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How to identify incipient RA; predicting and classifying remission; reducing disability; and a gene study identifies aggressive synovial cells, with hints at treatment target.
"Early" was the watchword about rheumatoid arthritis from the American College of Rheumatology meeting in Washington: Strive for early recognition, early treatment, and early remission. Abstracts described below can be found online in the ACR meeting abstract supplement (http://www.rheumatology.org/education/annual/2012_Abstract_Supplement.pdf).
• Progress toward better markers of preclinical RA. A team from Amsterdam went in search of biomarkers that pinpoint rheumatoid arthritis much earlier than rheumatoid factor and anti-citrullinated protein antibodies (ACPA). Their test based on interferon response and B-cell related genes showed 85% specificity and 52% sensitivity in identifying "pre-RA." (Abstract #2668)
• Yet more reason to catch RA early, and act quickly and effectively: Evidence from a large Canadian cohort shows that the chief predictors of sustained clinical remission from RA are not a particular course of treatment; they are young age, relatively mild pain, and rapid progress to remission. Conventional DMARDs achieved remission within 2 years for patients treated early enough. (Abstract #2610)
• However you define remission, nearly half of patients still have fatigue and one in ten still feel pain. Rheumatologists at NYU have teamed up with peers in Paris to strive for a rigorous definition of remission, and propose a set of tests that could standardize its assessment in routine care. (Abstract #2639)
• Half of RA patients also feel disabled, but there are ways to reduce this. A survey of RA patients in the UK reveals contributors to their sense of disability. Focus on improving their mood, suggest the researchers, and on helping them to set goals and to move about with less pain, especially outdoors. (Abstract #2693)
• An epigenetic biomarker is distinctive in synovial cells from RA patients. A subtype of synovial cells taken from RA patients have a different methylation pattern than the same cells taken from patients with osteoarthritis or from unaffected individuals. These patterns are associated with cell adhesion and inflammation, and could not only explain the aggression of synovial cells in RA but could serve as a target for treatment, say the researchers from the University of California-San Diego. (Abstract #1610)
ACR2012 Highlights: Rheumatoid Arthritis Comorbities and Adverse EventsMore from ACR2012:
Sex and Other Risks: Caring for Teens in Pediatric Rheumatology Briefer Two-Drug Regimen Offers Dramatic Results in Lupus Case SeriesStepping Down Anti-TNF Appears Safe in RA After Remission Continued Promise for Rituximab in Vasculitides Good News About Belimumab and SLE