A Biological Crystal Ball for Rheumatoid Arthritis?

A $102 test could be the crux between good health and a future of chronic illness

A rheumatoid arthritis diagnosis can have a devastating impact on quality of life, but catching the disease early could make a huge difference on outcomes. Now, a new study published in the Aug. 5, 2015 online issue of

Arthritis and Rheumatology

, shows that two routine laboratory tests could predict the development of rheumatoid arthritis in people with a familial history of rheumatoid arthritis.

_¹

[[{"type":"media","view_mode":"media_crop","fid":"40370","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7396294479258","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4120","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]] Researchers report that the presence of the autoantibodies rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), predicted risk as early as five years before any signs and symptoms appeared, presenting a “window of opportunity” for prevention. The IgM-rheumatoid factor (IgM-RF) test, which can cost around $43, and the anti-CCP2 antibody test, which can cost around $102, were administered to 819 asymptomatic relatives of 252 patients with rheumatoid arthritis (69% female, 41% offspring, mean age 36 ± 12 years).

²

 Researchers found that children of people with rheumatoid arthritis had a three-fold risk of developing the disease. And, testing positive for both IgM-RF and anti-CCP2, revealed a 64% more likelihood to develop rheumatoid arthritis over five years and 58% when only anti-CCP2 was positive. Over a 5-year period, 11 (1.3%) tested positive at baseline for both anti-CCP2 and rheumatoid factor, 12 (1.4%) tested positive for anti-CCP2, 16 (2%) tested positive for rheumatoid factor only and 17 (2%) met the criteria established by the American College of Rheumatology (ACR) for rheumatoid arthritis. Rheumatoid arthritic patients were invited to bring first- and second-degree blood relatives (such as siblings and cousins) with no history of rheumatoid arthritis to take part in the study. The patients were given a medical history and blood tests for rheumatoid factor and a newer, more sensitive test for anti-CCP, second-generation anti-cyclic citrullinated peptide IgG (anti-CCP2). Every four months, participants (41% had parents with rheumatoid arthritis) were followed with structured interviews using a questionnaire designed to spot indications of rheumatoid arthritis. Those found to be positive underwent in-office clinical exams and joint assessments to detect signs and symptoms of rheumatoid arthritis.  The study’s results amount to 205 person-years for the anti-CCP2 positive group and 3,312 persons-year for the seronegative group - giving combined rheumatoid factor and anti-CCP2 a positive predictive value of 64% and 58% for anti-CCP2 alone. To date, there have been several published studies that have reported that RF, and more recently anti-CCP, are present years before rheumatoid arthritis (RA) develops, but there have been only two studies on relatives of patients with RA.  While the study must be validated in other populations, because the blood tests are currently available to clinicians, the researchers conclude that screening high-risk relatives of rheumatoid arthritic patients provides an opportunity to develop primary prevention and early treatment of rheumatoid arthritis.  “Early initiation of an optimal treatment strategy can limit the overall impact of the disease,” wrote the authors of the study, which was led by Cesar Ramos-Remus, MD, of the Unidad de Investigación en Enfermedades Crónico-Degenerativas in Mexico. “Early use of disease-modifying antirheumatic drugs (DMARDs) markedly reduces inflammation and joint destruction associated with RA.” An early diagnosis and follow-up treatment with disease-modifying anti-rheumatic drugs could offset the devastating impacts of rheumatoid arthritis over a lifetime, which can be expensive, costing approximately $2,700 monthly for biologics.

³

References:

1. Ramos-Remus C, Castillo-Ortiz JD, Aguilar-Lozano  L, et al., Autoantibodies in Predicting Rheumatoid Arthritis in Healthy Relatives of Rheumatoid Arthritis Patients.Arthritis & Rheumatology. Accepted article. Online 5 August 2015. DOI: 10.1002/art.39297. 

2. Bose N, Calabrese LH., Should I order an anti-CCP antibody test to diagnose rheumatoid arthritis? Cleveland Clinic Journal of Medicine. CCJM 2012 Apr;79(4):249-252.

3. Yazdany J, Dudley RA, Coverage for High-Cost Specialty Drugs for Rheumatoid Arthritis in Medicare Part D., Arthritis & Rheumatology. May 25, 2015. DOI: 10.1002/art.39079