Can Synovial Pathobiology Integrate with Current Clinical and Imaging Prediction Models to Achieve Personalized Health Care in Rheumatoid Arthritis?

Abstract

Although great progress has been made in the past decade toward understanding the pathogenesis of rheumatoid arthritis (RA), clinicians remain some distance from a goal of personalized health care. The capacity to diagnose RA early, predict prognosis, and moreover predict response to biologic therapies has been a research focus for many years. How currently available clinical prediction models can facilitate such goals is reviewed in this article. In addition, the role of current imaging techniques in this regard is also discussed. Finally, the authors review the current literature regarding synovial biomarkers and consider whether integration of synovial pathobiology into clinical prediction algorithms may enhance their predictive value.

Transcriptional Profiling of Synovial Macrophages Using Minimally Invasive Ultrasound‐Guided Synovial Biopsies in Rheumatoid Arthritis

“…While arthroplasty has the ability to collect large pieces of synovial tissue, its utility as a vehicle to obtain tissue for research purposes from RA patients in the United States and in longitudinal manner is challenging (23, 29, 41, 45, 63–66). Moreover, the tissue obtained from arthroplasty is usually late stage and may not reflect the ongoing active disease, which may be obtained using ultrasound guided synovial biopsy.…”

“…Recent advances in ultrasound technology have opened up a new opportunity for rheumatologists to perform minimally invasive ultrasound-guided synovial tissue biopsies (25). While arthroplasty allows for the collection of large pieces of synovial tissue, using it as a method of obtaining tissue from RA patients for research purposes in the US and in a longitudinal manner is challenging (23,29,41,45,(64)(65)(66)(67). Moreover, the tissue obtained from arthroplasty is usually late stage and may not reflect ongoing active disease, unlike tissue which may be obtained 850 MANDELIN ET AL using ultrasound-guided synovial biopsy.…”

“…Moreover, the tissue obtained from arthroplasty is usually late stage and may not reflect ongoing active disease, unlike tissue which may be obtained 850 MANDELIN ET AL using ultrasound-guided synovial biopsy. The fact that ultrasound-guided synovial biopsies may be performed in the clinic without a surgical suite and require minimal to no recovery time for the patient outweighs the smaller amount of tissue retrieved (23,29,41,45,(64)(65)(66)(67). In fact, in several countries in Europe, this technique is used to obtain synovial tissue for research purposes in a large number of patients without significant complications (34)(35)(36)(38)(39)(40)(68)(69)(70)(71)(72)(73).…”

Six-month prospective trial in early and long-standing rheumatoid arthritis: evaluating disease activity in the wrist through sequential synovial histopathological analysis, RAMRIS magnetic resonance score and EULAR-OMERACT ultrasound score

“…The study of synovial biopsies from patients with rheumatoid arthritis (RA) has led to breakthroughs in disease understanding and the development of new targeted therapies. Current studies are investigating whether synovial tissue analysis can be used as an instrument for personalised medicine in RA for diagnosis, prognosis and treatment stratification 1 2. The development of ultrasound-guided synovial biopsy (USGSB) as a minimally invasive, safe and well-tolerated technique for retrieving synovial tissue has accelerated research in synovial histopathology 3–5.…”

Responses to Cytokine Inhibitors Associated with Cellular Composition in Models of Immune‐Mediated Inflammatory Arthritis

“…In addition, erosive disease can be seen in patients with combinations of RA, PsA, and SpA (11,12). Thus, IL-6 inhibition seems to be more efficacious in RA patients with a high C-reactive protein level (13) and inhibition of lymphocytes with either rituximab or abatacept is more efficacious in anticitrullinated protein antibody-positive RA patients (14). Thus, IL-6 inhibition seems to be more efficacious in RA patients with a high C-reactive protein level (13) and inhibition of lymphocytes with either rituximab or abatacept is more efficacious in anticitrullinated protein antibody-positive RA patients (14).…”