Background: Glucocorticoids (GC) are powerful anti-inflammatory agents widely used in clinical practice for treatment of patients with rheumatoid arthritis (RA) [1]. According to most scientific publications, relapse of RA after GC withdrawal is the serious reason for the inability to stop GC leading to their chronic use [1, 2]. For daily clinical practice it is important to study the risk factors of RA flare after GC discontinuation.

Objectives: The aim of the work is to study the predictors of RA flare following GC withdrawal despite continuation of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in Ukrainian cohort of patients with different disease durations.

Methods: 126 patients with early (56.3%) and advanced (43.7%) RA who newly started GC as bridging therapy with concomitant csDMARD were included in the study. Most of them were female 107 (84.9%), seropositive (RF: 60.3%; ACCP: 60.9%) with mean age of 51.0±11.4 years and disease duration of 42.1±57.6 months. Prescribed DMARDs included methotrexate (n = 47), leflunomide (n = 39), sulfasalazine (n = 10), DMARD combination (n = 30). At each monitoring stage (after 6, 12, 18, 24, 30 and 36 months of treatment) the possibility of GC withdrawal, achievement of clinical remission and the duration of remission were analyzed. The criterion for unsatisfactory control of RA was the ratio of the time of clinical remission to the total duration of GC exposure (from GC initiation to discontinuation) of less than 50%. Statistical analysis was performed using SPSS 29.0. Certainty disagreements average values were estimated using non-parametric of the Mann-Whitney criterion for quantitative signs and criteria χ ² for frequency indicators. To identify prognostic markers that affect RA flare following GC withdrawal, the method of logistic regression analysis was used with the calculation of the odd ratio (OR) and 95% confidence interval. Analysis of the quality of the regression model, assessment of its sensitivity and specificity were carried out by Receiver Operator Characteristic (ROC) analysis with determination of the area under the ROC curve. The difference was considered probable at p<0.05.

Results: During 3 years of syudy, 89 patients managed to cancel GC without further disease aggravation in the period from 3 to 30 months, mostly in the first half of the year. In the general cohort of patients, the duration of GC usage ranged from 3 to 36 months and averaged 11 months. Exacerbation of RA was observed in 29.4% of patients, mostly within 6 months after GC withdrawal. Patients with RA flare had 1.7 times longer duration of GC exposure (χ ² =4.17, p<0.05), a shorter duration of remission (χ ² =10.9, р<0,01), higher disease activity according to DAS28 (ESR) after 12 months of therapy (р<0,01), cumulative GC dose (p<0.001) and higher proportion of dissatisfied control of RA (χ ² =45,5, р<0,001) compared to the alternative group. According to multivariate regression analysis, a higher cumulative GC dose (OR 17.4 [2.62-116.4]; p=0.003) and RA activity after 12 months (OR 4.06 [1.36-12.0]; p=0.012) were associated with the risk RA flare after GC discontinuation. The results of the ROC analysis revealed the independent prognostic significance for increasing RA activity of such factors as a higher cumulative GC dose (regression criterion>1.37), dissatisfied control of RA activity and a higher DAS28 index (ESR) after 12 months of treatment start (regression criterion>4,37).

Conclusion: The flare following GC withdrawal is observed in a third of patients with RA with undergoing csDMARDs therapy, primarily within the first 6 months. Indicators of dynamic monitoring, rather than baseline data, affect the risk of RA exacerbation after GC discontinuation. Independent predictors of increased RA activity after GC withdrawal are a higher cumulative GC dose (according to the results of ROC analysis – more than 1.3 g), dissatisfied control of RA activity and a higher DAS28 index (ESR) after 12 months of treatment (according to the results of ROC analysis – above 4.3).

REFERENCES: [1] Bergstra SA, Sepriano A, Kerschbaumer A et al. Efficacy, duration of use and safety of glucocorticoids: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis.2022;82(1):81–94. https://doi.org/10.1136/ard-2022-223358 .

[2] Iaremenko O.B., Mykytenko H.M. Is it possible to refuse taking glucocorticoids in rheumatoid arthritis against the background of using synthetic disease-modifying agents. Zaporizhia Medical Journal. 2023;25,N.4(139):309-315. https://doi.org/10.14739/2310-1210.2023.4.277503 .

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.