ADED Benefits

Advanced diagnostics lead to the early detection of joint disease.

Whether it is the value of nutrition, the latest in drug therapy, or otherwise, today's research is informed by the idea that antirheumatic therapy ought be aggressive, proactive and optimally, preventative. Meaning, it's good to treat arthritis in its earliest stages but better to treat it before the first symptoms occur. As a result, "early detection" seems to be an especially compelling front in arthritis research. And now more than ever, with technological advances and increasing medical knowledge, early detection is less a guessing game than a matter of anticipation.

To begin with, technology--especially imaging technology--is producing techniques that are increasingly sensitive to developing erosions. Magnetic resonance imaging (MRI) and ultrasounds are fast overtaking X-rays and radiographs, which have been deemed slow and imprecise. Whereas X-rays and radiographs might only show the obvious, long after the patient feels its effects, the immediate clarity and nuance of this next generation of imaging allows doctors to accurately predict joint erosion at a much earlier stage. Thermography, imaging through heat production, is also opening new doors. In 2004, researchers at Duke University found a new use for thermal scanners originally intended for computer circuit boards: the machine could also sense the minute temperature increases in finger joints. These increases are the beginnings of joint inflammation and the sooner doctors can detect these increases, the sooner they can begin the right treatment, before the joint temperature cools and the hands become creaky.

These machines are impressive in their sophistication and precision. But their imaging capabilities become useful after the onset of arthritis, after the first hints of morning stiffness, and after the first signs of joint tenderness. The most interesting front of early detection efforts involves special blood tests for high-risk individuals, most notably those with a family history of rheumatoid arthritis. These blood tests can look for certain antibodies and subsequently predict rheumatoid arthritis several years (maybe even up to ten years) before the patient must cope with any clinical symptoms.

In the past few years, researchers have found a clear correlation between two specific antibodies and the chance of rheumatoid arthritis in later years. When these antibodies, charmingly named IgM rheumatoid factor (IgM RF) and anti-cyclic citrullinated peptide (anti-CCP), are in high levels, there is an increased risk of arthritis. A significantly increased risk of rheumatoid arthritis. Estimated likelihoods vary from study to study; one study found a 49% predictive value in these blood tests, another found a 91% predictive value. Still, every study concludes in no uncertain terms that testing for these two antibodies is undeniably important in any early detection effort.

The outcomes of aggressive antirheumatic treatment in such an early stage remain unknown; it could delay the onset, minimize its impact, or, hopefully, fully prevent the onset. Because this is a novel field of research, the body of evidence is still growing. As one study writes, should someone have high levels of IgM RF and Anti-CCP, the best treatment before any sort of onset would be the same treatment available for those already with arthritis, the same drug therapy and the same suggestions on moderate exercise and good nutrition. There are many unanswered questions on what to do next, but this sort of predictive research and technology is bringing about exciting new possibilities. Maybe most importantly, predictive research and aggressive treatment can foster a positive "take charge" patient mentality rather than sitting around and waiting for the encroaching creak--this isn't your grandmother's arthritis after all.

Article References
Schellekens GA, Visser H, de Jong BA, et al. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum. 2000 Jan;43(1):155-63.

Ward M. Clinical Epidemiology: Diagnostic and Prognostic Tests. Curr Opin Rheumatol 15(2):104-109, 2003.

"Thermal Scanning Offers Promise of Early Arthritis Detection", 7/12/2004 http://dukemednews.duke.edu/news/article.php?id=7799 Site accessed 4/26/2005.

Nielen MM, van Schaardenburg D, Reesink HW, et al. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum. 2004 Feb;50(2):380

Jansen AL, van der Horst-Bruinsma I, van Schaardenburg D, et al. Rheumatoid factor and antibodies to cyclic citrullinated Peptide differentiate rheumatoid arthritis from undifferentiated polyarthritis in patients with early arthritis. J Rheumatol. 2002 Oct;29(10):2074-6.

van Venrooij WJ, van de Putte LB. Early diagnosis of rheumatoid arthritis with a test based upon a specific antigen: cyclic citrullinated peptide. Ned Tijdschr Geneeskd. 2003 Feb 1;147(5):191-4.