Abstract
In recent years, patient outcomes have improved dramatically with the availability of effective treatments for the management of rheumatoid arthritis (RA). RA, however, is a heterogeneous disease with variable disease progression and treatment response. Whereas some patients respond to a single disease-modifying antirheumatic drug, others require more intensive treatment strategies. Assessing disease severity at diagnosis and monitoring disease activity on an individual level would be a more accurate way of tailoring therapy, ensuring optimal treatment for those at greatest risk of disease progression, long-term disability, and joint damage without unnecessary overtreatment. Assessment of disease activity and severity is currently based on a combination of clinical and laboratory parameters that aid treatment decisions. Use of biomarkers may provide a more accurate means of objectively assessing the disease. This article reviews the role of biomarkers in the management of RA.
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References and Recommended Reading
Maini R, St Clair EW, Breedveld F, et al.: Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet 1999, 354:1932–1939.
Klareskog L, van der Heijde D, de Jager JP, et al.: Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 2004, 363:675–681.
Brown AK, Conaghan PG, Karim Z, et al.: An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008, 58:2958–2967.
Smolen JS, Aletaha D, Grisar J, et al.: The need for prognosticators in rheumatoid arthritis. Biological and clinical markers: where are we now? Arthritis Res Ther 2008, 10:208.
Emery P, McInnes IB, van Vollenhoven R, Kraan MC: Clinical identification and treatment of a rapidly progressing disease state in patients with rheumatoid arthritis. Rheumatology (Oxford) 2008, 47:392–398.
Marotte H, Pallot-Prades B, Grange L, et al.: The shared epitope is a marker of severity associated with selection for, but not with response to, infliximab in a large rheumatoid arthritis population. Ann Rheum Dis 2006, 65:342–347.
de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Verpoort KN, et al.: Progression of joint damage in early rheumatoid arthritis: association with HLA-DRB1, rheumatoid factor, and anti-citrullinated protein antibodies in relation to different treatment strategies. Arthritis Rheum 2008, 58:1293–1298.
Criswell LA, Lum RF, Turner KN, et al.: The influence of genetic variation in the HLA-DRB1 and LTA-TNF regions on the response to treatment of early rheumatoid arthritis with methotrexate or etanercept. Arthritis Rheum 2004, 50:2750–2756.
Potter C, Hyrich KL, Tracey A, et al.: Association of rheumatoid factor and anti-cyclic citrullinated peptide positivity, but not carriage of shared epitope or PTPN22 susceptibility variants, with anti-tumour necrosis factor response in rheumatoid arthritis. Ann Rheum Dis 2009, 68:69–74.
Padyukov L, Lampa J, Heimburger M, et al.: Genetic markers for the efficacy of tumour necrosis factor blocking therapy in rheumatoid arthritis. Ann Rheum Dis 2003, 62:526–529.
Pinto JA, Rego I, Rodriguez-Gomez M, et al.: Polymorphisms in genes encoding tumor necrosis factor-alpha and HLA-DRB1 are not associated with response to infliximab in patients with rheumatoid arthritis. J Rheumatol 2008, 35:177–178.
Szodoray P, Szabo Z, Kapitany A, et al.: Anti-citrullinated protein/peptide autoantibodies in association with genetic and environmental factors as indicators of disease outcome in rheumatoid arthritis. Autoimmun Rev 2009 May 7 (Epub ahead of print).
Hughes LB, Danila MI, Bridges SL: Recent advances in personalizing rheumatoid arthritis therapy and management. Personalized Medicine 2009, 6:159–170.
Plenge RM, Criswell LA: Genetic variants that predict response to anti-tumor necrosis factor therapy in rheumatoid arthritis: current challenges and future directions. Curr Opin Rheumatol 2008, 20:145–152.
Bukhari M, Lunt M, Harrison BJ, et al.: Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis: results from the Norfolk Arthritis Register Study, a large inception cohort. Arthritis Rheum 2002, 46:906–912.
Meyer O, Labarre C, Dougados M, et al.: Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage. Ann Rheum Dis 2003, 62:120–126.
Berglin E, Johansson T, Sundin U, et al.: Radiological outcome in rheumatoid arthritis is predicted by presence of antibodies against cyclic citrullinated peptide before and at disease onset, and by IgA-RF at disease onset. Ann Rheum Dis 2006, 65:453–458.
Bos WH, Bartelds GM, Wolbink GJ, et al.: Differential response of the rheumatoid factor and anticitrullinated protein antibodies during adalimumab treatment in patients with rheumatoid arthritis. J Rheumatol 2008, 35:1972–1977.
Bruns A, Nicaise-Roland P, Hayem G, et al.: Prospective cohort study of effects of infliximab on rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies in patients with long-standing rheumatoid arthritis. Joint Bone Spine 2009, 76:248–253.
Cuchacovich M, Catalan D, Wainstein E, et al.: Basal anticyclic citrullinated peptide (anti-CCP) antibody levels and a decrease in anti-CCP titres are associated with clinical response to adalimumab in rheumatoid arthritis. Clin Exp Rheumatol 2008, 26:1067–1073.
Visser K, Verpoort KN, van Dongen H, et al.: Pretreatment serum levels of anti-cyclic citrullinated peptide antibodies are associated with the response to methotrexate in recentonset arthritis. Ann Rheum Dis 2008, 67:1194–1195.
Nakamura RM: Progress in the use of biochemical and biological markers for evaluation of rheumatoid arthritis. J Clin Lab Anal 2000, 14:305–313.
Smolen JS, Van Der Heijde DM, St Clair EW, et al.: Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis Rheum 2006, 54:702–710.
Buch MH, Seto Y, Bingham SJ, et al.: C-reactive protein as a predictor of infliximab treatment outcome in patients with rheumatoid arthritis: defining subtypes of nonresponse and subsequent response to etanercept. Arthritis Rheum 2005, 52:42–48.
Emery P, Gabay C, Kraan M, Gomez-Reino J: Evidencebased review of biologic markers as indicators of disease progression and remission in rheumatoid arthritis. Rheumatol Int 2007, 27:793–806.
Buch MH, Reece RJ, Quinn MA, et al.: The value of synovial cytokine expression in predicting the clinical response to TNF antagonist therapy (infliximab). Rheumatology (Oxford) 2008, 47:1469–1475.
Fabre S, Dupuy AM, Dossat N, et al.: Protein biochip array technology for cytokine profiling predicts etanercept responsiveness in rheumatoid arthritis. Clin Exp Immunol 2008, 153:188–195.
Gerlag DM, Tak PP: Novel approaches for the treatment of rheumatoid arthritis: lessons from the evaluation of synovial biomarkers in clinical trials. Best Pract Res Clin Rheumatol 2008, 22:311–323.
Kraan MC, Haringman JJ, Weedon H, et al.: T cells, fibroblast-like synoviocytes, and granzyme B+ cytotoxic cells are associated with joint damage in patients with recent onset rheumatoid arthritis. Ann Rheum Dis 2004, 63:483–488.
Bresnihan B, Gerlag DM, Rooney T, et al.: Synovial macrophages as a biomarker of response to therapeutic intervention in rheumatoid arthritis: standardization and consistency across centers. J Rheumatol 2007 34:620–622.
Kavanaugh A, Rosengren S, Lee SJ, et al.: Assessment of rituximab’s immunomodulatory synovial effects (ARISE trial). 1: clinical and synovial biomarker results. Ann Rheum Dis 2008, 67:402–408.
Vos K, Thurlings RM, Wijbrandts CA, et al.: Early effects of rituximab on the synovial cell infiltrate in patients with rheumatoid arthritis. Arthritis Rheum 2007, 56:772–778.
Humby F, Manzo A, Kirkham B, Pitzalis C: The synovial membrane as a prognostic tool in rheumatoid arthritis. Autoimmun Rev 2007, 6:248–252.
Dass S, Rawstron AC, Vital EM, et al.: Highly sensitive B cell analysis predicts response to rituximab therapy in rheumatoid arthritis. Arthritis Rheum 2008, 58:2993–2999.
Burgoyne CH, Field SL, Brown AK, et al.: Abnormal T cell differentiation persists in patients with rheumatoid arthritis in clinical remission and predicts relapse. Ann Rheum Dis 2008, 67:750–757.
Young-Min S, Cawston T, Marshall N, et al.: Biomarkers predict radiographic progression in early rheumatoid arthritis and perform well compared with traditional markers. Arthritis Rheum 2007, 56:3236–3247.
Visvanathan S, Marini JC, Smolen JS, et al.: Changes in biomarkers of inflammation and bone turnover and associations with clinical efficacy following infliximab plus methotrexate therapy in patients with early rheumatoid arthritis. J Rheumatol 2007, 34:1465–1474.
Green MJ, Gough AK, Devlin J, et al.: Serum MMP-3 and MMP-1 and progression of joint damage in early rheumatoid arthritis. Rheumatology (Oxford) 2003, 42:83–88.
Tchetverikov I, Lard LR, DeGroot J, et al.: Matrix metal-loproteinases-3, -8, -9 as markers of disease activity and joint damage progression in early rheumatoid arthritis. Ann Rheum Dis 2003, 62:1094–1099.
Garnero P, Gineyts E, Christgau S, et al.: Association of baseline levels of urinary glucosyl-galactosyl-pyridinoline and type II collagen C-telopeptide with progression of joint destruction in patients with early rheumatoid arthritis. Arthritis Rheum 2002, 46:21–30.
Verstappen SM, Poole AR, Ionescu M, et al.: Radiographic joint damage in rheumatoid arthritis is associated with differences in cartilage turnover and can be predicted by serum biomarkers: an evaluation from 1 to 4 years after diagnosis. Arthritis Res Ther 2006, 8:R31.
Landewe R, Geusens P, Boers M, et al.: Markers for type II collagen breakdown predict the effect of disease-modifying treatment on long-term radiographic progression in patients with rheumatoid arthritis. Arthritis Rheum 2004, 50:1390–1399.
Mullan RH, Matthews C, Bresnihan B, et al.: Early changes in serum type II collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy. Arthritis Rheum 2007, 56:2919–2928.
Crnkic M, Mansson B, Larsson L, et al.: Serum cartilage oligomeric matrix protein (COMP) decreases in rheumatoid arthritis patients treated with infliximab or etanercept. Arthritis Res Ther 2003, 5:R181–R185.
Morozzi G, Fabbroni M, Bellisai F, et al.: Low serum level of COMP, a cartilage turnover marker, predicts rapid and high ACR70 response to adalimumab therapy in rheumatoid arthritis. Clin Rheumatol 2007, 26:1335–1338.
Marotte H, Gineyts E, Miossec P, Delmas PD: Effects of infliximab therapy on biological markers of synovium activity and cartilage breakdown in patients with rheumatoid arthritis. Ann Rheum Dis 2009, 68:1197–1200.
Geusens PP, Landewe RB, Garnero P, et al.: The ratio of circulating osteoprotegerin to RANKL in early rheumatoid arthritis predicts later joint destruction. Arthritis Rheum 2006, 54:1772–1777.
Hakala M, Risteli J, Aman S, et al.: Combination drug strategy in recent-onset rheumatoid arthritis suppresses collagen I degradation and is associated with retardation of radiological progression. Scand J Rheumatol 2008, 37:90–93.
Syversen SW, Goll GL, van der Heijde D, et al.: Cartilage and bone biomarkers in rheumatoid arthritis: prediction of 10-year radiographic progression. J Rheumatol 2009, 36:266–272.
Keeling SO, Landewe R, van der Heijde D, et al.: Testing of the preliminary OMERACT validation criteria for a biomarker to be regarded as reflecting structural damage endpoints in rheumatoid arthritis clinical trials: the example of C-reactive protein. J Rheumatol 2007, 34:623–633.
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Nam, J., Villeneuve, E. & Emery, P. The role of biomarkers in the management of patients with rheumatoid arthritis. Curr Rheumatol Rep 11, 371–377 (2009). https://doi.org/10.1007/s11926-009-0053-x
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DOI: https://doi.org/10.1007/s11926-009-0053-x