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Arthritis early warning breakthrough
June 20, 2007
Liesbeth de Bakker
Dutch researchers have discovered that the first signs of arthritis can
be detected in the blood up to 14 years before symptoms of the
crippling disease emerge. The discovery has opened up a whole new
avenue for preventive treatment. Researchers in Amsterdam are now
compiling a group of at-risk people for preliminary testing.
Rheumatoid arthritis involves inflammation of the joints.
Treatment has improved a lot in recent years, and if detected early,
arthritis patients undergoing therapy can now continue to lead a normal
life. If the disease goes untreated, however, the joints deform and
leave a person handicapped.
The disease affects around one percent of the population of the
developed world. Its impact on society is not as big as, for instance,
diabetes or cardiovascular disease, but since it affects a person's
ability to move and work, onset at an early age places a heavy economic
burden on society.
"A lot of money can be saved by a good treatment," says Dirkjan
van Schaardenburg, an arthritis expert at the Jan van Breemen Institute
Prevention is priority
That's why Dr van Schaardenburg and
colleagues are looking into ways to prevent the disease even before it
begins. Recently they made great headway in this area after analysing
standard blood-donor blood samples.
"We found 80 patients of whom they had stored blood from before
they had their symptoms," Dr van Schaardenburg says. The team looked
for 'rheumatoid factors' or 'anti-CCP', auto-antibodies that react
against a person's own cells and tissues instead of targeting foreign
invaders such as bacteria.
"We found these factors in half of the patients at a mean of
five years before the symptoms started. In one person this period was
even 14 years."
An early check for arthritis is now possible
This shows that there is a lag period before people start
noticing symptoms of the disease, and this suggests new possibilities
for preventive treatment. But Dr van Schaardenburg warns that one has
to tread carefully with such an approach.
"You [would be treating] people who don't
have any complaints; they are healthy, so you can't give them a
treatment which would make them ill or give them side-effects."
Based on earlier experience and recent tests, Dirkjan
van Schaardenburg and his team have decided that "one or two injections
with an anti-inflammatory substance would be feasible, because people
don't have to think about taking medicine all the time."
At the Jan van Breemen Institute
they are currently recruiting people who have a higher-than-average
chance of getting arthritis. Some of them have family members with the
"If you have someone in the family with rheumatoid
arthritis, then the risk of the disease is somewhat increased - not
very large but enough to offer them screening," Dr van Schaardenburg
In addition, people who do not have
arthritis but have proven problems with their joints in combination
with increased auto-antibody concentrations can also enlist for the
trial. "They don't have joint swelling and normally these people would
not get treatment, but now we say you can come to us."
If arthritis goes untreated it can cause severe joint deformation
Dr van Schaardenburg is hoping for many more potential
arthritis patients in the Netherlands to in order to get a group large
enough to judge whether preventive treatment with anti-inflammatory
injections is helpful.
"It's difficult to say what the effect will be on the
occurrence of the disease because normally if you have these
autoantibodies it takes on average 5 to 10 years before the symptoms
start," he says.
"In the meantime, though, we will check the
auto-antibody concentrations in the blood. If they go down, that would
be a sign we might be having success, and that you might see in quite a
short time, lets say six months."
In that time the team expects around 100 people to have
finished initial testing. They will have more concrete results in about
two years' time.
Towards long-term protection
Dr van Schaardenburg
also anticipates learning more about the way arthritis develops, and
hopes that the knowledge may allow other, more effective preventive
treatments to be used in the future. He says there are "several
proteins which you can inject which stop the disease very efficiently,
better than the drugs we have now".
But these proteins cannot be used yet in symptomless
people, because the long-term effects are unknown. "If our tests turn
out to be safe, then we can use them in people who are not ill yet, and
we might be able to stop the disease for a very long time just with one
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