Timing the therapeutic window of opportunity in early rheumatoid arthritis: proposal for definitions of disease duration in clinical trials

Abstract

The effects of treatment in early rheumatoid arthritis (RA) and the consequences of delayed therapy represent important areas for research. The concept of a 'window of opportunity' is now well established and considerable attention has been paid to when it might close. However, in order to study how long the window of opportunity lasts, the timing of its opening must be precisely defined. An analysis of definitions of 'onset' in clinical studies reveals imprecision and heterogeneity, making accurate assessment of this important concept of the 'window of opportunity' very difficult. In this paper we propose that, in clinical trials in early RA, data on durations since onset of symptoms and onset of joint swelling as well as disease duration based on fulfilment of classification criteria should be routinely presented.

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

“…Symptom onset in EAC and ESPOIR was delineated identically and defined as the first musculoskeletal symptom (either being pain or swelling) relevant to the current presentation 13. The symptom duration was defined as the duration between this patient reported symptom onset and inclusion and was determined by subtraction of dates, expressed in weeks.…”

Effects of PVA coated nanoparticles on human immune cells

“…8,9,[22][23][24] It has been shown that the earlier patients with RA are treated the more effective is the treatment. 25,26 Thus there is an urgent need for a very early diagnosis of RA in order to enable earlier treatment and to reduce or even to stop the progress of the disease. Furthermore, an early diagnosis can prevent joint damage, thereby lowering the additional therapeutic and disability costs which arise from reduced work capacity of the patients: nearly 30% of patients give up work within 1 year as a result of their condition and almost 60% within 6 years of diagnosis.…”

Clinical, Functional, and Radiographic Benefits of Longterm Adalimumab Plus Methotrexate: Final 10-year Data in Longstanding Rheumatoid Arthritis

“…Current recommendations for patients with poor prognostic factors suggest treatment with MTX for 3 to 6 months before considering the addition of biologic DMARD therapy 12 , but some rheumatologists continue MTX for longer periods before considering the addition of biologic therapy 13,14 . For patients early in the course of disease (< 3 years' duration), there may be a window of opportunity (estimated to be at least 6 months) during which the timely addition of anti-TNF therapy to MTX-inadequate responders can result in optimal therapeutic responses 15 . However, a 2-year delay appears to exceed this window, resulting in an inability to improve outcomes 16 .…”