Background Recent cumulative evidence suggests that early therapeutic intervention by DMARDs including MTX could prevent progression of RA. However, it is not clarified how early and which population of the patients should be taken early therapeutic intervention by DMARDs. Previously we reported that the patients with early-onset UA (EUA) showing high-titer anti-citrullinated peptide antibodies (ACPA) (>15 U/ml) developed RA within a year at high-rate (>80%) (ref.1).
Objectives To examine whether very early therapeutic intervention of MTX could prevent development of RA in the patients with EUA showing high-titer of ACPA.
Methods A prospective controlled study was conducted. The total number of 48 patients with UA showing high-titer of ACPA (>15 U/ml) who have never treated with any non-biologic DMARDs or biologics. All patients were fulfilled with 1994 JCR classification criteria for early RA (ref.2) but not 1987 ACR classification for RA. They participated in this study with given written informed consents and divided into two groups according to their decision. One group was treated with MTX concomitant with corticosteroid (PSL< 10mg/day) and/or NSAID (MTX+ Group, n=30). The other was treated without MTX (MTX- Group, n=18). Primary endpoint was development of RA defined by fulfilling 1987 ACR classification for RA at a time point of one year after the entry. Supplementally bone-progression was assessed by Heijdi-modified Sharp scores (H-S score).
Results As shown in Figure 1(Kaplan-Meier), 5 of the 30 patients (16.7%) in the MTX+ Group developed RA compared with 14 of the 18 patients (77.8%) in the MTX- Group (HR 0.214 [95% CI 0.093-0.495], p < 0.001). Although the mean interval changes from the baseline of H-S score per year showed no significant differences in the two groups (MTX+ versus MTX- : 2.0 (SD7.6) versus 2.9 (SD4.7), p = 0.312), the number of patients without obvious radiographical progression was relatively more in MTX+ (18 /23, 78.3%) compared to in MTX- (6 /11, 54.5%). In addition, there were no particular findings regarding to adverse events.
Conclusions Although short-term observation, very early therapeutic intervention of MTX might prevent development of RA in some populations of EUA.
Kudo-Tanaka E et al. Clin Rheumatol 2007.26:1627-33.
Yamamoto S. Ryumachi 1994.34:1013-8.
Disclosure of Interest None Declared