Novel Biomarkers Improve Diagnosis in Early RA

MADRID, Spain — Testing for 4 new biomarkers improves the diagnosis of early rheumatoid arthritis (RA) in patients who test negative on conventional tests.

The panel of biomarkers — UH-RA 1, UH-RA 9, UH-RA 14, and UH-RA 21 — had 85% specificity for RA. These markers were found in 36% of patients with early RA and in 24% of patients who were seronegative for rheumatoid factor and anticitrullinated protein antibody.

"It is imperative to detect the presence of RA early so that patients can be treated during the window of opportunity," said lead investigator Liesbeth De Winter, MS, from the Hasselt University in Diepenbeek, Belgium. "With early treatment, at least 50% of patients can achieve remission, yet one third of patients with RA are seronegative on tests for conventional biomarkers. The use of these novel biomarkers can improve the diagnostic yield and potentially improve outcomes."

De Winter presented the results during a news conference here at the European League Against Rheumatism Congress 2013.

In the future, it might be possible to use these biomarkers to predict the course of disease and response to therapy, she noted.

De Winter and her team tested antibody reactivity with the 4 biomarkers in 293 patients with RA, 97 healthy control subjects, and 90 rheumatic control patients with a variety of other types of arthritis.

Of the 293 RA patients, 34% were seronegative for rheumatoid factor and anticitrullinated protein antibody. Of those, 26% tested positive for the 4 biomarkers.

Negative for Conventional Markers

The biomarkers closed the serologic gap by 8% in this study population.

The biomarkers "closed the serologic gap by 8% in this study population," De Winter reported.

In addition, 13% of the 39 RA patients with a disease duration of less than 1 year tested positive for the 4 biomarkers.

Serum testing for the 4 biomarkers could be done as part of routine care for RA patients, when serum is often taken, De Winter explained, so the test will not be "too expensive."

The investigators plan to study the biomarkers in larger populations to determine the feasibility of widespread use.

News conference moderator Maya Buch, MD, from the University of Leeds in the United Kingdom, explained that "the current emphasis in the field is to diagnose patients as early as possible so we can treat to target and improve outcomes. Patients who are seronegative for rheumatoid factor and/or anticitrullinated protein antibody are at risk of being neglected."

Identifying biomarkers to enable the early diagnosis of RA will help close the gap and identify more patients who are candidates for treatment, she said. "This is an incremental step."

RA is a heterogeneous disease, Dr. Buch noted. "Probably no single biomarker will be able to identify all RA patients," she said. "It will take a multiple panel of biomarkers."

Ms. De Winter and Dr. Buch have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2013: Abstract OP0181. Presented June 14, 2013.

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