Use of risk stratification to target therapies in patients with recent onset arthritis; design of a prospective randomized multicenter controlled trial
Claessen SJJ et al. - First rheumatological study for treatment in early arthritis based on a prediction rule where treatment will be stratified according to the probability of persistent arthritis has entered the clinical trial. Different combinations of treatment per stratum will be evaluated; treatment will start early, and patients will not need to meet the ACR-criteria for rheumatoid arthritis. Methods- Randomized trial is currently being performed to determine which induction therapy is most effective in the very early stage of persistent arthritis
- Induction therapy will be based on a prediction model that predicts pts' propensity for persistent arthritis
- Pts ≥18 yrs with recent-onset arthritis (n=810) are being stratified according to the likelihood of their developing persistent arthritis
- Following therapies are planned:
- Pts with a high probability persistent arthritis: combination of DMARDs vs monotherapy MTX
- Pts with an intermediate probability of persistent arthritis: DMARDs of various intensities
- Pts with a low probability: NSAIDs, hydroxychloroquine and a single dose of corticosteroids
- If disease activity is not sufficiently reduced, treatment will be adjusted according to a step-up protocol
- If remission is achieved for at least 6 mo, medication will be tapered off
- Pts will be followed up every 3 mo over 2 yrs
Results- The trial is being conducted in the southwestern Netherlands, and the results are awaited
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