AB0206 REVEALING THE POTENTIAL OF INTRAVENOUS PULSE STEROID THERAPY: IMPRESSIVE RESULTS IN ATTAINING REMISSION OR LOW DISEASE ACTIVITY IN REFRACTORY RHEUMATOID ARTHRITIS

Background: Refractory rheumatoid arthritis (rRA) poses significant challenges in its management, affecting a considerable percentage of patients (ranging from 6-20% based on different criteria) [1]. Unfortunately, there is a paucity of studies investigating the use of pulse steroid therapy in treating refractory rheumatoid arthritis. Objectives: The primary objective of this study was to evaluate the effectiveness of low-dose intravenous pulse steroid therapy in achieving remission in patients with rRA. Methods: A total of 268 patients with rRA, who had previously failed to achieve remission with two or more traditional disease-modifying antirheumatic drugs (csDMARDs), or at least one traditional csDMARD plus one or more biological and/or target synthetic DMARDs, were enrolled in this randomized controlled trial. Participants were randomly assigned to one of two equal groups: Group 1 received pulse intravenous methylprednisolone (125 mg) for two consecutive days, followed by a gradual tapering of oral steroid over a span of two weeks. Group 2, on the other hand, did not receive any additional treatment. Both groups were monitored at baseline and monthly for a total of four months. Outcome measures included Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR), American College of Rheumatology 20% improvement criteria (ACR20), ACR 50 and ACR70. Throughout the study, systemic medications were kept unchanged for a period of four months. Results: The mean age of the active group was 34.7±12.5 years compared to 36.2±13.2 years for control group; p value = 0.340. Out of the 134 active cases, 101 (75.4%) were females; compared to 70.9% among the control group; p value = 0.408. Regarding the mean disease duration of the study groups, it was 8.4±3.4 years for the active group, compared to 8.9±4.1 for the control group; p value = 0.278. The active group surpassed the control group in achieving remission or low disease activity within one month, a trend that continued for three months. Notably, this difference was significant across all parameters, except for ACR70 (Table 1). Moreover, we observed that male patients, those with polyarticular disease activity, non-smokers, non-diabetics, and individuals with positive rheumatoid factor exhibited a more favorable response to the treatment. Surprisingly, age and disease duration did not impact the overall response. These findings offer valuable insights for clinicians when determining suitable treatment strategies for patients with refractory rheumatoid arthritis. Conclusion: Low intravenous pulse steroid is an effective option in achieving and maintaining remission or low disease activity in challenging refractory rheumatoid arthritis. REFERENCES: [1] Elsaman A, Maaty A, Hamed A. Genicular nerve block in rheumatoid arthritis: a randomized clinical trial. Clinical rheumatology. 2021;40(11):4501-9. Acknowledgements: NIL. Disclosure of Interests: None declared.