Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.
Mod Rheumatol. 2021 Jul;31(4):803-808. doi: 10.1080/14397595.2020.1864914. Epub 2021 Mar 8.
To retrospectively evaluate whether oral glucocorticoid (GC) administration can be tapered or discontinued over a 2-year observation period in patients with rheumatoid arthritis (RA) undergoing a stable oral GC treatment, without deterioration in the disease status.
Methotrexate (MTX) and prednisolone (PSL) dosages were increased and decreased, respectively, to the maximum extent possible. Concomitant biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) were used as required. Changes in PSL and MTX use and disease status were evaluated at baseline (BL), year-1, and year-2.
Thirty-six patients were enrolled (median age, 65.4 years; disease duration, 7.1 years). The proportion of patients using PSL decreased over 2 years (100-13.9%, < .0001). While no change was observed in the proportion of patients using MTX, the average administered dose increased at year-1 ( = .06). Moreover, b/tsDMARDs were administered in nine patients (two in year-1, seven in year-2). The Clinical Disease Activity Index remission rate increased from 25.0% to 38.9%. Serious adverse events were identified in two patients.
Oral GC administration was discontinued without deterioration in the rheumatoid arthritis disease control.
回顾性评估在接受稳定口服糖皮质激素（GC）治疗的类风湿关节炎（RA）患者中，在 2 年观察期内是否可以逐渐减少或停止口服 GC 的使用，而不会导致疾病状况恶化。
尽可能增加甲氨蝶呤（MTX）和泼尼松龙（PSL）的剂量，并相应减少 PSL 的剂量。根据需要使用生物制剂或靶向合成的改善病情抗风湿药物（b/tsDMARDs）。在基线（BL）、第 1 年和第 2 年评估 PSL 和 MTX 使用和疾病状况的变化。
共纳入 36 例患者（中位年龄 65.4 岁；病程 7.1 年）。2 年内使用 PSL 的患者比例下降（100-13.9%， < .0001）。虽然 MTX 使用患者的比例没有变化，但 MTX 的平均给药剂量在第 1 年增加（ = .06）。此外，9 例患者使用了 b/tsDMARDs（第 1 年 2 例，第 2 年 7 例）。临床疾病活动指数缓解率从 25.0%增加到 38.9%。两名患者出现严重不良事件。
在不恶化类风湿关节炎疾病控制的情况下，停止了口服 GC 的治疗。
