Arthritis

A study in to Rheumatoid Arthritis

Overview

Our researchers are currently working on assessing and improving the treatment and prevention of a number of diseases which affect the joints, including rheumatoid arthritis and osteoarthritis.

Models are being developed using both genetic testing and lifestyle information to predict which individuals are at the highest risk of developing rheumatoid arthritis. Once an accurate model is developed we will be able to conduct clinical trials into the prevention of this disease in high risk individuals.  

In the field of treatment we are testing different types of therapy and evaluating new ways of measuring response to treatment, such as MRI imaging in osteoarthritis trials. Our researchers co-ordinate a number of national registers, in which patients are being treated with new biologic agents. We are also assessing the safety of these drugs and older drugs such as steroids, as well as trying to establish which patients respond using genetic and disease specific measures.

Problem

Rheumatoid arthritis is the most common form of inflammatory arthritis.  Currently finding the best treatment for each individual patient is still a matter of ‘trial and error’. Methotrexate (MTX) is usually the first drug to be used, which many patients respond well, however some develop with side effects of nausea, vomiting, liver abnormalities and bone marrow suppression, and need treatment with a biologic agent.  Any delay in finding an effective treatment may result in permanent joint damage. 

What we have achieved to date

In this study, which is co-ordinated from Manchester, but recruiting nationwide. We aim to develop a composite score based on demographic, genetic, clinical and psycho-social factors, for prediction of clinical response to MTX at six months, in patients with RA. This will increase the likelihood of suppressing the disease activity within the first few months which is critical to the long term health of joints.

What we aim to achieve

Our study will be investigating over one thousand patients with RA who are starting on MTX. We will be investigating over one thousand patients with rheumatoid arthritis who are starting on methotrexate. Patients will be either starting MTX as monotherapy or in combination with other DMARDs including oral steroids, for the first time.

Blood will be taken for genetic testing (RNA and DNA extraction) and measuring of other factors. The first sample is taken before they take their first dose of MTX and then assessed again at 3, 6 and 12 months for response to the drug as well as adverse events. An assessment is also conducted via a questionnaire, around psychological variables, such as the patient’s beliefs in whether the drug will work and whether they take the medication. Other assessments also include the Health Assessment Questionnaire and the beliefs and medication questionnaire (BMQ).

Patients are to record their MTX and folic acid dosage every week as well as mode of administration and any adverse events or changes in medication for 12 months. 

Genetic, biochemical and psycho-social variables will be tested singly and in combination for their ability to predict response and/or adverse events. Depending on the relative contributions of the variables, strategies will then be developed to improve response or to by-pass MTX therapy in those in whom non-response or adverse reactions can be reliably predicted.