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New Tool Has the Potential to Diagnose Rheumatoid Arthritis

A group of researchers in Europe have discovered a blood test that has the potential to diagnose Rheumatoid Arthritis (RA) in its early stages. Because the majority of RA damage happens within the first 2 years of the disease, it is very important that treatment starts as early and aggressively as possible.1

Diagnosing RA can be especially challenging in the early stages of the disease, as RA shares symptoms with other inflammatory and autoimmune diseases.2 Currently, there is no single test that can diagnose RA in patients; rather, physicians rely on a series of laboratory tests, a patient’s medical and family history, and physical exams.3

How is RA currently diagnosed?

Physicians often test patients for anti-cirtullinated protein antibodies (ACPA) when testing for RA, as these laboratory values can be a good biomarker for the disease. However, researchers realized not all RA patients test positive for ACPA.4 These patients are challenging to diagnose, and researchers wanted to look at alternative laboratory tests that may help these patients receive early treatment.

What were researchers looking for?

Researchers looked at a group of cells in the immune system known as T helper 17 cells (Th17).2 Th17 are a very specific type of T cell, which is a type of white blood cell known as a lymphocyte. These Th17 cells produce a cytokine or protein known as Interleukin 17 (IL17).5 IL-17 causes inflammatory responses, and plays a role in many auto-immune diseases, including RA.

Is there a link between Th17 cells and RA?

Researchers know that Th17 plays a role in RA, but they wanted to look at the epigenetics of Th17 and if the was any association between the epigenetics and an RA diagnosis.

What does epigenetics have to do with RA?

Most people know that their genes are the microscopic guides that tell our body how to produce the cells that make every person an individual. Your genes are like a blueprint for your body to create certain cells that makeup everything from your hair and eye color, to telling your immune system how to function, to letting your body know how much sleep you need at night.

Epigenetics can determine how diseases are formed in the body

Epigenetics are like on and off switches for your how your body reads your genetic blueprint.6 They are an important part of how you become an individual, but they are also responsible for how certain diseases can be formed in your body.

Epigenetics can play a role in many cancers, autoimmune diseases and possibly even Alzheimers. Your epigenetics can be influenced by many factors, such as the environment, your stress level, and even how much you exercise.

What were the results of the study?

Researchers looked at blood samples of 172 patients who showed early symptoms of inflammatory arthritis and 49 otherwise healthy patients.2 These patients were followed for two years until their disease could be definitively diagnosed. Researchers used a genetic test to look at the counts of the Th17 cells responsible for creating IL-17 in the blood samples of these patients. The test also confirmed if the Th17 had been activated epigenetically to create Il-17.

Lower Th17 cell count and the development of RA

Researchers found that patients who had lower counts of Th17 cells were more likely to develop RA than other similar inflammatory conditions. This association between lower Th17 counts and RA was also found to be true in patients who were ACPA-positive and ACPA-negative.2 This epigenetic Th17 test was found to a better predictor of RA than other currently used methods such as swollen joint counts or C-Reactive protein values.

Why is this important?

This study is an important new development in the early diagnosis of RA. Getting RA patients early, aggressive treatment is an important factor in limiting and slowing the amount of damage RA can cause to both the joints and the other systems of the body. Having a precise and simple laboratory test is an excellent way to get patients quicker access to the treatments that they need. This test has the potential to give doctors a fast, accurate diagnosis.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Rheumatoid Arthritis: Symptoms, Diagnosis and Treatment. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/. Published 2019. Accessed July 10, 2019.
  2. Burska A, Thu A, Parmar R et al. Quantifying circulating Th17 cells by qPCR: potential as diagnostic biomarker for rheumatoid arthritis. Rheumatology. 2019. doi:10.1093/rheumatology/kez162
  3. Diagnosing Rheumatoid Arthritis. Arthritis.org. https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/diagnosing.php. Published 2019. Accessed July 10, 2019.
  4. Kurowska W, Kuca-Warnawin EH, Radzikowska A, Maśliński W. The role of anti-citrullinated protein antibodies (ACPA) in the pathogenesis of rheumatoid arthritis. Cent Eur J Immunol. 2017;42(4):390–398. doi:10.5114/ceji.2017.72807
  5. Tesmer LA, Lundy SK, Sarkar S, Fox DA. Th17 cells in human disease. Immunol Rev. 2008;223:87–113. doi:10.1111/j.1600-065X.2008.00628.x
  6. A Super Brief and Basic Explanation of Epigenetics for Total Beginners. What is Epigenetics?. https://www.whatisepigenetics.com/what-is-epigenetics/. Published 2019. Accessed July 10, 2019.

Comments

  • Connie Rifenburg
    3 months ago

    I wonder if the biologic you take and how it works (Orencia works with the T-cells) might be a way of qualifying the Th17 test? My RA dr just today was talking to me about changing Orencia to another biologic. I’m not unhappy with Orencia, but he thinks a new biologic might work better. I asked if the “new” biologic would travel the same way as Orencia because I was allergic to Humira, Enbrel, Xanjel(?). And he said each of those biologics targets a different way to the RA. He said there were MANY ways. The “new” one was different from all the rest I’ve tried. That sounded interesting, but also scary. Humira’s reaction was almost deadly for me. Enbrel was just huge red marks at the injection site. Xanjel didn’t do anything at all. Since I KNOW Orencia doesn’t have any side effects with me (over 3+ yrs) and it is working somewhat well enough, do I try something new on the chance it would work better? He said to go home and think about it.

    Is there any place to look up this study in Europe? Thanks, Connie

  • Richard Faust moderator
    4 months ago

    This test looks really interesting. I can see a limitation in that there are quite a few T helpers that produce a corresponding interleukin, which can play a role in the inflammatory process. For example recent research found the interleukin-6 may be a primary driver in inflammation for juvenile RA. What will be interesting is if now that there is this test for the Th17, will there be similar test for the other T helpers that may indicate RA. Best, Richard (RheumatoidArthritis.net Team)

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