Inflammatory arthritis in adults
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that can affect many tissues and organs, but principally in flexible joints such as the knee.
Around 370,000 people in the UK have rheumatoid arthritis (RA), which is an autoimmune disease in which many joints become inflamed, eventually leading to the destruction of the joint. There are a variety of treatments available to doctors for the management of patients with RA but finding the most effective medication for individual patients is currently based on trial and error.
Both disease-modifying anti-rheumatic drugs (DMARDs) (non-biologic drugs such as methotrexate and sulphasalzine) and biologic drugs can control inflammation and slow or stop the disease process in RA. Patients with RA are treated first with DMARDs, because these are inexpensive, generally well-tolerated and work well in some patients. Drugs targeting the Tumor Necrosis Factor (TNF) inflammatory pathway (anti-TNF drugs) are recommended as the first-choice biologic therapy for those who fail to respond to DMARD therapy. However, a significant minority of patients fail to respond to each of the therapies and each drug is associated with serious side effects, which affect a small number of patients.
What we aim to achieve:
It has been consistently shown that the patients with the best long-term outcomes from RA (i.e. those who do not develop joint damage or disability) are those who are treated early in their disease and with a drug that is effective for them. There are a number of factors that impact on whether a particular treatment will be effective; some cannot be changed, such as the genes carried by patients, whilst other factors are potentially modifiable. We aim to identify which RA patients will respond best to which drug to maximise the benefit of therapy to individuals.
The factors analysed will include smoking status and how patients view their RA (which are known to influence treatment response and could potentially be changed) as well as genetic biomarker information. By analysing results from large numbers of patients with RA who have been followed from when they first receive a drug, over time until it can be determined whether they responded to that drug, we will identify groups of factors or ‘signatures’ that predict treatment response.
The strategy will improve cost-effectiveness of both DMARD and biologic treatments for RA and allow better targeting of scarce health-care resources. For RA patients, this should mean that their disease is controlled more quickly and more effectively. In turn, this will lead to less disability in the long-term. Furthermore, exposure to possible side effects of drugs unlikely to be effective will be minimised. For the public, better targeting of health-care resources will allow more effective use of the resources available.