Can Rheumatoid Arthritis Be Prevented?
Rheumatoid arthritis is one of the most common autoimmune diseases. It causes chronic inflammation in the joints and, without appropriate treatment, can lead to permanent damage.
However, the disease does not always develop suddenly. Some people go through a period in which autoantibodies can be detected or inflammatory symptoms appear, even though they do not yet meet the diagnostic criteria for rheumatoid arthritis.
This is precisely what the researchers wanted to investigate: whether intervening early could prevent the progression to established rheumatoid arthritis.
How Was the Study Conducted?
PALABA was a randomised clinical trial conducted across 14 rheumatology centres in Spain.
The analysis included 70 patients with palindromic rheumatism, a condition characterised by recurring episodes of joint pain and inflammation that resolve without causing permanent damage.
All participants tested positive for rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA), markers associated with an increased risk of developing rheumatoid arthritis.
Participants were divided into two groups:
- 34 patients received abatacept, a medication that inhibits T-cell activation.
- 36 patients received hydroxychloroquine, a medication used to treat certain rheumatic diseases.
The treatment and follow-up period lasted 24 months.
What Did the Study Find?
In the primary statistical analysis, the estimated proportion of patients who developed rheumatoid arthritis was:
- 20.6% in the abatacept group.
- 50% in the hydroxychloroquine group.
The difference was statistically significant (p = 0.010).
However, in the primary analysis, cases with missing data were classified as treatment failures.
When the researchers analysed only the available data, rheumatoid arthritis had developed in 3 of 30 patients (10%) in the abatacept group and 10 of 28 patients (35.7%) in the hydroxychloroquine group.
The difference remained statistically significant (p = 0.019).
Abatacept was also associated with less severe episodes and higher rates of symptom remission. [1]
What Are the Study’s Limitations?
One of the main limitations is that the trial was open-label. Both patients and doctors knew which treatment was being administered, potentially influencing how the outcomes were assessed.
Furthermore, the study involved a relatively small number of participants; several did not complete the trial, and follow-up was limited to two years.
We therefore do not know whether the benefits persist after treatment is discontinued.
The study was funded by Bristol Myers Squibb, the company that markets abatacept. According to the publication, the company was not involved in the study design, data analysis or interpretation of the findings.
Conclusion
The findings suggest that early treatment may help reduce progression to rheumatoid arthritis in certain individuals at high risk of developing the disease.
However, the results cannot be generalised to the wider population, nor do they establish that rheumatoid arthritis can be permanently prevented.
Larger clinical trials and follow-up after treatment discontinuation are needed before more reliable conclusions can be drawn about the long-term effectiveness of this approach.