Precision Medicine in Rheumatic Diseases: The Example of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that typically affects the joints. Over the last few decades, the prognosis of RA has changed dramatically, but the rate of responses to the currently available drugs is still sub-optimal. 

This may be explained by the fact that, although RA has typical clinical manifestations, its histological and molecular characteristics are heterogeneous, and due to both genetic and environmental factors. Clinical decision making is currently based on clinical features and serum biomarkers such as rheumatoid factors and anti-cyclic citrullinated peptide antibodies, but these are not present in all RA patients. The development of new diagnostic and predictive biomarkers (particularly synovial biomarkers) may help to overcome current treatment failures and lead to more tailored treatments.

There are some limitations to applying precision medicine to the management of RA, including the education and participation of all of the involved stakeholders (not only patients, but also healthcare professionals, politicians and industry representatives) and the high cost of innovative technologies. However, careful planning of research programmes and the definition of priorities should eventually lead to considerable savings in healthcare expenditure.