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Early, intensive treatment that combines methotrexate with prednisone can reduce the debilitating fatigue tied to rheumatoid arthritis — even in patients at low risk of severe disease, finds a two-year study.

Rheumatoid arthritis causes chronic inflammation that can lead to weakness, exhaustion, and abnormal tiredness in up to 90% of patients, explained researchers from Belgium. Their study examined whether intensive treatment directly after diagnosis could change the disease course and reduce fatigue. 

The investigators followed 80 patients with a low risk profile who were randomized into two groups. Immediately following diagnosis, participants received either 15 mg of methotrexate weekly or a combination therapy of 15 mg of methotrexate weekly plus cortisone (prednisone), starting at 30 mg and tapered weekly to 5mg. Both methotrexate and prednisone suppress inflammation, but prednisone is a quicker-acting anti-inflammatory and researchers used it as a bridge between initial treatment and the time the methotrexate took to be effective.

While disease activity in both groups was “comparable” over time, patients who received the intensive combination therapy for two years were less tired than patients in the monotherapy control group. Differing fatigue levels between the groups became more pronounced over time, the researchers reported.

In response, the European League Against Rheumatism has recommended that clinicians consider initiating early, intensive treatment, even in low-risk patients.

The study was published in Annals of Rheumatic Diseases.