Is Rheumatoid Arthritis 2 Separate Diseases?

According to the Rheumatoid Arthritis Support Network, about 1.4 million people in the United States suffer from rheumatoid arthritis (RA). Experts don't know as much as they would like about the chronic condition, including how to treat it. But one new idea poses an interesting idea. It could be that RA is not a single disease, but instead may actually be two distinct conditions. 

Two Possible RA ‘Subtypes’

RA causes a distinct group of symptoms, which include joint pain and swelling, morning stiffness, low-grade fever, depression and weight loss, which doctors can use to clinically diagnose patients. Most people with the disease also test positive for “rheumatoid factor” autoantibodies, which are specific to RA. However, up to 40% of patients with all the clinical signs of the disease consistently have negative blood tests. So, what gives?

Some researchers believe there may be important differences between these two groups, one great enough to merit a split in how the disease is diagnosed. They argue their case in an article recently published in PLOS Medicine, explaining that patients’ treatment outcomes often depend on whether or not they test positive for rheumatoid factor autoantibodies.

For reasons experts are still trying to figure out, people clinically diagnosed with RA who test negative for the autoantibodies tend to respond far worse to available treatments. Because these cases are so unresponsive and tend to have more negative outcomes, some experts believe autoantibody-negative RA could be a whole different disease, one that requires different treatment and may have very different worries than the RA-positive counterpart.

If RA is Two Distinct Diseases

If RA is actually two distinct diseases, it might require two very different therapeutic approaches. Researchers hope that a closer look at both types might offer new avenues for improving the prognosis for people who don’t have rheumatoid factor antibodies. 

It’s even possible that a different blood test is just waiting to be discovered, one that might define the second RA type and help point doctors toward more effective treatment options for this group. Hopefully, these recent ideas will help to guide future research and lead to breakthroughs.

RA is a serious illness that cuts lives short. A more specialized look at the differences between what may actually be two types of the disease could provide some missing puzzle pieces and therefore a clearer picture and better treatment options.

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