Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes chronic inflammation of the synovial membrane of multiple joints, generating swelling, pain and stiffness, and that can lead to a progressive cartilage and bone destruction resulting in severe joint deformities and disability. The disease can have also systemic manifestations.
The clinical evolution of RA is fluctuating with periods of exacerbation and remission; the prognose differs a lot from one patient to another and in some cases can be rapidly progressive.
The treatment paradigm of RA has changed a lot in the last years due to new concepts in the diagnosis and in the treatment goals, and since more successful treatment options are now available. The main goal of disease-modifying anti-rheumatic drugs (DMARD) treatment is to achieve remission.
Currently the mainstay of RA treatment includes conventional synthetic drugs (csDMARDS), biological, and novel potential small molecule DMARDs (called tsDMARDS, targeted synthetic DMARDs), which have allowed a significant progress to attenuate disease activity and decrease joint deformity. But even with a medical treatment, 40% of patients will develop some type of functional disability after 10 years of evolution.
Patients with early arthritis should be treated as soon as possible (ideally within 3 months after onset of symptoms) in order to reduce and even prevent the risk of joint damage and disability. DMARDs have been shown to slow disease progression in RA. However, there is a wide variation in patient clinical response to current therapies. Among the DMARDs, Methotrexate (MTX) monotherapy should be part of the first treatment strategy (unless contraindicated), with or without Glucocorticoids (GC) as bridging therapy for most patients.
However, it fails to control the disease activity in 30-40% of patients (Rau R 2010).
The optimum treatment goal is remission, or at least low disease activity in patients irresponsive to earlier treatments. Until the desired treatment target is reached, drug therapy should be reviewed at least every 3 to 6 months.
Due to the heterogeneity of patients´ clinical evolution and treatment response, it is important to adjust the treatment at a patient basis. EULAR recommends “a regular monitoring of disease activity, treatment adverse events and comorbidities to guide decisions on choice and changes in treatment strategies to reach this target”.
The availability of diagnostic tools that allow to evaluate for each patient the clinical efficacy of the drugs before administration can help clinicians to take treatment informed decisions to prevent delays in the use of the more effective treatments for each patient and to avoid the risk of unnecessary adverse events and costs.
IMBG can support clinicians to individualize immunosuppressive treatment based on the patients´ immune profile of response to the disease-modifying antirheumatic drugs (DMARDs) tested.