To treat or not to treat? Current attitudes on treatment aimed at modifying the disease burden in clinically suspect arthralgia: a survey among participants of the TREAT EARLIER trial and healthcare professionals

Abstract

ObjectivesWhile awaiting therapies accomplishing rheumatoid arthritis (RA)-prevention in individuals at-risk, recent evidence supports that a 1-year methotrexate treatment may lead to sustained reduction in disease burden and subclinical joint inflammation in patients with clinically suspect arthralgia (CSA). We aimed to study the previously unexplored attitudes of CSA patients and rheumatologists on 1-year DMARD treatment in the arthralgia phase to reduce the disease burden, while not preventing RA.MethodsCSA patients who participated in the TREAT EARLIER trial, thus being expert by experience, were informed on the trial results. Thereafter they completed an anonymous questionnaire about their attitudes on treatment in the CSA phase. We used the same approach for Dutch healthcare professionals in rheumatology.ResultsThe majority of trial participants (85%) considered the effects of the 1-year treatment as found in the TREAT EARLIER trial, beneficial in the symptomatic at-risk stage. 79% would recommend a 1-year methotrexate course to others with comparable joint complaints. Two-thirds indicated RA prevention and improving disease burden to be equally important treatment goals in the CSA phase. Most healthcare professionals (88%) were inclined to prescribe 1-year treatment to CSA patients aimed at long-term improvement of symptoms and functioning, while not preventing RA development. 59% believed the profits of a 1-year methotrexate course to outweigh disadvantages, for example, side effects.ConclusionsA considerable willingness exists among CSA patients and rheumatologists to start a 1-year treatment resulting in long-term improvement of symptoms and functioning, while not preventing RA. This emphasises the need for more research optimising treatment regimens and disease monitoring in individuals at-risk to facilitate such treatment decisions in the future, while avoiding an intervention, either limited or for a prolonged period, which may have harms that outweigh benefits.Trial registration numberThe Netherlands Trials Registry (NTR4853-trial-NL4599). EudraCT number: NL2014-004472-35.

Novel insights into the management of rheumatoid arthritis: one year in review 2024

“…Additionally, only half of the doctors who agreed with treatment actually treated pre-RA patients in their clinical practice, citing concerns about potential side effects as their main reason for hesitancy. However, among patients, most respondents were satisfied with the treatment, although satisfaction decreased among those who progressed to confirmed RA (59). The Abatacept in individuals at high risk of rheumatoid arthritis (APIPPRA) and Abatacept Reversing subclinical inflammation as measured by MRI in ACPA positive Arthralgia (ARIAA) trials investigated the effects of abatacept in patients with pre-clinical rheumatoid arthritis (RA), focusing on clinical and imaging outcomes (60,61).…”