Prevention remains the ‘holy grail’ for RA, and closer than ever
DESTIN, Fla. — Although early detection of rheumatoid arthritis is critical in reducing disease severity, the prevention of rheumatoid arthritis through early treatment remains a lofty goal for rheumatologists, according to a presenter at the 2019 Congress of Clinical Rheumatology.
“[RA prevention] has certainly been a ‘Holy Grail’ for the last 40 years for me and whether we can ever actually prevent the disease — and I can say now, we don’t know — but we will have a very good chance to finally answer that question in the next few years,” Paul Emery, MD, of the University of Leeds, England, said.
There have been significant advances in RA including the accepted concept that RA is treatable; the importance of early treatment; and the realization that disease phenotype is an endpoint of a continuum of immunological and other events, he said. He noted that there is a preclinical and clinical phase of the continuum.
“There is the ability to identify individuals at risk before they get arthritis, and also to a degree predict the timing of development,” Emery said.
In the preclinical phase, environmental/lifestyle risk factors include smoking, low socioeconomic status, periodontal disease and low alcohol intake. While surprising, low alcohol intake is “actually is a very consistent finding.”
“The big advance was the discovery of [anti-citrullinated protein antibodies] which were specific for the development of RA,” he said.
There are more antibodies in development, specifically anti-CarP (anticarbamylated protein), Emery said.
“We found that everybody who had a high titre CCP [cyclic citrullinated peptide] was positive for it and it has a small predictive value in patients,” he said.
“More recently, we have been looking at anti-CCP3 from Inova,” Emery said. “The results were so remarkable, I decided to include them today.”
“CCP3 is completely bimodal,” he said remarking on unpublished data of 650 CCP2-positive patients who do not yet have arthritis.
Of those patients, a portion were anti-CCP3 positive and “nearly, virtually all developed arthritis.”
Anti-CCP3 is more sensitive than CCP2 and, possibly more specific, and valuable at the initiation of autoimmunity, he said. Emery believes the full data will be presented later this year. – by Joan-Marie Stiglich, ELS
Emery P. Can we prevent rheumatoid arthritis? Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Fla.
Disclosure: Emery reports speakers’ bureau roles with AbbVie, Amgen, BMS and Celgene.