Treating very-early-stage rheumatoid arthritis patients with abatacept, methotrexate, methylprednisolone, rituximab, or TNF-blockers may greatly reduce future rheumatoid arthritis risk at or beyond 52 weeks. That’s according to a literature review culled from 1,156 patients, which was presented today at the Annual European Congress of Rheumatology conference in Madrid.

“Our review of the available clinical data supports the rationale for early treatment in these patients,” said Stephane Hilliquin, lead author, of Paris’ Pitié Salpêtrière University Hospital, in a EULAR press release.

There has been growing interest in pre-RA, the release adds, as there has been greater understanding of how rheumatoid arthritis develops (pathogenesis). Pre-RA refers to “undifferentiated arthritis or very early RA, a clinical stage in which very early intervention could be more efficacious,” it adds.

Some, such as the authors of a 2016 Rheumatology (Oxford) review, avoid the term. “We will not use the term pre-RA, since it can only be determined in retrospect after the patient has developed clinically apparent RA,” the authors wrote. :From a prospective point of view, many persons with multiple risk factors will never develop RA, and it would be inappropriate to classify these persons as being in a pre-disease stage of RA.” (Other studies refer to “very early RA.”)

But Dr. Hilliquin and colleagues found in their literature review that active treatment of pre-RA patients produced “a significant reduction in the risk of occurrence of RA at 52 weeks or more,” according to the release.  “There was no statistically significant difference in the absence of disease progression as seen on X-ray between those taking active treatments or placebo due to the disease being at such an early stage,” he said

The review reinforces a new EULAR campaign called “Don’t Delay, Connect Today,” per the release. That campaign stresses “the importance of early intervention in the treatment of people with rheumatic and musculoskeletal diseases through early diagnosis and early referral,” Dr. Hilliquin said. Further research is necessary to better understand the benefits and risks of early aggressive pre-RA treatment, he added.