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Preclinical rheumatoid arthritis (RA) is a hot new area wherein at risk individuals (seropositive, first degree relatives of RA patients, etc.) are being studied to assess the triggers that lead to progression to RA or whether therapies can be used to avert the onset of RA.
Hilliquin and colleagues undertook a systematic literature review and meta-analysis to assess if there are randomised controlled trials of disease-modifying antirheumatic drugs (DMARDs) or glucocorticoids used in at risk individuals - those with genetic and/or environmental risk factors and/or systemic autoimmunity associated with RA, without clinical synovitis/arthritis.
They identified 10 trials that included 1156 patients, with mean symptom duration 16.2±12.6 weeks.
In those with arthralgia, and without arthritis (people at risk of RA), two available studies failed to show significant reduction in RA occurrence at week 52 or more (pooled OR 0.74, 95% CI 0.37 to 1.49).
For people with undifferentiated arthritis, seven studies revealed significant risk reduction with OR 0.73(95% CI 0.56 to 0.97) in the development of RA.
This metanalysis shows that early therapeutic intervention may significantly reduce the risk of RA onset but only those with undifferentiated arthritis.