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Prednisolone plus a disease modifying antirheumatic drug improved outcomes in early rheumatoid arthritis

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 Q In patients with early rheumatoid arthritis (RA), does adding low dose prednisolone to the first use of a disease modifying antirheumatic drug (DMARD) improve outcomes?

Clinical impact ratings IM/Ambulatory care ★★★★★★☆ Rheumatology ★★★★★☆☆


Embedded ImageDesign

randomised controlled trial.

Embedded ImageAllocation


Embedded ImageBlinding

blinded (outcome assessors).*

Embedded ImageFollow up period

2 years.

Embedded ImageSetting

6 centres in southern Sweden.

Embedded ImagePatients

259 patients 18–80 years of age (mean age 55 y, 64% women) who were starting treatment with a first DMARD for active RA of ⩽1 year’s duration. Patients with previous DMARD or glucocorticoid treatment, low bone mineral density (BMD), or a history of fragility fracture were excluded.

Embedded ImageInterventions

prednisolone, 7.5 mg daily for 2 years (n = 124), or no prednisolone (n = 135). The choice of DMARD (mainly methotrexate or sulfasalazine) was at the attending physician’s discretion. All patients also received calcium, 1000 mg daily.

Embedded ImageOutcomes

change in joint damage in the hands and …

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  • * See glossary

  • For correspondence: Dr B Svensson, University of Lund, Lund, Sweden. bjoern.svensson{at}

  • Sources of funding: Swedish Rheumatism Association; 80-Year Foundation of King Gustaf V; Ugglas Foundation; Börje Dahlins Foundation; Gorthon Foundation in Helinsingborg; Stiftelsen för Rörelsehindrade I Skåne.

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