ORAL STEROIDS AS BRIDGE THERAPY IN RHEUMATOID ARTHRITIS PATIENTS STARTING WITH PARENTERAL GOLD. A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

The efficacy of oral prednisone as bridge therapy in rheumatoidarthritis (RA) was studied. Forty patients starting aurothioglucosewere randomized to receive either prednisone or placebo for18 weeks. The dose was 10 mg/day in the first 12 weeks, 7.5mg/day in weeks 13 and 14, 5 mg/day in weeks 15 and 16, and2.5 mg/day in weeks 17 and 18. Patients were followed for 44weeks. We found that disease activity was significantly lowerin the prednisone group as early as week 1 and continued upto week 12. Response to prednisone was noticed in 60% of thepatients. After tapering prednisone, a rebound deteriorationwas noticed at weeks 20 and 24 in 58% of the responders. Nosignificant differences in X-ray progression were found betweenthe two groups. We concluded that oral prednisone (10 mg/day)significantlyreduces short-term disease activity in 60% of patients withactive RA. The rebound deterioration after tapering the dosemeans that bridge therapy with prednisone using this dose-reductionscheme is not recommended. KEY WORDS: Rheumatoid arthritis, Prednisone, Efficacy