Parenteral steroids in early RA were linked to less steroid use at a year

Design

Prospective inception cohort, multivariable analysis

Population

2,222 adults with early rheumatoid arthritis in Canada

Primary outcome

Glucocorticoid use and advanced therapy at 12 months

Effect

Still on GC: 26% parenteral vs 47% oral; advanced therapy 14% in both

The Canadian Early Arthritis Cohort included 2,222 adults with newly diagnosed RA, 2007 to 2023, excluding those on steroids beforehand or on advanced therapy by three months.

In the first three months, 75% received no glucocorticoid, 19% oral, 5% parenteral (intra-articular or intramuscular) and 1% both. At 12 months, 47% of the oral group were still on steroids against 26% of the parenteral group (adjusted OR for continued use 9.8 oral and 4.1 parenteral, versus none). Escalation to advanced therapy was similar at about 14%.

A depot or joint injection as bridging therapy may make it easier to come off steroids than starting a daily tablet. The groups were not randomised, and those given injections may have had fewer active joints.

• Consider intramuscular or intra-articular steroid as bridging therapy when starting a csDMARD.
• If oral steroids are used, set a stop date at the outset.
• Review steroid use at every visit in the first year.
• Do not delay csDMARD escalation because steroids are controlling symptoms.

Why it matters

Oral bridging steroids in early RA often become long-term steroids, with all their harms.

Don't overread it

Observational — patients chosen for injections may differ in disease pattern from those given tablets.

The statistics, in plain English

Odds ratios of 9.8 and 4.1 compare each group with patients who had no steroids at all; the comparison of interest is between them, where parenteral use carried roughly half the odds of oral. The escalation rates were almost identical, suggesting disease control was similar.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.