Methylprednisolone pulse therapy in conjunction with azathioprine in rheumatoid arthritis

In the management of rheumatoid arthritis two potentially useful roles for methylprednisolone (MP) pulse therapy are presently recognised: in patients in whom second line drugs have not led to a satisfactory remission or have caused side effects, and in bridging the gap between the start and the delayed onset of effect of a slow-acting antirheumatic drug. Recently it was shown that MP-pulse therapy was effective in accelerating the response to sulphasalazine and D-penicillamine. Nineteen patients with a persistently active rheumatoid arthritis, who had failed to respond to at least two slow-acting antirheumatic drugs, were treated with MP-pulse therapy in conjunction with azathioprine. Twelve patients continued this treatment for 6 months and 8 for 12 months. MP-pulse therapy resulted in an immediate improvement in Ritchie articular index, grip strength, ESR and CRP. However, this improvement lasted less than six weeks. After 6 months some improvement due to the effect of azathioprine became apparent. Some rather serious side effects were noted. It is concluded that MP-pulse therapy has a (short lasting) beneficial effect in persistently active rheumatoid arthritis. However MP-pulse therapy is not suitable to bridge the gap between the introduction of azathioprine-treatment and the delayed response to this drug.