Rheumatoid arthritis in adults: management

Recommendation ID: NG100/2
Question: Short-term bridging treatment with glucocorticoids:- What is the clinical and cost effectiveness of short-term bridging treatment with glucocorticoids for adults with RA starting a new disease-modifying anti-rheumatic drug (DMARD), including the most effective dosing strategy and mode of administration?
Any explanatory notes (if applicable): Why this is important:- All DMARDs have a slow onset of action. In some cases, response may not be seen for 2 to 3 months. In contrast, glucocorticoids have an immediate effect on joint pain and swelling. In clinical practice, several different regimens are prescribed to 'bridge' the time between the initial prescription of DMARDs and the clinical response. However, good quality evidence from randomised controlled trials (RCTs) demonstrating the effectiveness of glucocorticoids as bridging treatment is limited and inconclusive. Further research is needed to inform recommendations for practice regarding whether bridging treatment with steroids should be used until the new DMARD begins to take effect.
The optimal dosing strategy and mode of administration for bridging glucocorticoids also needs to be established. Although the anti-inflammatory response is dose dependent, side effects of glucocorticoids vary according to both the dose and the duration of treatment.

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	31/07/2018