Most Early Rheumatoid Arthritis Patients Can Stop Prednisolone After Short-Term Use: Study
Norway: Researchers have reported that most patients with newly diagnosed rheumatoid arthritis can successfully discontinue oral glucocorticoids after short-term bridging therapy when treatment is carefully tapered and closely monitored. The findings, published in Annals of the Rheumatic Diseases, are from a study led by Gina Hetland Brinkmann of Diakonhjemmet Hospital and the REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases in Oslo, Norway.
Glucocorticoids are often used as short-term “bridging therapy” when starting disease-modifying antirheumatic drugs (DMARDs) in early rheumatoid arthritis (RA) to rapidly control inflammation and symptoms. However, concerns about long-term toxicity and uncertainty about optimal duration have led to differing guideline recommendations. The European Alliance of Associations for Rheumatology recommends short-term use with tapering within three months, while the American College of Rheumatology advises minimizing or avoiding glucocorticoids due to safety concerns.
To assess whether short-term glucocorticoids can be safely discontinued, researchers analyzed data from the ARCTIC Trial. The study included patients with recent-onset RA who had not previously received DMARD therapy. Participants started methotrexate monotherapy along with prednisolone bridging therapy, beginning at 15 mg and tapering to zero over seven weeks. Patients were then followed for two years to evaluate prednisolone discontinuation and usage patterns.
A total of 230 patients were enrolled, and 227 who initiated prednisolone bridging therapy were included in the analysis. The mean age was 52 years, and 62% were women. The average disease activity score was 3.47, indicating moderate disease activity, and 82% of participants were positive for anticitrullinated peptide antibodies.
The study revealed the following findings:
- Most patients were able to discontinue glucocorticoids shortly after the tapering phase.
- By the end of the 7-week taper, 84% of patients had stopped prednisolone.
- The proportion increased to 89% at 3 months and reached 95% within 24 months of follow-up.
- Among those who discontinued prednisolone after the initial 7-week period, around 80% did not restart the drug during the study.
- Overall, glucocorticoid exposure was low, with a median prednisolone use of 55 days over the 2-year follow-up.
- About 5% of patients continued prednisolone throughout the entire study period.
- Continuous prednisolone use for at least 3 months was observed in 22% of patients.
- Patients requiring longer glucocorticoid therapy generally had more severe disease.
- These patients needed more frequent adjustments in DMARD therapy and were more likely to receive biologic treatments.
- They also showed lower remission rates compared with patients who discontinued prednisolone earlier.
The investigators acknowledged certain limitations. The study lacked a comparison group without bridging therapy or with different tapering regimens. Although unlikely due to close monitoring, some patients may have restarted prednisolone outside the study without reporting it. However, the study’s strengths include rigorous follow-up and detailed documentation of glucocorticoid use.
Overall, the findings indicate that short-term prednisolone bridging followed by structured tapering can be successfully discontinued in most patients with newly diagnosed RA. The results support recommendations from the European Alliance of Associations for Rheumatology and highlight the importance of systematic follow-up, protocol-based tapering, and timely DMARD adjustments to reduce long-term glucocorticoid exposure.
Reference:
Brinkmann GH, Sundlisæter NP, Nordberg LB, Sexton J, Ikdahl E, Aga AB, van der Heijde D, Solomon DH, Lillegraven S, Haavardsholm EA. Successful discontinuation of oral glucocorticoids after short-term bridging therapy in patients with newly diagnosed rheumatoid arthritis. Ann Rheum Dis. 2026 Jan 30:S0003-4967(26)00003-8. doi: 10.1016/j.ard.2026.01.003. Epub ahead of print. PMID: 41620379.
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