Early treatment for pre-rheumatoid arthritis may reduce risk of developing RA

In patients with pre-rheumatoid arthritis, early therapeutic intervention may significantly reduce the risk of developing rheumatoid arthritis (RA), according to results from a meta-analysis presented at the Annual European Congress of Rheumatology (EULAR 2017).

“Our review of the available clinical data supports the rationale for early treatment in these patients,” claimed lead author Dr. Stephane Hilliquin, Pitié Salpêtrière University Hospital, Paris, France. “In those studies where pre-RA patients received active treatment, there was a significant reduction in the risk of occurrence of RA at 52 weeks or more,” he said. “Although there was no statistically significant difference in the absence of disease progression as seen on X-ray between those taking active treatments or placebo due to the disease being at such an early stage.”

For their analysis, Dr. Hilliquin and colleagues conducted a systematic literature review of PubMed, Embase, and the Cochrane databases, as well as the EULAR and American College of Rheumatology congress abstracts from the past 2 years. They searched with the terms “undifferentiated arthritis” or “very early rheumatoid arthritis (VERA)” associated with “therapy” or “treatment.” They limited their search to randomized, controlled trials published in English over the past 5 years.

They identified 595 abstracts, and 9 randomized controlled trials, with eight focusing on undifferentiated arthritis, and one on very early arthritis. The total number of subjects included was 1,156, with a weighted mean aged of 45.8 years, and mean symptom duration of 16.2 weeks. (66% female). Early therapeutic intervention in pre-RA patients included methylprednisolone, methotrexate, TNF-blocker, abatacept, or rituximab.

Early therapeutic intervention with either 80- to 120-mg methylprednisolone (IM), methotrexate, a TNF-blocker, abatacept, or rituximab reduced the risk of occurrence of RA with a pooled odds ratio (OR) of 0.72 (95% CI: 0.54, 0.96; P < 0.02).

They found no statistically significant difference between the treatments or placebo, for the absence of radiographic progression (pooled OR: 1.36 [0.82, 2.27]). The outcome was assessed at week 52 for all studies, except for Van Dongen 2007 (PROMPT), where it was assessed at week 120.

“Our data nicely complements the newly launched EULAR campaign: ‘Don’t Delay, Connect Today’, which is emphasizing the importance of early intervention in the treatment of people with rheumatic and musculoskeletal diseases through early diagnosis and early referral. However, the benefit/risk balance and feasibility of early aggressive treatment of pre-RA in clinical practice will still need further assessment,” concluded Dr. Hilliquin.