Reflective Practive

Rheumatoid arthritis

The initial presenting features of early rheumatoid arthritis do not substantially differ from other forms of inflammatory arthritis.1 Patients can present with a wide range of manifestations, including a history of swelling in joints, early morning stiffness lasting greater than 30 minutes, and systemic symptoms such as tiredness combined with objective evidence of synovitis (inflammation of the membrane lining joints).2 There are a wide range of conditions that can mimic rheumatoid arthritis:2

Post-viral arthritis

Seronegative spondyloarthritis

Connective tissue diseases

Crystal arthritis

Other conditions

Laboratory investigations should be used to help identify rheumatoid arthritis early, potentially leading to improved patient outcomes1

Rheumatoid arthritis has a global prevalence of 0.24%3
Early detection and appropriate treatment of rheumatoid arthritis can affect the disease course, prevent the development of joint erosion, and/or retard progression of erosive disease1
Up to 20% of rheumatoid arthritis patients have rheumatoid factor but do not have anti-CCP antibodies4

What are the benefits of early diagnosis?

Early identification and treatment of rheumatoid arthritis can:1
  • Affect the disease course
  • Prevent the development of joint erosion
  • Retard progression of erosive disease
In fact, rheumatoid arthritis may be considered a potentially curable condition if identified and treated during the evolutionary process from inflammatory arthritis to established disease.1

How can tests be used to personalise care?

Out of a large number of inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, there are only a few tests that are specific for rheumatoid arthritis. When used together, these tests can provide considerable diagnostic and prognostic guidance in the early diagnosis of rheumatoid arthritis patients.1

Anti-cyclic citrullinated peptide (CCP) antibodies

  • Anti-CCP antibodies are detectable several years before the onset of rheumatoid arthritis, and patients with anti-CCP antibodies are more likely to have severe disease5,6

Rheumatoid factor IgM

  • Up to 20% of rheumatoid arthritis patients have rheumatoid factor but do not have anti-CCP antibodies.4 These patients can be identified by testing for rheumatoid factor IgM. In non-symptomatic subjects, rheumatoid factor IgM is a risk factor for developing rheumatoid arthritis; risk is related to the titre7

Rheumatoid factor IgA

  • Elevated rheumatoid factor IgA correlates with disease activity, and indicates a poor clinical response to TNF-α inhibitors. Therefore, testing for rheumatoid factor IgA provides additional prognostic guidance7-9

Rheumatoid factor IgG

  • In non-symptomatic subjects, rheumatoid factor IgG is a risk factor for developing rheumatoid arthritis; risk is related to the titre7
Together, these tests can help to identify rheumatoid arthritis patients sooner; identify patients that are at risk of more severe disease; identify patients who are less likely to respond to TNF-α inhibitors; and enable clinicians to start tailored treatment sooner.1,5-9 Like all tests, these tests should always be interpreted in conjunction with a clinical history
References
  1. Heidari B. Caspian J Med 2011; 2: 161-170.
  2. Suresh E. J R Soc Med 2003; 97: 421-424.
  3. Cross M, et al. Ann Rheum Dis 2014; 73: 1316-1322.
  4. Bizzaro N, et al. Clin Chem Lab Med 2007, 45: 150-157.
  5. Kokkonen H, et al. Arthritis Res Ther 2011; 13: R13.
  6. Svärd A, et al. Arthritis Res Ther 2008; 10: R75.
  7. De Angelis V, Meroni PL. Rheumatoid Factor. In: Autoantibodies, 2nd edition 2007, eds: Shoenfeld, Gershwin, Meroni. Elsevier, Amsterdam, pp 755-762.
  8. Jonsson T et al. Scand J Rheumatol 2000; 29: 190-1
  9. Bobbio-Pallavicini F, et al. Ann Rheum Dis 2007;66:302-307.
  10. Aletaha D, et al. Arthritis Rheum 2010; 62: 2569-81
  11. Halldorsdottir HD, et al. Ann Rheum Dis 2000; 59: 149-51
  12. Jaskowski et al. J Rheumatol 2010; 37: 1582-8

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