TREAT EARLY ARTHRALGIA TO REVERSE OR LIMIT IMPENDING EXACERBATION TO RHEUMATOID ARTHRITIS

1. Age >= 18 years, 2. Patients without clinically detectable arthritis but with
arthralgia of small hand or feet joints of recent-onset (<1 year) that
according to the rheumatologist is suspect to be an early presentation of RA
(this symptom complex is called Clinically Suspect Arthralgia, CSA), 3.
Extremity MRI positive for subclinical inflammation., 4. Ability and
willingness to give written informed consent and to comply with the
requirements of the study protocol

1. Symptoms or signs making diagnoses other than RA more likely. These are
amongst others >6 tender points or Heberden or Bouchard nodules (the presence
of such characteristics preclude CSA) , 2. Presence of, or history of,
clinically apparent arthritis (this precludes CSA), 3. Previous or current
treatment with DMARDs or corticosteroids (this precludes CSA), 4. Contra
indications for MRI: certain metal implants, pacemakers, GFR<30 ml/min., 5.
Pregnancy or the wish to become pregnant, breast feeding, 6. Bone marrow
hypoplasia, 7. Elevated hepatic enzyme levels (ASAT, ALAT >3 times normal
value), 8. Serum creatinine level >150 umol/l or estimated clearance of <60%,
9. Serious infections such as hepatitis, pyelonefritis in the past three months
or chronic infectious disease such as chronic chest infections with
bronchiectasis