Parenteral steroids in early RA were linked to half the rate of ongoing steroid use at a year

Design

Prospective inception cohort analysis, adjusted logistic regression

Population

2,222 adults with early RA in the Canadian Early Arthritis Cohort

Primary outcome

Glucocorticoid use and advanced therapy escalation at 12 months

Effect

Steroid use at 1 year 47% (oral) vs 26% (parenteral); OR 9.8 vs 4.1 against no GC

This analysis of the Canadian Early Arthritis Cohort included 2,222 adults with newly diagnosed rheumatoid arthritis enrolled 2007-2023. In the first three months, 75% received no glucocorticoid, 19% oral, 5% parenteral (intra-articular or intramuscular) and 1% both.

At 12 months, glucocorticoid use was 8% without early steroids, 47% after oral, 26% after parenteral and 63% after both. Compared with no early steroid, the adjusted odds of steroid use at a year were 9.8 for oral and 4.1 for parenteral. Escalation to advanced therapy was similar (14% in both the oral and parenteral groups).

Bridging steroids in early RA are meant to be temporary, but oral courses often persist. A depot or intra-articular injection ends by design.

This is observational, and patients chosen for oral steroids may have had more widespread disease.

• Consider intramuscular or intra-articular glucocorticoid as the bridge when starting csDMARDs.
• If oral steroids are used, set a written tapering plan and stop date at the start.
• Review steroid use at every visit in the first year.
• Escalate DMARD therapy rather than prolonging steroids.

Why it matters

The route of a bridging steroid appears to decide whether it remains a bridge.

Don't overread it

This was observational; patients given oral steroids may have had different disease, so route may not be the cause of persistence.

The statistics, in plain English

Odds ratios of 9.8 and 4.1 compare each route with no steroids at all. The direct comparison, 47% vs 26% still on steroids, is the practical figure.

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