The Use of Biomarkers to Predict and Monitor Treatment Outcomes in Rheumatoid Arthritis

REVIEW ARTICLE


Paul Emery

Affiliation: Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds. NIHR Leeds Musculoskeletal Biomedical Research Unit,Leeds Teaching Hospitals Trust, Leeds, United Kingdom

ABSTRACT

Current recommendations for the management of rheumatoid arthritis (RA) suggest a stepped approach that begins with disease‐modifying anti‐rheumatic drugs (DMARDs). These are followed by the addition of treatment with anti‐tumor necrosis factor (TNF) therapies and other disease‐modifying biological therapies, as determined by the patient’s response. Thus, patients who remain resistant to first‐ and second‐line treatments often wait many months before receiving the drugs to which they respond. Unfortunately, the patient’s condition is likely to worsen over this period. It is also possible that this delay could result in a missed therapeutic window. More sophisticated use of biomarkers could identify these treatment‐resistant patients at earlier stages. For instance, patients who are seropositive for the biomarker anti‐cyclic citrullinated peptide (anti‐CCP) have a high risk of disease progression and often display a poor response to methotrexate treatment. Abatacept, a T‐cell co‐stimulation blocker, has been recently shown as beneficial in anti‐CCP‐positive patients with undifferentiated arthritis or early RA. Because T cells are also implicated in the early pathogenesis of RA, it is possible that blockage of T‐cell co‐stimulation could help alter the progression of early RA in this subset of patients. More precise targeting of RA therapy could result in lower rates of treatment resistance, improved patient outcomes, and greater use of healthcare resources on more effective therapies.

Keywords: rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs), anti-tumor necrosis factor (TNF), anti-cyclic
citrullinated peptide (CCP), biomarkers, abatacept, T cells, cytokines, quality of life

Correspondence: Professor Paul Emery, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, United Kingdom. Tel: +(44)113-392-4883; Fax:+(44)113-392-4991; e-mail: p.emery@leeds.ac.uk