Introduction: In early rheumatoid arthritis (RA), low-dose oral prednisone (PDN) co-medication yields better clinical\nresults than monotherapy with disease-modifying anti-rheumatic drugs (DMARDs). In addition, ultrasonography (US)\nevaluation reveals rapid and significant effects of glucocorticosteroids on subclinical synovitis. No data currently\nexist that examine the clinical and US results offered by glucocorticoid co-medication over DMARD monotherapy\nin early RA patients.\nMethods: Two hundred and twenty patients with early RA (< 1 year from clinical onset) were treated according to\na low disease activity (LDA) targeted step-up protocol including methotrexate (MTX) and, in the active treatment\narm, low-dose (6.25 mg/day) oral PDN over 12 months. Clinical disease activity measures were collected at\nbaseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months.\nGrey-scale and power Doppler (PD) synovitis were scored (0 to 3) for each joint. At 12 months, clinical remission\naccording to the disease activity score among 28 joints was defined as the clinical outcome, and a total joint PD\nResults: Each group included 110 patients with comparable demographic, clinical, laboratory and US characteristics.\nAt 12 months, the LDA rate was similar in the two groups, whilst the clinical remission rate (risk ratio = 1.61 (95%\nconfidence interval = 1.08, 2.04)) and PD negativity rate (risk ratio = 1.31 (95% confidence interval = 1.04, 1.64)) were\nsignificantly higher in the MTX+PDN group.\nConclusion: In early RA, despite a similar response rate in terms of LDA, low-dose oral PDN co-medication led to a\nhigher proportion of clinical remission and PD negativity compared with MTX monotherapy, thus ensuring a better\ndisease activity control.
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