Early MTX, DMARD Combos, May Benefit Undifferentiated Arthritis


For early undifferentiated arthritis, give methotrexate or combinations of DMARDs and corticosteroids sooner rather than later to suppress disease activity and radiographic progression, says a literature review.

Wevers-de Boer KVC, Heimans L, Huizinga TWJ, C F Allaart CF. Drug therapy in undifferentiated arthritis: a systematic literature review. Ann Rheum Dis (2013) 72:1436-1444 doi:10.1136/annrheumdis-2012-203165

A review of the medical literature about early treatment for undifferentiated arthritis (UA) suggests that methotrexate (MTX) or combinations of disease modifying anti-rheumatic drugs (DMARDs) and corticosteroids -- given sooner rather than later -- may help suppress disease activity and radiographic progression, preventing development of persistent arthritis.

At the same time, the review concedes that predicting outcomes in individual patients is not yet possible, evidence is still limited about the potential for inducing remission and/or permanently altering the course of undifferentiated arthritis, and the long-term benefit of early treatment is still unclear.

The review by authors from Leiden University in the Netherlands encompasses 18 publications: 9 analyzing randomized controlled trials (RCTs), 2 examining uncontrolled, open-label trials, and 7 publications evaluating observational cohort studies. It found no RCTs comparing early versus late UA treatment.

Specific findings:

•  MTX monotherapy can postpone, but not prevent, development of RA, and may slow down radiological progression.
•  DMARD combination therapy is, at least after 4 months, superior to MTX monotherapy in patients with UA at high risk of developing persistent arthritis.
•  Initial combination therapy with MTX and multiple DMARDs, or corticosteroids, appears to result in better short-term clinical outcomes, but long-term data is unavailable.
•  Early treatment with abatacept appears to suppress progression of radiological damage, but its long-term benefits remain uncertain.
•  A single corticosteroid injection likely has no long-term benefit, and repeated injections may postpone DMARD need, but do not prevent progression to RA.

However, the review says it is yet to be determined which treatment may provide the best results.


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