Lopez-Olivo MA, et al. - A systematic review and meta-analysis of direct and indirect trial evidence were performed to assess the efficacy of treatments for patients with undifferentiated arthritis (UA). With the largest effect observed for methotrexate, treating patients with UA resulted in a statistically significant delay in the development of rheumatoid arthritis (RA). These findings suggested that there was a window of opportunity to treat patients with UA early, to delay subsequent progression to RA.

Methods

• From inception to January 2016, the physicians searched 4 electronic databases, clinicaltrials. gov, and bibliographies of relevant articles.
• In this systematic review, 2 reviewers independently screened and assessed the studies.
• The development of rheumatoid arthritis (RA) was the primary outcome.

Results

• The physicians included 9 studies.
• Interventions included methotrexate, abatacept, infliximab, intra-articular or intramuscular glucocorticoids, and radiation synovectomy.
• Compared to placebo or no treatment (odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.90), treating patients resulted in lower rates of RA at 12 months.
• Patients treated with methotrexate were less likely to develop RA at 12 months compared to patients treated without methotrexate (OR 0.13, 95% CI 0.03-0.48), from direct meta-analysis.
• At 30 or 60 months, this difference was no longer significant.
• Most interventions demonstrated a decreased risk of developing RA compared to placebo at 12 months, reaching statistical significance for methotrexate (OR 0.16, 95% CI 0.08-0.33), and intramuscular methylprednisolone (OR 0.72, 95% CI 0.53-0.99), from indirect comparisons.