Oral Versus Intramuscular Steroid Use to Control Rheumatoid Arthritis Flares: A Pragmatic Randomized Clinical Trial

• Status: NOT_YET_RECRUITING
• Trial end date: 2029-07-01

Summary

People living with rheumatoid arthritis (RA) often experience flares-periods where their symptoms suddenly get worse. These flares can cause significant pain, make it harder to move and do daily activities, and lower overall quality of life. Doctors often treat flares with medications called glucocorticoids (GCs), which reduce inflammation. These medications can be taken by mouth (oral/PO) or given as a single injection into the muscle (intramuscular/IM). However, it's not clear which option works better from the patient's point of view-especially when it comes to relief of symptoms, improvements in function, and satisfaction with treatment. Most research so far has focused on how well the drugs control the disease, rather than how they impact the patient's overall experience.

Our Research Questions:

1. Does a single GC injection work just as well as taking pills over a few weeks in improving symptoms reported by patients?

2. How do the two treatments compare in terms of symptom relief, ability to function, and patient satisfaction?

3. What do patients think and feel about using GCs to treat RA flares?

What We Think:

We believe that a one-time GC injection is just as good as taking pills for a few weeks when it comes to managing RA flares. In fact, the injection might even be safer and preferred by patients.

What We're Doing:

We will study 220 adults with RA who are currently having a flare (with at least 3 swollen and tender joints). These patients will be recruited from rheumatology clinics at the University of Toronto and must not have used GCs in the past month. They will be randomly assigned to receive either:

A single injection (Methylprednisolone 120 mg), or Oral pills (Prednisone starting at 15 mg daily and tapering down over 3 weeks).

The main thing we'll look at is how much better patients feel after 6 weeks, based on a questionnaire designed to measure RA flares. We'll also look at how well they function, how satisfied they are with the treatment, and whether they had any side effects.

In addition, 20 patients (10 from each group) will be interviewed to understand their experiences and opinions about flare treatment in more detail.

Why This Is Possible:

We've already surveyed University of Toronto rheumatologists who support the idea and provided input on study design. We've also partnered with experts in research methods, national arthritis organizations, and patient groups to make sure the study is relevant and meaningful. Ethics approval has been obtained.

Why It Matters:

RA flares can have a major impact on people's lives. While current treatments help control inflammation, we need to better understand how these treatments affect people from their own perspective. This study will shift the focus to what matters most to patients, helping doctors and patients choose the best treatment based not only on medical results but also on the patient's experience. This could lead to more effective and personalized care for people living with RA.

• Phase: PHASE4

Details

• Lead Sponsor: Sunnybrook Health Sciences Centre
• Collaborator: The Physicians' Services Incorporated Foundation
• Treatments: Glucocorticoids