This study will aim to test the utility of synovial histopathology and cell type as a potential biomarker to guide therapeutic decisions in RA patients failing DMARD therapy and started on Rituximab, Tocilizumab or Etanercept therapy.Specifically, can a diagnostic synovial biopsy showing a B-cell “rich/poor pathotype” define specific disease responsive/resistant subsets for patient stratification and help rationalise biologic drug choice?
The main aim of this study is to test the utility of synovial histomorphology and B cell type as a potential biomarker to guide therapeutic decisions in patients failing DMARD therapy. We hypothesise that stratification of patients according to their synovial B cell infiltrate (poor or rich phenotypes) will better define response rates. We hypothesise that the other two treatment options (Tocilizumab and Etanercept) are superior to Rituximab in B-cell-poor patients.
These different B cell numbers can be investigated by analysing a synovial biopsy, where small pieces of tissue of an inflamed joint are taken for examination under a microscope. There are more details about the synovial biopsy procedure later in the website.
We hope this will provide evidence for more effective identification of patients for different treatment groups following failed DMARD therapy. The ultimate aim is to provide a tailored approach to treatment decisions in patients at this stage of their disease, in order to maximise their potential response to therapy The images above were provided by Dr Mohey El Shikh.
This study is jointly funded by MRC and ARUK | Copyright STRAP 2014 | Experimental Medicine & Rheumatology Department, Queen Mary University London