Wouldn’t it be amazing if we could stop rheumatoid arthritis (RA) before it develops, before it starts wreaking havoc in our bodies?
Does that sound like science fiction or a fairy tale? It isn’t. It’s getting closer to becoming a reality.
A bit of background
Five years ago, I listened to Edward C. Keystone, M.D., F.R.C.P(C) one of the foremost rheumatologists in Canada, talk about how the anti-CCP blood test was leading us toward a bright new future. Because the anti-CCP test can detect RA up to 15 years before it starts, he said it was leading to a rheumatologist being able to identify individuals at the pre-clinical stage of RA. That is, before symptoms begin. This is exciting because it can lead to a future in which RA can be stopped before it affects the systems in your body.
Although I was delighted to hear this, I have to admit that I thought this was very far into the future. But only five years later, it’s starting to become reality.
Researchers in the U.S. and Europe are starting clinical trials in what is called proof-of-concept studies to investigate whether it is possible to prevent RA from developing. A proof-of-concept study is an early stage study of clinical drug development, which usually happens after a drug shows potential in safety testing or animal models. This type of study tends to be small and may not be fully completed.
At present, there is one study in the U.S., and four studies in the UK, Netherlands, and Germany.
The studies use different criteria for inclusion. In some, participants will have tested positive for RA using the anti-CCP or Rheumatoid Factor tests. Some of the studies also will require participants to have arthralgia (joint pain), whereas others are including individuals who do not have joint pain, or who have shown subclinical inflammation in the joint on an MRI.
Participants will be randomly assigned to receive a medication or a placebo. Using a number of different RA meds, either DMARDs or Biologics, the studies will examine the impact of this early treatment on the development of RA.
“[P]prevention of RA may be within reach in the near future,” wrote Kevin Deane, M.D., Ph.D., the principal investigator for the U.S. study, which uses hydroxychloroquine.
One additional European study using rituximab (Rituxan) has been completed. Results showed that one single infusion of rituximab did not prevent RA from developing, although it did appear to delay the disease. Individuals in the placebo group who developed RA did so after 12 months, whereas those who were in the treatment group and got RA did so after 24 months.
We are living in the future and it’s a bright one. These studies are looking at what is the holy grail in rheumatology: stopping RA before it has a chance to damage our bodies. A cure.
Before we get too excited, we need to remember that these are proof-of-concept clinical trials. The rituximab study appears to show some hope for this concept of stopping RA before it starts, but much more research is needed. There is a long way to go before we get to a point where preventing RA is a normal clinical practice. But this is an amazing start.
See More Helpful Articles:
Remission in RA: an Interview with Dr. Yusuf Yazici
How Do Biologics Treat RA?
RA Treatment Q&A: Biologics with Dr. Justin Peng
Extra-Articular or Systemic Manifestations of RA
Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.