Biomarkers: Steps towards personalized medicine in RA

22 August 2016

Dr Marwan Bukhari (UK) explains how recent advances in biomarkers will build on existing knowledge to improve safety and efficacy of treatment for rheumatoid arthritis.

My name is Marwan Bukhari and I'm a Rheumatologist in the Northwest of England; working at the Royal Lancaster Infirmary in the south end of the Lake District. 

My interest is in biomarkers for rheumatoid arthritis. The reason that I think they are very interesting and worth looking at, especially at national and international meetings, is that you now have a concept that patients should have personalized medicine that you use just for that specific type of patient. The more you know about your patient the more you can stratify them to give a treatment that can therefore be quite powerful and effective, but can also be quite toxic, and knowing which patients you need to give the treatment to is actually quite important. Some of the biomarkers have been used for quite a long period of time, including rheumatoid factor and CCP as either a positive or negative to stratify patients for severity and maybe features of disease as well as for severe disease.

Nowadays, we have much more important markers, including markers that will tell you more about your patient. An example of this is the levels of rheumatoid factor and anti CCP antibodies. If you stratify patients by these you can then see which patients will respond to treatment better, and we know for a fact that drugs, for example like rituximab at abatacept, will have a better response with higher levels of rheumatoid factor and CCP. On the other hand, you also can look at other types of newer biomarkers, for example the NDBA or the vector chip, which doesn't just tell you that you have the disease, it tells it you will have severe disease, that you will need to treat the patient with larger amounts of medication, and you can stratify your patient from early on. One of the newer biomarkers currently around is 14-3-3 eta that you can now use not just to diagnose arthritis, but to look at patients who will progress and will have severe disease. Therefore, you can escalate the treatment for these patients quite easily. 

I think the future is going to be us looking at a combination of all of these markers. They might include genetic markers, single-nucleotide polymorphisms, and other ways that we can then combine them differently to see which set of patients will respond. Hopefully this will result in us being able to find a chip that you put a drop of blood on and you'll be able to tell the patient which sort of drug will suit them. I think that this will be the future and we are hoping to see it in my professional lifetime.