The effect of methylprednisolone pulse therapy on methotrexate treatment of rheumatoid arthritis.

We randomly assigned 30 active rheumatoid arthritis (RA) patients who started oral methotrexate (MTX, 7.5 mg/week) treatment, into 3 groups. Group I received no additional corticosteroids; Group II was treated with 3 oral pulses of 100 mg prednisolone and Group III with 3 intravenous pulses of 1000 mg methylprednisolone (MP) on alternate days during the first week. Parameters of disease activity were measured at the start, after 10 days and at regular intervals up to 1 year. In Group I maximal improvement occurred after 18 weeks and in Group III after 6 weeks. This effect was sustained during the study. The initial effects in Group II were not as strong as in Group III and of shorter duration. No serious side effects were noticed. Our results suggest, that MP-pulse therapy seems to be useful in bridging the gap between the introduction of MTX and the response to this drug. Furthermore, we found that patients who were HLA-DR4-positive showed a better clinical response after 1 year than HLA-DR4-negative patients.