Background Rheumatoid arthritis is characterised by antibodies to citrullinated proteins (ACPA) and rheumatoid factor (RF) in the preclinical phase.
Objective To determine whether an intervention aimed at decreasing autoantibody levels in people at risk may be effective in preventing progression to arthritis.
Methods 83 patients with arthralgia positive for ACPA or IgM-RF were randomly allocated to intramuscular injections of 100 mg dexamethasone or placebo at baseline and 6 weeks. The primary end point was a 50% antibody reduction or normalisation at 6 months.
Results The primary end point was reached in one patient in each group. Patients treated with dexamethasone had reductions of antibody levels after 1 month (ACPA 222% and IgM-RF 214%), which persisted at 6 months for ACPA. During a median follow-up of 26 months, arthritis development in both groups was similar (20% vs 21%).
Conclusion In autoantibody-positive patients with arthralgia, dexamethasone treatment decreases ACPA and IgM-RF levels, but does not prevent arthritis development.
Trial registration number: ISRCTN73232918.
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Funding This study is financially supported by the Netherlands Organisation for Health Research and Development (ZonMw), grant number 6100.0010. The funding source did not have any involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Competing interests None.
Ethics approval Approval from the ethical committee, Jan van Breemen Instituut/Slotervaart Hospital, Amsterdam, The Netherlands.
Provenance and peer review Not commissioned; externally peer reviewed.