Objectives: To evaluate the ability of TNF antagonist therapy to produce remission and prevent progression to RA in patients with poor prognosis undifferentiated inflammatory arthritis (UA).
Methods: Patients with UA of less than 12 months duration and having relapsed after a single parenteral corticosteroid injection were recruited into a double-blind placebo-controlled trial of infliximab or placebo mono-therapy administered at weeks 0, 2, 6 and 14. Methotrexate was added at week 14 if no clinical response (raised CRP and clinical synovitis) was achieved. Standard outcomes were collected at baseline, infusion visits and weeks 26 and 52. The primary outcome was clinical remission at week 26.
Results: Seventeen patients were randomised (10 infliximab, 7 placebo) all with poor prognostic features. At week 14, the infliximab group had greater improvements in CRP and HAQ but by week 26 there was just a trend favoring infliximab for EMS, TJC, SJC and HAQ; there was no significant difference in DAS28 between the two groups. Furthermore only 3 patients were in clinical remission (2 infliximab, 1 placebo). By week 52, 100% patients in the infliximab group and 71% (5/7) patients in the placebo group had developed rheumatoid arthritis (RA).
Conclusions: In poor prognosis UA, a short course of TNF antagonist therapy provided modest short-term relief but did not prevent the development of RA. Poor prognosis UA patients relapsing after corticosteroid have a very high risk of evolving to RA and are suitable candidates for interventional therapy.
- rheumatoid arthritis
- undifferentiated inflammatory arthritis