In the future, rheumatoid arthritis, or RA, might be detected before its symptoms become evident, and early cases could be stopped in their tracks, if recent research pans out.

Scientists presented findings at the American College of Rheumatology, or ACR, Annual Scientific Meeting in Atlanta Nov. 6 to 11 on two studies that could affect early detection and treatment of the autoimmune disease.

Early detection
One study focused on a new classification system to identify potential RA cases. Using criteria in the 2010 ACR/European League Against Rheumatism Rheumatoid Arthritis classification might make it possible to spot early warning signs of RA before people are diagnosed.

“If our goal is to achieve lifelong, drug-free remission, it may require someone to intervene and treat a person very early in the process – maybe even earlier than waiting until someone comes into the clinic,” says Jason R. Kolfenbach, MD, the study’s lead author and an assistant professor at the University of Colorado Denver School of Medicine in Aurora.

The new criteria, introduced as a replacement for those established in 1987, are intended to better identify cases of early disease. The new system classifies patients on a zero-to-10 scale. People are considered to have RA if they score six or higher, which means, among other things, that they have an inflamed joint capsule in at least one area that can’t be explained by another condition.

Colorado researchers used these criteria to test 1,790 patients taking part in an ongoing RA study of symptoms, joints and biomarkers of people at risk for developing the disease. That analysis identified 21 patients who have not been diagnosed with RA but appear to have early risk factors, including multiple swollen and tender joints.

Of those 21, 11 also had high levels of C-reactive protein, which indicates inflammation is present, six tested positive for rheumatoid factor and one was positive for more specific antibodies commonly seen in RA patients.

“We’ve been prospectively following a lot of these people since 2002. Now we can sub-identify those who might be at higher risk for developing what we might consider as RA,” Dr. Kolfenbach says. “We aren’t using [the criteria] to diagnose a patient, but to classify them so we can do initial analysis and find out the long-term implications.”

Researchers plan to track these subjects over time to see if they develop full-blown RA. Results of the study might some day lead to an early screening test for the disease, they say.

“Right now we can’t tell from looking at [subjects] how far away they might be from the diagnosis of RA in the clinical setting, or if they will avoid the diagnosis altogether,” Dr. Kolfenbach says. “We hope that nobody develops this, but if we capture them just before diagnosis or significantly before and identify factors that provide a high level of certainty of persistent disease, then we can intervene and treat, even before patients present to the doctor.”

Early Treatment
Another study shows that newly diagnosed RA patients and those suspected of having the disease but not yet diagnosed may be able to achieve remission – meaning they have no symptoms or disease activity – if they take methotrexate and prednisone for four months.