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Optimising treatment in rheumatoid arthritis: a review of potential biological markers of response
  1. P Emery1,2,
  2. T Dörner3
  1. 1Division of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, NHS Trust, Leeds, UK
  3. 3Charité Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Professor Paul Emery, Arthritis Research UK, Division of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; p.emery{at}


Following a greater understanding of the pathogenesis of rheumatoid arthritis (RA), the treatment of this chronic disease has improved with the availability of biological agents targeting key molecules. Despite this, initial treatment produces an inadequate response in many patients and guidance on the optimal treatment for these patients is needed. Research in specific patient populations aims to define predictive biomarkers of response to identify those patients most likely to benefit from treatment with specific agents. Although there have been conflicting results from studies of various genetic markers, single nucleotide polymorphisms in the tumour necrosis factor (TNF) −308 promoter region may play a role in response to specific TNF inhibitors. Microarray analysis of mRNA expression levels has identified unique sets of genes with differentially regulated expression in responders compared with non-responders to the TNF inhibitor infliximab. Of the various protein biomarkers studied, rheumatoid factor and/or anticitrullinated protein autoantibodies may have a future role in predicting response or guiding the order in which to use biological agents. Further research is needed with larger, well-designed studies to clarify the current understanding on the role of biomarkers in predicting treatment response in RA to help guide clinical decision-making. Individualised treatment has the potential to improve the therapeutic outcomes for patients.

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  • Competing interests Professor Emery has provided expert advice and undertaken clinical trials for Merck/Pfizer/Abbott/BMS/Roche/Novartis and Professor Dorner's disclosures are Study support, speaker's and consultation honoraria by Roche, Chugai and UCB.

  • Provenance and peer review Not commissioned; externally peer reviewed.