Oral versus intramuscular glucocorticoids in rheumatoid arthritis

You may be able to join the LEADER trial if you are 18 or older and have been diagnosed with rheumatoid arthritis. You must have active symptoms right now, which means having at least three swollen joints and three tender joints. You also need to be preparing to start, switch, or increase your main long-term arthritis medication.

You will not be able to take part if you have received steroid tablets or injections in the past 28 days, or if your doctor advises against steroid treatment. The study is also not suitable for people with poorly controlled diabetes, women who are pregnant or planning a pregnancy, or anyone diagnosed with fibromyalgia or widespread chronic pain in the last six months.

Taking part in the study lasts for about six months. You will be randomly placed by a computer into one of four treatment groups: higher-dose tablets that reduce over six weeks, lower-dose tablets that reduce over four weeks, a single higher-dose injection into your muscle, or a single lower-dose injection.

Most study checks happen during your usual clinic visits, but you will have one extra visit two weeks after starting. During the first three months and again at month six, your care team will examine your joints, ask you to fill in short surveys about pain, mood, and daily activities, and take routine blood samples. You will only need one extra blood draw for the study at your week two visit. You will also be given a simple finger-prick kit to do at home, which checks how your body's natural stress hormones are responding to the steroid.