Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Experts Discuss the Latest Precision Medicine Research

Susan Bernstein  |  Issue: February 2018  |  February 18, 2018

Personalized immunomonitoring, or studying gene expression profiles to identify molecular pathways linked to disease activity, was used in a recent pediatric SLE study.6 Researchers looked at 486 gene transcripts in 158 pediatric lupus patients and 48 healthy controls, and found that children with elevated disease activity had specific interferon and plasmablast signatures.

Because lupus is highly heterogeneous, “each individual patient seems to have different modules that may be important to their disease and their disease activity,” said Dr. James. Transcriptional immunomonitoring is an intriguing tool for lupus research, but “the challenge is that some parts of these modules are driven by genetics, which can lead to constant changes in the modules for subsets of patients. Concurrent infections can also change expression in some modules, so additional investigation, especially in adult patients, can help the practicing clinician know if we can stop the patient’s therapy, or if a patient needs more aggressive therapy.” Additional modules may also help identify patients at higher flare risk before they come into the office, she said.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Current research on soluble mediators, such as complements, autoantibodies, cytokines, chemokines and shed receptors, may help complete the puzzle. In a 2017 study of African-American lupus patients, researchers found soluble mediators that suggested which patients were about to flare.7 This research could help develop an algorithm or “soluble mediator score” to help select patients for future clinical trials, or point to which patients need therapy modifications, she said.

Precision Medicine in JIA

Rheumatology currently views pediatric and adult arthritis as two separate disease families, but they should be viewed as a continuum, said Peter A. Nigrovic, MD, director at the Center for Adults with Pediatric Rheumatic Illness at Brigham and Women’s Hospital, and associate professor of medicine at Harvard Medical School, both in Boston, Mass. Further, using GWAS data to identify similar forms of arthritis across age groups may lead to better understanding of disease mechanisms, he said.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

“Adult and pediatric arthritis have historically been described using totally distinct nomenclatures, and this has had consequences,” said Dr. Nigrovic. “Treatment algorithms begin with naming the disease for which they are intended to be used. Insurers approve medications for some diseases and not others. Researchers include only patients with a particular disease in their studies. Any attempt at precision medicine therefore requires that we get the nomenclature right. But it’s not easy to decide what goes with what.”

Disease classification should anchor on the “primacy of pathogenesis,” encompassing genetics and biological features as well as clinical phenotype, he said. As researchers dig more deeply into patient subgroups, both similarities and differences emerge. “Seropositive and seronegative RA are distinguished not only by the presence of certain autoantibodies, but also by the presence of immune complexes and complement fixation in joints, by the abundance of specific T cells in synovial tissues, and by environmental and genetic risk factors. Spondyloarthritis describes another family, with a distinct gender ratio and pattern of affected joints, the prevalence of enthesitis, and the prominent genetic association with HLA-B27.”

Page: 1 2 3 4 5 6 7 8 9 10 | Single Page
Share: 

Filed under:Meeting ReportsRheumatoid ArthritisSystemic Lupus Erythematosus Tagged with:ACR/ARHP Annual MeetingArthritisbig dataGenetic researchgenomicsLupusPrecision MedicineRheumatoid arthritis

Related Articles
    Gene Manipulation Has Potential to Alter Genomes, Impact Society

    Gene Manipulation Has Potential to Alter Genomes, Impact Society

    January 19, 2016

    Every so often, a major scientific breakthrough profoundly alters the trajectory of scientific research. In the 1960s, microbiologists sparked the recombinant-DNA revolution with the discovery that bacteria have innate immune systems based on restriction enzymes. These enzymes bind and cut invading viral genomes at specific short sequences, and scientists rapidly repurposed them to cut and…

    Switches That Regulate Gene Expression Offer Better Understanding of Rheumatic Disease Say Experts at the 2013 ACR/ARHP Annual Meeting

    March 1, 2014

    New studies examine why turning on or off switches in genes that control the genome can contribute to pathogenesis of such autoimmune diseases as systemic lupus erythematosus or rheumatoid arthritis

    Genome-Wide Association Studies of SLE

    February 12, 2011

    What do these studies tell us about disease mechanisms in lupus?

    Advances in Precision Immunology Require Precision Controls to Further Research

    October 17, 2017

    CHICAGO—During the 2017 annual Federation of Clinical Immunology Societies (FOCIS) meeting, a session focused on precision immunology and its advances. Precision immunology describes the identification of host, immune system and tumor factors that can be used to select an immunotherapy approach. Thus, the first step in precision immunology is to identify soluble factors, immune cell…

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences