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There is a paucity of guidance on how to best manage patients who may be at risk for rheumatoid arthritis (e.g., first degree relative, seropositivity) and who manifest joint pain but not enough synovitis to be classified as RA.
These researchers undertook a systematic literature review and meta-analysis to address whether disease-modifying antirheumatic drugs (DMARD) or steroid therapy might delay or avoid the onset of RA. They narrowed their review to 10 studies and 1156 patients (with a mean symptom duration of 16.2 weeks) with either undifferentiated arthritis or arthralgia.
They found that DMARD and steroids did not reduce the risk of RA in arthralgia patients after 52 weeks of therapy (pooled OR 0.74, 95% CI 0.37 to 1.49).
On the other hand, there were 7 studies in which DMARD use in patients with undifferentiated arthritis was associated with a significantly reduced the risk (OR 0.73; 95% CI 0.56 to 0.97).
These studies provide modest evidence of DMARD or steroid benefit in patients with undifferentiated arthritis, but not so for arthralgia only patients.