The CCP Study: Coordinated Programme to Prevent Arthritis - Can We Identify Arthritis at a Pre-clinical Stage ?
This is a 12-month, prospective, observational cohort trial involving Primary Care Trusts (PCTs) wishing to take part in the study and the Early Arthritis Clinic (Anti-CCP sub-clinic) at Chapel Allerton Hospital. The approximate duration of subject participation will be 12 months and the approximate total duration of the study will be 10 years. Patients who have not developed inflammatory arthritis within the 12 month period will have the opportunity to continue follow up within the clinic on an annual basis with additional visits as clinically indicated until the development of IA.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||The CCP Study: Coordinated Programme to Prevent Arthritis - Can We Identify Arthritis at a Pre-clinical Stage ?|
- Anti-CCP Ab (+). [ Time Frame: 12 years ] [ Designated as safety issue: No ]The primary objective of this study is to determine the proportion of community patients with new-onset, non-specific musculoskeletal complaints who are anti-CCP Ab (+).
- Anti-CCP positive developing I.A [ Time Frame: 1 year ] [ Designated as safety issue: No ]
Secondary objectives in this study include:
1. The number of anti-CCP positive patients who develop an inflammatory arthritis by 12 months / after 12 months.
- Defined as symptoms and signs of synovitis.
- Synovitis is defined as the presence soft tissue swelling and at least 1 of the following 2 criteria; tenderness or decreased range of motion.
- Anti-CCP positive developing RA [ Time Frame: 1 year ] [ Designated as safety issue: No ]The number of anti-CCP positive patients who develop RA by 12 months/ after 12 months (defined by 1987 ACR and the 2010 ACR/EULAR criteria).
- Presenting complaints [ Time Frame: 1 week ] [ Designated as safety issue: No ]To document the initial presenting complaint of all patients (anti-CCP positive and negative)
- Predictors for the development of an IA. [ Time Frame: 12 years ] [ Designated as safety issue: No ]
To determine usefulness of hs-CRP in predicting development of an IA in patients with positive anti-CCP Ab.
To determine usefulness of MRI and HRUS in predicting development of an IA in patients with positive anti-CCP Ab.
- First degree familymembers who are anti-CCP Ab (+) [ Time Frame: 10 years ] [ Designated as safety issue: No ]To determine the percentage of people with family members who have RA who are anti-CCP Ab (+)
Biospecimen Retention: Samples With DNA
DNA sample currently retained as part of a sub-study for a departmental tissue bank.
|Study Start Date:||January 2007|
|Estimated Study Completion Date:||January 2020|
|Estimated Primary Completion Date:||January 2020 (Final data collection date for primary outcome measure)|
Musculoskeletal symptoms - Pre diagnosis
Patients presenting with non-specific musculoskeletal complaints at risk of development of RA.
There is accumulating evidence for the need to identify patients with rheumatoid arthritis (RA) early. Damage occurs early and early treatment is effective. Clearly there is a need to improve ways of identifying these patients.
It is recognised that patients with RA often have non-specific musculoskeletal complaints in the months or years prior to development of RA (unpublished observations). Family members of patients with RA are also at greater risk of developing RA.
Given we know that earlier identification of patients enables earlier treatment and this leads to better long-term outcomes, we need a method of identifying patients at the pre-clinical stage of disease.
C-reactive protein (CRP) is an acute phase reactant, produced by the liver, primarily in response to stimulation by interleukin-6 (IL-6). The lower limit of detection of routine CRP is 8mg/dL (or higher), yet the mean CRP in the general population is <2mg/dL11 (as measured by high sensitivity assays). Therefore, patients with early RA may have low-grade inflammation not detected by routine CRP. This has been demonstrated in patients with established disease12, but no studies have been done in early disease. Disease activity variables correlated with increases in highly-sensitive CRP (hs-CRP) and hs-CRP was better than ESR at predicting disease activity and severity12. Interestingly, on retrospective analysis of blood donor serum, increased levels of hs-CRP have been noted in RA patients during the pre-clinical phase, most commonly within the two years prior to symptom onset13. This suggests immunologic changes occur prior to the development of the symptomatic stage and provides an exciting tool for assisting in the diagnosis of very early inflammatory disease
Please refer to this study by its ClinicalTrials.gov identifier: NCT02012764
|Chapel Allerton Hospital : Leeds Institute of Rheumatic and Musculoskeletal Medicine||Recruiting|
|Leeds, West Yorkshire, United Kingdom, LS7 4SA|
|Contact: Paul Emery 0113 3924844 firstname.lastname@example.org|
|Contact: Jackie Nam 0113 3924844 email@example.com|
|Principal Investigator: Paul Emery|
|Sub-Investigator: Jackie Nam|
|Sub-Investigator: Laura Hunt|
|Study Chair:||Paul Emery||University of Leeds|