An immunological biomarker to predict MTX response in early RA

  title={An immunological biomarker to predict MTX response in early RA},
  author={Frederique Ponchel and Vincent Go{\"e}b and Rekha Parmar and Yasser M. El-Sherbiny and Marjorie Boissinot and Jehan El Jawhari and Agata N. Burska and Edward M. Vital and Stephanie R Harrison and Philip G. Conaghan and Elizabeth M. A. Hensor and Paul Emery},
  journal={Annals of the Rheumatic Diseases},
  pages={2047 - 2053}
Objectives The therapeutic goal for patients with rheumatoid arthritis (RA) is clinical remission. This is best achieved by early diagnosis and appropriate therapeutic intervention. RA is associated with dysregulation of T-cell subsets (naïve, regulatory (Treg) and inflammation-related cells (IRC)) early in the disease. Our aim was to test the hypothesis that T-cell subset quantification can predict the achievement of clinical remission with early treatment in RA. Methods T-cell subsets were… 

A2.42 Clinical utility of measuring naÏve CD4+T-cell in early ra patient to predict remission on mtx: A replication study

This study confirms the ability of baseline naïve T-cell subset analysis in predicting early RA remission with first-line MTX therapy, suggesting clinical utility for the selection of the most appropriate therapy at disease presentation.

T cell subsets: an immunological biomarker to predict progression to clinical arthritis in ACPA-positive individuals

T cell subset dysregulation in ACPA+ individuals predates the onset of IA, predicts the risk and faster progression to IA, with added value over previously published clinical predictors of progression.

Response to methotrexate predicts long-term patient-related outcomes in rheumatoid arthritis

The initial response to MTX is an independent predictor of PRO in RA as assessed after an average of 18 years, and a clinical improvement of at least 20 % 1 year after the initiation of MTX was associated with a favourable outcome in all three dimensions of the ICF.

Predicting methotrexate resistance in rheumatoid arthritis patients

Progress made in the area of MTX non-response/resistance in RA patients is described, with particular focus on application of the following elements as predictive markers: proteins related to MTX transport and function, intracellular MTX concentration, immune cell frequencies, cytokines, and clinical factors.

Predicting methotrexate resistance in rheumatoid arthritis patients

Progress made in the area of MTX non-response/resistance in RA patients is described, with particular focus on application of the following elements as predictive markers: proteins related to MTX transport and function, intracellular MTX concentration, immune cell frequencies, cytokines, and clinical factors.

Diagnosis and management of early inflammatory arthritis

In early DMARD naive IA, use of bDMARD may not be superior to csDMARDs with a treat-to-target approach; in patients with MSK symptoms, anti-CCP testing identifies individuals at risk of developing IA; additional biomarkers improve prediction and are feasible for clinical use.

The advances of methotrexate resistance in rheumatoid arthritis

The recent findings regarding the critical signaling pathways of MTXR in RA are discussed, which provide research targets and directions for a drug therapy that develop preventive strategies and effective treatments ofMTXR.


Investigations are needed to study the nature of heterogeneity of pathogenetic mechanisms of RA, to improve methods for monitoring disease activity and biomarkers for the efficiency of and resistance to therapy and to develop differentiation therapy, including those related to a search for new therapeutic targets.

Quantifying circulating Th17 cells by qPCR: potential as diagnostic biomarker for rheumatoid arthritis.

The epigenetic qPCR assay showed that low levels of Th17 cells were predictive of developing RA, particularly in the ACPA-negative patients, and suggest the recruitment of Th 17 to the inflammatory disease site, consistent with high CXCR4 expression.



Abnormal T cell differentiation persists in patients with rheumatoid arthritis in clinical remission and predicts relapse

IRC persistence in remission confirms their important role in chronic inflammation as circulating precursors of pathogenic cells and suggests that IRC are an acquired feature of RA.

A good response to early DMARD treatment of patients with rheumatoid arthritis in the first year predicts remission during follow up

A good response to treatment during the first year seems to be independently associated with remission rather than initial treatment alone.

Early rheumatoid arthritis is associated with a deficit in the CD4+CD25high regulatory T cell population in peripheral blood.

A smaller CD4+CD25high regulatory T-cell population in peripheral blood of individuals with early active RA prior to disease-modifying treatment is demonstrated, which may be a contributory factor in the susceptibility to RA and suggests novel approaches to therapy.

Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration.

RA patients with longer disease duration do not respond as well to treatment compared with patients with early disease, and female sex, prior DMARD use, disease functional class, and disease activity also have effects on the likelihood of patient response to treatment.

Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis.

There is a window of opportunity for highly successful treatment of RA in the first year, and especially within the first 3 months of therapy, indicating that early diagnosis and therapy may be the crucial step in achieving optimal control of disease progression and prognosis in RA.

Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-contro

Remission induction with infliximab plus MTX provided a significant reduction in MRI evidence of synovitis and erosions at 1 year, and functional and quality of life benefits were sustained, despite withdrawal of inflIXimab therapy, which may have significant implications for the optimal use of expensive biologic therapies.

CD4+ T-cell subsets in rheumatoid arthritis

T-cell subsets demonstrated interesting biomarker features that remain to be investigated in relation with early diagnostic, prognostic and prediction of treatment response in relation to rheumatoid arthritis.

Sex: a major predictor of remission in early rheumatoid arthritis?

Women had more severe disease with a considerably lower remission rate than men, although the disease activity before treatment seemed similar, and early remission of rheumatoid arthritis by 28-joint Disease Activity Score<2.6 was as frequent or more frequent in this study than in most previous reports.

Combination etanercept and methotrexate provides better disease control in very early (≤4 months) versus early rheumatoid arthritis (>4 months and <2 years): post hoc analyses from the COMET study

Treatment of VERA with ETN+MTX provides qualitatively improved clinical outcomes not seen with MTX monotherapy, supporting the pivotal role of TNF inhibition in early disease.

Outcome of intensive immunosuppression and autologous stem cell transplantation in patients with severe rheumatoid arthritis is associated with the composition of synovial T cell infiltration

The findings provide strong circumstantial evidence for a role of T cells in established RA, and demonstrate a role for the synovium in post-transplantation T cell reconstitution, which is associated with longlasting clinical responses in most patients.