Artritis reumatoide

Research Progress Related to Rheumatoid Arthritis

Over the last several decades, research has greatly increased our understanding of the immune system, genetics, and biology. This research is now showing results in several areas important to rheumatoid arthritis. Scientists are thinking about rheumatoid arthritis in exciting ways that were not possible years ago.

Genetics

NIAMS-supported researchers have identified several genetic factors that predispose some people to develop rheumatoid arthritis, as well as factors connected to disease severity. Scientists know that more than one gene is involved in determining whether a person develops rheumatoid arthritis and how severe the disease will become.

An international research team identified dozens of new areas in the human genome associated with rheumatoid arthritis and found that many are already the targets of drugs approved for other conditions. The findings hint at new treatment approaches for the disease.

Researchers are investigating the potential connection between health, disease, and the human microbiome, which is the entire population of microorganisms that inhabit the human body. One study found that the presence of a specific type of gut bacteria correlated with rheumatoid arthritis in newly diagnosed, untreated people. The finding suggests a potential role for the bacteria in the disease.

The Disease Process

NIAMS intramural researchers are studying the natural history of rheumatoid arthritis in children and adults in an effort to understand how the disease progresses and impacts patient symptoms and functional status.

Investigators are also exploring whether patients with rheumatoid arthritis in remission while taking tumor necrosis factor-alpha (TNF-α) inhibitors can remain in remission after withdrawal of these medications. In addition, investigators are attempting to identify predictors of relapse in these individuals.

Scientists are continuing to understand the molecular underpinnings of rheumatoid arthritis and are working to develop tests that could help diagnose rheumatoid arthritis earlier and identify patients who would benefit most from specific treatments.

New Therapies

Researchers continue to identify molecules that appear to play a role in rheumatoid arthritis and thus are potential targets for new treatments. The path between identifying the molecule and developing a drug that targets it is long and difficult. Fortunately, this path has been successfully negotiated, and new drugs have emerged that successfully reduce symptoms and damage in rheumatoid arthritis. Researchers continue to identify more candidate drugs, with hopes that these will have fewer side effects or will cure more patients.

• Tofacitinib: Tofacitinib, approved for the treatment of rheumatoid arthritis in 2012, was from a new class of drugs developed to target Janus kinases. One member of this family, JAK3, was discovered in the early 1990s by a National Institutes of Health (NIH) laboratory at the NIAMS. Subsequent studies carried out at the National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the NIAMS, showed that genetic defects in JAK3 can cause severe combined immunodeficiency. This discovery led to the idea that drugs blocking Janus kinases would suppress the immune system and might be protective against the damaging inflammation of rheumatoid arthritis and certain other autoimmune diseases.
• NIH AMP Program: The NIAMS is leading the Accelerating Medicines Partnership in Rheumatoid Arthritis and Lupus (AMP RA/Lupus). The goal of this program is to integrate data from multiple genome-wide analytic approaches to generate a comprehensive understanding of the mechanisms of tissue damage in rheumatoid arthritis and lupus.
• Joint inflammation: NIAMS-funded researchers have determined that joint inflammation can continue in rheumatoid arthritis, even after clinical symptoms have eased. This finding may help doctors determine when a patient is truly in remission and can safely stop treatment.