Predicting the Future: Prognostication in Rheumatoid Arthritis

At baseline, these patients underwent MRI of the hands and feet and were evaluated for swollen joint count, positivity for rheumatoid factor and anti-citrullinated protein antibodies (ACPA), and elevation of C-reactive protein. The primary outcome measure was development of RA at one year of follow-up.

The researchers found that tenosynovitis, as seen on MRI in these patients, was independently associated with RA development, especially among patients with the absence of rheumatoid factor and ACPA. In patients without tenosynovitis in oligoarthritis or polyarthritis, essentially no progression to RA was seen.

These data are helpful in both preventing overtreatment and identifying patients at higher risk of progression to RA, although Dr. den Hollander noted that implementation of such routine use of MRI in real-world clinical practice may be challenging.

Dr. Alivernini

Synovial Tissue Macrophages

In the third lecture, Stefano Alivernini, MD, PhD, consultant in rheumatology, Catholic University of the Sacred Heart, Milan, Italy, talked about the transcriptomic signature of sustained remission in RA as seen in synovial tissue macrophages. Essentially, Alivernini et al. sought to evaluate the histological composition of synovial tissue in RA patients who were in sustained clinical and ultrasound remission.³ The researchers hoped to identify synovial biomarkers that are predictive of disease flares or, conversely, of disease remission using histology, macrophage phenotyping and spatial transcriptomics.

The researchers found that synovial tissue enhancement of macrophages positive for MerTK (a member of the Tyro-AxlMerTK family of receptor tyrosine kinases) was associated with remission maintenance in RA patients in sustained remission after treatment modification.

In addition, digital spatial profiling analysis revealed unique transcriptomic signatures of lining and sublining macrophages in patients in remission that are then associated with subsequent disease flare after treatment modification.

By understanding RA on this molecular level, researchers and clinicians may one day be able to identify features that predict maintenance of remission or high likelihood of relapse of disease.

2 New Antibodies

Dr. van der Woude

Later in the session, Diane van der Woude, MD, PhD, rheumatologist and head of the Outpatient Clinic, Leiden University Medical Center, the Netherlands, spoke about two new antibodies that may be relevant in patients with seronegative RA. Dr. van der Woude noted that antimalondialdehyde-acetaldehyde (antiMAA) antibodies have, in the past, been described in patients with seropositive and seronegative RA, osteoarthritis, systemic lupus erythematosus and a number of cardiovascular diseases.