RA News Vol. 8: Predicting TNF Response, Prednisone Increases Remission, New Mayo Clinic Heart Disease Risk Study
Brief rundown of 3 recent RA news articles that could make big impact
1. Simple urine test may predict who responds to TNF biologics!
British researcher Dr. Sabrina Kapoor noted that the metabolites which are a result of the effects of tumor necrosis factor (TNF) on metabolism should be present in the urine or blood of patients. She found that pretreatment levels of histamine, glutamine, xanthurenic acid, and ethanolamine were found to be correlated with patients’ response to anti-TNF therapy.
Urine samples from 16 Rheumatoid disease patients were compared with those of 20 Psoriatic arthritis patients (PsA). Samples from the patients with RA were highly correlated (85%) with the treatment outcomes. This was a very small study, but it the results indicate it may be possible to use such a test to indicate which RA patients have TNF-dependent disease activity and thus will respond to this type of treatment.
Read more on urine tests predict TNF Biologic response in RA patients in Rheumatology News.
2. “Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early Rheumatoid Arthritis.”
In an Italian study of 220 early onset RA patients, “low-dose prednisone” used as a “co-medication” with methotrexate resulted in a higher proportion reaching clinical remission and low disease activity measured with power Doppler ultrasound. Power Doppler was used because the authors are aware that damaging “sub-clinical” inflammation can be detected with ultrasound (US), providing a more accurate assessment of whether prednisone helps achieve a state of very low disease activity or remission.
Methotrexate doses were raised from 10 mg weekly to 25 mg, as tolerated. One half of patients received the prednisone dose starting at 12.5 mg per day, lowered to 6.25 mg daily after two weeks. “The frequency of patients achieving clinical remission (DAS28<2.6) was significantly higher” in the methotrexate with prednisone group. “Similarly, the probability of reaching PD negativity was significantly higher” in the methotrexate with prednisone group.
However, “low disease activity” levels were similar in both groups, about 75%, again demonstrating the value of aggressive treatment in early onset RA with therapeutic adjustments intended to “treat to target” of low disease activity or remission.
Read more about prednisone improving ultrasonographic and clinical results in early onset Rheumatoid Arthritis.
3. “A new Mayo Clinic study shows that heart disease risk assessment tools commonly used by physicians often underestimate the danger faced by rheumatoid arthritis patients.”
Mayo Clinic confirms standard heart disease risk tools drastically underrate heart disease risk in Rheumatoid Arthritis. According to Dr. Eric Matteson, “Physicians caring for patients with rheumatoid arthritis should be aware of this heightened risk even when conventional risk factors seem to indicate no increased risk, and consider measures to assess and lower CV risk in these patients.”
This study draws from the Rochester Epidemiology Project which, as we’ve noted before, allows Mayo Clinic to more closely estimate the actual incidence of RA and other health conditions.
“The observed heart disease risk turned out to be twice as high among women and 65 percent higher in men than the Framingham risk score predicted, and the Reynolds tool had similar shortcomings, researchers found. Patients 75 and older proved to be three times more at risk than the Framingham score indicated. Patients with positive rheumatoid factor also had more heart disease events than the risk scores predicted,” reported Sharon Theimer for Mayo Clinic News.
Read more about challenges to measuring heart disease risk with Rheumatoid Arthritis.
Related reading
- 20 Facts About Rheumatoid Heart Disease, important research facts ignored in the news
- Every article on RAW about Rheumatoid heart disease
- Articles on RA Warrior about Musculoskeletal Ultrasound for RA
- RA Disease in the News, Vol.7: Increased Atrial Fibrillation Risk, Steroids Reduce Citrullination, Self-performed Joint Counts
Wow! It will be interesting to see if future studies back up that small study predicting which patients will benefit from the biologics. I am lucky enough to have responded to Enbrel after MTX failed to help, although it’s certainly not a return to full function and I also need Plaquenil and an NSAID. I’m so grateful that we’ve finally got a combination that allows me some return of function. Wouldn’t it have been nice for me and my doctor both to know from the moment of diagnosis that I might be one of those who would respond? And wouldn’t it be even more important and helpful for those who won’t respond? They wouldn’t waste valuable time, losing function and enduring side effects on therapies that aren’t going to help.
Yes, it will be good when we can do that. And the urine test could be fast and cheap too – and done in a clinic, if it’s accurate.
Of course what we need are options for the other patients – new types of treatments and a new paradigm – for those who don’t respond to current treatments and have no relief.
I read the article about the urine test and the correlation – how exciting it would be to know if these drugs would work! But I noticed that the RA patients selected were all RF positive and antiCCP positive and the the PSA patients didn’t have any correlation but did respond – very confusing! So they didn’t try a correlation for RF negative RA – like me, no help there!
I do know that we do need markers. It seems to be a heterogenous disease; no patient is the same and there is no such thing as classic RA – or if there is, it is few and far between.
Hi Leslie, It was a very preliminary test to see if there is a correlation worth pursuing. I suppose that they chose people who were serum positive so they could absolutely ensure diagnosis (that they were dealing w/ RA patients) before they made any conclusion. Practically, we’ll need tests – and treatments – for each type of patient (phenotype) under the one (general) diagnosis that we now call RA.
I read further about the long term outcomes of glucocorticoid (prednisone) treatment. Specifically, I read the article “Safety of Medium to Long-term Glucocorticoid Therapy in Rheumatoid Arthritis: A Meta-analysis” by Ravindran, Rachapalli and Choy (2009) in Rheumatology, Vol 48, pp 807-811 clearly shows that there is not sufficient evidence to support the benefits of prednisone over time (2 years or longer). There is evidence for using prednisone in the initial stages of RA to control inflammation and pain. The positive effects are substantial up to 6 months after initial diagnosis. I think it is important to not mislead the RA group about long-term benefits of steroid use !!! For me, I intend to use prednisone as needed but have decided not to use it on a low dose continuous basis, as has been suggested. I’ve decided the risks outweigh the benefits and I cannot see that there is sufficient scientific evidence to convince me otherwise. I am a big fan of RA warrior and Kelly’s work !! Many many thanks…
Hi Helen. I hear your concern. And I hope disease treatment works well for you. There are a large number of people who are non-respondsers or inadequate responders and require something (pain meds, nsaids, or prednisone for example) to make it bearable or to help them keep going, depending.
Reading and doing your own research is good. I’ve read dozens of articles that discuss the various methods of steroid use for RA. More than that though, I’ve learned from hearing from thousands of patients. There is wide variety of use & response as well as side effects.
By the way, there are a few other articles here that discuss prednisone in case you want to read more: https://www.rawarrior.com/tag/prednisone-and-rheumatoid-arthritis/