Rheumatologists may be divided about the interpretation of a trial of dose-halving in patients in remission from rheumatoid arthritis (RA) on non-biologic therapy, which shows that the half dose leads to more flares.

In the ARCTIC REWIND study, 160 patients who had been in remission on stable conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) for at least a year with no biologic therapy were randomly allocated either to continue on the same dose, or to have their dose halved.

Participants were 55 years old on average and some two-thirds were women. The most common csDMARD regimen was methotrexate monotherapy at a mean dose of about 20mg/week.

All had no swollen joints and a Disease Activity Score below 1.6.