Primary-care clinicians can jump-start treatment for rheumatoid arthritis (RA) by ordering an inexpensive lab test before the patient sees a specialist.
Rheumatologists routinely test for antibodies to cyclic citrullinated peptide (anti-CCP) during initial evaluations, but most clinicians do not.
A retrospective study of 100 patients at a British clinic showed that prior knowledge of anti-CCP status would have doubled (from seven to 13) the number of patients immediately discharged, halved (from 45 to 23) the number given a trial of corticosteroids, and increased the number started on disease-modifying antirheumatic drugs by 50% (from 19 to 28). Eight patients would have received more intensive treatment from the outset.
The results were presented at the American College of Rheumatology’s annual meeting in Boston. Another presentation found that changing the diagnostic protocol for RA may identify a larger number of patients earlier in the progression of the disease.
“The current criteria for diagnosis include elements that may not become apparent until later in the disease,” observes lead researcher Katherine P. Liao, MD, of Brigham and Women’s Hospital in Boston. Those criteria include the presence of rheumatoid nodules and radiographic changes, which can take months to develop.
Dr. Liao’s study found that by adding anti-CCP testing and dropping rheumatoid nodules and radiographic changes from the protocol, the proportion of 292 patients diagnosed with RA jumped from 51% to 74%. In a subset of patients symptomatic for less than six months, the proportion soared from 25% to 63%.