Rheumatoid arthritis seems to be two different diseases: autoantibodies hold the answer

Disease activity improves over time for most people with rheumatoid arthritis. But long-term outcomes only improve in people with autoantibodies says a new study in PLOS, adding to evidence that rheumatoid arthritis with and without autoantibodies are two distinct diseases.

Rheumatoid arthritis is the most common type of autoimmune arthritis, caused when the immune system attacks healthy cells in the linings of joints. Over the last decade it has become clear that there are differences in people with and without autoantibodies in their blood.

New study

New research saw experts collect yearly data from 1,285 people with rheumatoid arthritis between 1993 and 2016. In total, 823 of the volunteers had autoantibody-positive rheumatoid arthritis and 462 people had autoantibody-negative rheumatoid arthritis.

In both groups, disease activity decreased over time.

But sustained drug-free remission rates increased, as a new treat-to-target treatment strategy became common in 2006 to 2010, in those with autoantibody-positive, but not autoantibody-negative, rheumatoid arthritis.

And mortality and disability rates decreased with only in autoantibody-positive patients.

“The disconnection between improvement in disease activity and subsequent improvement in long-term outcomes in rheumatoid arthritis without autoantibodies suggests that the underlying pathogenesis of rheumatoid arthritis with and without autoantibodies is different,” the authors say. “We propose that it is time to formally divide rheumatoid arthritis into type 1, with autoantibodies, and type 2, without autoantibodies, in the hope that it leads to stratified treatment in autoantibody-positive and autoantibody-negative rheumatoid arthritis.”

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