Research Update: Prognosis of Outcomes for Rheumatoid Arthritis – What are the Risk Factors?
In the past, it has only been possible to explain some of the joint damage caused by rheumatoid arthritis (RA) based on known risk factors. In order to improve treatment for RA, future approaches to treatment will increasingly need to be tailored to individual patients and individually configured.
Personalized medicine in RA treatment
The goal is to develop individual treatments tailored to the needs of the individual patient, “personalized medicine” for rheumatoid arthritis diagnosis and treament (for more on the subject of personalized medicine, refer to the background article Early Detection and Personalised Medicine – What Biomarkers Tell Us on our rheumachec homepage). (more…)
Immunofluorescence patterns help eliminate “false positives” in diagnosing autoimmune rheumatic diseases
The detection of anti-nuclear antibodies, the ANA test, is a clear (laboratory-) diagnostic indicator of rheumatic autoimmune disease. One of the standard laboratory tests for the detection of these antinuclear antibodies is IIF, the indirect immunofluorescence assay, on human HEp-2 cells (ANA-HEp-2 test).
ANA-HEp-2 indirect immunofluorescence test (IIF): antibodies against RNP (ribonucleoproteins) – interphase nucleoli: coarse granular positive, nucleoli neglected; mitotic cells: negative (400x) – © ORGENTEC Diagnostika, Mainz
However, for up to 13% of healthy individuals, indirect immunofluorescence may detect anti-nuclear antibodies. Most of these healthy people will not develop an autoimmune disease – despite the positive ANA test. It is thus a challenge for the physician to differentiate these healthy, false-positive patients from those ANA-positive patients who already have an inflammatory rheumatic disease or who truly have an increased risk of developing such an autoimmune disease.
Several very specific IIF patterns
In a large study, Brazilian IIF experts have now worked out the fundamental differences between the ANA-HEp-2 test results on serum samples from healthy individuals and the immunofluorescence patterns from serum samples of patients with rheumatic disease; they have described various IIF patterns that can be used to differentiate between the two patient groups (Mariz et al. 2011). This study was published a few weeks ago in the January issue of Arthritis & Rheumatism, the journal of the American College of Rheumatology (ACR). In their article, the scientists from the Universidade Federal de São Paulo, Brazil, explain in detail that there are several very specific immunofluorescence patterns in the ANA-HEp-2 assay with which the autoimmune rheumatic diseases (ARD) are truly associated. (more…)
Found last Week on the Internet, part 1: Up-to-date Articles on Autoimmunity and Autoimmune Diseases
Duroux-Richard I, Jorgensen C, Apparailly F. miRNAs and rheumatoid arthritis – promising novel biomarkers. Swiss Med Wkly. 2011 Mar 18;141:w13175 – doi: 10.4414/smw.2011.13175 – Free full text available! – Today, the most challenging issue in the field of rheumatoid arthritis is the identification of biomarkers for early disease diagnosis and for prediction drug response. micro(mi)-RNAs certainly represent an realistic option for optimal diagnosis an disease treatment.
Roux CH, Breuil V, Valerio L, Amoretti N, Brocq O, Albert C, Grisot C, Allam Y, Chevalier P, Pradier C, Euller-Ziegler L. Etanercept Compared to Intraarticular Corticosteroid Injection in Rheumatoid Arthritis: Double-blind, Randomized Pilot Study. J Rheumatol. 2011 Mar 16. [Epub ahead of print]. – Patients with rheumatoid arthritis who had persistent (more…)
According to a recently published study anti-MCV could be a better test for diagnosing RA than anti-CCP2
Rapid intensive treatment may prevent patients with rheumatoid arthritis (RA) from developing severe health damages and improve their state of health and quality of life. Therefore, early reliable diagnosis is a prerequisite. At present, the most helpful biomarkers to achieve this goal are antibodies against citrullinated proteins (ACPA) that can be detected in the blood of RA patients. (more…)
Our Point-of-Care-Test rheumachec for Diagnosing Rheumatoid Arthritis – a Highly Accessed Research Article in Arthritis Research & Therapy!
Several days ago, a colleague pointed out to me a publication in the journal Arthritis Research & Therapy that came about largely through collaboration with scientists at ORGENTEC Diagnostika. Needless to say that this article was already familiar to me – already before its initial online publication in the summer of this year, I had read excerpts from it and extensively discussed the work and the results of this evaluation study with co-workers and clients. (more…)
The EIRA Study: Vaccinations and RA Risk – no Association found!
“Common adult immunizations are not associated with an increased risk of developing rheumatoid arthritis” – that is the result of research published in the October issue of The Annals of the Rheumatic Disease, the EULAR journal. Last week that data were also presented at the American College of Rheumatology ACR Annual Scientific Meeting (took place from 6th to 11th November).
Common adult vaccinations don’t increase the risk of developing RA, recent results of the Swedish EIRA Study Group say.
“Vaccinations are among the events which have long been postulated as inciting agents for rheumatoid arthritis, as well as for many other chronic inflammatory diseases of unknown origin,” lead investigator in the study, Camilla Bengtsson, PhD, stated in her lecture last Monday at the Georgia World Congress Center in Atlanta, USA.
No increased RA risk following immunizations
“In our case-control study including incident cases of newly diagnosed rheumatoid arthritis, no increased risk of RA following immunization was observed, at least not in the five years prior to disease onset”, the epidemiologist at the Institute of Environmental Medicine at Karolinska Institutet in Stockholm, Sweden, explained in more detail, noting that the study is still ongoing. From Dr. Bengtsson’s point of view these results are indicating that immunological provocation with commonly used vaccines in their present form do not carry a risk of rheumatoid arthritis in adults. (more…)
A link between B cell receptor expression and autoantibody production in rheumatoid arthritis
By now, it is a well known fact, that B cells play an important role in the development of autoimmunity. On the one hand, they are the precursors of the antibody-secreting plasmablasts and memory cells; on the other hand they also act as antigen-presenting cells.
Various cells of the immune system express a plethora of receptors that bind to the
Fc-portion of immune complexes containing IgG (Fc-gamma-receptors, FcγR), but
B cells and plasma cells only express the low affinity FcγRIIb. This receptor has repressive functions and mediates the deletion of autoreactive B cells and the inhibition of IgG secretion, thereby helping to preserve B cell tolerance.
Human autoimmune diseases that are characterized by an abnormal production of autoreactive antibodies have been suspected to come along with impaired FcγRIIb function. Alterations of the expression of FcγRIIb on B cells have been shown for Lupus erythematosus and several other autoimmune diseases, but until now, data have been lacking for rheumatoid arthritis. (more…)
Biomarkers are the key to prevention and early detection of disease …
… of this I am convinced. And I am firmly convinced that laboratory diagnostics and the use of biomarkers will have a critical effect on the medicine of tomorrow.
Why am I so sure of this? It has already been demonstrated that biomarkers can be used to optimize treatment for individual patients with diabetes. In the future, individualized medicine (also sometimes called “personalized medicine”) will not only significantly increase the efficiency of treatment; it will also greatly improve prevention and early detection. Today it is already possible to carry out a diagnosis in the symptom-free phase of a disease by using biomarkers. This is of great benefit to the patients who receive early and targeted treatment. (more…)
Rheumatism affects more than just the joints: the heart and circulatory system are also at risk!The knowledge gradually sinks in, even for patients: inflammatory rheumatic diseases like rheumatoid arthritis (RA) not only damage the joints, but also the blood vessels. Patients with rheumatism thus have an increased risk of suffering a heart attack or stroke.
Why is this the case? Rheumatoid arthritis (RA) not only causes inflammation of the musculoskeletal system; it also affects the walls of blood vessels. In addition, RA patients have an increased incidence of hardening of the arteries, arteriosclerosis. “These patients have a 30 to 60 % higher risk of suffering a heart attack or stroke.”
These figures are given by Professor Dr. med. Jürgen Braun, Medical Director of the Ruhr Centre for Rheumatism in Herne, Germany (Rheumazentrum Ruhrgebiet). (These figures and excerpts, and those that follow, were published by the German Society of Rheumatology- Deutsche Gesellschaft für Rheumatologie, DGRh, in the run-up to the 38th Congress of the DGRh (38. Kongress der Deutschen Gesellschaft für Rheumatologie e.V.), which is currently underway in Hamburg.) Prof. Jürgen Braun adds, “The danger increases further when patients have elevated lipid levels, high blood pressure or diabetes, or are overweight.” (more…)
New ACR/EULAR 2010 Classification Criteria for Rheumatoid Arthritis (RA)
European and American rheumatologists have established new criteria for the classification of rheumatoid arthritis (RA). The Revised Classification Criteria for Rheumatoid Arthritis will appear in the September issue of Arthritis & Rheumatism; they can also be viewed online or as a free download at the ACR homepage (accessed 23/08/2010). (more…)