Key clinical point: Early initiation of a single glucocorticoid injection with 1-year methotrexate treatment in patients with arthralgia at risk for rheumatoid arthritis (RA) did not prevent clinical arthritis but improved overall disease burden.
Major finding: At 2 years, the risk of developing clinical arthritis persisting for ≥2 weeks was similar (hazard ratio 0.81; 95% CI 0.45-1.48). However, methotrexate vs placebo showed sustained decrease in magnetic resonance imaging-detected joint inflammation (mean difference [MD] −1.4 points; P < .0001) and improvement in physical functioning (MD −0.09; P = .0042), pain (MD −8; P < .0001) and morning stiffness of joints (MD −12; P < .0001). No new adverse events were reported.
Study details: Findings are from TREAT-EARLIER, a randomized controlled proof-of-concept trial, including 236 patients with arthralgia clinically predisposed to RA who were randomly assigned to receive single glucocorticoid injection+methotrexate or placebo for 1 year.
Disclosures: This study was funded by the Dutch Research Council, supported by the Dutch Arthritis Society. The authors declared no conflicts of interest.
Source: Krijbolder DI et al. Intervention with methotrexate in patients with arthralgia at risk of rheumatoid arthritis to reduce the development of persistent arthritis and its disease burden (TREAT EARLIER): A randomised, double-blind, placebo-controlled, proof-of-concept trial. Lancet. 2022;400(10348):283-294 (Jul 23). Doi: 10.1016/S0140-6736(22)01193-X