Effect of dexamethasone on autoantibody levels and arthritis development in patients with arthralgia: a randomised trial.
BACKGROUND
Rheumatoid arthritis is characterised by antibodies to citrullinated proteins (ACPA) and rheumatoid factor (RF) in the preclinical phase.


OBJECTIVE
To determine whether an intervention aimed at decreasing autoantibody levels in people at risk may be effective in preventing progression to arthritis.


METHODS
83 patients with arthralgia positive for ACPA or IgM-RF were randomly allocated to intramuscular injections of 100 mg dexamethasone or placebo at baseline and 6 weeks. The primary end point was a 50% antibody reduction or normalisation at 6 months.


RESULTS
The primary end point was reached in one patient in each group. Patients treated with dexamethasone had reductions of antibody levels after 1 month (ACPA 222% and IgM-RF 214%), which persisted at 6 months for ACPA. During a median follow-up of 26 months, arthritis development in both groups was similar (20% vs 21%).


CONCLUSIONS
In autoantibody-positive patients with arthralgia, dexamethasone treatment decreases ACPA and IgM-RF levels, but does not prevent arthritis development.


BACKGROUND
ISRCTN73232918.
Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
W H
WH
Bos
B A C
BA
Dijkmans
M
M
Boers
R J
RJ
van de Stadt
D
D
van Schaardenburg
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D018771:Arthralgia / Q000188:drug therapy* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000517:prevention & control*; D015415:Biomarkers / Q000378:metabolism; D003907:Dexamethasone / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D012217:Rheumatoid Factor / Q000276:immunology
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D007075:Immunoglobulin M; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D003907:Dexamethasone; D012217:Rheumatoid Factor