We may be watching the slow evolution of the ability to measure Rheumatoid disease activity (DA) which could obviously revolutionize care for the disease, if handled properly. “Visible” evidence can be a valuable tool in treating a disease that does its damage concealed inside of a body.
2006: Remission imaging study reveals Rheumatoid Arthritis disease activity
Remember Dr. Brown’s 2006 study we discussed in the 1st Frying Pan post, Swelling Take Two? Imaging proved that nearly every RA patient judged by rheumatologists to be in “remission” actually experienced damaging and painful synovitis and / or bone edema. I suspect those patients knew their disease was active, and relied upon having a discerning doctor to treat them.
2009: ARRS study proves usual RA disease activity measures inadequate
The American Roentgen Ray Society (ARRS) found “Current methods used in evaluating disease remission in rheumatoid arthritis (RA) rely on composite scores base entirely on clinical and laboratory assessments. The purpose of this presentation is to show that it is inadequate to rely on clinical and laboratory data alone in monitoring disease progress in RA,” Imaging Raises the Bar for Remission in Rheumatoid Arthritis. They monitored two patients over several years correlating surgical biopsy specimens with clinical, laboratory, and radiographic appraisals of disease activity. Since correlations were so weak, they recommended that “Imaging therefore should be used continuously and in conjunction with clinical and laboratory parameters to evaluate disease activity.”
2012: Study identifies biomarkers by Laser Scanning Cytometry
Synovial tissues from 17 RA patients (from joint surgeries) were examined and compared to injured joints of those who do not have RA. Several antigens which have been significant in RA research were found to associate with types of RA disease activity, leading to a conclusion that they could be used as RA biomarkers with laser scanning cytometry (LSC). “Biomarkers identifying highly local inflammatory processes in synovial tissue might in future be used for radiodiagnostic approaches that would allow a differentiation of patients with active synovitis from those with disease remission.” Certain combinations of biomarkers were found to clearly discriminate between non-RA arthritis, mild or high RA activity, and long-standing RA with sensitivity and specificity levels about 70% or greater.
Science will catch up with RA, as I’ve said many times. But its capacity to measure disease activity may never be perfect. We will most likely always rely on doctors who are perceptive enough to rely on patients to tell them whether RA is active.
Important related reading
- Measuring Rheumatoid Arthritis Disease Activity
- The HAQ’s, the RAPID’s & the Rest: 3 Reasons It’s a Moot Point
- 2 Reasons Monitoring Rheumatoid Arthritis Matters
- Predicting Rheumatoid Arthritis