Treating patients in the very earliest detectable stages of the disease could prevent some patients from going on to develop full-blown rheumatoid arthritis, according to new data presented at the European League Against Rheumatism (EULAR) conference in Amsterdam, the Netherlands.
The results of the PROMPT study compared with the widely-used rheumatoid arthritis treatment methotrexate with placebo in 110 patients who had early signs of arthritis, but in whom the actual form of the disease, rheumatoid or osteoarthritis, had not been diagnosed.
After one year of treatment, fewer patients in the methotrexate group had gone on to develop arthritis, and there was also evidence that joint destruction was slowed.
Tom Huizinga of Leiden University Medical Centre in the Netherlands told reporters that one of the key findings of the study was that a antibody-based blood test, known as anti-CCP, could be used to identify the patients who would get the benefit of early treatment with methotrexate.
In anti-CCP-positive patients, the onset of rheumatoid arthritis was postponed, he said, while there was no effect of drug treatment in the anti-CCP-negative group.
Anti-CCP is quite widely-used in Europe, but less commonly by rheumatologists other countries such as the USA. It is well-established and relatively cheap, noted Huizinga.
“The results raise the possibility of using anti-CCP testing to develop personalized therapy to at least retard the development of rheumatoid arthritis,” he concluded. He also noted that the findings raise interesting scientific questions, as identifying the precise process behind the delay in developing rheumatoid arthritis, could guide the development of new ways to intervene and prevent it.
Commenting on the findings, Paul Emery of the University of Leeds in the UK, said the study was “extremely important,” as it addresses “a theory that has only just come of age – that early intervention during the phase in which patients are developing into rheumatoid arthritis, may influence and actually prevent a disease that is lifelong.”
If backed up in other studies, the findings could have significant benefit not only to patients but also in reducing the enormous cost to society of rheumatoid arthritis.
“Most people are seen too late, and given treatment too late,” said Emery, adding that “governments don’t allow us to use the most effective medicines early. This is one of the big messages we want to get out.”