Background/Purpose: Treatment of rheumatoid arthritis (RA) should aim at full remission. However, we experienced that rapid radiographic progression (RRP) existed despite initial tofacitinib and methotrexate combination therapy in early RA (unpublished data). In RRP, initial tofacitinib and methotrexate might be inadequate. To compare remission and radiographic non-progression in RRP patients treated with tofacitinib or with tofaficitinib plus intra-articular steroid injection.

Methods: We designed a single-blind(X ray reader and assessment physician), randomized controlled trial. We screened 48 RRP (CRP> 10 mg/L, RF +, and ACPA+) early (disease duration<6 months) RA patients for inclusion. 39 were randomly allocated tofacitinib group (T group) or tofacitinib plus intra-articular steroid injection group (T plus I group). All patients were taking methotrexate (from 10 to 22mg a week). For T plus I group, palpate examinations of both MP and PIP joints, wrists, elbows, shoulders, and knees were performed every 4 weeks. If swollen joints were existed, intra-articular steroid injections were intensified in each swollen joints. Co–primary endpoints were proportion of patients showing clinical remission (SDAI <3.3) and radiographic non-progression (Δ modified total Sharp score ≤0.5) at 52 weeks. Analysis was by intention-to-treat with last observation carried forward to missing data.

Results: The characteristics of each group at baseline were not significantly different. Clinical remission at 52weeks was achieved by more patients in the T plus I group (29.2%) than in the T group (21.3%) (p<0.05). Radiographic non-progression at 52 weeks was achieved by more patients in the T plus I group (33.4%) than in the C group (23.7%) (p<0.05).

Conclusion: Results of this reveal that combination of intra-articular steroid injection and tofacitinib can achieve a high clinical and radiological remission rate in early RRP RA.

References:

1) Effectiveness of initial treatment allocation based on expert opinion for prevention of rapid radiographic progression in daily practice of an early RA cohort. Durnez A, et al. Ann Rheum Dis. 2011 Apr;70(4):634-7. Epub 2010 Dec 21.

2) A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Visser K, et al. Ann Rheum Dis. 2010 Jul;69(7):1333-7. Epub 2010 May 24.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/combination-of-intra-articular-steroid-injection-and-tofacitinib-more-effective-than-tofacitinib-in-rapid-radiographic-progression-patients-with-rheumatoid-arthritis/