Putting a Stop to Rheumatoid Arthritis Before it Begins
While there is no cure for rheumatoid arthritis, it appears that physicians can stop the progression to rheumatoid arthritis in those patients who have so-called "undifferentiated arthritis." This, along with the halting of joint destruction as determined by x-ray, can be accomplished with methotrexate, as shown in a study recently published in the journal Arthritis and Rheumatism.
The term "undifferentiated arthritis" can best be defined as an inflammatory arthritis that does not fulfill all the American College of Rheumatology criteria for the classification of rheumatoid arthritis.
And it appears that this can also be thought of as a window of opportunity, during which time aggressive treatment actually reverses the disease process.
The study in question followed patients who had been diagnosed with undifferentiated arthritis during the previous two years.Some patients received methotrexate; some received the placebo drug.
The authors of the study found that 40% of the study subjects treated with methotrexate progressed to rheumatoid arthritis, while 53% of those patients who received the placebo progressed to rheumatoid arthritis. In addition, the placebo group progressed much more rapidly to rheumatoid arthritis.
When the researchers looked at the x-rays of the study subjects, there was significantly less damage in the patients taking methotrexate, and larger reductions in measurements of disease activity.
Interestingly, methotrexate was of benefit only in those patients who tested positive for the anti-cyclic citrullinated (anti-CCP) antibody.
It would appear that a subset of patients with undifferentiated arthritis who are anti-CCP positive would benefit most from intervention.Perhaps the use of some of the newer "biologic" drugs would be even more beneficial during this window of opportunity.
In the meantime, it is key that primary care physicians refer patients with inflammatory arthritis to their local rheumatologist as soon as possible, so that rheumatoid arthritis might be prevented, or at least rendered less aggressive.