Researchers evaluated the potential benefit of the T-cell costimulation modulator abatacept in individuals at risk of rheumatoid arthritis, according to a recent study published by Cope in The Lancet. Individuals with serum antibodies to citrullinated protein antigens, rheumatoid factor, and disease indicators such as inflammatory joint pain may be at an elevated risk of developing rheumatoid arthritis. In the phase IIb APIPPRA trial, researchers randomly assigned 213 participants aged 18 years and older at risk of rheumatoid arthritis to receive either 125 mg of subcutaneous abatacept injections once weekly (n = 110) or placebo (n = 103) for 12 months. The primary endpoint of the trial was the time to development of clinical synovitis in three or more joints or rheumatoid arthritis as defined by American College of Rheumatology and European Alliance of Associations for Rheumatology 2010 criteria. During treatment, 6% (n = 7) of the patients who received abatacept met the primary endpoint compared with 29% (n = 30) of the patients who received placebo. Further, by week 12, 92.8% and 69.2% of the patients in the abatacept and placebo group, respectively, remained without rheumatoid arthritis. After a follow-up of 24 months, 25% (n = 27) of the patients in the abatacept group and 37% (n = 38) of those in the placebo group had developed rheumatoid arthritis. Abatacept was linked to improved pain scores, functional well-being, quality-of-life measurements, and subclinical synovitis scores by ultrasonography; however, the positive effects did not persist at a follow-up of 24 months. The recent findings represent the potential of abatacept interventions in this high-risk patient population. In a companion press release on the findings from King’s College London, the study authors concluded: “[The research] showed that a therapy licensed for use in treating established rheumatoid arthritis is also effective in preventing the onset of disease in people at risk … [and easing] symptoms such as pain and fatigue.”