Early initiation of treatment alleviates symptoms in rheumatism
Early treatment for rheumatoid arthritis leads to significant improvements in pain, fatigue, and quality of life — regardless of whether patients receive biologic drugs or conventional therapy. This is shown by a new international study which was led from Karolinska Institutet, and recently published in The Lancet Rheumatology. Biologic drugs provided slightly greater improvements, but the differences between treatments were small.
Rheumatoid arthritis is a chronic joint disease that causes pain, stiffness, and fatigue. Earlier data from the NORD-STAR study have shown that early aggressive treatment can efficiently hamper disease activity (1,2). The present results from NORD-STAR show how different treatment strategies affect patients’ own experience of the disease during the first year. The study included 795 patients from six countries who had recently been diagnosed and had not yet started treatment.
Participants were divided into four groups: three received biologic drugs (certolizumab pegol, abatacept, or tocilizumab) combined with methotrexate, while the fourth group received active conventional treatment with methotrexate, bridging corticosteroid therapy and other medications. Researchers followed the patients for 48 weeks and measured pain, fatigue, physical function, and health-related quality of life.
The results show that all groups improved significantly within just a few weeks. After one year, more than half of the patients had reached a level considered clinically meaningful. Biologic drugs provided slightly greater improvements in pain and physical health compared to conventional treatment. For example, 80 percent of patients receiving abatacept or certolizumab pegol reported a clear reduction in pain, compared to 68 percent in the conventional group. However, differences in physical function were small.
“Our results show that early and effective treatment is crucial to reducing the disease burden. The differences between biologic and conventional treatments were smaller than expected, but biologic drugs may provide an additional improvement for some patients,” says Jon Lampa, Professor at the Department of Medicine, Solna, Karolinska Institutet.
The study is one of the few that compares several biologic drugs with conventional treatment in early disease. The researchers emphasise that treatment choices should be tailored to the patient’s needs and that long-term effects need further investigation.
The NORD-STAR study was conducted in collaboration between researchers in Sweden, Norway, Denmark, Finland, Iceland and the Netherlands. It was funded by, among others, the Swedish Research Council, Region Stockholm, NordForsk, and patient organisations. Pharmaceutical companies UCB and Bristol Myers Squibb contributed with medications. Some researchers report consultancy fees from the pharmaceutical industry.
Publication
"Certolizumab pegol, abatacept, tocilizumab or active conventional therapy in early rheumatoid arthritis: 48-week patient-reported outcomes from the NORD-STAR trial"
Lampa J, Nordstrom D, van Vollenhoven R, Lund Hetland M et al. The Lancet Rheumatology, online 23 March 2026, doi: 10.1016/S2665-9913(26)00007-X.
Previous results from NORD-STAR
1.
Active conventional treatment and three different biological treatments in early rheumatoid arthritis: phase IV investigator initiated, randomised, observer blinded clinical trial.
Hetland ML, Haavardsholm EA, Rudin A, Nordström D, Nurmohamed M, Gudbjornsson B, Lampa J, Hørslev-Petersen K, Uhlig T, Grondal G, Østergaard M, Heiberg MS, Twisk J, Lend K, Krabbe S, Hyldstrup LH, Lindqvist J, Hultgård Ekwall AK, Grøn KL, Kapetanovic M, Faustini F, Tuompo R, Lorenzen T, Cagnotto G, Baecklund E, Hendricks O, Vedder D, Sokka-Isler T, Husmark T, Ljoså MA, Brodin E, Ellingsen T, Söderbergh A, Rizk M, Olsson ÅR, Larsson P, Uhrenholt L, Just SA, Stevens DJ, Laurberg TB, Bakland G, Olsen IC, van Vollenhoven R,
BMJ 2020 Dec;371():m4328
2.
Certolizumab pegol, abatacept, tocilizumab or active conventional treatment in early rheumatoid arthritis: 48-week clinical and radiographic results of the investigator-initiated randomised controlled NORD-STAR trial.
Østergaard M, van Vollenhoven RF, Rudin A, Hetland ML, Heiberg MS, Nordström DC, Nurmohamed MT, Gudbjornsson B, Ørnbjerg LM, Bøyesen P, Lend K, Hørslev-Petersen K, Uhlig T, Sokka T, Grondal G, Krabbe S, Lindqvist J, Gjertsson I, Glinatsi D, Kapetanovic MC, Aga AB, Faustini F, Parmanne P, Lorenzen T, Giovanni C, Back J, Hendricks O, Vedder D, Rannio T, Grenholm E, Ljoså MK, Brodin E, Lindegaard H, Söderbergh A, Rizk M, Kastbom A, Larsson P, Uhrenholt L, Just SA, Stevens DJ, Bay Laurbjerg T, Bakland G, Olsen IC, Haavardsholm EA, Lampa J,
Ann Rheum Dis 2023 Oct;82(10):1286-1295