Researchers at the Mayo Clinic funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have identified markers that are early indicators of progressive disease in rheumatoid arthritis (RA).

Jörg Goronzy, M.D., and his colleagues found that the following factors present at disease onset predict x-ray evidence of fast progression:

• older age
• bone that has worn away (erosions)
• rheumatoid factor, an antibody in the blood
• rheumatoid factor titer (measurement of amount of rheumatoid factor in reaction with a specific testing medium)
• variations in specific genes related to immune function and to the protein uterglobin
• T cells (CD4+,CD28null) associated with an aging immune system

The research looked at many possible biologic markers for their predictive potential, and ruled out some potential markers, including initial joint pain and swelling.

The two-year study followed the disease progression of 111 patients with recent diagnoses of RA. Each participant received the same baseline treatment, one that was stepped up only when joint inflammation did not significantly improve. About half of the patients never developed erosive disease.

Rheumatoid arthritis is a form of arthritis that causes inflammation of the joint lining and often affects many different joints. It can damage the cartilage, bone, tendons and ligaments, causing pain, stiffness, swelling and loss of joint function. RA progression can vary widely, and early aggressive treatment with disease-modifying antirheumatic drugs is frequently recommended, although there are some toxicity risks. The study’s findings suggest that more appropriate treatment strategies could be based on likely disease course, and underscore the need for further investigation.

The National Arthritis Foundation and the Mayo Foundation also supported the study.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is part of the U.S. Department of Health and Human Services?National Institutes of Health, the leading Federal agency in biomedical and behavioral research. The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at www.niams.nih.gov.

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Goronzy J, et al. Prognostic markers of radiographic progression in early rheumatoid arthritis. Arthritis and Rheumatism, 2004;50(1):43-54.