New Answers, More Questions

Back around 1990, a change was taking place. For years prior, much of the health advice given to women came from data primarily learned by studying men. Doctors started to wonder whether they were giving the best advice to women, or whether their female patients would be better served by different treatments. To learn more, large-scale studies focusing on health issues in women started getting underway. The Women's Health Initiative was one. We covered some results from that study in a recent feature article in Arthritis Today, called "Beyond the Headlines" (July-August, 2006).

Now results of another large-scale study of women –– The Women's Health Study (WHS) –– have been released. Started in 1992, the WHS began to look at heart disease in women. Doctors knew that heart disease increased in women after they went through menopause and they had recently learned from a large study of male doctors (the Physicians' Health Study) that taking aspirin could reduce the risks of heart disease. But would aspirin therapy work for women? Would another treatment, such as taking vitamin E, be better? Doctors wanted to know, and they recruited nearly 40,000 women aged 45 or older to find out. The study was supposed to be 15 years long, ending in 2007. It's been extended through 2009, however, as they continue to look at genetic material gathered from the women's blood samples (the women had blood samples taken regularly throughout the years of the study) so they can learn how to better predict risk for major health conditions.

I tell you all that to tell you this: Rheumatoid arthritis (RA) is one of the health conditions they evaluated. Like the Women's Health Initiative, some of the results may raise more questions. As part of the WHS, rheumatologists from Brigham and Women's Hospital/Harvard Medical School in Boston looked at blood samples from 398 women from the study who reported having been diagnosed with RA about 10 years ago. Of those 398, the rheumatologists confirmed RA in 90 of the women. (Does that mean more than 300 women are being treated for RA that they don't really have??!!)

The rheumatologists then studied those 90 women, to see if their levels of C-reactive protein (CRP) could have predicted their RA. CRP is a chemical produced by the body when inflammation is occurring somewhere in the body. It's known to be an indicator of disease activity in RA. Doctors wanted to know if CRP levels were high in the women with RA prior to their being diagnosed with the disease. If the CRP levels were high, it could mean that a simple blood test might be able to indicate which women are more likely to develop RA later in life.

But alas, it did not. The doctors found that the women's previous CRP levels were not associated with their incidence of developing RA. Even around the time the women were diagnosed with RA, their CRP levels were not predictive. CRP may be a good measure of how severe your RA may be -- that is, the higher your CRP level, the more pain and stiffness you may feel -- but apparently it's not a great predictor for whether you'll develop the condition. The search for a simple way to predict RA continues.

I wonder this, however, both as an editor and a patient: If you have a high CRP level for months before you are diagnosed, does that mean something other than RA is causing your chronic inflammation? Or does it mean that the RA diagnosis came too late? Either way, how can you be sure you are on the right treatment now?

Is there a doctor in the blog?? If so, your insight is welcomed!