Early Detection Strategies for RA

Scientists are investigating possible clues to the development of RA, as well as better methods for detecting the disease as early as possible. At the ACR’s 2010 Annual Meeting, which was held in Atlanta in November, significant milestones in this effort were announced.

Could fat play a role of RA inflammation? Adipose tissue, or body fat, serves as an energy store for the body, but also produces cytokine-like cells called adipokines that may promote inflammation in RA. German researcher Ulf Müller-Ladner, MD, spoke about his research on the connection between adipose tissue and RA inflammation at the ACR’s Annual Meeting. He noted that adipokine levels are higher in people with RA, and that some existing RA therapies, such as TNF-inhibitors, may help suppress these cells.

At least five genes have been identified that seem to be associated with RA development, said researchers at the ACR Basic Science Symposium. But how does a person with the gene develop RA? Likely through environmental factors, such as smoking or contracting an infection. People with higher anti-cyclic citrullinated protein antibody (ACPA) levels in the body are at higher risk of developing RA, the scientists noted. One study in Manitoba is examining Native American tribes with high rates of RA to learn more about the ACPA-RA connection.

Doppler Ultrasonography (DUS), used in many medical settings, is being refined and studied for use in tracking the effectiveness of RA treatments by measuring inflammation in the joints, like synovitis. Newer, high-resolution ultrasound imaging techniques like DUS can help doctors evaluate disease activity more effectively.

Doctors once thought RA was an infectious disease, and treated it with antibiotics like minocycline. While we now know otherwise, scientists are revisiting the RA-infection connection. The opening lecturer at the ACR’s 2010 Annual Meeting, Gerald Weissmann, MD, of New York University, spoke about his current research on whether the bacteria causing gingivitis, or gum disease, may cause or trigger RA in people with genes that predispose them to the disease.

Another lecturer addressed the similarity between joint and gum inflammation and noted that oral inflammation is common and often severe in people with RA. Clifton Bingham III, MD, of Johns Hopkins University Arthritis Center, discussed how early recognition of periodontal disease may help doctors spot RA earlier, and quitting smoking, improving oral hygiene, and use of antibiotics may be helpful interventions.

Clinical trials looking at the role of bacteria in RA development are under way, involving both medical and dental researchers.

While a diagnosis of RA is certainly a life-altering event, there has never been a more promising time when it comes to developing new ways to stop disease progression, prevent joint damage and enhance the quality of life for those affected.