Optimising Arthritis Strategies in Elderly patients (≥70 years) with rheumatoid arthritis in sustained low disease activity (the OASE study): A Prospective Target Trial Emulation Study Evaluating Tapering of Disease-Modifying Anti-Rheumatic Drugs vs. Usual Care Based on Patient Preference
Rheumatoid arthritis causes painful, swollen joints. Many people take long-term medications to keep it under control. While these medicines are very effective, they can also cause side effects or react with other treatments. This can become more of an issue as people get older. The OASE study is looking at adults aged 70 and over whose arthritis has been stable and quiet for some time. It aims to see if patients can safely and slowly reduce their arthritis medicines instead of staying on their usual full dose. Patients can help choose whether they prefer to try lowering their dose or stay on their current treatment. Doctors will closely monitor everyone for between two and five years. The main aim is to see if reducing medicine keeps joints healthy while improving general wellbeing and cutting down on unwanted side effects.
At a glance
What is this study about?
Rheumatoid arthritis is a long-term condition that causes pain, stiffness, and swelling in the joints. Doctors usually treat it with powerful medicines called disease-modifying anti-rheumatic drugs (DMARDs) or biological treatments. These treatments help calm the immune system. When they work well, arthritis symptoms can settle down into what doctors call 'low disease activity' or remission.
However, staying on strong immune-calming medicines for many years can sometimes cause problems. For older adults, these medicines can increase the risk of infections or cause unwanted side effects, especially if they are already taking tablets for other health conditions. Doctors want to know if older adults whose arthritis is calm really need to stay on their original full doses, or if taking less medicine might actually be better for their overall health.
The OASE study is designed to answer this question for people aged 70 and older. It compares what happens when people gradually reduce their arthritis medication dose against what happens when people keep taking their normal prescription. Uniquely, the study takes patient preferences into account when deciding whether to reduce the dose or continue as usual.
By following participants closely over several years, the researchers hope to create clearer, safer guidelines for doctors. This could help older people with arthritis enjoy good joint health while taking fewer medicines and experiencing fewer side effects.
Key takeaways
- The study tests whether older adults with stable rheumatoid arthritis can safely take lower doses of medication.
- It is aimed at adults aged 70 and older whose arthritis is currently well-controlled.
- Patients help decide whether they prefer to try lowering their medicine or keep their current dose.
- Your health and joints will be closely monitored for two to five years.
- If your arthritis flares up at any point, your doctor can quickly return you to your full treatment.
Who may be eligible?
This study is designed for adults aged 70 and older who have been diagnosed with rheumatoid arthritis. To be suitable, your arthritis must currently be quiet and well-managed, meaning you have not had recent severe flare-ups and your joint swelling and pain are low.
You also need to be currently taking regular arthritis treatment. This includes standard tablets like methotrexate or leflunomide, or targeted injections and tablets known as biologics or JAK inhibitors.
People who are experiencing an active arthritis flare-up, or whose condition is not yet stable, will not be suitable for dose reduction right now. Your arthritis specialist can review your medical records to confirm if your joint health has been steady enough to take part safely.
Could this study suit you?
Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.
- I am aged 70 or older.
- I have been diagnosed with rheumatoid arthritis.
- My arthritis is currently well-controlled with few or no active symptoms.
- I am currently taking a regular medicine for my arthritis (such as methotrexate, a biologic injection, or a daily tablet).
- I am willing to attend regular clinic check-ups over the next few years.
What does participation involve?
If you decide to take part, you will first have a detailed discussion with the study team about your arthritis and your personal preferences. Depending on what you and your doctor decide, you will either slowly reduce the dose of your arthritis medicine or stay on your usual treatment.
You will attend regular clinic visits where doctors will examine your joints, carry out routine blood tests, and ask you about any pain, stiffness, or side effects. If you are reducing your medicine and your arthritis begins to flare up, your doctor can quickly adjust or restart your treatment to bring it back under control.
The main part of the study lasts for 24 months (two years), but the team will continue to follow your health for up to five years. You do not have to pay for any study tests, and you can stop taking part at any time without it affecting your everyday NHS care.
Potential risks and benefits
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Common questions
What does 'tapering' mean?
'Tapering' means slowly and carefully reducing the amount of medicine you take over time, rather than stopping it all at once.
What happens if my arthritis gets worse during the study?
Your joints will be checked regularly. If you have a flare-up, your doctor can immediately increase your dose or restart your original medicine to settle your symptoms.
Do I have to reduce my medicine if I join?
No. The study is based on patient preference. You and your specialist will discuss your options and decide together whether tapering or staying on your current dose is best for you.
How long does the study last?
The main study checks your progress over two years (24 months), with long-term follow-up continuing for up to five years.
Will taking part affect my normal NHS care?
No. You will continue to be cared for by an arthritis specialist, and taking part will not negatively affect any other NHS treatments you receive.
How to find out more
Always speak to your GP or specialist before deciding to take part in a study.
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