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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.