Abatacept Reverses Subclinical Arthritis in Patients with High-risk to Develop Rheumatoid Arthritis -results from the Randomized, Placebo-controlled ARIAA Study in RA-at Risk Patient
Authors: Juergen Rech et al.
Rheumatoid Arthritis (RA) has a long pre-clinical phase of the disease, including the presence of autoantibodies associated with RA, unspecific symptoms or infra-clinical joint inflammation (sometimes called ‘clinically suspect arthralgias’). The authors of this trial hypothesized that treating patients in the late pre-clinical phases of the disease with abatacept might allow to prevent the development of full-blown RA. Indeed, by interfering in the antigen presentation to T lymphocytes, abatacept operates at an early stage of the inflammatory cascade.
98 patients who presented ACPA (anti-CCP antibodies) and sub-clinical joint inflammation on MRI, were randomized to receive either abatacept at standard dose or a placebo for a whole year. During the follow-up 35% of patients in the placebo group developed clinical arthritis versus 8% in the abatacept group.
At the moment, rheumatologist are not treating pre-clinical RA. In part because we have difficulty predicting reliably who will develop active RA in the future. This study shows that administering abatacept to this group of patients in late stages of pre-clinical RA (seropositivity and inflammation on articular imaging) prevents the progression to clinically overt RA. However, a longer follow-up is needed to establish whether the progression was definitely stopped or just retarded. For instance, a single rituximab injection in a similar population (the PRAIRI trial) was only able to postpone the development of clinical classifiable RA.