Current Concepts In Treating RA | Arthritis Information

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Current Concepts In Treating RA: What Recent Studies Reveal
- By Ara Dikranian, MD

Delving into the literature, this author discusses the current thinking on key markers of early disease activity in patients with rheumatoid arthritis (RA), reviews the impact of anti-TNF medications in early RA and assesses the potential of emerging biologic agents.

Rheumatoid arthritis (RA) affects more than two million adults in the United States.1 In the past decade, the advent of tumor necrosis factor inhibitors for the treatment of RA has ushered in a new era of targeted biologic modalities. We have seen a shift to more aggressive therapy involving earlier treatment and the use of multiple medications in combination. Although the long-term effects of new treatment approaches are not yet fully known, early results appear favorable.
       A substantial proportion of patients with inflammatory arthritis of short duration have remission and only some patients with persistent disease will go on to develop RA.2 Therefore, it is important to determine genetic, clinical, serological or radiographic markers that allow clinicians to identify patients with early disease destined for RA so they can provide appropriately targeted therapy.
       Functional alterations in cytokine regulation can predict and affect destructive disease among patients with early disease. In a genetic analysis to establish prognostic markers, Prots et al., showed that the 150V IL4R single-nucleotide polymorphism may be a candidate marker for early radiographic bone erosions in patients with RA.3 Khanna et al., showed that the TNFA-308 polymorphism is associated with significantly higher radiographic progression in a cohort of early seropositive RA patients.4
       Markers of inflammation or osteoclast activation can also provide information on the likelihood of joint destruction among patients with early disease. Aside from an elevated baseline erythrocyte sedimentation rate, researchers have recently shown that the osteoprotegrin/RANKL ratio is inversely related to bone destruction among patients with RA who have not been previously treated with disease modifying antirheumatic drug (DMARD) therapy.5,6 When it comes to serological findings, antibodies to citrullinated peptides (anti-CCP) serve as specific disease markers whose appearance in the blood can predate the onset of symptoms.7

 
I wasn't aware of this;  good to know they have recognized a difference:

 "Researchers have shown reduced radiographic progression at one year with rituximab as well.33 Cohen et al., reported on a specific subgroup of 457 REFLEX patients for whom radiographic data were available at week 56. Rituximab-treated patients experienced inhibition of structural damage progression by at least 50 percent as assessed by the Sharp-Genant total score, only when researchers subgrouped and stratified these patients according to baseline anti-CCP status. The researchers noted that anti-CCP negative patients progressed at the same rate as those in the placebo group."
[QUOTE=Suzanne]I wasn't aware of this;  good to know they have recognized a difference:

 "Researchers have shown reduced radiographic progression at one year with rituximab as well.33 Cohen et al., reported on a specific subgroup of 457 REFLEX patients for whom radiographic data were available at week 56. Rituximab-treated patients experienced inhibition of structural damage progression by at least 50 percent as assessed by the Sharp-Genant total score, only when researchers subgrouped and stratified these patients according to baseline anti-CCP status. The researchers noted that anti-CCP negative patients progressed at the same rate as those in the placebo group."
[/QUOTE]
 
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