Chef and Hero Food Author Seamus Mullen almost had to give up his career before it even began. He was diagnosed with rheumatoid arthritis in his early thirties and told he’d likely be in a wheelchair by 45. The doctors put him on medication with a slew of side effects, left him vulnerable to infection, and didn’t even completely get rid of his RA symptoms. He sat down with WellBe to share the story of how he finally healed completely, using only natural lifestyle and dietary changes, and now lives drug completely- and symptom-free.

The number of new diagnoses of rheumatoid arthritis fell by 20% in the first year of the COVID-19 pandemic, new research suggests.

The study, published today in The Lancet Rheumatology journal by researchers from King’s College London, shows there could be as many as a fifth of new cases that have gone undiagnosed, with cases not jumping up above pre-2020 levels. This suggests many of these patients have not been seen by their GP or been reviewed by a hospital specialist. However, for patients who were diagnosed during the pandemic, there did not appear to be more delays in starting treatment.

The study evaluated the diagnosis and treatment of different types of arthritis in England during the first two years of the pandemic.

Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are autoimmune diseases that primarily affect the joints and spine. People with these conditions experience chronic pain which can limit their mobility. If diagnosis and treatment is delayed, these conditions can lead to chronic disability due to joint damage, impaired function, work absence, and reduced quality of life. Early diagnosis and treatment of these types of arthritis improves outcomes for patients. Once diagnosed, patients can start highly effective treatments to control symptoms and prevent irreversible damage.

Each year, the quality of care for people with rheumatoid arthritis is benchmarked through a process of national audit. These audits were paused during the pandemic, however, making comparisons of care challenging.

Researchers from King’s College London used OpenSAFELY, a highly secure health data platform, to determine how the diagnosis and management of arthritis was affected by the pandemic. From a study population of over 17 million people in England, they were able to evaluate care for 31,000 people with new diagnoses of arthritis between April 2019 and March 2022.

The results showed that the number of newly recorded arthritis diagnoses fell by 20% in the year after the first COVID-19 lockdown, relative to the year before the pandemic. Arthritis diagnoses fell again as COVID-19 cases rose, before returning to pre-pandemic levels by April 2022. Researchers did not see a rebound in diagnoses after restrictions were lifted, suggesting that there is likely to be a substantial burden of undiagnosed patients.

Importantly, the study also showed that, for people who were diagnosed during the pandemic, the time to assessment by a hospital specialist was shorter than before the pandemic. This may be due to fewer hospital referrals overall and increased utilisation of virtual appointments during the pandemic.

Additionally, the proportion of patients who were started on treatment was similar before and during the pandemic. However, medications perceived to be safer, but less effective, were prescribed more frequently during the pandemic. This could relate to clinicians’ concerns about the effects of stronger medications on COVID-19 infections.

Lead author Dr Mark Russell, from King’s College London, said: “This study highlights that there are likely to be people with joint pain and swelling who remain undiagnosed as a consequence of the pandemic. It is important to speak to a doctor if you have these symptoms, as early diagnosis and treatment of conditions such as rheumatoid arthritis greatly improves outcomes for patients and increases the likelihood of disease remission.

“An important message of this study is that it is possible to assess the quality of care for patients with long-term health conditions using routinely collected health data. This approach could be applied to many other chronic health conditions and be used to provide feedback to NHS organisations and clinicians, with the aim of optimising care for patients.”

Researchers at the University of Colorado School of Medicine have discovered that a unique bacteria found in the gut could be responsible for triggering rheumatoid arthritis (RA) in people already at risk for the autoimmune disease. 

Kristine Kuhn, MD, PhD, associate professor of rheumatology, led a team of researchers from the Division of Rheumatology on the study, which published on October 26 in the journal Science Translational Medicine. CU School of Medicine student Meagan Chriswell is the lead author of the paper. 

“Work led by co-authors Drs. Kevin Deane, Kristen Demoruelle, and Mike Holers here at CU helped establish that we can identify people who are at risk for RA based on serologic markers, and that these markers can be present in the blood for many years before diagnosis,” Kuhn says. “When they looked at those antibodies, one is the normal class of antibody we normally see in circulation, but the other is an antibody that we usually associate with our mucosa, whether it be the oral mucosa, the gut mucosa, or the lung mucosa. We started to wonder, ‘Could there be something at a mucosal barrier site that could be driving RA?’” 

Discovering a new bacterium 

The CU researchers, with the help of a group led by Bill Robinson, MD, PhD, at Stanford University, took the antibodies created by immune cells from individuals whose blood markers showed they were at risk for the disease and mixed them with the feces of the at-risk individuals to find the bacteria that were tagged by the antibodies.   

To further test their hypothesis, the researchers used animal models to host the newly discovered bacteria. Those experiments showed that not only did the bacteria cause the animal models to develop the blood markers found in individuals at risk for RA; but some of the models showed development of full-blown RA as well. 

“Our collaborators led by Drs. Eddie James and Jane Buckner of Benaroya Research Institute confirmed that the T cells in the blood of people with RA will respond to these bacteria, but people who are otherwise healthy do not respond to these bacteria,” Kuhn says. “Through studies in humans and animal models, we were able to identify these bacteria as being associated with the risk for developing RA. They trigger an RA-like disease in the animal models, and in humans, we can show that this bacterium seems to be triggering immune responses specific to RA.” 

A new target for RA 

If the unique species of bacteria is indeed driving the immune response that leads to RA in individuals already at risk for the disease, Kuhn says, it might be possible to target the bacteria with medication to prevent that response from happening.   

“The next thing we want to do is identify, in larger populations of individuals at risk for RA, if these bacteria correlate with other genetic, environmental, and mucosal immune responses, and then ultimately, the development of RA,” Kuhn says. “Then we could say, ‘This is a marker that’s useful in helping predict who will go on to develop RA,’ and apply prevention strategies. The other opportunity there is that if we can understand how it is triggering these immune responses, we might be able to block the bacteria’s ability to do that. “ 

Studying the trigger mechanism 

The research took five years to conduct and analyze, Kuhn says, helped along by individuals who discovered they were at risk for RA and volunteered to support the research effort. Eventually the researchers want to examine exactly how the bacteria triggers the immune response, as well as different methods of preventing the reaction from happening. 

“There are a lot of different technologies that are just starting to come out that could selectively target a bacterium in the gut microbiome, for example, to prevent it from having immunogenic effects on the host,” she says. “For a long time, people have thought that antibiotics could be a useful therapy for RA, but rather than the sledgehammer effect of a traditional antibiotic that’s going to wipe out a large group of bacteria, we might be able selectively target this bacterium or its effects.” 

Basic schematic showing how the M@P-siRNAsT/I of the present study can function as a PA imaging-guided RA therapeutic. PBNPs: Prussian blue nanoparticles; CIA: collagen-induced arthritis; PL: pulsed laser; PA: photoacoustic; ROS: reactive oxygen species; RA: rheumatoid arthritis. CREDIT SIAT

The high level of reactive oxygen species (ROS) in the rheumatoid arthritis (RA) microenvironment and its persistent inflammatory nature can promote damage to joints, bones, and the synovium. Strategies that integrate effective RA microenvironment regulation with imaging-based monitoring could lead to improvements in the diagnosis and treatment of RA. 

A joint research team from the Shenzhen Institute of Advanced Technology of the Chinese Academy of Sciences and the University of Texas at Austin has proposed a new strategy that can achieve targeted treatment of rheumatoid arthritis. 

The researchers integrated small interfering RNAs (siRNAs^T/I) and Prussian blue nanoparticles (PBNPs) to silence the expression of the proinflammatory cytokines TNF-α/IL-6 and scavenge the ROS associated with the RA microenvironment. 

The study was published inPNAS on Oct. 18. 

To enhance the in vitro and in vivo biological stability, biocompatibility, and targeting capability ofthe siRNAs^T/I and PBNPs, the researchers prepared macrophage membrane vesicles (MMVs) to construct biomimetic nanoparticles, M@P-siRNAs^T/I. 

They found that the M@P-siRNAs^T/I suppressed TNF-α/IL-6 expression and overcame the hypoxic nature of the RA microenvironment, thus alleviating RA-induced joint damage in a mouse model. 

Moreover, near-infrared photoacoustic imaging (PAI) allowed the targeting behavior of the M@P-siRNAs^T/I to be followed in real time, thus permitting an evaluation of their therapeutic efficacy without the need for invasive procedures. 

These findings show that macrophage-biomimetic M@P-siRNAs^T/Iand their analogues assisted by PAI can provide a new strategy for RA diagnosis, treatment, and monitoring. 

Jim Morelli tells us what eye diseases Rheumatoid Arthritis patients are at higher risk for.