Short-term glucocorticoids reduce risk of chronic NSAID and analgesic use in early methotrexate-treated rheumatoid arthritis patients with favourable prognosis: subanalysis of the CareRA randomised controlled trial

Sofia Pazmino, Annelies Boonen, Diederik De Cock, Veerle Stouten, Johan Joly, Delphine Bertrand, René Westhovens, Patrick Verschueren, Sofia Pazmino, Annelies Boonen, Diederik De Cock, Veerle Stouten, Johan Joly, Delphine Bertrand, René Westhovens, Patrick Verschueren

Abstract

Objective: To explore non-steroidal anti-inflammatory drug (NSAID) and analgesic use in early rheumatoid arthritis (eRA) patients with a favourable risk profile initiating methotrexate (MTX) with or without glucocorticoid (GC) bridging.

Methods: Patients with eRA (≤1 year) and favourable risk profile (no erosions, negative rheumatoid factor and anticitrullinated protein antibodiesor low disease activity) in the 2-year CareRA trial were randomised to MTX 15 mg with a step-down GC scheme (COBRA Slim), or MTX without oral GCs, Tight-Step-Up (TSU). Used analgesics were recorded, including frequency, start/end date and indication. Chronic intake (≥90 consecutive days in trial) of NSAIDs, acetaminophen, opioids including tramadol and antidepressants for the indication of musculoskeletal (MSK) pain was considered. Treatments were compared using χ2 and analysis of variance with Holm's correction for multiple testing.

Results: In total, 43 patients were randomised to COBRA Slim and 47 to TSU. At study inclusion, 33/43 (77%) of patients in the COBRA Slim and 32/47 (68%) in the TSU arm had been using analgesics (p=0.5). During the trial, 67 NSAID and analgesics were used for MSK pain in 26/43 (60%) COBRA Slim patients of which 9/43 (21%) daily chronically (DC), while 107 NSAID and analgesics were used in 43/47 (92%) TSU patients, of which 25/47 (53%) DC. The total number of patients on NSAID and analgesics at any time during the study (p<0.01) and chronically (p=0.01) was significantly different between treatment arms. Number of patients on DC NSAIDs was also significantly different (p<0.01) between COBRA Slim 6/43 (14%) and TSU 19/47 (40%).

Conclusion: In eRA patients considered to have a favourable prognosis, initial oral GC bridging resulted in lower chronic NSAID and analgesic use.

Trial registration number: NCT01172639.

Keywords: analgesics; arthritis; glucocorticoids; rheumatoid.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Pain and disease activity in 28 joints with C reactive protein (DAS28CRP) evolution over the 2-year trial per treatment group. Data represented as violin plots. Each ‘half-violin’ represents each treatment group. The shape represents the density estimate of the variable: the more data points in a specific range, the larger the violin is for that range. The horizontal line represents the median and the vertical line the IQR.
Figure 2
Figure 2
Number of patients taking non-steroidal anti-inflammatory drug (NSAID) or analgesics at any point during the trial per treatment group, per visit and type of medication.
Figure 3
Figure 3
Survival analysis of time to the first recorded use of chronic analgesics with Kaplan-Meier.

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