{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:51:02Z","timestamp":1793321462911,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,5,9]],"date-time":"2020-05-09T00:00:00Z","timestamp":1588982400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The window of opportunity (WOO) hypothesis suggests a limited time frame to stop rheumatoid arthritis (RA). We hypothesised that a WOO could either be represented by a hyperbolic (\u2018curved\u2019) decline in the chance to achieve the outcome sustained drug-free remission (sDFR) over time, after which achieving sDFR is not possible anymore, or by a more gradual linear decline approaching zero chance to achieve sDFR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with RA (symptom duration &lt;2\u00a0years) were included from two randomised trials: BehandelStrategie\u00ebn (BeSt), n=508 and Induction therapy with Methotrexate and Prednisone in Rheumatoid Or Very Early arthritic Disease (IMPROVED), n=479. Cox-regression was performed to assess the shape of the association between symptom duration and sDFR (Disease Activity Score&lt;1.6, no disease-modifying anti-rheumatic drugs for \u22651 year) for patients starting slow-acting monotherapy (IMPROVED, BeSt) or fast-acting combination therapy (BeSt). Likelihood ratio tests were used to compare the fit of linear and non-linear models in both databases separately. Predictions from the best fitting models were used to assess whether the absolute risk to achieve sDFR approaches zero with increasing symptom duration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In BeSt and IMPROVED, 54\/226 and 110\/421 patients achieved sDFR with fast-acting treatment, and 53\/243 (BeSt) with slow-acting treatment. Non-linear models did not fit better than linear models (fast-acting treatment BeSt p=0.743, IMPROVED p=0.337; slow-acting treatment BeSt p=0.609). After slow-acting monotherapy, linear models declined steeper. None of the models approached zero chance to achieve sDFR over time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The chance to achieve sDFR decreased gradually over time, and decreased fastest in patients starting slow-acting monotherapy. In both treatment groups, we found no evidence for a WOO within 2\u00a0years symptom duration.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001242","type":"journal-article","created":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T11:45:12Z","timestamp":1590752712000},"page":"e001242","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Earlier is better when treating rheumatoid arthritis: but can we detect a window of opportunity?"],"prefix":"10.1136","volume":"6","clinical-trial-number":[{"clinical-trial-number":"isrctn32675862","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn11916566","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7136-5248","authenticated-orcid":false,"given":"Sytske Anne","family":"Bergstra","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy A","family":"Van Der Pol","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naghmeh","family":"Riyazi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, HAGA Hospital, The Hague, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne P M","family":"Goekoop-Ruiterman","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, HAGA Hospital, The Hague, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pit J S M","family":"Kerstens","sequence":"additional","affiliation":[{"name":"Rheumatology, Amsterdam Rheumatology & Immunology Center | Reade, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Lems","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, VU Medical Center, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-7520","authenticated-orcid":false,"given":"Tom W J","family":"Huizinga","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia F","family":"Allaart","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,29]]},"reference":[{"key":"2025090313161630000_6.1.e001242.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-203130"},{"key":"2025090313161630000_6.1.e001242.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.24661"},{"key":"2025090313161630000_6.1.e001242.3","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.142729"},{"key":"2025090313161630000_6.1.e001242.4","doi-asserted-by":"publisher","DOI":"10.1002\/art.27692"},{"key":"2025090313161630000_6.1.e001242.5","doi-asserted-by":"publisher","DOI":"10.1002\/art.22353"},{"key":"2025090313161630000_6.1.e001242.6","doi-asserted-by":"crossref","unstructured":"Monti S , Montecucco C , Bugatti S , et al. 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