HEALTHWATCH
Landmark test
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Diagnosing rheumatoid arthritis is never easy. But a new investigative procedure may help identify patients early. Dr Hiramalini Seshadri
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Photo: Shaju John
Painful hands?: See your doctor.
“But how can you say I have rheumatoid arthritis when my report says ‘negative’ for Rheumatoid Factor ?” asked Mallika when I told her that her joint pains were most likely related to early stage Rheumatoid Arth
ritis and that she needed proper treatment.
The diagnosis of rheumatoid arthritis was never easy. For a start, the Rheumatoid Factor was often negative in many cases and progressed to full-blown rheumatoid arthritis, earning the peculiar name of ‘sero-negative rheumatoid arthritis’ for that sub sect of patients.
On the other hand perfectly normal patients could test positive for the rheumatoid factor. To compound the confusion you could get a rheumatoid factor positivity in diseases far removed from arthritis.
Proper diagnosis
So much so that of the American Association of Rheumatology’s seven criteria for diagnosing rheumatoid arthritis, five are clinical symptoms and signs, not specific investigation reports.
In fact in India, until recently, the rule of thumb regarding such sero-negative arthritis was to see if the arthritis lasted for longer than six months before being labelled rheumatoid. The tragedy, however, was that often vigorous treatment was withheld until ‘proper diagnosis’, which led to joint erosion in many cases.
In the new millennium, however, research has revealed that two antibodies called anti-perinuclear factor and anti-keratin antibodies are very specific for rheumatoid arthritis and could be positive in many cases much before the rheumatoid factor became positive.
Unfortunately, a simple lab test to detect these antibodies could not be developed. The good news is that a cyclic citrullinated version of these antibodies (slightly chemically altered antibodies) could be picked up; the scientist who discovered this christened it the anti-CCP test.
Fascinatingly even at onset of arthritis if the CCP test was positive it seemed to have great predictive value; patients who tested positive for CCP, even though negative for rheumatoid factor, usually went on to develop severe erosive arthritis.
The CCP test, therefore, has become a landmark investigation not only to pick up rheumatoid arthritis early, but also to help identify patients at risk of developing severe erosive disease and, therefore, warrant early aggressive therapy. Fortunately it is a simple test and most labs in India can do it.
Coming back to Mallika, once we found she was CCP positive, but negative for rheumatoid factor, she qualified for early aggressive management. The good news is, she is much better today. Did you say you have stiff painful hands in the mornings? See your doctor and get a CCP test done.
The writer is a Senior Consultant, Holistic Internal Medicine and Rheumatology based in Chennai. E-mail: hiramalini@yahoo.com
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