Effect of daily low dose prednisone, divided or single daily dose, in the treatment of African Americans with early rheumatoid arthritis

Determine the effect of daily low divided or single daily dose of prednisone on the longitudinal change in the number of tender and swollen joints and HAQ scores in African Americans (AA) with early rheumatoid arthritis (RA) from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis (CLEAR) 1 Registry. In a prospective, multicenter observational cohort study, AA with early RA were enrolled and followed longitudinally for up to 5 years. 345 were enrolled. The mean age at enrollment was 51 years and 82% were women. At baseline, the prevalence of low dose prednisone use was 77% and median prednisone dose was 10 mg. At enrollment 238 patients were on single daily and 107 on divided daily doses of prednisone. There was a significant reduction during follow-up in the number of tender and swollen joints and in the HAQ scores in all patients. Cohort retention was 54%. The adjusted mean number of tender joints was approximately 2-3 joints lower for patients on divided daily dose compared to a single daily dose in follow up. The rate of osteopenia and osteoporosis at 5 years remained similar to baseline prevalence and no difference in the treatment groups. At 5 years the percentage of patients with hypertension was lower in the divided daily prednisone group. During the 5 years of follow-up, clinical outcomes improved in all AA patients with early RA. Reduced number of tender joints was associated with divided daily low doses of prednisone. Hypertension was less in those treated with divided daily doses of prednisone.