{
  "abstract": "Objectives To investigate whether in undifferentiated arthritis (UA) it is beneficial to start early treatment with disease-modifying antirheumatic drugs (DMARDs) compared with symptomatic therapy.Methods The Induction of Cure in Early Arthritis study is a 3-month multicentre single-blinded randomised controlled trial followed by a 9-month observational period. Patients with early DMARD-naïve UA (arthritis ≥2 joints, not fulfilling American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2010 Rheumatoid Arthritis criteria) received a glucocorticoid injection (40 mg intra-articular or intramuscular) and were randomised (1:1:1) to a 3-month intervention with (1) non-steroidal anti-inflammatory drugs (NSAIDs) in standard daily dose or (2) methotrexate (MTX) 15 mg/week increased to 25 mg/week or (3) baricitinib 4 mg/day. Primary endpoint was Disease Activity Score (DAS) (44/53 joints) improvement at 3 months. Differences between treatment arms were assessed with analysis of covariance, adjusted for baseline DAS.Results Patients were randomised to NSAID (n=29), MTX (n=28) or baricitinib (n=28). After 3 months, baricitinib gave a significant improvement in DAS compared with NSAIDs: adjusted mean change in DAS: −0.52 (95% CI −0.93 to −0.11; p=0.01). MTX gave a numerically similar improvement: −0.39 (95% CI −0.84 to 0.06, p=0.09). Although non-significant, at 12 months DAS was lowest in the MTX treatment arm 1.3 (SD 0.7), NSAID 1.6 (SD 0.9), baricitinib 1.7 (SD 0.9), p=0.38. Incidence rates of severe adverse events remained low during the study across all treatment arms.Conclusions In patients with UA, early DMARD treatment led to greater improvement in disease activity over 3 months compared with NSAIDs, with the improvement for baricitinib reaching statistical significance. Over 12 months, disease activity was not significantly different across treatment arms, with overall favourable outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Isabell S Nevins"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Joy Ardjuna van der Pol"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Lotte Van Ouwerkerk"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Gregory S Helmich"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Frisius Medical Center, Leeuwarden, The Netherlands",
        "Department of Rheumatology, Nij Smellinghe Hospital, Drachten, The Netherlands"
      ],
      "name": "Reinhard Bos"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Haga Hospital, The Hague, The Netherlands"
      ],
      "name": "Sjoerd M Van Der Kooij"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands",
        "Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands"
      ],
      "name": "Harald E Vonkeman"
    },
    {
      "affiliations": [
        "Rheumatology, Amphia Hospital, Breda, The Netherlands"
      ],
      "name": "Jessica Bijsterbosch"
    },
    {
      "affiliations": [
        "Rheumatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"
      ],
      "name": "Pascal Hendrik Pieter de Jong"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Maasstad Hospital, Rotterdam, The Netherlands"
      ],
      "name": "Melek Güler-Yüksel"
    },
    {
      "affiliations": [
        "Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands",
        "Department of Pharmacology and Toxicology, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Stefan Böhringer"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Tom W J Huizinga"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Floris A van Gaalen"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"
      ],
      "name": "Sytske Anne Bergstra"
    }
  ],
  "title": "Induction of Cure in Early Arthritis (I CEA): results of a randomised clinical trial to compare three treatment strategies in recent onset undifferentiated arthritis",
  "uid": "867c1436-43d3-558b-b6e6-3b02634bb1d4"
}