Résumé
It is recommended that vaccinations be performed before starting methotrexate (MTX), knowing that delaying its initiation may have an impact on the course of rheumatoid arthritis (RA). But what is the real impact of delaying MTX initiation by one month on the clinical and radiographic activity of RA at one year?Based on the VACIMRA multicenter, prospective, randomized, two-group study of patients with recent RA, comparing the vaccine protection obtained based on the delay between pneumococcal13-valent vaccine and methotrexate initiation, which was one month in one group of patients, compared with the immediate introduction of MTX just after vaccination in the other group, we analyzed disease activity on the basis of the imputed DAS28 VS at inclusion at 1, 2, 3, 6, and 12 months between the 2 groups. For structural progression, we performed a radiographic analysis (based on the modified Sharp score) of 100 RA patients from the Montpellier center at inclusion, 6 and 12 months. No significant difference was observed between the 2 groups for demographic, radiographic, clinical disease activity (DAS28 VS imputed) characteristics at inclusion and at 6 and 12 months of follow-up.In recent RA, the delayed initiation of MTX by one month to allow pneumococcal vaccination is not accompanied by a significantly different clinical and structural evolution as long as patients are closely followed with therapeutic adaptation to control the disease.