Clinical Research December 2007
Taken from NRAS magazine, Winter 2007
Weight measures 'underestimate fat levels in people with rheumatoid arthritis'
A new report published in the Annals of the Rheumatic Diseases has suggested that people with rheumatoid arthritis are likely to have higher levels of body fat than healthy people with similar body mass indexes.
Dr George Kitas and a team from the University of Wolverhampton and the University of Birmingham wanted to assess whether body mass index (BMI) and body fat differ between RA patients, patients with osteoarthritis (OA) and healthy individuals.
BMIs are used as a measure of obesity levels and are based on an equation which takes into account a patient's height and weight.
After analysing body fat and BMI in all the patients, it was found that, at any given body fat level, RA patients had a BMI that was significantly lower than that recorded in the healthy controls. This means that BMI could be underestimating the fat levels in people with RA. The team concluded: "In individuals with RA, BMI cut-off points should be reduced.”
These findings may be important in the context of the cardiovascular co-morbidity of RA.
New research to target more effective treatment for rheumatoid arthritis
A team led by Dr Ann Morgan at the Leeds Institute for Molecular Medicine in St James’s Hospital at the University of Leeds, will examine the genetic make-up of 1,000 people with RA in West Yorkshire in order to see if it is possible to predict which of them will develop the condition most severely.
Antibodies such as rheumatoid factor play a large role in the development and perpetuation of inflammation in RA, and Dr Morgan has found that genetic differences in antibody receptors called Fc gamma receptors seem to influence the development of the disease. This group of genes will be studied further to see if they can be used as a marker to predict the severity of RA from the start of the illness.
These ongoing studies could establish the precise changes that are present in these genes and the way that these changes in the genetic make-up alter our susceptibility for rheumatoid arthritis. If the investigators are correct, this genetic information may also help guide the choice and intensity of treatment offered.
Anti-TNF therapy may produce drug-free remission
Latest results from the BeSt study demonstrate the possibility of drug-free remission for patients with rheumatoid arthritis (RA).
The BeSt study is a Dutch randomised controlled trial that compares four treatment strategies for early RA. Patients are allocated to one of the following groups and treatment is adjusted at three month intervals as necessary:
• sequential monotherapy
• step-up combination therapy
• initial combination therapy with tapered high-dose prednisone
• initial combination therapy with infliximab
Data presented in June 2007 at the EULAR Congress show that four years after receiving methotrexate and infliximab as initial treatment for RA, 51% of patients (61/120) discontinued infliximab because of continuous improvement (mean 35 months) reaching clinical remission (DAS ≤2.4). In addition, 17% of patients were able to discontinue all anti-rheumatic drugs and remain in clinical remission with minimal joint damage progression. These findings suggest that there is a possibility to alter the course of early RA and achieve drug-free remission with infliximab.
Professor Peter Taylor, Kennedy Institute of Rheumatology Division, Faculty of Medicine, Imperial College London, comments: “The results of the BeSt study are important because they show that in rheumatoid arthritis patients, early, intensive combination-treatment provides better clinical outcomes for patients. Furthermore, this data suggests that after a period of induction therapy, biologic-free or even drug-free remission may in fact be possible.”
In addition, a report published in the September issue of Annals of the Rheumatic Diseases using data from the BeSt study group, showed that patients with recent onset rheumatoid arthritis (RA) dislike taking steroids and prefer to be treated with initial combination therapy with infliximab. This conclusion was drawn from the results of a survey completed by patients participating in the BeSt study. The survey was the first of its kind to focus more on the patient’s feelings and perceptions of the quality of care and measured outcomes than on the patient’s preference for the prescribed medication. It was sent out after patients had been on the trial for 2.2 years and before patients were informed about the BeSt study results.
The survey indicates that patients prefer to be treated with the therapy that provides the best clinical outcomes
Research to develop a test for rheumatoid arthritis
A Newcastle doctor has been awarded charitable funding from the Arthritis Research Campaign to carry out research which could ultimately develop a diagnostic test for rheumatoid arthritis.
Dr Arthur Pratt, who is based at the Musculoskeletal Research Group at Newcastle University, said “Inflammation in RA is in large part co-ordinated by particular white blood cells, so careful study of the genes that are switched on in these cells may help us to distinguish between different types of arthritis at the onset.” In its early stages RA can be difficult to distinguish from other, less damaging types of joint inflammation.
Dr Pratt’s ultimate aim is to develop a molecular gene signature that, along with symptoms, signs and other blood tests, will help to diagnose RA in its earliest stages.
New risk gene for rheumatoid arthritis and lupus opens door to more effective treatments
Scientists at The Feinstein Institute for Medical Research have identified a critical gene that increases a person's risk for rheumatoid arthritis and systemic lupus erythematosus, and may be involved with other autoimmune diseases.
The genetic link was described in the September 6th issue of the New England Journal of Medicine. In the study they analyzed DNA from 2,500 patients with rheumatoid arthritis (RA) or lupus. Genetic mapping enabled them to identify STAT4 as a culprit in susceptibility to both diseases.