Experts think that finding biomedical markers that indicate progressive arthritis is crucial to determining which patients need aggressive therapy. To find such markers, researchers from the Mayo Clinic College of Medicine for 2 years studied 111 patients who had early-stage rheumatoid arthritis.
During the study, all the subjects were started on hydroxychloroquine and progressed to a more dramatic treatment with methotrexate or other medications, depending on how their symptoms improved. The researchers conducted blood tests, took xrays, and looked at the clinical symptoms to find markers that might show the odds for disease progression. The results showed that 52% of the patients had their symptoms under control by methotrexate and nonsteroidal anti-inflammatory drugs. Also, 48% of the patients did not develop progressive disease. (These findings were published in Arthritis & Rheumatism, January 2004.)
The investigators found that clinical markers (functional status, the number of joints involved, joint pain and swelling) did not help in predicting disease progression. Positive rheumatoid factor (an antibody detected in a blood test), some genetic variations (particularly HLADRB1*04), and high levels of CD4 and CD28 null T-cells were indicators. Also, the team discovered that a different form of a gene of uteroglobin seems to protect against joint damage.