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Ann Rheum Dis doi:10.1136/ard.2007.084269

Does the use of TNF antagonist therapy in poor prognosis, undifferentiated arthritis prevent progression to rheumatoid arthritis?

  1. Benazier Saleem (benazir_saleem{at}yahoo.co.uk)
  1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
    1. Sarah Mackie (s.l.mackie{at}leeds.ac.uk)
    1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
      1. Mark Quinn (mark.quinn{at}york.nhs.uk)
      1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
        1. Sharmin Nizam (c.l.cook{at}leeds.ac.uk)
        1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
          1. Elizabeth Hensor
          1. University of Leeds, United Kingdom
            1. Steve Jarrett (sjardoc{at}aol.com)
            1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
              1. Philip G Conaghan (p.conaghan{at}leeds.ac.uk)
              1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
                1. Paul Emery (p.emery{at}leeds.ac.uk)
                1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
                  • Published Online First 30 January 2008

                  Abstract

                  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.