Glucocorticoid use among patients with rheumatoid arthritis during the first year of treatment-a cohort study

Glucocorticoid treatment for patients with rheumatoid arthritis (RA) is widely used as fast-acting bridging therapy to reduce disease activity. However, the safety is still discussed. This cohort study describes glucocorticoid dosage during the first year after treatment initiation in patients with RA and secondarily presents the one-year dosedependent infection risk. Hospital records were reviewed for 574 newly diagnosed RA cases treated at Department of Rheumatology Aalborg University Hospital between 2014 and 2022 to identify physician prescribed daily glucocorticoid dose and infections within the year following first visit. Daily glucocorticoid dose was presented. Secondary, the relative risk (RR) for one-year dose-dependent (non-exposed, low dose: 0-10 mg/day, high dose: >10 mg/day, from 21 days average) risk of first infection was calculated using modified Poisson regression. In total, 428 patients (75%) received glucocorticoid during the first year, with 313 (55%) initiated at first visit. Mean prescribed glucocorticoid dose was 9.3 mg/day, with 262 patients (46%) receiving tablets and 270 (47%) receiving intra-articular injection. Overall, 117 patients (20%) experienced an infection within the first year. The model was adjusted for asthma/chronic obstructive pulmonary disease, sex, and age, yielding a RR of 1.13 (95% confidence interval (CI): 0.77 to 1.67) for low-dose exposure versus non-exposure. Glucocorticoid dosages were highest early in disease course and declined substantially after the initial visit, suggesting that physicians in the Danish healthcare decrease dose within the first year after diagnosis. CI for dose-dependent infections risk were compatible with both benefit and harm.