Evaluating relationships between symptom duration and persistence of rheumatoid arthritis: does a window of opportunity exist? Results on the Leiden Early Arthritis Clinic and ESPOIR cohorts

Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study

“…During this so-called ‘window of opportunity’, chronicity of inflammation may be prevented and prolonged remission may be induced 28–30. It is estimated to encompass around 12 weeks from symptom onset 12. However, we found few differences in remission rates and only a trend for more DFR in patients with symptom duration <12 weeks compared with ≥12 weeks.…”

Two rheumatoid arthritis–specific autoantigens correlate microbial immunity with autoimmune responses in joints

“…Furthermore, the inclusion of citrullinated GNS in a test for ACPAs may increase the sensitivity of that test. These determinations have increased in importance, because earlier treatment with DMARDs may improve long-term outcomes, whereas a lack of diagnostic markers for seronegative patients may delay appropriate DMARD treatment, leading to less favorable clinical outcomes (44,45). Finally, in addition to DMARDs, the identification of patients with these antibody responses may allow the testing and development of adjunctive forms of treatment, such as brief, targeted antibiotic regimens or diet alterations.…”

The therapeutic window of opportunity in rheumatoid arthritis: does it ever close?

“…Data from patients with RA from two large clinical cohorts have been analysed by van Nies et al to address the relationship between symptom duration at initial rheumatology assessment (a surrogate for the time from symptom onset to disease modifying anti-rheumatic drug (DMARD) commencement) and favourable outcomes, namely (1) DMARD-free sustained remission; (2) sustained remission irrespective of DMARD use and (3) low rates of radiological progression 6. Their key finding is that the relationships between symptom duration and favourable outcomes are not linear and that, for all outcomes, a point is reached after which the benefit gained by reducing time to treatment is lessened.…”