A recently discovered cell type may one day help rheumatoid arthritis patients predict the onset of painful outbreaks of the disease.
In a small study published Wednesday in The New England Journal of Medicine, scientists found that the unseen cell type appeared in patients’ blood a week before their symptoms began. The researchers called these cells preinflammatory mesenchymal cells, or PRIME.
For those with the disease, not knowing when an outbreak will occur is one of the most troubling aspects of autoimmune disease, which causes the immune system to attack the body’s own tissue, particularly around the joints.
According to experts, the new discovery could lead to a future blood test that could warn patients of an impending outbreak, although they cautioned that much more research is needed.
Being able to tell a patient and their healthcare provider that they are about to get sick is “like a little magic medicine,” said study co-author Dr. Robert Darnell, a researcher at the Howard Hughes Medical Institute at Rockefeller University in New York. York.
PRIME cells may also be a potential target for the drugs, as the study researchers believe that these types of cells may play a role in attacking healthy tissue.
“We could find a way to block it so it doesn’t get into the joint. And maybe you wouldn’t get a sparkler then, ”said Darnell. “Therefore, it has potential therapeutic value to pursue.”
In the study, four patients sent blood samples by finger prick to the laboratory for one to four years. The patients also kept a journal documenting their symptoms and visited the clinic once a month.
The researchers sequenced the blood samples to observe genetic activity. Using information from patient clinic visits, symptom diaries, and blood samples, they discovered that PRIME cells appeared in the blood a week before an outbreak. The presence of the cells was also confirmed in blood samples from 19 additional patients. However, these patients did not maintain symptom diaries, making it unclear when the cells appeared in connection with an outbreak.
Dr. Diane Horowitz, an associate professor of medicine at the Hofstra Northwell School of Medicine in New York, said these findings benefit both scientists and patients.
“As scientists, it helps us discover the pathway that occurs before an outbreak, which will help us identify the outbreak, the medication options, the treatments, all that way,” said Horowitz, who was not involved in the new study. .
The research provides insight into what is happening at the cellular level that can induce arthritis, said Dr. Robert Carter, acting director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. “And so once we get to know those cells, we can find ways to develop treatments that will attack them and prevent the outbreak.” (Carter was also not involved in the new investigation.)
The way the research is going on “will also be interesting to patients, if there is a way that they can predict when they are going to have an outbreak, and can treat it earlier and fix an outbreak before it actually occurs,” Horowtiz said.
Most rheumatoid arthritis patients take daily medications like hydroxychloroquine, which first came to attention earlier this year as a possible treatment for COVID-19, or adalimumab (brand name: Humira), as recommended by the American College of Rheumatology, and take additional medications when a flare occurs.
One of the most challenging aspects of the disease is not knowing when an outbreak will arise.
“The hardest part of being diagnosed with and living with arthritis is the unexpected,” said rheumatoid arthritis patient Rebecca Gillett, a health messaging strategist at The Arthritis Foundation and an occupational therapist.
Still, experts noted that while the new findings are exciting, much more research is needed to fully understand the role that PRIME cells play in rheumatoid arthritis. “There is much more to be done before it can become clinically applicable to patients in this study,” Horowitz said.
Gillett agreed. “I feel like this is a very promising research study that is emerging, and the ability to do a larger, longitudinal study would really make a difference and give hope, I think for people living with rheumatoid arthritis like me,” he said. said.
The team’s next step is to evaluate more patients and confirm whether the presence of PRIME cells heralds an outbreak.
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