{"id":4624,"date":"2016-09-13T00:00:00","date_gmt":"2016-09-13T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/09\/13\/major-rheumatoid-arthritis-prevention-trial-underway-at-uch\/"},"modified":"2022-08-18T07:21:46","modified_gmt":"2022-08-18T13:21:46","slug":"major-rheumatoid-arthritis-prevention-trial-underway-at-uch","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/major-rheumatoid-arthritis-prevention-trial-underway-at-uch\/","title":{"rendered":"Major rheumatoid arthritis prevention trial underway at UCH"},"content":{"rendered":"
<\/div>

Stopping rheumatoid arthritis (RA) before it starts should be the goal of clinicians, said Kevin Deane, MD, PhD<\/a>. To that end, Deane and colleagues have started StopRA<\/a>.<\/p>\n

That stands for \u201cStrategy for the Prevention of Onset of Clinically-Apparent RA,\u201d and Deane, a University of Colorado School of Medicine rheumatologist, and his colleagues have been working for a decade to make America\u2019s first-ever RA prevention trial happen.<\/p>\n

\"Kevin
Kevin Deane, MD, the CU School of Medicine rheumatologist leading the national StopRA trial.<\/figcaption><\/figure>\n

The National Institutes of Health-funded effort enrolled its first patients in April. As of early September, Deane and colleagues had enrolled 12 patients en route to their goal of 200 participants. Half will take daily hydroxychloroquine (HCQ) pills \u2013 a standard RA treatment \u2013 for a year; the other half will take placebo pills. Deane and co-investigators will then monitor them all for another two years to see if a disease whose progression has forever seemed inevitable might indeed be halted before its autoimmune cascade takes hold.<\/p>\n

RA affects about 1 percent of the population, or more than 3 million people in the United States. The study Deane leads has 18 sites in addition to University of Colorado Hospital, including ones in Boston, Atlanta, Pittsburgh, Minneapolis, Oklahoma City, Omaha, San Francisco, Los Angeles and elsewhere. You\u2019d think finding 200 people willing to try what could amount to an RA vaccine wouldn\u2019t be so hard.<\/p>\n

But most people with RA don\u2019t know they have it until their immune systems have attacked their joints. At that point, patients can\u2019t stop RA, they can only manage the symptoms. And so Deane and colleagues aim to populate their randomized, double-blind, placebo-controlled<\/a> study with people who are still healthy but who have a 50-50 chance or higher of ending up with symptomatic RA within the next 36 months.<\/p>\n

Numbers game<\/strong><\/p>\n

There\u2019s a blood test that helps find such people. It looks for something called anti-cyclic citrullinated peptide-3, or anti-CCP3. People with RA have elevated anti-CCP3 levels. Deane has found that those without RA but with anti-CCP3 blood levels over a certain threshold have a \u00a0greater than 90 percent chance of getting RA, and a 50 percent or higher probability of it developing within three years.<\/p>\n

But the chances of finding someone with high anti-CCP3 blood levels and no RA symptoms are vanishingly small. It took about 3,000 screenings to find those 12 participants, Deane said. He estimates that, to land 200 subjects, study researchers will need to do more than 18,000 screenings.<\/p>\n

Fortunately, the StopRA team has help. The 9Health Fair<\/a> is including anti-CCP3 tests in their screening panel, for one. The Arthritis Foundation is getting the word out to rheumatologists and arthritis experts across Colorado (Deane said other sites have similar efforts afoot). And it\u2019s also made a difference that UCH is part of UCHealth, he said.<\/p>\n

\u201cThe UCHealth system has helped us immensely,\u201d Deane said. \u201cWe have a lot of rheumatologists in the system, especially here in Aurora, and up north.\u201d<\/p>\n

Family ties<\/strong><\/p>\n

The key is to find people whose immediate family members have RA, because those with close relatives with RA have a 5 percent to 7 percent risk of getting the disease in their lifetimes. Among the 12 participants in the study so far are family members of patients Deane sees in UCH\u2019s Rheumatology Clinic, he said. In addition to screening family members of those with the disease, however, the StopRA trial is screening anyone who is willing to be tested.<\/p>\n

While the science must play out over the next three years, there\u2019s reason to hope that the StopRA study will bear fruit. Deane and his CU colleagues have been investigating the roots of RA for decades<\/a>. The existence of biomarkers such as anti-CCP3 suggests that the disease starts long before RA\u2019s damaging inflammation manifests. If that\u2019s the case, early intervention could make a big difference.<\/p>\n

<\/div>\n

A Dutch study whose results were presented in June sampled RA biomarkers and treated half its 81-patient, high-risk cohort with a single dose of the antibody rituximab. The investigators found that, while those who received the drug and those who got a placebo ended up with symptomatic RA at similar rates two years later, those in the placebo wing got the disease a year sooner, on average.<\/p>\n

\u201cThe single dose delayed it, which is exciting,\u201d Deane said. \u201cIt might speak to that we just need to treat it longer, or with a different agent to prevent RA completely.\u201d<\/p>\n

Long view<\/strong><\/p>\n

StopRA is designed to do just that. But regardless of the immediate outcomes, having years of data on 200 or so patients at high risk of RA will advance the science of the disease, Deane said. The study\u2019s bounty of blood tests and evolving (or not-evolving) symptoms will provide Deane and team members, including colleagues Michael Holers, MD, and Christopher Striebich, MD, PhD<\/a>, with new windows into the disease\u2019s progression. The team will also gather diet and lifestyle-related data to capture factors such as smoking, recent pregnancy, and gum inflammation, which are associated with increased RA risk; as well as things like eating a lot of fish and drinking moderately, which may diminish RA risk.<\/p>\n

\u201cThe study will give us a lot of understanding of the biologic processes that underpin the development of RA so future studies can target them more directly,\u201d Deane said.<\/p>\n

The goal is to turn RA into a preventable disease, he added, which would have an immense impact on lives wracked with pain and disability \u2013 not to mention the estimated $40 billion<\/a> RA costs the United States each year.<\/p>\n

\u201cI think if we can identify and prevent it, we can make a huge positive impact on the health of society,\u201d Deane said.<\/p>\n

For more information on the StopRA trial, including a list of 9Health Fair events, visit<\/em> www.stop-ra.org<\/em><\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Stopping rheumatoid arthritis (RA) before it starts should be the goal of clinicians, said Kevin Deane, MD, PhD. To that end, Deane and colleagues have started StopRA. That stands for \u201cStrategy for the Prevention of Onset of Clinically-Apparent RA,\u201d and Deane, a University of Colorado School of Medicine rheumatologist, and his colleagues have been working […]<\/p>\n","protected":false},"author":23,"featured_media":3247,"comment_status":"open","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":[5,8],"tags":[101,100,102],"class_list":["post-4624","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","category-news","tag-arthritis-care","tag-rheumatoid-arthritis","tag-rheumatology"],"acf":[],"yoast_head":"\nMajor rheumatoid arthritis prevention trial underway at UCH - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Stopping rheumatoid arthritis (RA) before it starts should be the goal of clinicians, said Kevin Deane, MD, PhD. 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