Blood Test Predicts High Short-term Risk of RA

A high number of dominant B-cell receptor (BCR) clones in peripheral blood accurately predicted high-risk rheumatoid arthritis (RA) patients in a new study presented at the annual American College of Rheumatology meeting. 

Researchers used next-generation B-cell receptor sequencing on 129 RA-risk patients. They identified highly expanded clones (HECs), or dominant BCR clones, and labeled patients as BCR-positive if peripheral blood presented ≥ five dominant BCR clones at baseline. 

RA-risk individuals who developed arthritis within three years had more dominant BCR clones at baseline than RA-risk patients who did not develop arthritis (10.5 ± 5.2 vs. 2.0 ± 2.4; mean ± SD; < 0.0001). At three years, none of BCR-negative RA-risk patients went on to develop arthritis, compared with 32 (71%) of the BCR-positive individuals (estimated risk ratio [RR]: 120.1; 95%-CI: 7.5 – 1917; < 0.0001). The more BCR clones a patient had, the higher their risk of arthritis. Researchers divided BCR-positive patients into two groups: five to eight HECs (BCR-medium, n = 23) and ≥ nine HECs (BCR-high, n = 22); at three years, the BCR-high group had a significantly higher arthritis risk than the BCR-medium cohort. The presence of ≥ nine HECs was associated with a 91% predictive value (20/22). 

Study author Niek de Vries, MD, PhD, said, “In my view, a positive test might be an indication for preventive treatment and retesting at one year to evaluate the treatment effect.” 

“I think it’s very important to realize that what we test is the migration of B cells or plasmablast-like cells through the blood at the moment that we’re testing,” Dr. de Vries, a rheumatology professor at the University of Amsterdam, said. “This is completely different from a serological assessment of antibody production by plasma cells which are present in the bone marrow, which changes very little despite effective treatment. In contrast, if we test B cell migration while a patient gets corticosteroids we see an immediate disappearance of all these cells. So it’s a different parameter.” 

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Sources: Rheumatology NewsAmerican College of Rheumatology