11/19/10 In the future, rheumatoid arthritis, or RA, might be detected before its symptoms become evident, and early cases could be stopped in their tracks, if recent research pans out.
Scientists presented findings at the American College of Rheumatology, or ACR, Annual Scientific Meeting in Atlanta Nov. 6 to 11 on two studies that could affect early detection and treatment of the autoimmune disease.
Early detection
One study focused on a new classification system to identify potential RA cases. Using criteria in the 2010 ACR/European League Against Rheumatism Rheumatoid Arthritis classification might make it possible to spot early warning signs of RA before people are diagnosed.
“If our goal is to achieve lifelong, drug-free remission, it may require someone to intervene and treat a person very early in the process – maybe even earlier than waiting until someone comes into the clinic,” says Jason R. Kolfenbach, MD, the study’s lead author and an assistant professor at the University of Colorado Denver School of Medicine in Aurora.
The new criteria, introduced as a replacement for those established in 1987, are intended to better identify cases of early disease. The new system classifies patients on a zero-to-10 scale. People are considered to have RA if they score six or higher, which means, among other things, that they have an inflamed joint capsule in at least one area that can’t be explained by another condition.
Colorado researchers used these criteria to test 1,790 patients taking part in an ongoing RA study of symptoms, joints and biomarkers of people at risk for developing the disease. That analysis identified 21 patients who have not been diagnosed with RA but appear to have early risk factors, including multiple swollen and tender joints.
Of those 21, 11 also had high levels of C-reactive protein, which indicates inflammation is present, six tested positive for rheumatoid factor and one was positive for more specific antibodies commonly seen in RA patients.
“We’ve been prospectively following a lot of these people since 2002. Now we can sub-identify those who might be at higher risk for developing what we might consider as RA,” Dr. Kolfenbach says. “We aren’t using [the criteria] to diagnose a patient, but to classify them so we can do initial analysis and find out the long-term implications.”
Researchers plan to track these subjects over time to see if they develop full-blown RA. Results of the study might some day lead to an early screening test for the disease, they say.
“Right now we can’t tell from looking at [subjects] how far away they might be from the diagnosis of RA in the clinical setting, or if they will avoid the diagnosis altogether,” Dr. Kolfenbach says. “We hope that nobody develops this, but if we capture them just before diagnosis or significantly before and identify factors that provide a high level of certainty of persistent disease, then we can intervene and treat, even before patients present to the doctor.”
Early Treatment
Another study shows that newly diagnosed RA patients and those suspected of having the disease but not yet diagnosed may be able to achieve remission – meaning they have no symptoms or disease activity – if they take methotrexate and prednisone for four months.
Anyway, my mom, an RN, has always supported and believed me, got me to the right doctors, etc. However, the rest of the world! My peers, most especiall when I was young, really thought and acted as if I was a hypochondriac. After the first 9 months of getting treatment on board and working, I have worked my whole life.
So since I started having these problems with my meds, I also started having problems with medical leave issues at work. Talk about office politics! There were co-workers who used my illness and my medical leave issues to stab me in the back every chance they got. I also was trying the telecommuting/reasonable accommodation thing, without much luck. I was pretty much forced out--not fired--I chose to leave, but they made it absolutely uncomfortable and impossible to be there. When did my illnesses, my HR issues, become any business of my co-workers? You're right, it didn't! There was absolutely actionable actions, but that has never been my style. Loyal to a fault! So my doctor had been telling me for years that I needed to stop working, anyway. This gave me the chance to apply for SSDI, which took two years and three applications for approval to happen. WHEN will the government make it so people can afford to not only apply for the benefits they need and deserve, but receive them in a timely manner????
My spirits are lifted a little higher when I find more people like me. My docotr told me for years that i was a hypochondriac and take tylenol or motrin. At first I did what he said and it got worse. Then I began to try other OTC mediciations and then began to hound him like I was a stalker. He stuck to his guns so I left. The new doctor did the same. i went back and comtinued to complain and suffer until my husband got ill. I could barely walk. I was still working but was being counseled for leave abuse but explained that there was a medical issue and didnt know what it was. I was getting stressed between that, my husband being ill and my children.
I called the doctor's office and got his associate and he calmly said to come in. My husband accompanied me, he was beginning to doubting me too. I cried horribly as I talked to the dr. He calmly said let's start again and took a blood test.
I can say from that point on I'm a happier person. I have SLE with RA, OA, Sjogrens; that I can remember. I got a referral to a wonderul rheumetologist office and people listen to me. I take it all prednisone, methotrexate, ultracet, plaquenil, amytriptiline, fosamax and orencia. I feel much better now and its hard to believe its been app. 8 years. I miss being able to do things and am raising my grandchildren (7 years now). i still have issues and still fight at work about teleworking and reasonable accommodations but I'm still pushing.
Its a great thing to have this registry and be able to talk to others. Our entries may be long and drawn out but we need to get this out. It helps opur sanity.
I am happy to have those that understand hear my voice and know that I can always post a question that others cannot understand.
When we get enough support from our government maybe insurance issues and the need for prescription choices will increase.
Thanks for 'listening'!
So far, neither of my children (in their 30s) have any symptoms of RA or the other autoimmune disease that I have, e.g., Hashimoto's thyroiditis and type I diabetes (diagnosed in 1969).
I agree that policy changes must be made (hopefully at the federal level) to allow adults with pre-existing conditions to obtain affordable health insurance.
My father, sister, aunts and cousins have RA. My grandfather and his sister are people who died of conditions related to RA.
I have had it since I was 16. I did not get DMARD treament until I was in my 40s because it wasn't available.
I have a teenage daughter who has all the obvious signs I did. I also have two young cousins who are begining to have the same pains and injuries that I did at their age.
ALL of them have been warned not to get an RA diagnosis, as it will create a preexisting condition for insurance. If they do get treatment, and it doesn't work, they can face a lifetime of financial crisis caused by the costs of treating the disease.
Studies are no good, unless they match policy. Consider the unfightable insurance lobby in Congress when these articles are written.
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