TOPLINE:

More than 80% of patients with newly diagnosed rheumatoid arthritis (RA) discontinued prednisolone after 7 weeks of bridging therapy alongside methotrexate monotherapy. A subset of patients required ongoing low-dose treatment during the follow-up period.

METHODOLOGY:

• Researchers aimed to assess prednisolone discontinuation within 3 months of a short-term bridging regimen in patients with newly diagnosed RA managed with a treat‑to‑target approach.
• A total of 227 adult patients with RA naive to disease-modifying antirheumatic drugs (mean age, 51.6 years; 62% female) were included in this analysis from the 2-year ARCTIC trial.
• In the trial, patients were randomly assigned to either an ultrasound tight control strategy or a conventional tight control strategy, with all patients initiating methotrexate monotherapy at 15 mg/wk and a 7-week prednisolone bridging therapy, tapered from 15 mg/d to 0 mg over 7 weeks.
• The main outcome was successful prednisolone discontinuation, defined as no use for at least 4 consecutive months after completion of the bridging regimen. Discontinuation was assessed at multiple intervals up to 24 months.

TAKEAWAY:

• Overall, 84% of patients discontinued prednisolone at 2 months, and 95% discontinued by 24 months. Among the patients who discontinued after the 7‑week bridging therapy, 80% did not restart prednisolone over 24 months of follow-up.
• Higher prednisolone doses were received by 12 patients due to comorbidities. Moreover, 22% of patients had continuous prednisolone use for 3 months or more (including the 7-week bridging therapy).
• Methotrexate monotherapy was used by 68% vs 36% of patients who did not restart prednisolone after bridging therapy vs those who used prednisolone continuously for at least 3 months.
• At 24 months, remission rates were higher in patients who did not restart prednisolone than in those with continuous use (62% vs 39%).

IN PRACTICE:

“These findings support current EULAR recommendations and emphasize the advantages of lower glucocorticoid doses combined with a systematic follow-up,” the authors of the study wrote.

SOURCE:

The study was led by Gina Hetland Brinkmann, Diakonhjemmet Hospital, REMEDY Center for treatment of Rheumatic and Musculoskeletal Diseases, Oslo, Norway. It was published online on January 29, 2026, in Annals of the Rheumatic Diseases.

LIMITATIONS:

The study did not use a control group without bridging therapy or with a different tapering regimen. The possibility of patients resuming prednisolone use outside the study without notification could affect the accuracy of the results.

DISCLOSURES:

The study was supported by the REMEDY Center and the Research Council of Norway. Two authors disclosed receiving speaking and lecture fees. Two others reported having ties, including consulting or advisory relationships, with multiple companies, one of whom also reported being an associate editor of Annals of the Rheumatic Diseases.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.