PARIS, France—Injecting patients who have very early inflammatory polyarthritis with a 3-week course of intramuscular (IM) steroids may stop the progression to arthritis, according to new results from the Steroids In Very Early Arthritis (STIVEA) trial, which were presented at the annual European League Against Rheumatism (EULAR) meeting in Paris, France.1

"Treatment of patients with very early inflammatory polyarthritis with IM steroids appears to postpone prescription of second-line therapy and prevent patients from progressing to RA."—Suzanne M. M. Verstappen, MD
"Treatment of patients with very early inflammatory polyarthritis with IM steroids appears to postpone prescription of second-line therapy and prevent patients from progressing to RA," conclude researchers led by Suzanne M. M. Verstappen, MD, of the University of Manchester in the UK.

Fully 113 patients with early inflammatory arthritis (defined as 4-11 weeks in duration) with soft tissue swelling of ≥2 joints and hand involvement were randomized to IM steroids, and 132 to placebo. Patients in the steroid group received three IM injections of 80 mg methylprednisolone at 1-week intervals. Patients were followed for 12 months: they were assessed monthly for 6 months after the first injection, and were reassessed at 1 year by a general practitioner.

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At 6 months, 78% in the placebo arm and 62% in the steroid treated arm either had started or had been referred to a rheumatologist for further treatment. Overall, placebo patients were more likely to need further therapy during the first 6 months of the trial compared with patients in the steroid patients, the study showed. ?In the placebo group, 60% of patients had arthritis compared with 50% in the steroid group at 1 year. Moreover, 20% of patients in the steroid arm were arthritis-free at 1 year compared with 10% in the placebo arm.

Nineteen percent of patients taking placebo had undifferentiated inflammatory polyarthritis at 1 year compared with 20% in the steroid group. The percentage of other inflammatory diseases was 6% in the placebo group versus 2% in the steroid group, and 5% of patients in the placebo group developed noninflammatory diseases compared with 8% who received steroids. Overall, 20 placebo patients and 21 steroid patients were withdrawn from the study for reasons that included loss to follow-up, consent withdrawal, and death.

Reference
1. Verstappen SMM, McCoy M, Roberts C, et al. A 3-week course of IM steroid injections may prevent the progression of very early inflammatory polyarthritis: Results of the STIVEA trial Presented at: EULAR 2008; June 11-14, 2008; Paris, France. Abstract OP-0041.