TNF blocker therapy does not prevent progression to rheumatoid arthritis

September 6, 2008

Ann Rheum Dis 2008;67:1178-1180.

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Reuters Health - Sep. 01, 2008

NEW YORK (Reuters Health) - Although short-term treatment with a tumor

necrosis factor (TNF) antagonist may provide symptom relief to patients with

undifferentiated arthritis, it does not prevent the development of

rheumatoid arthritis, new research shows.

" As far as we know, this is the first placebo-controlled trial of TNF

blockade in patients with undifferentiated arthritis, " note Dr. P. Emery and

associates from the University of Leeds in the UK.

As reported in the ls of the Rheumatic Diseases for August, the study

involved 17 patients with undifferentiated arthritis of less than 12 months

duration who had experienced a disease relapse after a single corticosteroid

injection.

The subjects were randomized to receive infliximab or placebo at weeks 0, 2,

6, and 14. In addition, methotrexate was given at week 14 to patients

without a clinical response, defined as an elevated C-reactive protein level

and clinical synovitis.

At 14 weeks, the infliximab group showed greater improvements in CRP level

and overall health status. By 26 weeks, however, there was only a trend

favoring infliximab in improving early morning stiffness, tender joint

score, and swollen joint score; the 28 joint count Disease Activity Score

was not significantly different between the groups.

Just two infliximab-treated patients and one given placebo achieved clinical

remission. At 1-year follow-up, the percentage of patients with progression

to rheumatoid arthritis was not significantly higher in the infliximab

group: 100% vs. 71%.

" The study suggests that the outcome of poor prognosis, undifferentiated

arthritis is not influenced by short-term treatment with TNF blockade as

measured either by remission or by preventing progression to rheumatoid

arthritis, " the team concludes.

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