Black RJ, et al. - The researchers performed this study to describe oral glucocorticoids (GCs) use in rheumatoid arthritis (RA). Furthermore, they aimed to determine any change in use over time and factors correlated with oral GCs use, commencement or cessation. With reduced commencement and increased cessation of GCs, the probability of oral GC use decreased over time. The modest effect of biologic disease-modifying anti-rheumatic drugs (bDMARDs) on GC cessation was not statistically significant.

Methods

• The researchers identified adult patients with RA in the Australian Rheumatology Association Database (ARAD), a national Australian registry that collects long-term outcome data from patients with inflammatory arthritis.
• They categorized patients by their ARAD date of entry (DOE), with population-averaged logistic regression and transition state analysis used to determine any change in GC use over time.
• They used fixed-effects panel regression to investigate whether GC current use was correlated with pain/arthritis activity/Health Assessment Questionnaire (HAQ) scores or medication use.
• To evaluate whether these factors influenced the commencement or cessation of GCs, transition state analysis was used.

Results

• A baseline ARAD questionnaire was completed by 3,699 patients with RA (73% female, mean age 57 years).
• According to ARAD DOE, the probability of GC use decreased over time: September 2001 to March 2005, 55% (95% CI 52-58%); March 2005 to September 2008, 47% (45-49%); September 2008 to March 2012, 42% (39-45%); and March 2012 to October 2015, 39% (34-43%) (p < 0.001).
• GC current use was associated with conventional synthetic disease-modifying anti-rheumatic drugs (OR 10.13; 95% CI 8.22-12.47), non-steroidal anti-inflammatory drugs (1.18; 1.02-1.37) and opioids (2.14; 1.84-2.48), which was also noted for lower pain scores (0.94; 0.90-0.98), higher arthritis activity scores (1.09; 1.05-1.14) and poorer HAQ scores (1.52; 1.30-1.79).
• Use of bDMARDs was not correlated with GC current use (0.98; 0.83-1.15) or GC cessation (HR 0.87; 95% CI 0.75-1.01), however, it was associated with GC commencement (0.54; 0.47-0.62).