In January 2020, doctors flocked to the ACR Winter Symposium to discuss new trends, treatments, and burgeoning research within the field of rheumatology. Dr. Jeffrey Curtis, MD, MS, MPH presented on the use of precision medicine in treating rheumatoid arthritis. The Rheumatologist notes that effective treatment requires hitting the sweet spot: the right therapeutic option given at the exact right time.

According to Dr. Curtis, precision medicine uses a blend of data to predict incidences in rheumatoid arthritis, which allows for earlier, better, and more focused treatment. Check out his presentation, as well as other abstracts from varied ACR meetings and symposiums, from the American College of Rheumatology Archives.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder which impacts joints throughout your body. There is no known cause for RA. However, it occurs when the immune system mistakenly attacks healthy tissue around your joints, leading to pain and inflammation.

For some people, rheumatoid arthritis steadily progresses. But for others, the symptoms plateau and the condition doesn’t worsen. Generally, though, symptoms come and go. The onset of symptoms is called a flare, while a period without symptoms is called remission. Rheumatoid arthritis is more prevalent in females.

Symptoms include:

• Fatigue
• Anemia (low levels of red blood cells)
• Dry mouth
• A “pins and needles” sensation, where the tingling occurs around the joints
• Swollen or bumpy fingers
• Skin redness
• Joint swelling, stiffness, weakness, tenderness, and pain
• Muscle aches
• Bone erosion and joint deformity

Read more about rheumatoid arthritis.

The Presentation

Rheumatoid Arthritis Data

Dr. Curtis believes that targeted rheumatoid arthritis treatment depends on 3 types of data:

• Clinical: This data is collected during routine patient care, or through clinical trials. It includes clinical trial data, claims, patient and disease registries, administrative data, health surveys, and electronic health records (EHRs).
• Biomarker: Biomarkers, or “biological markers,” are measurable signs or characteristics that provide insight into one’s health. For example, biomarkers may include blood pressure, cholesterol levels, or sweat chloride.
• Omics: According to Evolution of Translational Omics, omics are “the scientific fields associated with measuring [molecular measurements within a tissue or cell/biological molecules] in a high-throughput way.” Thus, omics data can be sourced from many areas of research. These include genomics and epigenomics, proteomics, lipidomics, metabolomics, and transcriptomics.

a special type of disease-modifying anti rheumatic drug (DMARD)…prescribed when conventional DMARDs have not worked. Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation.

So, TNF inhibitors are considered biologics. Additional biologics include interleukin inhibitors, B-cell inhibitors, and selective co-stimulation modulators. While these therapies are often effective, they do suppress your immune response. So, it is easier to get infections.

Dr. Curtis believes that research can predict the way that patients with rheumatoid arthritis will respond to biologic drug treatment. For example, studying bodily tissue can help researchers identify biomarkers associated with treatment response. Tracking macrophages, a type of white blood cell that appears at the side of infection or inflammation, also allows researchers to track disease response. Learn more in a 2019 study published in Mediators of Inflammation.

Utilizing RA Data

Data plays a crucial role in understanding and treating conditions like RA. But how can data be ethically shared between researchers and clinicians without violating patient rights?

Well, says Dr. Curtis, clinical data registries are one option. The American College of Rheumatology’s RISE registry is a great example. This HIPAA-compliant registry helps rheumatologists to:

[adapt] to new payment and delivery models, [meet] evolving certification requirements, and [use] EHR data to assess quality of care. There are more than 680 providers representing more than 1 million patients participating in RISE.

Sharing data helps doctors compare and contrast certain aspects of a disease or condition, as well as its treatment response. Not every patient reacts the same way. So this data allows doctors to understand how – and why – deviations in response occur.

In fact, this is the basis of precision medicine, the idea that Dr. Curtis is championing. Precision medicine separates from the idea that one treatment fits all patients. Rather, it takes into account patient lifestyle, age, genes, environment, and other factors. This helps to target certain treatments towards certain groups.

An article in Arthritis Care & Research shows that up to 2/3 of patients with rheumatoid arthritis did not change treatment plans, even with recurrent and severe symptoms. Sharing data, and finding ways to present it to patients, will not only engage patients in their care but allow them to understand why different treatments might benefit them.

The Importance of Doctor-Patient Communication

Throughout this presentation, Dr. Curtis emphasizes the importance of clear, open doctor-patient communication. This builds trust while keeping patients’ needs as the main focus. To maximize communication, Dr. Curtis suggests:

Building a relationship with patients. As doctors, it is important to strive for good patient outcomes and to provide the highest level of care. But focusing only on data or outcomes removes the patient focus. This means:

[making] sure your patients understand that you care about them as a whole patient, “not just inflamed joints and skin.”

Understanding patient treatment goals. Patients understand their health and want to do what’s best. So they might have questions about changing treatments, or specific goals they are striving for. Additionally, some patients will not want to deal with the potential side effects of a new treatment. Learning what the patient is seeking will allow doctors to better personalize treatment.

Using different data collection tools. Tools such as the PROMIS system allow patients to report data such as pain and anxiety levels, mental health, physical function, and social activities. This allows researchers to understand what data is most important to patients. These tools, such as questionnaires, reduce the time commitment for patients as they can be performed online.