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Blood Test Could Prevent Medication Trial and Error for RA Patients, Mayo Clinic Says

Presence of type-1 interferon helps guide treatment choices

A molecule in the blood shows promise as a marker to predict whether individual rheumatoid arthritis (RA) patients are likely to benefit from biologic medications or other drugs should be tried, a Mayo Clinic-led study has shown. The protein, analyzed in blood tests, may help avoid trial and error with medications, sparing patients treatment delays and unnecessary side effects and expense, the authors say.

The research is among several Mayo Clinic studies presented at the American College of Rheumatology annual meeting in Boston.

Researchers tested blood samples taken before RA treatment was administered. The patients were then treated with tumor necrosis factor-alpha inhibitors, a class of anti-inflammatory biologic drugs used for RA. They found that an immune-system protein –– type-1 interferon –– appears to serve as a valid marker to show whether individual RA patients will respond to biologics or whether other medications should be tried.

“We are trying to personalize therapy for rheumatoid arthritis. One of the main problems rheumatologists have had is that it’s hard to choose the right drug for the right person,” said senior author Timothy Niewold, MD, a rheumatologist at the Mayo Clinic in Rochester, Minnesota.

“Each new drug works for some people and not others. It’s not trivial, because the disease causes damage in the joints, and if it takes a year or two to find the right treatment, then damage can accrue,” Niewold said. “In the study, we looked at markers in the immune system that might help us guide our treatment choices.”

Methotrexate is often the first drug tried for RA. If that doesn’t work, biologic agents are often next. Those drugs have adverse effects, including a risk of infection, and patients should be tested for tuberculosis before taking them.

Getting RA under control is important not only to prevent the damage it causes directly, but to reduce the risk of other serious conditions, such as heart disease. RA patients are twice as likely to develop heart disease as the average person, and previous Mayo research has found that the severity of RA is a factor. People for whom methotrexate doesn’t work tend to have more severe RA, Niewold said.

More research is needed before use of the marker becomes standard practice, Niewold noted. A larger trial involving several institutions is under way. Future studies may examine whether the marker can also help guide medication decisions for other conditions treated with biologics, such as psoriatic arthritis, psoriasis, and inflammatory bowel disease, he said.

In other studies being presented at the American College of Rheumatology meeting, researchers found:

  • RA patients and their physicians often describe pain differently, leading to a gap between what patients understand their pain levels to be and how physicians rate the pain. Patients are more likely to describe pain using words with emotional connotations, possibly reflecting the activation of pain, mood, and fear networks in the brain by inflammation, researchers say. Physicians, meanwhile, are likelier to use sensory descriptions, such as “sharp,” “aching,” or “throbbing,” to characterize pain. Further research can help physicians develop new approaches to better ease pain, the study authors say.
  • RA flare-ups increase patients’ heart disease risk. “Every time joints flare up, it’s a knock against their hearts,” said co-author Eric Matterson, MD, rheumatology chair at the Mayo Clinic in Rochester. “Patients should keep track of their flare-ups and call their physician when they have a flare.”
  • Like people with RA, those with psoriatic arthritis are at higher risk of cardiovascular disease. Heart disease prevention, detection, and treatment efforts are especially important for such patients, the researchers say.
  • RA patients, whether women or men, are more likely to be hospitalized than are people without the inflammatory disorder. Men with RA are more likely to be hospitalized for depression, whereas women and people 45 to 64 years old with RA are more likely to be hospitalized for diabetes.

Source: Mayo Clinic; November 17, 2014.

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