Early intervention may prevent RA onset
medwireNews: Results of a systematic review and meta-analysis suggest that early therapeutic intervention may reduce the risk for rheumatoid arthritis (RA) onset among patients with undifferentiated arthritis.
These findings “reinforce the view of ‘the sooner the better’ in terms of therapeutic decision-making within the pathogenic RA continuum,” say Bruno Fautrel (Institut Pierre Louis d’épidémiologie et Santé publique, Paris, France) and colleagues.
As reported in the Annals of the Rheumatic Diseases, the systematic review included data from 1156 patients taking part in 10 randomized controlled trials investigating the use of DMARDs or glucocorticoids in individuals at risk for RA or those with early disease.
Participants included individuals with joint pain but no clinical arthritis, patients with undifferentiated arthritis, and those with very early RA, defined as those with clinical arthritis evolving for less than 16.0 weeks and meeting the 2010 ACR/EULAR criteria for RA, but not the 1987 ACR criteria. The average symptom duration was 16.2 weeks, and the majority of trials were placebo-controlled. A total of nine trials reported the occurrence of RA.
When the results of the seven studies carried out in patients with undifferentiated arthritis were pooled, those receiving therapeutic intervention – including prednisolone, methotrexate, infliximab, etanercept, and abatacept – had a significant 27% reduced risk for developing RA according to the 1987 ACR criteria after 1 year compared with patients in the control arms.
Fautrel and team note that “[a]ll drugs tended to reduce the risk of RA occurrence, except TNF [tumor necrosis factor] blockers.”
Indeed, when the three studies investigating infliximab or etanercept were removed from the analysis, therapeutic intervention was associated with a 32% reduced risk for RA development.
“This finding is likely to be a class effect rather than a single molecule effect because it was observed with two different agents, one soluble receptor (etanercept) and one monoclonal antibody (infliximab),” say the study authors.
Agents such as methotrexate, rituximab, and glucocorticoids “may have a broader effect and act higher in the pathogenic cascade, including antigen presentation and early steps of the autoimmune reaction,” thereby preventing immune system activation and the development of RA, whereas TNF blockers may “only reduce already existing inflammation,” they speculate.
The researchers found no significant impact of therapeutic intervention with dexamethasone or rituximab in the two studies involving patients with arthralgia without arthritis, however, which they say could be “partly due to a lack of power with the only two available studies.”
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