PT  - JOURNAL ARTICLE
AU  - Ingiäld Hafström
AU  - Inga-Lill Engvall
AU  - Johan Rönnelid
AU  - Annelies Boonen
AU  - Désirée van der Heijde
AU  - Björn Svensson
AU  - on behalf of the BARFOT study group
TI  - Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study
AID  - 10.1136/bmjopen-2014-005246
DP  - 2014 Jul 01
TA  - BMJ Open
PG  - e005246
VI  - 4
IP  - 7
4099  - http://bmjopen.bmj.com/content/4/7/e005246.short
4100  - http://bmjopen.bmj.com/content/4/7/e005246.full
SO  - BMJ Open2014 Jul 01; 4
AB  - Objective To analyse if predictors of radiographic progression differ between patients treated with or without prednisolone in early rheumatoid arthritis (RA). Radiographs of hands and feet were assessed using the modified Sharp/van der Heijde score and radiographic progression was defined as an increase in the total Sharp score above 5.8 (the smallest detectable change). Design Prospective, randomised study of patients with early RA. Setting Secondary level of care; six participating centres from southern Sweden; both urban and rural populations. Participants In all, 225 patients, 64% women, with a diagnosis of RA according to the American College of Rheumatology criteria, were included if they were between 18 and 80 years of age and had a disease duration of less than 1 year. Intervention The patients were randomised to 7.5 mg prednisolone daily for 2 years (P-group; n=108) or no prednisolone (NoP-group; n=117) when they started with their first disease-modifying anti-rheumatic drug and were prospectively followed for 2 years. Results The frequency of patients with radiographic progression after 2 years was 26% in the P-group and 39% in the NoP-group (p=0.033). Relevant interactions between treatment and rheumatoid factor (RF) (p=0.061) and between treatment and anti-cyclic citrullinated peptide 2 (anti-CCP) (p=0.096) were found. RF and anti-CCP independently predicted radiographic progression only in the NoP-group, OR (95% CI) 9.4 (2.5 to 35.2), p=0.001 and OR (95% CI) 8.7 (2.5 to 31.3), p=0.001, respectively. Conclusions The presence of RF and anti-CCP predicted radiographic progression in patients not treated with prednisolone but failed to predict progression in patients treated with this drug. The data suggest that early treatment with prednisolone may modulate not only inflammation but also autoimmunity-associated pathogenetic mechanisms. Trial registration number ISRCTN20612367.