People with rheumatoid arthritis sometimes liken the chronic inflammatory disorder to a fire. Rheumatoid arthritis, or RA, is caused when the immune system attacks the joints. Symptoms include pain and warm, swollen joints, and over years they often spread from fingers and toes to elbows, hips and shoulders. Severe cases can lead to deformities that leave joints gnarled and disabled, and sometimes body parts such as the eyes, lungs and skin are affected.
Rheumatologist Kevin Deane, MD, PhD, an associate professor at the University of Colorado School of Medicine, uses the same analogy as his patients. But he takes it one step farther.
“If a fire can be caught early, it is quite easy to extinguish, perhaps even with a simple bucket of water,” Deane said. “RA is likely like that, where if we catch it early before the ‘inferno’ stage with blood testing, even mild drugs might stop it from getting worse.”
Testing a potential prevention for rheumatoid arthritis
Deane is the principal investigator of a study researchers hope will enable doctors to do just that, which could prevent the ranks of the 1.5 million Americans with rheumatoid arthritis from growing any larger. The StopRA clinical trial, short for “Strategy for the Prevention of Onset of Clinically-Apparent RA,” is the first clinical trial of a drug that could prevent RA conducted in the U.S.
The study was designed by scientists at the CU Anschutz Medical Campus and is funded by the National Institutes of Health. CU Anschutz is the lead site for the study, with 18 other institutions working to screen up to 20,000 people who are likely to develop RA. The goal is to identify 200 people to enroll in the study, and already more than 3,000 people have been screened and 20 enrolled across the country.
Deane and a team of researchers are testing to see if hydroxychloroquine, an anti-inflammatory drug already used to treat patients experiencing RA flareups, can also be used to prevent it. For patients who are already diagnosed with RA, the medication has been shown to decrease pain and swelling, prevent further joint damage and reduce the risk of disability, according to the American College of Rheumatology.
But currently people with RA only begin taking hydroxychloroquine after they have been experiencing symptoms. In other words, the fire is raging and uncontained, and drugs like hydroxychloroquine could take several weeks or months to be effective.
Blood test predicts cases of RA
Deane said people with a high probability of developing RA can be identified by a blood test for the blood marker anti-cyclic citrullinated peptide, or anti-CCP. He said it appears in the blood several years before, on average, symptoms develop.
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To learn more about the StopRA study, including how to enroll, visit www.Stop-RA.org
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If Deane and his colleagues’ hypothesis is correct, doctors in the future could give hydroxychloroquine to patients who test positive for anti-CCP but before arthritis occurs. The drug could reset the immune system so the joint pain, stiffness and swelling never develop.
Deane said StopRA researchers are casting a wide net to locate possible subjects because they need to find people years before they first see a doctor or feel RA’s symptoms.
“The trick is how to find people who have an abnormal blood level of anti-CCP but who don’t have joint inflammation yet,” Deane said.
Enrolling participants from around U.S.
Nationally, there are the 18 sites that includes cities from Boston to Los Angeles. Locally, CU Anschutz researchers are working with University of Colorado Hospital, UCHealth, the 9Health Fair and the Colorado chapter of the Arthritis Foundation to identify candidates.
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“Because of the large number of people that we need to test for anti-CCP in order to find those who can be in our trial, we need all hands on deck, and the community at Anschutz has really stepped up to support the trial,” Deane said.
Since RA runs in families, the team is focusing on members of patients’ immediate families, although anyone can be tested and potentially enroll.
The double-blind randomized study will give half the subjects placebos and half hydroxychloroquine for one year. They will track the patients for another two years to see if the treatment had the intended effect. By the study’s end in 2020, Deane is optimistic they’ll be on the way to being able to prevent the disorder.
“We believe that this study has a strong chance at transforming how we treat RA,” Deane said.