Rheumatoid Arthritis: A Year in Review

Electric shocks, hot tea, and cryogenic freeze are just a few of the topics that came up in 2016 during the constant search to better understand and treat rheumatoid arthritis.

While pundits and friends alike may view 2016 with pessimism, science did not weep at celebrity deaths or become embittered by politics. As this year glides off into the night, it’s time to look back on some of the many medical discoveries that enlightened, informed, and fascinated over the last 12 months.

The focus today is rheumatoid arthritis (RA), from promising new treatments to alarming new trends and downright bizarre observations. Electric shocks, hot tea, and cryogenic freeze are just a few of the topics that came up in the search to better understand and treat painful joint inflammation. Keep in tune with ongoing asthma drug approvals and study findings in the rheumatoid arthritis condition center, check out features and interviews from November’s American College of Rheumatology Annual Meeting in Washington, DC, and read on for the full collection.

There May Soon Exist an Early Blood Test for It

“For the first time we measured small fragments from damaged proteins that leak from the joint into blood. The combination of changes in oxidised, nitrated and sugar-modified amino acids in blood enabled early stage detection and classification of arthritis — osteoarthritis, rheumatoid arthritis or other self-resolving inflammatory joint disease,” said Dr. Naila Rabbani, lead author of the study.

The researchers believe this test could identify the eventual onset of OA or RA long before symptoms become noticeable, allowing patients and their healthcare providers to prepare a treatment plan in hopes of mitigating the condition’s often-devastating effects. The test could be available to patients in about two years.

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Green Tea Could Be Good For It

Green tea has been tied to a slew of health benefits, such as lowering high blood pressure and cholesterol. But it turns out that a compound found in this particular variety of tea has anti-inflammatory properties that block effects of rheumatic disease, according to researchers from Washington State University.

The team analyzed the compound epigallocatechin-3-gallate (EGCG), found in green tea, and its interaction with the transforming growth factor β-activated kinase 1 (TAK1), which plays a role in rheumatoid arthritis activity. It turns out that EGCG was able to inhibit kinase activity, according to the research in Arthritis & Rheumatology. The findings indicated that EGCG is able to block the effects of rheumatoid arthritis, all without interfering with other cellular functions.

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Cryotherapy Might Not Be a Safe Way to Deal with It

“Based on purported health benefits seen in many promotions for cryotherapy spas, consumers may incorrectly believe that the FDA has cleared or approved WBC devices as safe and effective to treat medical conditions. This is not the case,” Aron Yustein, MD, a medical officer in the FDA’s Center for Devices and Radiological Health, said in a news release. Whole body cryotherapy, either with freezing water or liquid nitrogen, has become a trendy spa option offered for the treatment of rheumatic pain, such as that from fibromyalgia or RA. The FDA this year decided to advise against it.

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An Implantable Bioelectronic Device Might Help Alleviate It

“I believe this study will change the way we see modern medicine, helping us understand that our nerves can, with a little help, make the drugs that we need to help our body heal itself,” Kevin J. Tracey, MD, said of the study by his team published in Proceedings of the Natural Academy of Sciences. The hope was that stimulation of the vagus nerve would inhibit the production of cytokines, key inflammatory agents in diseases like RA, most specifically tumor necrosis factor (TNF).

After increasing levels of stimulation over the first six weeks of the study, corresponding with decreases in TNF production, the device was turned off for two weeks, during which TNF levels rebounded significantly.

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Some Common Treatments for It May Expose Patients to Strep Infections

Interleukin-1β (IL-1beta), a cytokine that plays in important role in the body’s immune response, is part of the body’s early defense system for bacterial infections. Anti-inflammation treatments for autoimmune conditions like rheumatoid arthritis (RA) often times inhibit IL-1beta to mitigate the inflammation that it initiates when infection is detected. Unfortunately, by disabling this response, the body is dramatically exposed to infections, leaving it as much as 300 times more vulnerable to Group A Streptococcal infections, including those of the flesh-eating variety.

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GSK Is Trying to Study it With an Interactive App

Built on Apple’s ResearchKit platform, GlaxoSmithKline recently launched an app-based study called Patient Rheumatoid Arthritis Data from the Real World (PARADE). Designed to collect real-life pain and quality-of-life data from RA sufferers without requiring clinic visits, the study will track 300 patients over 3 months. Taking advantage of mobile portability and convenience, the study will produce a large volume of data, ranging from a patient's own subjective pain ratings all the way to its own specially-developed exercise.

“The task uses ResearchKit’s vibrate and sound functionalities in order to instruct the user when to begin the exercise, switch hands, and end the exercise. During the exercise, ResearchKit will collect motion data from the sensors in the device,” Rob DiCicco, Vice President of Clinical Innovation and Digital Platforms at GSK, explained to MD Magazine in an interview.

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High BMI Might Surprisingly be Protective Against It—in Males

Despite the wide range of medical conditions exacerbated by being overweight or obese, rheumatoid arthritis may not be one of them, for men at least. “To our knowledge, this is the first nested case control study to investigate this issue in men,” said Carl Turesson, lead author of a paper published in Rheumatology, “The effect of obesity on the risk of RA did not appear to be substantially different from that of overweight. However, a differential effect of very high BMI cannot be ruled out.”

The metabolic pathways related to the adipose tissue and hormone related factors could also have had a protective effect against RA, the authors surmised. For males, being overweight or obese at inclusion in the health survey was associated with a decreased risk of subsequent RA diagnosis in both health survey cohorts of between 40 and 63%. There was no such link for women, however.

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Alpha Defensins May Be a Clue to Stopping It at Its Source

Researchers from the University of Edinburgh observed human cells to determine if inflammation in the body could be restricted in patients with arthritis or if other inflammatory diseases could be controlled. The researchers’ previous work led them to compounds called alpha defensins, which are absorbed by macrophages and aid the body in stopping the spread of bacteria. When macrophages take in the alpha defensins, compounds prevent macrophages from producing cytokines — the cause of patients’ inflammation.

“This discovery opens the door to new approaches for the treatment and prevention of chronic inflammation,” the researchers said in a statement. “We are hopeful that with further research, these treatments could be exploited in the near future.”

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Another Key to It May Reside in Our Mouths

Researchers for decades have theorized a link between gum disease and rheumatoid arthritis. No matter their confidence until this point, never had evidence as direct and verifiable been identified as what Johns Hopkins researchers found this month. Maximilian F. Konig, MD, one of the study’s authors, said the work “may be the closest we’ve come to uncovering the root cause of RA.”

Analyzing periodontal samples, the researchers realized that there was a similar process at play in the gums of patients with periodontal disease as in the joints of people with RA: hypercitrullination. When the regular release of citrullinated proteins becomes overactivated, the body produces an extensive amount of antibodies to get rid of them, leading to the immune system’s painful attacks on the body’s own tissue known as RA. One gum disease-causing bacteria in particular, Aggregatibacter actinomycetemcomitans, was detected in both a group of patients with gum disease and in one with RA, at a significantly higher rate than the healthy controls.

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It Can Go Hand-in-Hand with Myocardial Inflammation

At the 2016 American College of Rheumatology Annual Meeting in Washington, DC, Columbia University researchers presented what they said was “the largest number of RA patients ever studied for myocardial inflammation.” They found that patients with RA, specifically those with moderate-to-severe disease scores and higher BMIs, had higher standardized uptake value (SUVmax) scores than the healthy controls. Those undergoing treatment with biologic drugs that weren’t tumor necrotic factor inhibitors (TNFi) had SUVmax values 35 percent lower than those on a TNFi or on no treatment, indicating an increased presence of myocardial inflammation in those with RA that could potentially be countered by treatment with a non-TNFi biologic.

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