There has been recognition that RA results in gradual, cumulative destruction of joints and other parts of the body. Since we now have powerful treatment options, there has been a push to begin using them earlier. However, it’s harder to identify RA in its early stages, when diagnostic techniques such as RF testing aren’t as helpful. Therefore, there is a need for new diagnostic techniques for the identification of patients with joint problems in the early stages of RA.
That’s the context, and the social problem, described in the article. The study in question, however, is a little different. It’s about understanding the processes that lead to RA and techniques that may, in the future, lead to a test for patients who may develop RA in the future. There is no available evidence that treatment can stave off RA in patients who don’t have symptoms yet.
We would have liked to have seen the article use additional sources besides the press release. Where it does not rely on the press release, it seems to stray too far. The article claims that the investigators "say the finding paves the way for developing a blood test for early diagnosis of the mysterious disease." We don’t believe they said that, neither in the published study nor even the press release. The authors say the technique could help identify people at risk for developing RA in the future — people who are not yet patients — as opposed to patients who have an early stage of the disease.
Contrary to the article’s headline, the study in question did not assess a blood test for RA, and there is no blood test now. After the headline, the story really never improved.
Costs are not applicable as there is no diagnostic test developed yet.
Quantified benefits do not apply, as this study was not a clinical trial.
Quantified harms are not directly applicable to this type of research. Note, however, that there is a harm of assigning a label of "pre RA" to a perfectly healthy person with a positive blood test of unknown significance. There are always potential harms of screening; as in this story, though, they are often ignored.
This was an epidemiologic study, not a clinical study, not a study of a new diagnostic technique or new diagnostic criteria for RA. It may be a subtle point, but we feel the evidence was misapplied to the wrong context.
We would also have liked a clearer description of who was being studied.
In a sense, the article could be seen as disease-mongering. Let’s say in the future, there is a blood test in hospitals to look for these blood markers. You’re feeling healthy and go in for a physical. As part of your regular bloodwork, your doctor orders this test. (We’re not saying she ever would, but bear with us.) The test results indicate you have several markers of pre-RA in your blood. Does that mean you’ve been diagnosed with RA? No. RA is a clinical disease, and there are well-defined diagnostic criteria. In this scenario, you don’t have any joint problems — and you can’t have rheumatoid arthritis if you don’t have arthritis.
The article’s statement "the finding paves the way for developing a blood test for early diagnosis" implies that the presence of these blood markers is a surrogate for a diagnosis of arthritis.
No independent source is cited.
While potential conflicts of interest are not provided, according to the published study, the authors did not disclose any relevant conflicts of interest.
The story allows the researcher to say "Our findings present an opportunity for better predicting the risk of developing RA" but we are not told anything about any other research to guide such predictions. Are we to believe this is the ONLY research in this field?
We think the story is misleading on this point. While it notes that a blood test has not yet been developed, and that further studies are needed before that could happen, the headline of the article makes it sound like the article is reporting on a blood test. This study was not about a clinical test — a "blood test" for patients. It was far more preliminary than that.
This criterion does not apply, as there is no diagnostic test yet.
The story appears to rely almost entirely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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