Which RA Patients Need Early, Aggressive

CRP, Anti-CCP, Ultrasound Can Predict Which RA Patients Need Early, Aggressive Treatment to Stave Off Rapid Progression

Severe inflammation is associated with rapid, severe, extensive damage in rheumatoid arthritis (RA), but the subgroup of patients most at risk can be helped with modern treatments such as biologics. The damage can be identified by readily available clinical tools, according to Paul Emery, MD, head of the academic unit of musculoskeletal disease at Leeds University in the UK. Dr. Emery, reviewed in Rheumatology recent advances in clinical identification and treatment of rapidly progressing RA.1

Several biologic markers and clinical indicators have been identified to help predict or establish which of the patients have rapidly progressing disease or who are at most risk for rapid progression. Early diagnosis of patients with rapidly progressing RA enables immediate and intensive intervention (eg, with biologic therapy) and a greater opportunity to change the course of disease,” Dr. Emery said.

http://www.mskreport.com/articles.cfm?articleID=2920
Lynn492008-04-01 07:20:20

"Rheumatoid factor (RF) positivity early in the disease course predicts more severe RA but is not a very useful predictor later in the disease. Patients with anticyclic citrullinated peptide (anti-CCP) antibodies at the time of diagnosis are likely to have greater radiological progression than those without anti-CCP at baseline, but antibody levels do not predict changes in disease activity, according to Dr. Emery. Assessing anti-CCP along with antikeratin antibodies (AKAs) gives better predictive power, but Dr. Emery pointed out that tests for AKAs are not routinely available in most clinical settings."

I wonder what this could mean for me. I have a fairly high CCP. No damage in initial x-rays done in Jan. Meds are controlling RA really well right now without biologics. Hmmm

I wonder what that means for me?

My doctor still thinks I'll need biologics when I am completely tapered off the prednisone. I take MTX as well.

They still haven't found proper treatment for me, swellings get horrible, then ease etc.

It's been 3yrs for me since diagnosed and already i have a deformed wrist that won't bend backwards or side to side and a finger that looks all wavy from damage. I hate to see what my knees look like.

So, i totally believe we have to hit things hard immediately. I feel bad when people say they want to hold off on the meds a while cuz they don't really think they need them. I wish i could have taken the meds right away without reactions, but my doctor is an idiot.

So, now i am damaged and just have to hope that when i get pain killers, i don't get addicted.

I think doctors are a bit too timid. Once you have a diagnosis, you might as well show some backbone and start putting up a good fight. RA can do a lot of damage in a short period of time.

I was very lucky in that my RD started treatment with MTX at my second visit. I was fairly young (19), and she said that we needed to do this now to prevent issues later. I was also my dr.'s first patient on Enbrel when that came out years ago. I still function pretty normally after 10+ years of this disease. Hit it fast and hard. Mab52- My current doctor would agree with you.

After being under another doctor's care for 2 months with no response to the meds and having incredible swelling and level 10 pain for 12 hr. cycles- continuing my 15 mgs of MTX he jacked my prednisone dose up to 40 mgs. The next day I was a new woman. I'm down to 12.5 at this point and still feeling good but he keeps talking about biologics.

I have a great Dr.. anyone new, i say get on the meds, ASAP!!!.. this is such a fast degenerative disease!

I know he put me on meds, pretty quick.. and he always listens and i'm lucky!!.. not the ra :P

but the DR and his staff, are soooo nice and understanding!!
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