COMMENTS AND RESPONSES Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis TO THE EDITOR: The article by Bakker and colleagues (1) presents

impressive control of disease activity in patients with rheumatoid arthritis (RA), which ironically may have attenuated the apparent treatment effect of prednisone. Overall, 67 % of patients who re-ceived no prednisone had no erosions—only 11 % fewer than the 78 % of patients treated with 10 mg/d of prednisone for 2 years, albeit a statistically significant difference. The strongest treatment effects that were maintained over 2 years involved patient functional status, which generally is more significant than laboratory and radiographic data to predict work disability and mortality in patients with RA (2). Although unequivocal advantages are documented for 10-mg/d prednisone treatment added to tight control with methotrexate (and adalimumab if indicated by Disease Activity Score 28), 10 mg of prednisone may not necessarily be “low-dose, ” as noted in the report (1). No statistically significant differences in adverse events were seen over 2 years (1). However, over long periods, 10 mg/d of prednison