Effects on joint destruction and remission, bone turnover and lack of influence on atherogenesis: a review of the BARFOT low-dose prednisolone studies on patients with early RA

As early as in 1948 a woman with severe rheumatoid arthritis (RA) was successfully treated with glucocorticoids. However, not until recently has the role of GCs in the treatment of RA been clarified and supported by scientific evidence in a limited number of randomised studies. The present article reviews four reports from the BARFOT (Better Anti-Rheumatic FarmacOTherapy) low-dose prednisolone study based on 250 patients with early RA. These patients were randomised to have either DMARDs only or DMARDs plus prednisolone 7.5 mg daily for two years. It was shown that low-dose prednisolone in addition to a DMARD was superior to DMARDs alone in the ability to inhibit joint damage and induce clinical remission.

A follow-up study demonstrated that remission after 2 years with low-dose prednisolone was associated with reduced joint destruction also after 4 years. Prednisolone had no or minor effects on bone density and the frequency of adverse effects was small. A third article measuring markers of bone synthesis and resorption demonstrated that the suppressive effect on bone synthesis exerted by prednisolone was counteracted by the ability of prednisolone to hamper the inflammatory mediated increase in bone resorption. In a fourth article assessing intima-media thickness and endothelial function, no influence of prednisolone 7.5 mg daily on atherosclerosis was observed. Altogether, these four studies provide evidence for recommending low-dose prednisolone treatment in combination with DMARDs for at least two years to patients with recent onset RA.