What if you knew 16 years before you ever got a diagnosis that you would be stricken with an incurable illness?
Would you make different lifestyle choices? Would you start preventative measures? Would it give you comfort or anxiety? How would it shape your attitude towards life and health?
These are all questions that may soon come to the forefront of rheumatology — particularly in the minds of patients with or predisposed to rheumatoid arthritis (RA).
That’s because Oxford University researchers recently created a blood test that may be able to figure out a person’s chance of developing the disabling autoimmune illness up to 16 years in advance.
Looking for a Peptide
The test would attempt to identify a specific immunodominant peptide in addition to the “usual” autoantibodies found in patients with RA.
The peptide, an “extracellular protein,” is called citrullinated tenascin-C (cTNC) and is often found in higher levels in the joints of rheumatoid arthritis patients. This led Oxford scientists to wonder if it was, in fact, the thing that activates autoimmune antibodies in individuals with RA, and the cause of — or a contributor to — a process called citrullination.
During inflammatory RA flares, proteins are altered through citrullination, which is believed to cause the body’s immune system to viciously attack itself.
In a statement to the press, lead study researcher, Anja Schwenzer, Ph.D said, “we knew that tenascin-C is found at high levels in the joints of people with RA.”
Her team worked to see if this tenascin-C protein could actually be citrullinated, thus serving as a target for the autoantibodies attacking the body during RA flare-ups.
The study looked at more than 2,000 patients. The blood test accurately diagnosed RA in about 50 percent of cases. Unlike some other tests, it also had a low rate of false positives.
“What is particularly exciting is that when we looked at samples taken from people before their arthritis began, we could see these antibodies to cTNC up to 16 years before the disease occurred” said Professor Kim Midwood of the Oxford University Kennedy Institute. “On average, the antibodies could be found 7 years before the disease appeared,”
Why Discovery Is Important
This discovery may be crucial because most rheumatologists acknowledge the importance of early detection and early treatment in rheumatoid arthritis. The earlier RA is treated, the more effective treatments may be and the less disability and deformity may occur.
This blood test may allow doctors to monitor predisposed patients closely and help them get their disease under control the moment symptoms begin to appear.
“Early diagnosis is key, with research showing that there's often a narrow window of opportunity following the onset of symptoms for effective diagnosis and control of disease through treatment,” said Stephen Simpson, director of research at Arthritis Research UK, the organization that funded the study. “Furthermore, current tests for rheumatoid arthritis are limited in their ability to diagnose disease in different patients,”
So far, the test has not been made available to the public and there’s no word on when it will be or precisely how it might change current RA treatment protocols. There was also no mention of cost, how medical professionals would know when to use the blood test, or which types of patients would benefit most from having this kind of information in advance.
While most responses to the development of this blood test have been positive and hopeful, some reactions, like that of the Health News Review Organization, argue that it verges on fear-mongering and almost urges the creation of a new disease: “pre-RA.”
What Patients Think
In an informal survey done via an arthritis community page on Facebook, patients seemed split as to whether or not they would want to know ahead of time.
“I would want to know so that I could manage expectations and try to get in better shape before I started having symptoms,” said Michael Moore of Pennsylvania.
Sarah Kocurek from Texas agrees.
“I would have loved a heads up on my diseases,” she said. “I definitely would have chosen different things, such as having the chance to have my doctors catch it earlier and start treatment sooner. And, for me personally, I think I would have appreciated having the extra time to do things. To be able to prepare instead of having so much taken from me.”
Ariana Nyswonger of Oregon has a similar opinion.
“I'd like to know, because even if I don’t actually get it I would’ve never had taken advantage of being healthy,” she said. “I would’ve walked more, exercised more, and did more things my parents told me for years to do. I’d use it to take advantage of life and do things that may be able to prevent it from happening.”
However, Cheryl Diletto of Arizona says she would “be perfectly happy living blindly happy and being in the moment, not worrying about an illness that may or may not come to fruition.”