“The idea is that, in the earliest phase of the disease, patients who have limited signs and symptoms of what may progress to full-blown RA have the best chance to go into permanent remission after treatment with a progressive combination of anti-rheumatic drugs,” says Cornelia Allaart, MD, PhD, an associate professor of rheumatology at Leiden University Medical Center in the Netherlands.

Dr. Allaart and her research team studied 261 patients who had recently developed RA and 161 with “undifferentiated” arthritis, meaning they have arthritis in more than one joint and are at risk of getting a full-blown case. All were taking 60 milligrams a day of prednisone, which was reduced over seven weeks to 7.5 mg a day, as well as 25 milligrams of methotrexate a week.

One hundred fifty-three RA patients, 58.6 percent of the newly diagnosed group, achieved remission, as did 107 people with undifferentiated arthritis – 66.5 percent of that group. In all, 63 percent of the participants went into remission and all reported functioning better in daily life.

“These percentages are much higher than previously recorded in trials and cohorts, but then again, that may be because we are aiming for that by including patients with milder symptoms that were normally left out,” Dr. Allaart says.

Although the results are encouraging, Dr. Allaart says the real test comes when the medication is tapered and stopped in the patients who achieved remission. In an earlier study, her research team showed that methotrexate can be effective in postponing development of RA from the undifferentiated arthritis stage, but when the medication was stopped, patients relapsed and the disease progressed. Researchers want to see if the addition of prednisone results in a different outcome.  

For now, Dr. Allaart says patients should consult a doctor as soon as they have complaints about their joints.

“Doctors have to establish as soon as possible whether there is arthritis,” Dr. Allaart says. “They should treat each arthritis as a potential emergency, since there is evidence that early start of treatment not only makes sure that the patients will feel better more quickly, but will also prevent severe joint damage progression, which determines functioning in the long run.

“It is my dream to change the face of rheumatoid arthritis itself,” she adds. “It has become known, for lack of effective therapies until recently, as a chronic, progressively debilitating disease. But if we are early enough and start treatment with the most effective drugs, we can look at RA as being an acute, treatable illness, and start looking for a potential cure in the next decade.”