PULMORAEffects of Tofacitinib vs Methotrexate on Clinical and Molecular Disease Activity Markers in Joints and Lungs in Early Rheumatoid Arthritis (PULMORA) - A Randomized, Controlled, Open-label, Assessor-blinded, Phase IV Trial

Study start date: November 7, 2020

Inclusion Criteria: 1. Diagnosis of seropositive (i.e., presence of RF and/or anti-CCP antibodies) rheumatoid arthritis (RA) according to the ACR/EULAR 2010 criteria within 24 months. 2. No previous treatment with disease modifying anti-rheumatic drugs (DMARDs). History of prednisone use is allowed but should have been discontinued 2 weeks before baseline measurement. 3. Active disease with ≥2 painful and ≥2 swollen joints in 66/68 joints and CRP ≥2.0 mg/L 4. Aged 18-80 years 5. The subject has given written consent to participate in the study. Exclusion Criteria: 1. Current active inflammatory joint disease other than RA. 2. Significant and/or uncontrolled cardiac, pulmonary disease, nervous system, renal, hepatic, endocrine or gastrointestinal disorders or severe RA which in the investigator's opinion would preclude patient participation. 3. Malignancy within the past 5 years, except for successfully treated cervical carcinoma in situ, basal cell and squamous cell carcinoma of the skin, with no evidence of recurrence or metastatic disease for at least 3 years. 4. Primary or secondary immunodeficiency (history of, or currently active), including known history of HIV infection. 5. Pregnant or lactating women. For subjects in part II the following exclusion criteria also apply: 6. Women of childbearing potential not willing or able to use highly effective methods of birth control per ICH M3 (R2) for 28 days prior and 3 months after end of study. 7. Active infection (excluding fungal infections of nail beds) requiring i.v. anti-infectives within 4 weeks, or oral anti-infectives within 2 weeks prior to baseline. 8. Positive tests for hepatitis B (HBsAg or HBV DNA),hepatitis C serology or SARS-CoV2 9. History of herpes zoster infection during last 10 years. 10. History or risk of venous thromboembolism or diverticulitis. 11. Positive tuberculosis history and/or positive Quantiferon test. 12. Hemoglobin \<90 g/L. 13. Absolute neutrophil count \< 1500 cells/uL. 14. ASAT or ALAT \>2.0 times the upper limit of normal. 15. High or very high risk (≥ 5%) of cardiovascular death within 10 years by SCOREx1,5. 16. Multiple incidental solid/subsolid lung nodules of size ≥6 mm, single incidental solid lung nodules ≥8 mm.