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Joint Pain Forum – News you can use!

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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 in Amsterdam.

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."

Volunteers wanted
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 disease.

"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 says.

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 injection."

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