Rheumatoid Arthritis Blood Work and Personalized Medicine: What’s Your Perspective?

Blood work plays a crucial role in understanding and managing your rheumatoid arthritis — but how do these lab tests play a role in your treatment decision making? What if they could help predict whether a new treatment would work? 

A new study titled, “Patient Perceptions of Rheumatoid Arthritis Blood Work and Utility of a Test Predicting Response to New Medication: A Cross-sectional Survey in the ArthritisPower,” from the Global Health Living Foundation (GHLF) and CreakyJoints, and published in Arthritis Care & Research, asked patients to share their perceptions about RA blood work, reasons their doctor orders these tests, and how results are used.  

“To feel engaged in treatment decision making, people living with RA need to understand why their rheumatologist orders tests and how the results are used to guide choices about care,” explains lead author W. Benjamin Nowell, PhD, Director, Patient-Centered Research and principal investigator of the ArthritisPower Research Registry. 

About the Survey 

During May and June 2022, 405 people with RA completed an ArthritisPower survey to examine their perception of lab testing and a blood test to predict response to a new medication. A large majority — 86.7 percent — of respondents were female, 89.9 percent were white, and they had a mean age of 57.9. Current medications included csDMARD, bDMARD, and tsDMARD.  

Participants were asked about the reasons for lab testing and how they value different attributes of a blood test to predict treatment response. The results of the survey included the following: 

• Most patients understood that their doctor ordered laboratory tests to check for active inflammation (85.9%) or assess side effects of medications (81.2%) 
• Most feared (91.4%) that their current RA medication would stop working and many (81.7%) feared that they would waste time trying to find an alternative, effective therapy 
• Of the many lab tests available, most patients felt that the C-reactive protein (CRP) test was most helpful to themselves to understand their disease activity 
• In the event of needing to start a new treatment, nearly all patients were very or extremely interested in a blood test that could help to accurately predict whether such new medication would be effective (89.2%) 

Patients were concerned that they would waste time trying a new medication that didn’t work. When asked about the attributes of a hypothetical test that could predict whether a new RA medication would work well for them, patients valued a test that would be highly accurate over its potential cost or the wait time to get results.  

Changing Medications 

Changing medications is a common occurrence for most individuals with RA, often due to worsening disease or the current medication losing effectiveness. Severe side effects that interfere with daily life or incompatibility with other medications can also necessitate a change. 

Researchers noted the high percentage of people (91.4 percent) who worried that their current RA medication might eventually stop working for them, necessitating a change in medication, but Nowell said he was not surprised by this result because it reflects a common experience and topic of discussion among people living with RA. 

This process of switching medications can be daunting and involves trial and error. A reliable blood test that can determine how patients will respond to a new medication would be highly beneficial.  

The survey respondents indicated that accuracy was more important to them than the cost or waiting time for such a test. “People living with RA worry about the trial-and-error process of RA treatment, especially if it means wasting time on a new medication that doesn’t work for them,” says Nowell, noting that “respondents would be willing to pay a little more or wait a little longer if they could have high accuracy.” 

The Potential of Biomarkers to Improve RA Treatment 

Many survey respondents expressed interest in biomarkers and their potential benefits. Biomarkers are measurable characteristics of the body, such as HDL (good cholesterol), LDL (bad cholesterol), and triglycerides.  

Ongoing research aims to identify biomarkers that can aid in the diagnosis and treatment of RA. However, the currently available biomarkers (CRP and ESR) have limitations. They can be elevated for various reasons, and some individuals with RA may have stable biomarker levels despite their diagnosis or disease activity. 

“This study points to the need for biomarker tests that can predict which types of medications are most likely to be effective for an individual patient, a goal of personalized medicine,” says Nowell.  

While a biomarker for Parkinson’s disease was discovered in early May 2023, allowing for earlier diagnosis and treatment, it remains uncertain whether similar biomarkers exist for RA or if they have yet to be discovered. Researchers are actively working towards finding biomarkers to distinguish types of RA and that can help tailor treatments to each individual with RA. 

What This Means for You 

Remember, you are an active participant in your health care journey, and your rheumatologist is there to support you every step of the way. Don’t hesitate to reach out and seek clarification to ensure you have a clear understanding of your blood work results and how they impact your care and treatment decisions. 

Be a More Proactive Patient with ArthritisPower

ArthritisPower is a patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.