{"id":33483,"date":"2020-08-04T10:50:42","date_gmt":"2020-08-04T16:50:42","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=33483"},"modified":"2021-05-25T09:05:49","modified_gmt":"2021-05-25T15:05:49","slug":"rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\/","title":{"rendered":"Rheumatoid arthritis clinical trial sifts blood for disease risk"},"content":{"rendered":"
<\/div>
\"Becky
Becky Dittman with (from left) stepson Sam Kannady, husband Brian Kannady, and sons Tyler Dittman and Chase Dittman. Dittman is enrolled in a rheumatoid arthritis clinical trial to screen for a blood market that indicates increased risk for the disease. Photo courtesy of Becky Dittman.<\/figcaption><\/figure>\n

Until relatively recently, neither Becky Dittman nor Elizabeth Wethington knew much about rheumatoid arthritis. They\u2019d heard of it in passing, but no family members, friends or acquaintances that they knew of suffered from it.<\/p>\n

Wethington\u2019s only brush with rheumatoid arthritis (RA) came as a young girl. She recalls seeing the gnarled and swollen fingers of one of her grandmother\u2019s friends who she learned had the disease.<\/p>\n

\u201cIt was an early lesson, but it wasn\u2019t connected to me,\u201d says Wethington, now 44. \u201cI didn\u2019t know the day-to-day struggles she had.\u201d<\/p>\n

When Dittman, 49, first Googled rheumatoid arthritis about a year and a half ago, she was looking for black-and-white information about the disease but found only a sea of gray.<\/p>\n

\u201cI was looking for causes and cures and what can be done to stop it, but there was not a lot of conclusive info out there,\u201d she said. \u201cEverything was very vague and general. That was scarier than having the facts of what you can do about RA.\u201d<\/p>\n

On the trail of rheumatoid arthritis<\/strong><\/h3>\n

Today, both Dittman and Wethington are taking an active role in research that aims to increase understanding of and possibly ease or even prevent the effects of rheumatoid arthritis, an autoimmune disease that attacks and inflames the lining of the joints. The disease causes symptoms that include pain, swelling, fatigue, loss of sleep, and a general flu-like feeling, said Dr. Kevin Deane<\/a>, associate professor of Medicine-Rheumatology<\/a> at the University of Colorado School of Medicine<\/a>.<\/p>\n

\"Elizabeth
Elizabeth Wethington with son James and daughter Margarita. Washingon is enrolled in a rheumatoid arthritis clinical trial and receives a daily year-long course of hydroxychloroquine or a placebo. Photo courtesy of Elizabeth Wethington.<\/figcaption><\/figure>\n

Deane is principal investigator for an ongoing trial with the shortened name StopRA<\/a> that is recruiting patients to UCHealth hospitals and more than a dozen others around the country. The goal: screen for a blood marker \u2013 anti-cyclic citrullinated peptide, or anti-CCP3 \u2013 that indicates significantly increased risk for rheumatoid arthritis. The trial tests the effectiveness hydroxychloroquine versus a placebo in preventing the onset of RA in those individuals with the marker.<\/p>\n

The disease affects about 1 % of people with normal levels of anti-CCP who also have no first degree relatives (mother or father, for example) with the disease — about 1.3 million people in the United States<\/a>. But people with abnormal levels of the anti-CCP3 antibody have a 50 percent chance of getting RA within three years, Deane said.<\/p>\n

\u201cThe risk with the marker is not 100 %, but we feel it\u2019s strong enough to try to intervene to try to learn how we can prevent people from going on to get full-blown RA,\u201d Deane said. \u201cBecause once that develops, it\u2019s a forever disease that requires lifelong therapy.\u201d<\/p>\n

The risk for individuals with a first-degree relative with RA increases five to sevenfold across the general population, Deane said, making them a particularly attractive screening target for anti-CCP3. But he emphasized that the screening is open to anyone 18 years or older who wants it.<\/p>\n

Rheumatoid arthritis clinical trial: drug vs. placebo<\/strong><\/h3>\n

Those who enroll in the randomized trial will receive a daily year-long course of either hydroxychloroquine \u2013 a drug already used to treat patients with RA, as well as lupus and malaria \u2013 or a placebo. Deane said hydroxychloroquine \u2013 which he said went from being \u201ca drug no one had heard of\u201d to a sudden subject of controversy after President Trump touted it as a \u201cgame-changer\u201d for the treatment of COVID-19 \u2013 helps to \u201creset the immune system\u201d and control inflammation in patients with RA.<\/p>\n

\u201cPatients with RA take it once a day with typically very few side effects, and it\u2019s very well tolerated,\u201d Deane said. \u201cThat makes hydroxychloroquine a good drug for this type of prevention trial where the safety and tolerability of a drug are very important.\u201d<\/p>\n

Enrolled patients meet regularly with their study team, which follows them for two years after completing the medication regimen to assess how many in each group contract RA within the three-year period.<\/p>\n

\"Dr.
Dr. Kevin Deane, principal investigator for the StopRA, a rheumatoid arthritis clinical trial. Photo courtesy of Kevin Deane.<\/figcaption><\/figure>\n

The ideal study outcome will determine if hydroxychloroquine really does trigger a reboot of the immune system, thereby preventing the onset of RA, Deane said. As he put it, \u201cThat will be the golden apple of success.\u201d<\/p>\n

But whatever the rheumatoid arthritis clinical trial data reveal, simply identifying more patients at high risk for RA and following them is beneficial, Deane added. He noted that on average, patients with RA experience symptoms for two years before they receive a diagnosis and treatment. By that time, the disease may be so severe that they require expensive treatments that carry their own risks, such as suppressing the immune system and increasing the risk of infection.<\/p>\n

\u201cIf we can identify the disease earlier, we can get patients on treatment earlier,\u201d Deane said. \u201cThat\u2019s important even if prevention doesn\u2019t happen.\u201d<\/p>\n

Slow sift for subjects<\/strong><\/h3>\n

The trial, which began four years ago<\/a>, had recruited 121 patients as of early July, about 60% of the way towards the goal of 200. To find them, study sites have screened more than 20,000 people, Deane said. The challenge is twofold. First, the percentage of people with elevated levels of anti-CCP3 is small. Second, most blood tests don\u2019t routinely screen for anti-CCP3.<\/p>\n

\u201cWe are very excited about the enrollment number,\u201d Deane said, \u201cbut these are hard people to find. We have to dig deep to find them.\u201d<\/p>\n

In Colorado, the digging extends to 9Health Fairs<\/a>, which include the anti-CCP3 screening in blood tests. The rheumatoid arthritis clinical trial has also gotten support from the Arthritis Foundation<\/a> and rheumatologists and primary care providers in private practices that Deane and other study leaders contact, encouraging them to refer individuals who are possible candidates for the study.<\/p>\n

The outreach in Colorado has paid off, Deane said: 65 of the 121 study enrollees have come from Colorado, and many have been referred from UCHealth.<\/p>\n

\u201cWe\u2019ve had excellent partnerships across the state to enroll that many subjects,\u201d he said.<\/p>\n

RA clinical trial volunteers light the way<\/strong><\/h3>\n

The partnerships, of course, include the patients who agree to commit their time to the study. Becky Dittman and Elizabeth Wethington came to the study via different paths, but they share an interest in assisting clinic researchers in their fight against RA.<\/p>\n

Dittman, a human resources benefits specialist for a Broomfield-based company, has finished her one-year medication regimen and now sees Deane and his team every few months for monitoring. So far, she said, she has no symptoms of RA.<\/p>\n

\n

How should RA patients protect themselves during the COVID-19 pandemic?<\/b><\/p>\n

Dr. Kevin Deane says that the limited data available indicates that people with full-blown RA and who are on immunosuppressant drugs have a slightly increased risk for more severe COVID compared to people without RA.<\/p>\n

\u201cIn particular, if they are taking regular steroids they have a higher risk,\u201d Deane said. \u201cIt is difficult to quantify but the risk for severe COVID related to RA is likely less than other risks such as age, diabetes and obesity.<\/p>\n

\u201cAt this time, we are asking individuals with RA to take the usual precautions such as social distancing, handwashing, and face coverings,\u201d Deane said. He added that patients should not taper or stop their medications without direct guidance from a rheumatologist.<\/p>\n

\u201cFor those patients who do contract COVID-19, we do recommend that they stop some of their RA medications,\u201d Deane concluded. However, he noted that the guidelines can change, so they should again talk to their rheumatologist. More guidance is available at https:\/\/www.rheumatology.org\/Portals\/0\/Files\/ACR-COVID-19-Clinical-Guidance-Summary-Patients-with-Rheumatic-Diseases.pdf<\/a>.<\/p>\n<\/div>\n

She enrolled in the StopRA trial after seeing her primary care physician for joint pain that lingered in her left hand. Blood tests revealed the elevated anti-CCP3 marker, and her PCP let her know about the study, telling her she\u2019d be a perfect candidate. Dittman then reached out to Deane\u2019s study team to let them know she was interested in enrolling, which she did in January 2019.<\/p>\n

Reading up on RA didn\u2019t provide much comfort, Dittman said. She was looking for a precise path forward to address her risk but didn\u2019t find one.<\/p>\n

\u201cThere wasn\u2019t a ton of concrete information,\u201d she said. \u201cThere are so many unknowns about RA, and that\u2019s scary. I was not hopeful. It\u2019s depressing if you read about all the symptoms and possible things that can happen to you through the process of the disease.\u201d<\/p>\n

Necessary precautions<\/strong><\/h3>\n

Instead of throwing her hands up in despair, Dittman took a positive step forward for herself and others. She said she\u2019s always tended toward moderation, but now makes sure she exercises regularly, including taking walks twice a day. She and her husband, two sons and stepson also moved into a one-story ranch home in Arvada last fall so she could avoid climbing stairs in the event symptoms of RA emerge.<\/p>\n

Joining the study helped to take some of the mystery out of RA, Dittman added. It gave her a \u201cheads up\u201d about her risk, made her more conscious of how she feels, and protected her with specialists familiar with a frightening disease.<\/p>\n

\u201cI feel like I have a team on my side,\u201d Dittman said. She wants others to have the same benefits.<\/p>\n

\u201cI just felt I had to do something because I didn\u2019t want someone else to feel the way I did,\u201d she said. \u201cNow that I have been part of this study, I have hope that they are going to figure this out, that the medications will get better and have fewer side effects. We\u2019re getting there through research.\u201d<\/p>\n

Addressing autoimmune risk<\/strong><\/h3>\n

Elizabeth Wethington, an administrative assistant in Aurora, received news of her abnormal anti-CCP3 levels last October after being hospitalized at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>. Her rheumatologist at UCH<\/a> then connected her with the study.<\/p>\n

Although she knows of no family history of RA, Wethington said she \u201chas a penchant for developing autoimmune disorders,\u201d including celiac disease<\/a> and Graves\u2019 disease<\/a>. She believes those disorders increase her risk for developing another, like RA. With that in mind, she joined the study in January 2020. She continues to take her study medication and now sees Deane and his team every three months.<\/p>\n

Thus far, Wethington said, she\u2019s experienced no joint pain. Interviewed in mid-July, she said she\u2019d just finished helping to paint the deck of the home she shares with her husband of 17 years and two children. In addition to plenty of typing required by her job, she knits and sews frequently and describes herself as \u201cexceedingly active.\u201d<\/p>\n

\"Elizabeth
Elizabeth Wethington (far left) skis with (from left) son James, husband Mark and daughter Margarita. Photo courtesy of Elizabeth Wethington.<\/figcaption><\/figure>\n

She wants to keep it that way and sees the study as a safeguard for her health, even if she\u2019s taking a placebo. She said, for example, that Deane\u2019s team and her rheumatologist stay in close communication with one another and note any changes in her condition.<\/p>\n

\u201cSeeing my physicians more frequently is wonderful, whether I\u2019m taking the medication or not,\u201d Wethington said. \u201cI\u2019ll find out very quickly if I transition to RA. I\u2019ll be right there and ready to get care.\u201d<\/p>\n

Contributing to science<\/strong><\/h3>\n

Wethington calls the study \u201ca great opportunity to learn about a disease that might affect me sometime in the future,\u201d but avoids \u201cpotentially scary information\u201d about RA that she might read on the web.<\/p>\n

\u201cI\u2019m trying to live in the moment,\u201d she said. \u201cI take each day as it comes and report back [to my providers].\u201d<\/p>\n

Like Dittman, Wethington also enrolled in the study as a way to improve the future lives of patients with the disease.<\/p>\n

\u201cScience needs data in order to work,\u201d Wethington said. \u201cIf I can help others by the use of my blood or tissue, I am happy to donate and help further science. If I can help the betterment of others, this is absolutely how I want to contribute.\u201d<\/p>\n

For his part, Deane believes the StopRA trial can raise awareness of RA and possibly build the testing infrastructure needed to find many more people at risk of the disease and those in early phases that require less aggressive treatment.<\/p>\n

\u201cNobody thinks twice today about getting a blood test for cholesterol,\u201d he said. \u201cWe would love to get RA to that point. This study could help to move public health in that direction.\u201d<\/p>\n

For more information about RA and the StopRA trial, visit <\/em>https:\/\/stop-ra.org\/<\/em><\/a>.<\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Until relatively recently, neither Becky Dittman nor Elizabeth Wethington knew much about rheumatoid arthritis. They\u2019d heard of it in passing, but no family members, friends or acquaintances that they knew of suffered from it. Wethington\u2019s only brush with rheumatoid arthritis (RA) came as a young girl. She recalls seeing the gnarled and swollen fingers of […]<\/p>\n","protected":false},"author":2143,"featured_media":33493,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[101,100],"class_list":["post-33483","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-arthritis-care","tag-rheumatoid-arthritis"],"acf":[],"yoast_head":"\nRheumatoid arthritis clinical trial sifts blood for risk - UCHealth Today<\/title>\n<meta name=\"description\" content=\"A clinical trial at UCHealth identifies patients with a blood marker that increases their risk for rheumatoid arthritis and tests hydroxychloroquine for it.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rheumatoid arthritis clinical trial sifts blood for disease risk\" \/>\n<meta property=\"og:description\" content=\"A clinical trial at UCHealth identifies patients with a blood marker that increases their risk for rheumatoid arthritis and tests hydroxychloroquine for it.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-08-04T16:50:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-05-25T15:05:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/08\/04112409\/StopRA-Trial-4-Elizabeth-Wethington-and-Kids.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Tyler Smith\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Tyler Smith\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/\"},\"author\":{\"name\":\"Tyler Smith\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/98c85c0e40c4933eedcec2cd054f349d\"},\"headline\":\"Rheumatoid arthritis clinical trial sifts blood for disease risk\",\"datePublished\":\"2020-08-04T16:50:42+00:00\",\"dateModified\":\"2021-05-25T15:05:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/\"},\"wordCount\":2207,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/2020\\\/08\\\/04112409\\\/StopRA-Trial-4-Elizabeth-Wethington-and-Kids.webp\",\"keywords\":[\"Arthritis Care\",\"Rheumatoid Arthritis\"],\"articleSection\":[\"Innovative care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/rheumatoid-arthritis-clinical-trial-sifts-blood-for-disease-risk\\\/\",\"name\":\"Rheumatoid arthritis clinical trial sifts blood for risk - 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