Therapeutic Interventions to Prevent and Delay Rheumatoid Arthritis Onset

According to a study in Annals of the Rheumatic Diseases, there have been recent advances in knowledge of the pathogenesis of rheumatoid arthritis (RA) that has led to promoting very early intervention. By using a systematic literature review (SLR) and meta-analysis (MA), researchers aimed to assess the efficacy of therapeutic interventions in preventing or delaying RA onset. 

The study used randomized controlled trials from PubMed, EMBASE, and Cochrane databases for English articles published from 2006 to 2016. Patients in these articles used disease-modifying antirheumatic drugs or glucocorticoids used in patients. These patients presented genetic and/or environmental risk factors for RA and/or systemic autoimmunity associated with RA, and/or symptoms without clinical arthritis and/or unclassified arthritis and in patients with RA. RevMan with the Mantel-Haenszel method was used to perform the MA.  

Ten reports of trials were selected out of the 595 abstracts originally screened. The occurrence of RA was available for nine studies; these studies assessed methylprednisolone, methotrexate, a tumor necrosis factor blocker, abatacept, or rituximab. In the group of people at risk of RA, the MA of the two available studies did not show significant reduction in RA occurrence at week 52 or more (pooled OR 0.74, 95% CI 0.37 to 1.49). The MA of the seven available studies revealed significant risk reduction with OR 0.73(95% CI 0.56 to 0.97) for people with undifferentiated arthritis.

“This MA demonstrates that early therapeutic intervention may significantly reduce the risk of rheumatoid arthritis onset in this very first phase of the disease,” the researchers concluded.

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SOURCE: Annals of the Rheumatic Diseases