Tool Helps Rheumatoid Arthritis Prognosis and Choice of Therapy

Tool Helps Rheumatoid Arthritis Prognosis and Choice of Therapy

By Staff

Antibodies that affect the inflammation in the joints of people with rheumatoid arthritis (RA), and researchers have now shown that antibodies against the cartilage protein, collagen II, are associated with a good prognosis.  The research was published in the journal Annals of Rheumatic Diseases from scientists at Uppsala University.

“Analyzing these antibodies, in combination with other relevant antibodies, could be used for predicting prognosis and choosing therapy for rheumatoid arthritis patients,” says Professor Johan Rönnelid who led the study.

Uppsala University released the following details on their study:

Rheumatoid arthritis (RA) is an inflammatory disease where the joints become stiff and swollen, and is associated with future joint destruction. This is caused by immune cells, which normally attack foreign organisms, instead react against the tissues in the joints, resulting in inflammation.

The symptoms in patients with RA are very variable but due to the pain and the effects on the joints the disease often becomes obstructing. The therapies that patients receive are given to dampen the inflammation and relieve the pain and to diminish future joint destruction.

In some RA patients antibodies are formed that target collagen II, an important protein in joint cartilage. These antibodies drive the inflammation early in the disease and the highest amounts of collagen antibodies have been detected at the time of diagnosis, after which the levels decrease during the first year.

In the present paper researchers at the Department of Immunology, Genetics and Pathology, Uppsala University, in collaboration with colleagues at Karolinska Institutet, have followed a large group of RA patients during five years to see if there is a correlation between the collagen antibodies and disease development.

“We found that patients with collagen antibodies showed increased signs of inflammation during the first six months after diagnosis, after this there was no difference compared to patients without any collagen antibodies. We also discovered that the presence of collagen antibodies at the time of diagnosis was associated with a better prognosis, says Vivek Anand Manivel, PhD student at the Department of Immunology, Genetics and Pathology and first author of the article.

For patients with RA it is common to examine the presence of antibodies against proteins called citrullinated peptides. In the studied patient group it was found that the presence of such antibodies showed an opposite association to inflammation as compared to collagen antibodies. The presence of antibodies against citrullinated peptides was associated with increased inflammation late in the follow-up time and patients with these antibodies had a more severe disease course during the follow-up.

“In all, our findings suggest that a combined analysis of antibodies against collagen and antibodies against citrullinated peptides could be a new tool for predicting the disease course and perhaps also for choosing therapy in newly diagnosed RA patients,” says professor Johan Rönnelid.

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Authored by: Staff

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Jean Price

This is intesting…and may in the future also be a benefit for choosing specific treatments, I would think….by using ones to target these different processes. There also is a blood test now called Vectra, which actually gives the level of current disease activity for the whole process of RA, since it is a systemic disease and affects many areas, not just the joints. I think it’s the closest anyone seems to have come to a test measuring pain levels….since with RA, as disease activity rises, so does the pain and discomfort! Plus is is affirming to patients when they can see a test result which gives some indication of the severity of their current disease…and an indication of their pain!

The Vector test measures ten different blood proteins, and then uses an algorithm of those measurements to come up with a numeric score. That score is then the level of present disease activity, within a range from none to severe, 0 to 100. This test is good to do at baseline and then to re-test some time after treatments have been started, and periodically thereafter….to gauge the treatment’s actual effectiveness. It’s not a diagnostic tool, but rather just a way to assess the overall RA activity at a specific time…since the disease can flare and have periods of remission, where symptoms and even rates of damage lessen.

I wonder if this type of research may eventually lead us to understand more about the immune system in general…and the many diseases which are involved when it is not working properly. For children, RA can be especially challenging..since many of the current medications for treatment have side affect which can impair systems that are still developing, and also depress their immune system at a time when they are exposed to more viruses, colds, and communicable diseases.