[Comment] Can we prevent the onset of rheumatoid arthritis in patients with high-risk features?

The initial APIPPRA randomised controlled trial followed anti-citrullinated protein antibody (ACPA) positive participants with arthralgias, without synovitis at study onset.1 Participants were randomly assigned to 125 mg abatacept subcutaneously weekly (n=110) or placebo (n=103) for 52 weeks, which was then discontinued. Patients were followed for a second year. The primary outcome in APIPPRA was the time to development of clinical synovitis in at least three joints or rheumatoid arthritis according to the American College of Rheumatology–European Alliance of Associations for Rheumatology (ACR–EULAR) criteria.