednisone group compared with the placebo group, no differences in clinical variables between the 2 groups were observed, due to greater use of additional therapy in the placebo group. We sought to investigate whether this discrepancy would extend to variables of well-being.
Methods: We conducted a double-blind, randomized, placebo-controlled clinical trial of prednisone (10 mg) in patients with RA; the duration of the study was 2 years. Following the placebo-controlled trial, a 1-year open-label followup study was conducted in 81 patients with early (Results: VDF scores in the 2 groups were not statistically significantly different. No statistically significant differences between groups were observed in almost all parameters of the IRGL. In the prednisone group (and only at 6 months), the VAS scores for morning pain and general well-being showed improvement comparable with the transient improvement in some of the disease activity variables. In the prednisone group, use of NSAIDs, analgesics, local injections of glucocorticoids, and physiotherapy sessions was approximately 50% that in the placebo group.
Conclusion: Although significant retardation of joint damage in the prednisone group indicates better disease control, no differences between the groups for variables of well-being were found. This discrepancy may be attributed to greater use of additional therapy in the placebo group. In future clinical trials, the use of additional therapies should be taken into account when analyzing the differences in effect between drugs.
Databáze: MEDLINE
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