Which arthralgia patients benefit most in reduction of subclinical joint inflammation by methotrexate treatment: results from the TREAT EARLIER trial
Authors' conclusion
CSA patients with subclinical inflammation who responded best to methotrexate during the first year were identified by increased levels of subclinical inflammation at diagnosis, primarily due to multiple sites of tenosynovitis with/without osteitis.
Study context
- Population
- Clinically suspect arthralgia (CSA) patients with subclinical inflammation
- Participants
- 115 treated patients
- Primary endpoint
- MRI-defined treatment response: reduction of MRI-detected synovitis, tenosynovitis or osteitis beyond the smallest detectable change
- Follow-up
- 12 months
Primary result
As reported in the abstract
MRI-defined treatment response (reduction of MRI synovitis, tenosynovitis or osteitis beyond smallest detectable change)
Treated
38%
44 events
- PPV for response, ≥2 sites with tenosynovitis
- 77%
- PPV for response, osteitis and tenosynovitis combined (≥1 feature at ≥2 sites)
- 79%
Further findings
Pain and physical functioning in MRI responders
- VAS pain change
- −22
- HAQ change
- −0.29
- Significantly improved
Predictors of MRI response
- PPV, ≥2 sites with tenosynovitis
- 77%
- PPV, osteitis and tenosynovitis combined (≥1 feature at ≥2 sites)
- 79%
- Baseline clinical variables not independently associated with response; tenosynovitis and osteitis levels particularly predictive
- PPVs similar in ACPA-positive and ACPA-negative patients at increased risk for rheumatoid arthritis (RA)
Original publication
Which arthralgia patients benefit most in reduction of subclinical joint inflammation by methotrexate treatment: results from the TREAT EARLIER trial. RMD Open. Published 20 January 2026. doi:10.
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