To illustrate his point, he referred to EULAR recommendations published in 2012 that identified these RA risk factors:5
- Environmental/lifestyle factors;
- Genetic risk;
- Systemic autoimmunity;
- Arthralgia-nonspecific symptoms; and
- Undifferentiated arthritis.
According to Dr. Emery, these risk factors will help in determining which patients to treat. “If you look at systemic autoimmunity, we know that multiple antibodies become positive, especially just before presentation, and they actually go on increasing unless you treat the patients. There’s already an autoantibody storm just prior to treating them,” he said.
Population screening of biomarkers, however, is not cost effective because not all people with risk factors will develop RA. He and colleagues, therefore, are currently conducting a series of studies to learn which factors signal a greater likelihood of disease progression.
To illustrate his point about the effectiveness of early awareness and treatment, Dr. Emery referenced one study, the ADJUST trial, which showed that of patients with pre-RA symptoms, those who received abatacept had no X-ray progression at six months while those on placebo progressed in a linear fashion.6
Dr. Emery ended his presentation by explaining that a palindrome is a good metaphor for the future of RA treatment strategies. “A therapy strategy based on pathogenesis is a palindromic shift, and that’s because [at the end of treatment] you’ll see the return to normal,” he said.
Stephanie Cajigal is a medical journalist based in California.
References
- Goëb V, Aegerter P, Villeneuve E, et al. Reduced IL-7 serum titres are associated with progression towards rheumatoid arthritis in less than 6 months inflammatory arthritis. Ann Rheum Dis. 2011;70(Suppl 2):A2.
- Vital EM, Dass S, Rawstron AC, et al. Management of nonresponse to rituximab in rheumatoid arthritis: predictors and outcome of re-treatment. Arthritis Rheum. 2010;62:1273-1279.
- Weisman MH. Progress toward the cure of rheumatoid arthritis? The BeSt study. Arthritis Rheum. 2005;52:3326-3332.
- Smolen JS, Emery P, Ferraccioli G, et al. Maintenance of remission in rheumatoid arthritis patients with low-moderate disease activity following withdrawal of certolizumab pegol treatment: Week 52 results from the CERTAIN study. Ann Rheum Dis. 2012;71(Suppl 3):361.
- Gerlag DM, Raza K, van Baarsen LG, et al. EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: Report from the Study Group for Risk Factors for Rheumatoid Arthritis. Ann Rheum Dis. 2012;71:638-641.
- Emery P, Durez P, Dougados M, et al. Impact of T-cell costimulation modulation in patients with undifferentiated inflammatory arthritis or very early rheumatoid arthritis: A clinical and imaging study of abatacept (the ADJUST trial). Ann Rheum Dis. 2010;69:510-516.
