Study: More attention needs to be paid for cartilage during RA diagnosis

This could lead to a paradigm shift in the treatment of rheumatoid arthritis: rheumatologists at the Medical University of Vienna have discovered, through a secondary study involving 3,000 female patients, that the condition of the cartilage in inflammatory joint rheumatism needs to be paid more attention than has previously been the case. Until now, the focus lay mainly on investigating the damage to the bone. The study also revealed that the signs of joint swelling are given more attention than the results of blood tests.

"It is important to maintain the joint's function. This is our aim, so that the patient retains the ability to pour a glass of milk, get out of the car or be able to wash him or herself. Our study has shown that preserving the cartilage structure for this level of functioning is more important than preserving bone structure. Bone structure can essentially be re-built, however damage to cartilage is irreparable. Cartilage is therefore the much greater problem in rheumatoid arthritis", says Josef Smolen, Director of the Clinical Division of Rheumatology of the University Department of Internal Medicine III. Smolen was only crowned by "Laborjournal online" as the most-cited German-speaking rheumatologist in middle of July 2011. In the field of rheumatology, Europe leaves the USA, which is usually the leader in all things medical, behind - and in Europe, Vienna is regarded as "the" leading centre for rheumatology.

Earlier treatment of cartilage

The results of the study show that in future more attention needs to be paid to the cartilage during diagnosis, for example during X-rays, while on the other hand treatment needs to be commenced earlier, and this includes preventative therapy. There are currently around 15 highly potent, anti-inflammatory medications available for this. Daniel Aletaha, the primary author of the study: "We need to protect both the cartilage and the bone from destruction. With X-rays, for example, slightly less attention has been paid in the past to cartilage destruction. This needs to be re-examined across the world in the light of our study results."

Around one per cent of the world's population is affected by rheumatoid arthritis, with the University Department at the MedUni Vienna within the AKH Vienna currently treating around 2,000 patients - 75% of them women. The study, published in the highly-respective specialist journal "Annals of the Rheumatic Diseases", ran for just under two years.

Patient examination more important than blood results

In a further study by the Viennese rheumatologists, which has also been published in the "Annals of the Rheumatic Diseases", the researchers also found that an assessment of inflammatory activity using blood results does not always yield the most meaningful answers. This is particularly true if the blood results fail to detect any inflammatory markers, although inflamed joints are seen in the clinical examination.

"In this context, the clinical examination of the patient takes precedence over the blood results, which then rank second in terms of importance", says study leader Aletaha. "After all, in a situation such as this, even with 'good' blood results, processes that can cause a joint to fail are still ongoing." This phenomenon is particularly important in situations in which the disease has been largely suppressed, but not completely, by treatment. Since this is true for around ten per cent of patients, further therapeutic considerations need to be made despite an unremarkable blood profile.