Double blind placebo controlled trial of pulse treatment with methylprednisolone combined with disease modifying drugs in rheumatoid arthritis - PubMed (original) (raw)
Clinical Trial
Double blind placebo controlled trial of pulse treatment with methylprednisolone combined with disease modifying drugs in rheumatoid arthritis
T M Hansen et al. BMJ. 1990.
Abstract
Objective: To assess whether monthly treatment with intravenous methylprednisolone enhances or accelerates the effect of disease modifying drugs in patients with rheumatoid arthritis.
Design: A 12 month double blind, placebo controlled, multicentre trial in which patients with active rheumatoid arthritis were randomly allocated to receive pulses of either methylprednisolone or saline every four weeks for six months. At the start of the pulse treatment all patients were started on penicillamine or azathioprine.
Setting: Four rheumatology departments in Denmark.
Patients: 97 Patients (71 women, 26 men) aged 23-84 (mean 60) who had active rheumatoid arthritis of at least four weeks' duration despite treatment with non-steroidal anti-inflammatory drugs.
Main outcome measures: Monthly clinical recording of morning stiffness, number of tender and swollen joints, blinded observers' evaluation of therapeutic effect, and patients' self assessed condition. Concomitant laboratory measurements of erythrocyte sedimentation rate and concentrations of C reactive protein and haemoglobin. Radiography to determine the number of erosions at the start of treatment and after 12 months.
Results: 57 Patients completed the trial, taking the same disease modifying drug throughout. Evaluation four weeks after each pulse treatment and at 12 month follow up showed no significant differences between the methylprednisolone and placebo groups in any of the clinical or laboratory variables. Radiography showed the same degree of progression of erosions in both groups. Evaluation of the total data on 97 patients and on the 57 who completed the trial showed the same lack of significance between the treatment groups.
Conclusions: Intravenous pulse treatment with steroids can be recommended only for rapid temporary relief of flares of disease in patients with rheumatoid arthritis. The response is short lived. Repeated pulses of methylprednisolone at four week intervals do not improve the results of treatment with drugs that induce remission such as penicillamine and azathioprine.
Comment in
- Pulse treatment with methylprednisolone in rheumatoid arthritis.
Corkill MM, Gibson T, Panayi GS. Corkill MM, et al. BMJ. 1990 Sep 1;301(6749):446. doi: 10.1136/bmj.301.6749.446-b. BMJ. 1990. PMID: 2094254 Free PMC article. No abstract available.
Similar articles
- Combination of methylprednisolone pulse therapy and remission inducing drugs in rheumatoid arthritis.
Hansen TM, Dickmeiss E, Jans H, Ingemann Hansen T, Ingeman-Nielsen M, Lorenzen I. Hansen TM, et al. Ann Rheum Dis. 1987 Apr;46(4):290-5. doi: 10.1136/ard.46.4.290. Ann Rheum Dis. 1987. PMID: 3296967 Free PMC article. Clinical Trial. - Methylprednisolone pulse therapy in conjunction with azathioprine in rheumatoid arthritis.
Bijlsma JW, Schenk Y, Ramselaar AC, Huber-Bruning O. Bijlsma JW, et al. Clin Rheumatol. 1986 Dec;5(4):499-504. Clin Rheumatol. 1986. PMID: 3816097 - A randomized double-blind controlled trial of sulphasalazine combined with pulses of methylprednisolone or placebo in the treatment of rheumatoid arthritis.
Ciconelli RM, Ferraz MB, Visioni RA, Oliveira LM, Atra E. Ciconelli RM, et al. Br J Rheumatol. 1996 Feb;35(2):150-4. doi: 10.1093/rheumatology/35.2.150. Br J Rheumatol. 1996. PMID: 8612028 Clinical Trial. - D-penicillamine induced pemphigus treated with methylprednisolone pulse therapy.
Wouters EA, De Clerck LS, Francx L, Stevens WJ. Wouters EA, et al. Acta Clin Belg. 1990;45(1):15-9. doi: 10.1080/17843286.1990.11718059. Acta Clin Belg. 1990. PMID: 2161600 Review.
Cited by
- The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis.
McWilliams DF, Thankaraj D, Jones-Diette J, Morgan R, Ifesemen OS, Shenker NG, Walsh DA. McWilliams DF, et al. Rheumatology (Oxford). 2021 Dec 24;61(1):76-89. doi: 10.1093/rheumatology/keab503. Rheumatology (Oxford). 2021. PMID: 34213524 Free PMC article. - Pulse treatment with methylprednisolone in rheumatoid arthritis.
Corkill MM, Gibson T, Panayi GS. Corkill MM, et al. BMJ. 1990 Sep 1;301(6749):446. doi: 10.1136/bmj.301.6749.446-b. BMJ. 1990. PMID: 2094254 Free PMC article. No abstract available. - Efficacy of methylprednisolone pulse therapy in children with rheumatoid arthritis.
Aghighi Y, Attarod L, Javanmard M. Aghighi Y, et al. Clin Rheumatol. 2008 Nov;27(11):1371-5. doi: 10.1007/s10067-008-0919-8. Epub 2008 Jul 5. Clin Rheumatol. 2008. PMID: 18604580 - Time trends in glucocorticoid use in rheumatoid arthritis: results from a population-based inception cohort, 1980-1994 versus 1995-2007.
Makol A, Davis JM 3rd, Crowson CS, Therneau TM, Gabriel SE, Matteson EL. Makol A, et al. Arthritis Care Res (Hoboken). 2014 Oct;66(10):1482-8. doi: 10.1002/acr.22365. Arthritis Care Res (Hoboken). 2014. PMID: 24821680 Free PMC article. - Unveiling the Rare Complication: Statin-Induced Immune-Mediated Necrotizing Myopathy.
Chowdhury FH, Mahneva O, Maharaj M, Marciales W. Chowdhury FH, et al. Am J Case Rep. 2023 Dec 13;24:e941387. doi: 10.12659/AJCR.941387. Am J Case Rep. 2023. PMID: 38087774 Free PMC article.
References
- Ann Intern Med. 1981 Jan;94(1):21-6 - PubMed
- Eur J Clin Pharmacol. 1982;21(5):385-8 - PubMed
- Lancet. 1982 Jul 31;2(8292):237-40 - PubMed
- Ann Rheum Dis. 1982 Oct;41(5):444-6 - PubMed
- Ann Rheum Dis. 1985 Nov;44(11):747-51 - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials