Use of parenteral compared with oral glucocorticoids in early rheumatoid arthritis for chance of being off steroids and escalation of therapy at 1 year.

Abstract

This study aimed to determine whether the route of glucocorticoid (GC) administration in patients with early rheumatoid arthritis (ERA) is associated with the odds of persistent GC use or escalation to advanced therapies at 12 months. Adults with newly diagnosed ERA (symptoms duration <1 year) enrolled in the Canadian Early Arthritis Cohort between 2007 and 2023 were included. Those with GC use 90 days prior to baseline, on advanced therapy by 3 months, or with <12 months of follow-up were excluded. Patients were stratified by GC use and route in the first 3 months and compared using analysis of variance or Wilcoxon tests. Adjusted multivariable logistic regression was used to calculate the odds ratios (OR). Among 2222 patients, median (SD) age was 55 (15) years, disease duration 5.5 (3.0) months, and the Clinical Disease Activity Index was 26 (14). During the first 3 months, 1661 patients (75%) received no GC, 421 (19%) oral, 121 (5%) parenteral (intra-articular and/or intramuscular), and 19 (1%) both oral and parenteral. Advanced therapies and GC use, respectively, at 12 months were 7% and 8% (no GC); 14% and 47% (oral); 14% and 26% (parenteral); 16% and 63% (both). The OR for GC use at 1 year was 9.8 (oral) and 4.1 (parenteral), compared with no GC (1.0). Patients receiving parenteral GC were half as likely to remain on GC at 12 months compared with those on oral GC. Rates of advanced therapy use were similar between groups. Parenteral GC administration may facilitate earlier discontinuation of steroids.