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Earlier
testing may result in earlier treatment for
Rheumatoid Arthritis
Newswise — Testing patients for anti-cyclic
citrullinated antibodies, also known as
anti-CCP antibodies, before they are seen by
a rheumatologist, could result in a
diagnosis and a shorter delay before
definitive treatment is begun, according to
research presented this week at the American
College of Rheumatology Annual Scientific
Meeting in Boston.
Rheumatoid arthritis is a chronic disease
that causes pain, stiffness, swelling, and
limitation in the motion and function of
multiple joints. Though joints are the
principal body parts affected by RA,
inflammation can develop in other organs as
well. More than 2 million Americans suffer
from RA; about 75 percent of those affected
are women.
People with suspected RA are frequently
tested for anti-CCP antibodies by
rheumatologists doing their initial
evaluation, but not by the primary care
physician who may first identify their
arthritis.
Early arthritis clinics in the United
Kingdom are designed to evaluate patients
with signs or symptoms of inflammatory
arthritis that have been present for less
than a year. Patients are typically tested
for the presence of rheumatoid factor before
their first visit. Investigators set out to
determine whether knowing a patient’s anti-CCP
status would alter early disease management
decisions.
In 100 consecutive new patients, the
pre-visit blood samples were tested
retrospectively for anti-CCP. Then actual
treatment strategies without the anti-CCP
results were compared to treatment
strategies proposed by three rheumatologists
and a registered nurse who had reviewed the
patient records and then were informed of
the anti-CCP results. Ultimately, 98 out of
the 100 patients had sufficient
documentation for the review.
In 100 consecutive new patients, the
pre-visit blood samples were tested
retrospectively for anti-CCP. Records from
each first visit were reviewed separately by
three rheumatologists and a registered
nurse, with the anti-CCP result blinded.
Treatment given at the first result was
recorded, then each reviewer independently
recorded the treatment strategy they would
have followed had the anti-CCP result been
available. Each independent treatment
strategy was then compared to see if there
was consensus; where there was consensus,
this was compared with actual treatment
strategy. Ultimately, 98 out of the 100
patients had sufficient documentation for
the review.
Actual treatment strategies ranged from
discharge/no treatment to standard or
intensive DMARD (disease-modifying
antirheumatic drug) therapy.
In this study, prior knowledge of the anti-CCP
status would have approximately doubled from
7 -13 the number of patients immediately
discharged; halved from 45 to 23 the number
given a trial of corticosteroids; increased
by 50% from 19 to 28 the number of patients
started on DMARDs at the first attendance;
and, in 8 patients, would have led to a more
intensive treatment regimen from the outset.
“Having the results of this relatively
inexpensive test available at the time of
their first assessment of patients with a
possible early inflammatory polyarthritis
would allow rheumatologists to make a faster
diagnosis, and shorten the delay before
treatment starts,” said David O’Reilly, MA,
MB, BChir, FRCP, West Suffolk Hospital UK,
Bury St. Edmunds, United Kingdom, and lead
investigator in the study. “It will also
allow a substantial reduction in patient
follow up and unnecessary corticosteroid
treatment. This test will help us give the
right treatment to the right patient without
delay.”
The American College of Rheumatology is the
professional organization of and for
rheumatologists and health professionals who
share a dedication to healing, preventing
disability and curing arthritis and related
rheumatic and musculoskeletal diseases.
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