RESEARCH - Does the use of TNF antagnoist therapy in poor prognosis, undifferentiated arthritis prevent progression to RA?

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Ann Rheum Dis. 2008 Jan 30 [Epub ahead of print]

Does the use of TNF antagonist therapy in poor prognosis,

undifferentiated arthritis prevent progression to rheumatoid

arthritis?

Saleem B, Mackie S, Quinn M, Nizam S, Hensor E, Jarrett S, Conaghan PG, Emery P.

Academic Section of Musculoskeletal Disease, University of Leeds,

United Kingdom.

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: /B>: 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.

PMID: 18234715

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=182347\

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