Incidence of Rheumatoid Arthritis Onset in Patients with Arthralgia and Anti- Citrullinated Peptide Antibody Positivity: Pilotstudy on Effectiveness of Hydroxychloroquin Treatment

Abstract

Objective: A relevant subset of patients with ACPA-positive arthralgia will develop arthritis within one year. Hence, an ACPA-positive patient cohort with arthralgia was treated with hydroxychloroquine (HCQ) and was followed-up in terms of RA-manifestation and arthralgia complaints. Methods:Since 2009 all patients presenting with arthralgia showing positive ACPA without clinical signs of arthritis were investigated retrospectively at a large outpatient facility in Lower Saxony, Germany. Body-weight adapted hydroxychloroquine-therapy was started at outset and assessments comprise a detailed documentation of arthralgias and rheumatological status (DAS28). The RA-onset rate within 12 months after enrollment is regarded as the primary outcome; secondary outcomes are the clinical course and humoral inflammatory activity. Results:Within 12 months one of 24 patients developed RA (5%), one further patient within 24 months (10%). Regarding the secondary outcomes the number of arthralgic sites decreased highly significant, the DAS28-score and the rheumatoid factor improved after both 12 and 24 months follow-up (p<0.05). Furthermore, the mean steroid dosage could be tapered from 5 mg to 1 mg, and to 0 mg, respectively. In contrast to the present pilot study, conventional treatment (without DMARDs) in seropositive arthralgia patients yielded about 6-fold and 3-fold higher rates of RA-incidence within 12 months and 24 months, respectively. Conclusion:Since these results are promising, randomized controlled studies are needed to evaluate the effects of HCQ on RA-prevention in seropositive arthralgia patients and to define its role regarding the clinical course of seropositive arthralgia within a possible "window of opportunity".

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