Is it possible to discontinue glucocorticoids in rheumatoid arthritis with the use of synthetic disease-modifying antirheumatic drugs?

Abstract

The aim of the work is to study the possibility of glucocorticoid (GC) discontinuation or their target dose achievement in patients (pts) with rheumatoid arthritis (RA) receiving conventional synthetic disease-modifying antirheumatic drugs (DMARDs). Materials and methods. 270 pts with RA (women – 86.6 %) aged 51.2 ± 0.71 years, with a disease duration of 50.20 ± 3.82 months were examined. Rheumatoid factor was found in 64.8 % of individuals, anti-cyclic citrullinated peptide (ACCP) antibodies – in 66.6 %. DMARD therapy included methotrexate (n = 91), leflunomide (n = 95), sulfasalazine (n = 51), hydroxychloroquine (n = 3) or its combination (n = 126). The SPSS (version 22.0) software was used for the statistical analysis. Results. During the 3-year study, GC was withdrawn in 33 % of pts in the period from 3 to 30 months (mostly in the first 6 moths). Among those who continued to take GC, the target dose (<7.5 mg/d) was achieved only in 32.6 % of pts. Among pts continuously receiving GC, compared with pts who discontinued GC therapy, there were significantly more women (89.5 % vs. 80.8 %), ACCP-positive pts (88.4 % vs. 55.0 %), with higher DAS-ESR values (5.29 ± 0.10 vs. 4.84 ± 0.15) and more pronounced structural changes on the SHS scale (43.40 ± 2.42 vs. 32.40 ± 2.71). According to the logistic regression analysis, female sex (OR 2.39), elderly pts (OR 1.02), ACCP-positivity (OR 3.73), disease activity by DAS-ESR (OR 1.19) and structural joint changes (OR 1.01) were significantly associated with the risk of continuing GC treatment. Only the initial dose of GC ≥7.5 mg/d was associated with the inability to reach the target dose of GC during the entire follow-up period (OR 6.32). Conclusions. Despite of the treatment with conventional synthetic DMARD, only a third of RA pts can withdraw GC, mostly in the first 6 months. For the pts who continue taking GC, the target dose can be achieved in 33 % of them. Independent predictors of the impossibility to withdraw GC are female sex, old age, ACCP-positivity, higher RA activity according to DAS-ESR and more pronounced joint destruction in early stages. An initial GC dose ≥7.5 mg/d is a negative prognostic factor in achieving the target dose.