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World Arthritis Day
(12th October)

World Arthritis Day (12th October)

Editor: Dr. Praful B. Godkar (Ph.D)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.

Awareness about the IVD laboratory tests is necessary to fulfil the main aim of World Arthritis Day (WAD), i.e., early differentiation of Musculoskeletal diseases and confirmed diagnosis of Rheumatoid Arthritis (RA) to prevent misdiagnosed  and inappropriate drug treatments, delayed interventions, and related complications. (1). The global prevalence of RA has increased by around 14.1% since 1990, with an estimated 17.6 million people living with RA in 2020 (2). The rise in RA cases is partially due to an aging population, with older individuals being more susceptible to the disease. Women continue to have a higher prevalence of RA compared to men. In the case of large number of individuals, the influence of environmental factors such as infections, vitamin D deficiency, cigarette smoking, air pollution and high non-vegetarian diets contribute to the development of systemic autoimmunity and autoantibodies on the onset of symptoms of RA (3, 4, 5, 6).

Q1. What specific routine tests and recent innovative biomarkers most commonly used for the differentiation of RA from Ostioarthritis and Gout? ANS: Rheumatoid arthritis (RA) is often diagnosed using the following routine laboratory tests and biochemical markers (7) :

ANS: 

ROUTINE TESTS

RHEUMATOID ARTHRITIS (RA) OSTIOARTHRITIS AND GOUT
1) Complete Hemogram May reveal anemia that is usually associated with RA Usually Anemia is not of observed
2) Rheumatoid factor (RF) Present in many patients with RA RA test negative
3) Erythrocyte sedimentation rate (ESR) High ESR Mostly normal ESR Or marginally increased
4) C-reactive protein (CRP) High CRP level Mostly normal or moderately increased
5) Serum uric acid Absent Present in Gout
RECENT INNOVATIVE BIOMARKERS (8)
6) Anti-cyclic citrullinated peptide (anti-CCP) antibodies Present in more than 75% of patients Anti-CCP: Absent
7) Serum total iron Decreased Mostly Normal
8) Serum hepcidin Increased Normal
9) Serum transferrin Decreased Mostly normal

Note

1. Nearly 30-40% RA patients may not show Rheumatoid factor (RF) or Anti-CCP antibodies, hence, Rheumatologist make a Clinical Diagnosis and start treatment (Ref: Dr. Yojana A. Gokhale, MD, Rheumatologist, Ex-HOD Sion Hospital, Consultant, Goregaon, Mumbai)

2. Anemia is due to secondary reasons (increased inflammatory reactions in the body due to RA). Patient may be suffering from Primary reasons (dietary deficiencies,  genetic reasons or other reasons).

Q2. What are the recent innovations in IVD that have significantly impacted the management and monitoring of RA?

ANS: Advanced 5th generation Hematology, Biochemistry, Immunology analyzers along with IVD-POCT technology based diagnostic kits could diagnose RA and Gout at early stage to prevent misdiagnosed and inappropriate drug treatments, delayed interventions, and related complications(1).

Q3. How does timely detection of RA through IVD impact patient outcomes and overall healthcare costs?

ANS: Identification of RA at initial presentation and treatment at earlier stage can affect disease course, prevent the development of joint erosions or retard progression of erosive disease. Early diagnosis and treatment may affect disease outcomes even to a remission state (9, 10).

References

  1. Gossec L, Combescure C, Rincheval N, et al. Relative Clinical influence of Clinical, Laboratory, and Radiological Investigations in Early Arthritis on the Diagnosis of Rheumatoid Arthritis. Data from the French Early Arthritis Cohort ESPOIR. J Rheumatol. 2010;37:2486–92.
  1. Cross, M.; Smith, E.; Hoy, D.; Carmona, L.; Wolfe, F.; Vos, T.; Williams, B.; Gabriel, S.; Lassere, M.;Johns, N. The global burden of rheumatoid arthritis: Estimates from the global burden of disease 2010 study. Ann. Rheum. Dis. 2014, 73, 1316–1322.
  1. Balandraud, N.; Picard, C.; Reviron, D.; Landais, C.; Toussirot, E.; Lambert, N.; Telle, E.; Charpin, C.; Wendling, D.; Pardoux, E. HLA-DRB1 genotypes and the risk of developing anti citrullinated protein antibody (ACPA) positive rheumatoid arthritis. PLoS ONE 2013, 8, e64108
  1. Sugiyama, D.; Nishimura, K.; Tamaki, K.; Tsuji, G.; Nakazawa, T.; Morinobu, A.; Kumagai, S. Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies. Ann. Rheum. Dis. 2010, 69, 70–81.
  1. Pedersen, M.; Stripp, C.; Klarlund, M.; Olsen, S.F.; Tjønneland, A.M.; Frisch, M. Diet and risk of rheumatoid arthritis in a prospective cohort. J. Rheum. 2005, 32, 1249–1252.
  1. Pattison, D.J.; Symmons, D.P.M.; Lunt, M.; Welch, A.; Luben, R.; Bingham, S.A.; Khaw, K.T.; Day, N.E.;Silman, A.J. Dietary risk factors for the development of inflammatory polyarthritis: Evidence for a role of high level of red meat consumption. Arthritis Rheum. 2004, 50, 3804–3812.
  1. A N Baer, E N Dessypris, S B Krantz. The pathogenesis of anemia in rheumatoid arthritis: a clinical and laboratory analysis. Semin Arthritis Rheum (1990) Feb;19(4):209-23.
  1. Heidari B, Lotfi Z, Firouzjahi AR, Heidari P. Comparing the diagnostic value of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Res med. 2009;33:156–61.
  1. Finckh A, Liang MH, van Herckenrode CM, de Pablo P. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta-analysis. Arthritis Rheum. 2006;55:864–72.
  1. van der Helm-van Mil AH, Detert J, le Cessie S, et al. Validation of a prediction rule for disease outcome in patients with recent–onset undifferentiated arthritis: moving toward individualized treatment decision–making. Arthritis Rheum. 2008;58:2241–7.

11. Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.

12. Gossec L, Combescure C, Rincheval N, et al. Relative Clinical influence of Clinical, Laboratory, and Radiological Investigations in Early Arthritis on the Diagnosis of Rheumatoid Arthritis. Data from the French Early Arthritis Cohort ESPOIR. J Rheumatol 2010; 37: 2486-92.

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