New method of predicting rheumatoid arthritis offers early help to sufferers

Jan 31 2007

Dutch researchers believe they may have come up with a new way of predicting whether patients with arthritic symptoms will progress to the autoimmune form of the disease, rheumatoid arthritis.

With rheumatoid arthritis the best strategy for preventing the potentially crippling joint damage in patients is very early, aggressive treatment with a potentially toxic combination of drugs.

The ability to differentiate between those patients who will develop full-blown rheumatoid arthritis from those who will not, could mean earlier treatment could be made available to rheumatoid arthritis patients thereby reducing the damage to the joints of sufferers while sparing those who will not develop the disease the side effects linked to rheumatoid arthritis drugs.

Lead researcher Dr. Annette van der Helm-van Mil, a rheumatologist at Leiden University Medical Center in the Netherlands, believes it is not desirable to subject patients to treatments which will not in the long run be of benefit; it is better to give rheumatoid arthritis drugs only to the patients who have a high chance of progressing to the disease.

Rheumatoid arthritis is an autoimmune disease that affects some 2.1 million Americans, most of them women.

The disease often initially appears as "undifferentiated arthritis," a condition that lacks the criteria for a more definitive diagnosis and as many as 50 percent of patients with undifferentiated arthritis will spontaneously go into remission, while another third will progress to rheumatoid arthritis.

Van der Helm-van Mil says that treatment of rheumatoid arthritis with the drug methotrexate early on can reduce future joint damage but is also potentially toxic, which is why being able to sort out early on those with true rheumatoid arthritis is so important.

For the study, the Dutch researchers looked at 570 patients at the Leiden Early Arthritis Clinic with undifferentiated arthritis, 177 of whom progressed to rheumatoid arthritis within one year.

By using a combination of questionnaires, physical examinations, and blood samples, the researchers were able to identify nine variables, including gender, age, the number and distribution of stiff and swollen joints, along with three laboratory tests.

On the basis of the assessments, the researchers drew up a 14-point predictive score, with 0 being the lowest likelihood of progression to rheumatoid arthritis and 14 representing the highest likelihood.

It was found that none of the study's patients with a score of 3 or less ended up with a diagnosis of rheumatoid arthritis, while all with a score of 11 or greater did.

Experts say the model may prove to be a useful tool for predicting rheumatoid arthritis and may be a better way of identifying which patients will benefit from early treatment.

The findings are published in the February issue of Arthritis and Rheumatism.