A window of opportunity exists when rheumatoid arthritis patients have the best chance of remission

This study investigated whether there is a window of opportunity for treating rheumatoid arthritis.

It has been reported that the longer rheumatoid arthritis is left untreated the worse the outcome is for patients. Unfavorable outcomes include more severe joint destruction, a higher need of surgery, a higher mortality rate and a lower chance of achieving remission following drug treatment.

There are two possibilties as to why this may be true: first, patient treatment may need to start as early as possible or there may be a gradual decline in treatment success, or second,  a prolonged window of opportunity may exist which allows for stronger response to treatment. It is not known which of these options is true and this requires further investigation to improve patient care.

This study followed 1271 patients from two separate trials for a minimum of 1 year or up to 5 years. There were 738 patients in trial 1 and 533 in trial 2. All patients were being treated with disease modifying antirheumatic drugs (DMARDs, such as methotrexate [Trexall, Rheumatrex]). The main outcome was DMARD-free sustained remission; this was defined as the sustained absence of swelling by physical examination after stopping DMARD therapy, and all other medications, for the entire period of follow-up.

11.5% of patients from trial 1 and 5.4% from trial 2 achieved DMARD-free sustained remission. In both trials there was no direct correlation between the duration of symptoms before treatment and the chance of achieving remission.

The authors also analyzed the duration of symptoms that was most statistically discriminative for treatment success. The symptom duration with the best discriminative ability was 14.4 weeks in trial 1 and 19.1 weeks in trial 2. This suggests that there is a window of opportunity at the beginning of symptom presentation when drug treatment might yield a better outcome. This does not mean that beginning DMARD treatment after the window of opportunity is useless, it may however not be as successful.

The authors concluded that there is a confined period of time (a window of opportunity) when rheumatoid arthritis patients are more susceptible to treatment.