Evidence map›Paper›PMID 31168406›Full record

ReviewRMD open2019

Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives.

Leonie E Burgers, Karim Raza, Annette H van der Helm-van Mil

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in RMD open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 105 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
105citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

105 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
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  9. Observational
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  14. Observational
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  16. Review
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  18. Article
  19. Review
  20. Observational

45 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Leonie E BurgersDepartment of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
Karim RazaImmunity and Infection, University of Birmingham, Birmingham, UK.
Annette H van der Helm-van MilDepartment of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands.ORCID 0000-0001-8572-1437

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The therapeutic window of opportunity in rheumatoid arthritis (RA) is often referred to. However, some have questioned whether such a period, in which the disease is more susceptible to disease-modifying treatment, really exists. Observational studies are most frequently referenced as supporting evidence, but results of such studies are subject to confounding. In addition formal consensus on the definition of the term has never been reached. We first reviewed the literature to establish if there is agreement on the concept of the window of opportunity in terms of its time period and the outcomes influenced. Second, a systemic literature search was performed on the evidence of the benefit of early versus delayed treatment as provided by randomised clinical trials. We observed that the concept of the window of opportunity has changed with respect to timing and outcome since its first description 25 years ago. There is an 'old definition' pointing to the first 2 years after diagnosis with increased potential for disease-modifying treatment to prevent severe radiographic damage and disability. Strong evidence supports this concept. A 'new definition' presumes a therapeutic window in a pre-RA phase in which the biologic processes could be halted and RA development prevented by very early treatment. This definition is not supported by evidence, although is less well studied in trials. Some suggestions for future research in this area are made.

Indexed as

Arthritis, RheumatoidDisease ManagementDisease ProgressionHumansRadiographyRandomized Controlled Trials as TopicSeverity of Illness IndexTime FactorsTime-to-TreatmentTreatment Outcomeoutcomes researchrheumatoid arthritistreatment

Identifiers

PMID31168406
PMCPMC6525606

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.