Today, there are many treatments for patients with rheumatoid arthritis (RA), yet there is little information to help identify which therapy will work for a particular patient. Therefore, the current standard is a costly and time-consuming trial-and-error process of one medication after another, which creates a tremendous burden on the patient.
Thus, there is an overwhelming need to develop new testing to predict response to treatment. Unfortunately, markers that indicate sensitivity or resistance to a particular medication are lacking. For the most part, researchers have so far utilized blood testing without success. Recent research has suggested that the joint lining itself, the tissue that is damaged by RA, may hold the secret. Until now, researchers have obtained this tissue by taking biopsies during arthroscopic surgery or joint replacement, but this requires a trip to an OR and these patients typically have very advanced disease which does not reflect the behavior of RA at the time when therapeutic decisions need to be made -- prior to progressive joint damage.
There is a potential solution. Over the past decade, ultrasound technology has significantly advanced and is now widely used by rheumatologists, especially in Europe where ultrasound-guided joint biopsies have become important in research. To bring this technology to the United States, we have assembled a consortium of leading academic rheumatology groups, led by Northwestern University, including the University of Alabama at Birmingham, Columbia University, Mayo Clinic, Washington University, and University of Michigan to form the RhEumatoid Arthritis SynOvial tissue Network (REASON).
We are now successfully performing minimally-invasive ultrasound-guided joint biopsies on American patients who have active RA, and the samples from these patients are being studied with some of the newest and most advanced testing in existence. We hope with this testing to identify a marker within the joint lining which will predict medication outcomes and bring the era of trial-and-error medication switching to an end.
Harris R. Perlman, PhD
Arthur M. Mandelin, MD, PhD