![]() The study’s statistical methods were previously described in detail ( 5). Each institution’s institutional review board approved the study all participants provided written informed consent. National Death Index, a government-run death database. Information on death was obtained from family members, physicians, and the U.S. Participants were followed from study entry to death, withdrawal from the study, or December 2006. Medication dose and smoking status data were not available. Arthritis medication data were collected by patient report on each questionnaire and updated every six months. Patients completed a Health Assessment Questionnaire (HAQ) biannually by mail this validated instrument included the HAQ-Disability Index (HAQ-DI) and measures of pain, global health, medication use, resource utilization, comorbidities, and selected health behaviors ( 7). The RA diagnosis was verified by the study’s rheumatologists or by medical record review (6% of cases). Adults with RA as described by the 1987 ACR criteria ( 6) were recruited from ten North American rheumatology practices (seven university centers and three community practices) to participate in the Arthritis, Rheumatism, and Aging Medical Information Systems (ARAMIS) study between July 1981 and December 2006. This prospective, longitudinal observational study assessed changes in the treatment, costs, and outcomes of an open cohort of RA patients over 25 years of enrollment. We hypothesized that prednisone use would be associated with an increased risk of mortality, and that this increased risk would be reduced by the concomitant use of DMARDs. Additionally, because prednisone is commonly used in combination with disease-modifying anti-rheumatic drugs (DMARDs), and because the use of some DMARDs, such as methotrexate, has been associated with lower mortality risks ( 5), we sought to determine if concomitant DMARD use modified the mortality risk associated with prednisone use. We examined the association between prednisone use and mortality in a 25-year observational study of patients with RA, and used two different statistical approaches to adjust for potential bias in treatment selection. However, because prednisone is often used to treat patients with more severe RA, it is still unclear if the increased mortality risk is due to the medication or related to its use by sicker patients ( 3). In addition, prednisone use has been associated with an increased risk of death in patients with RA, with mortality risk approximately twice that of patients not treated with prednisone ( 2, 3, 4). Although glucocorticoids reduce inflammation and arthritis symptoms, improve physical function, and appear to have disease-modifying properties ( 1), their chronic use is associated with numerous potentially life-threatening side effects and comorbidities. ![]() Glucocorticoids have been used to treat rheumatoid arthritis (RA) since the 1950’s, but their role in the management of RA remains a matter of debate.
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