Rheumatoid arthritis begins as joint inflammation that, in some people, spontaneously resolves, while in others it becomes a chronic, disabling disease. Why this matters: Doctors cannot yet predict which patients will achieve remission—a state with no detectable arthritis symptoms—either on their own or with drugs. As a result, many people receive unnecessary treatment, incurring side effects and costs, while others are treated too late to prevent joint damage. The core problem is a lack of tools to match the right treatment to the right patient at the right time. Potential impact: If successful, this project would enable clinicians to identify, through blood tests and advanced joint imaging, which early arthritis patients are likely to remit without drugs and which need aggressive therapy. It would also develop methods to spot healthy individuals at risk of developing RA in the future. This could reduce overtreatment, cut healthcare costs, and shift the goal from managing chronic disease to preventing it altogether—a fundamental change in how early arthritis is handled.
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Joint inflammation may either resolve spontaneously or evolve into rheumatoid arthritis (RA). RA is a chronic disease which causes joint pain and swelling, and ultimately deformity and disability. People with RA who are diagnosed and treated early do much better than those in whom diagnosis and treatment are delayed. They have less joint damage and long term disability. The best possible response to a drug, a clinical state called remission in which there are no detectable signs or symptoms of arthritis, is only achieved in a minority of people. New research is urgently needed to identify which subgroups of people with arthritis are most likely to achieve clinical remission without the need for drug therapy, or in response to arthritis drugs. This would mean that only those people who need treatment receive it, thus reducing the costs of treatment and the risk of side effects. The aims of our research project are to enable the delivery of the right treatment to the right patient at the right time. We aim to establish how to measure the state of clinical remission not only at the bedside but also in the laboratory (eg using new ways to visualise affected joints and combining these with blood tests that assess the health of the immune system), and to identify individuals who may be at risk of developing RA in the future. To achieve these objectives, we will work closely with the pharmaceutical industry to collect information about all clinical studies that have been undertaken in patients with RA. We will then study the characteristics of patients with RA who have been recruited to clinical trials and received either (a) placebo (a lookalike drug but with no effects), or (b) active drug, and use this information to see if we can identify the factors that predict spontaneous or treatment-induced clinical remission. We will also set up a new, UK-wide research study of early RA patients to investigate this in more detail. These patients will receive treatment according to nationally approved guidelines. We will observe them in detail, collecting information about their arthritis and how they respond to teatment. Finally, we will undertake some studies to see if it possible to identify healthy individuals who are likely to develop RA in the future. This could pave the way for new ways to treat, or even prevent, early arthritis.
Andrew Cope (Principal Investigator)Brian Tom (Co-Investigator)David Scott (Co-Investigator)Deborah Symmons (Co-Investigator)Ian Bruce (Co-Investigator)Jane Worthington (Co-Investigator)Karim Raza (Co-Investigator)Peter Taylor (Co-Investigator)
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