Additionally, the researchers found antibodies rising very late or very early before a diagnosis of RA, indicated different forms or endotypes of the disease.
“Differences in patterns of elevation of autoantibody isotypes can help us understand what factors drive initial autoantibody elevations compared with later increases in autoantibodies,” Dr. Deane says. “For example, individuals who had antibodies rise early in the course of the disease more often had manifestations of RA, such as dry eyes and mouth, and lung disease.”
In terms of broader effect of studying how RA develops, Dr. Deane says, “Currently, RA is only established after someone has been diagnosed with arthritis. But we may need to start identifying those in a pre-RA period during which blood tests show abnormalities in the immune system, sometimes years before patients report symptoms or full-blown arthritis develops.”
Dr. Deane says pre-RA could be used in the same way pre-diabetes is used to describe someone with higher than normal blood sugar levels, or pre-hypertension, where blood pressure levels are above normal or optimal levels.
“The key is letting people know they are at risk of developing RA,” Dr. Deane says. “By identifying and modifying risk factors, such as obesity, smoking or other factors in pre-RA, we may be able to prevent progression of the disease in vulnerable individuals.”
Right now, a diagnosis of RA is forever, but Dr. Deane says detecting the disease at the preclinical phase, before the onset of joint damage, may protect joints and allow doctors to treat patients with less toxic immunomodulatory therapies and/or risk factor modification to prevent future onset.
“In the same way blood tests reveal high cholesterol, blood-based tests can now identify patients before they get full-blown RA, opening new avenues for screening and possible prevention strategies,” Dr. Deane says.
Additionally, researchers found antibodies rising very late or very early in RA indicated different forms of the disease.
“Differences in patterns of elevation of autoantibody isotypes can help us understand what factors drive initial autoantibody elevations compared with later increases in autoantibodies,” Dr. Deane says. “For example, patients who had antibodies rise early in the course of the disease seemed to have better clinical outcomes when they underwent more aggressive therapy.”
Clinical Trial Tests a Possible Prevention
Dr. Deane also serves as the principal investigator of the StopRA clinical trial, short for Strategy for the Prevention of Onset of Clinically-Apparent RA, the first clinical trial in the U.S. of a drug that may prevent RA. Launched in 2016 and funded by the National Institutes of Health, the study is testing whether hydroxychloroquine, which is already used to treat patients with established RA, can also be used to prevent RA.2
