Kaitlyn D’Onofrio

DocwireNews

A high number of&nbsp;dominant B-cell receptor (BCR) clones in peripheral blood&nbsp;accurately predicted high-risk rheumatoid arthritis (RA) patients in a new study presented at the annual American College of Rheumatology meeting.&nbsp;Researchers used next-generation B-cell receptor sequencing on 129 RA-risk patients.&nbsp;They identified highly expanded clones (HECs), or dominant BCR clones, and labeled patients as BCR-positive if peripheral blood presented&nbsp;&ge;&nbsp;five&nbsp;dominant BCR clones&nbsp;at baseline.&nbsp;<a href="https://twitter.com/ALGaffoRheumMD/status/1054045192637083649">https://twitter.com/ALGaffoRheumMD/status/1054045192637083649</a>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 &plusmn; 5.2 vs. 2.0 &plusmn; 2.4; mean &plusmn;&nbsp;SD;&nbsp;P&nbsp;&lt;&nbsp;0.0001). At three years, none of BCR-negative RA-risk patients went on to develop arthritis, compared with&nbsp;32 (71%) of the BCR-positive individuals (estimated&nbsp;risk ratio [RR]: 120.1; 95%-CI: 7.5 &ndash; 1917;&nbsp;P&nbsp;&lt;&nbsp;0.0001).&nbsp;The more BCR clones a patient had, the higher their risk of arthritis. Researchers divided BCR-positive patients into two groups:&nbsp;five to eight&nbsp;HECs (BCR-medium, n = 23) and&nbsp;&ge;&nbsp;nine&nbsp;HECs&nbsp;(BCR-high,&nbsp;n&nbsp;=&nbsp;22); at three years, the BCR-high group had a significantly higher arthritis risk than the BCR-medium cohort. The presence of&nbsp;&ge;&nbsp;nine&nbsp;HECs&nbsp;was associated with a 91% predictive value (20/22).&nbsp;<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
<a href="https://twitter.com/hashtag/ACR18?src=hash&amp;ref_src=twsrc%5Etfw">#ACR18</a> <a href="https://twitter.com/hashtag/plenaryI?src=hash&amp;ref_src=twsrc%5Etfw">#plenaryI</a> identifying pts at high risk for imminent onset of RA and then target to prevent. Expansive clones of B cell repertoire Cohort of pts +ACPA but no arthritis BCR test. Sens 100% Spec 87%. PPV 71%. NPV 100%. As Number of BCR+ clones increase and more risk
&mdash; Marie Kuchynski MD (@Doctorkuch) <a href="https://twitter.com/Doctorkuch/status/1054044657741635585?ref_src=twsrc%5Etfw">October 21, 2018</a>
</blockquote><script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>Study author&nbsp;Niek&nbsp;de Vries, MD, PhD, said,&nbsp;&ldquo;In my view, a positive test might be an indication for preventive treatment and retesting at&nbsp;one&nbsp;year to evaluate the treatment effect.&rdquo;&nbsp;<a href="https://twitter.com/DrMAUrsani/status/1054044350580187136">https://twitter.com/DrMAUrsani/status/1054044350580187136</a>&ldquo;I think it&rsquo;s very important to realize that what we test is the migration of B cells or&nbsp;plasmablast-like cells through the blood at the moment that we&rsquo;re testing,&rdquo; Dr. de Vries, a rheumatology&nbsp;professor at the University of Amsterdam, said.&nbsp;&ldquo;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.&nbsp;So&nbsp;it&rsquo;s a different parameter.&rdquo;&nbsp;<a href="https://proddocwire.wpengine.com/docwire-pick/rheumatoid-arthritis-patients-flareups/">Rheumatoid Arthritis Patients with Low Disease Activity Still Have Flareups</a>&nbsp;<a href="https://proddocwire.wpengine.com/abstracts/prevalence-rheumatoid-arthritis-patients/">Association of anti-RNP with HLADR4 and its prevalence in rheumatoid arthritis patients</a>&nbsp;<a href="https://proddocwire.wpengine.com/docwire-pick/palindromic-rheumatism-rheumatoid-arthritis/">Unique Imaging Sets Palindromic Rheumatism Apart from Rheumatoid Arthritis</a>&nbsp;<a href="https://proddocwire.wpengine.com/docwire-pick/prevent-delay-rheumatoid-arthritis/">Therapeutic Interventions to Prevent and Delay Rheumatoid Arthritis Onset</a>&nbsp;Sources:&nbsp;<a href="https://www.mdedge.com/rheumatologynews/article/177751/rheumatoid-arthritis/novel-blood-test-brings-ra-prevention-closer">Rheumatology News</a>,&nbsp;<a href="https://acrabstracts.org/abstract/identifying-individuals-with-high-risk-for-imminent-onset-of-rheumatoid-arthritis/">American College of Rheumatology&nbsp;</a>

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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 ...

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