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New approach to Rheumatoid Arthritis

(Southern Health News, February 2017)

New approach to rheumatoid arthritis aims for drug-free remission

Southern Adelaide Local Health Network researchers are trialling a unique ‘target and treat’ approach to the debilitating disease, Rheumatoid Arthritis (RA).

The research aims to develop individualised treatments that will take the guess work out of managing the disease and see patients given the most effective treatment.

The study, called the ARBITRATE study (arthroscopic synovial biopsy based targeted biologic therapy versus conventional therapy in adults with RA), has set a high bar for the targeted treatment - drug free remission.

“This approach has never been attempted in patients with rheumatoid arthritis before. If successful, it is probable that the study will lead to a paradigm shift in the way RA is currently treated,” said Dr Mihir Wechalekar, a Consultant Rheumatologist for the Southern Adelaide Local Health Network.

This and other research work involving the Repatriation General Hospital-based synovial tissue lab - one of very few such laboratories world-wide and the only of its kind in Australia- has generated intense interest in the upcoming area of personalised and precision medicine, and has engendered highly successful international and national collaborative partnerships.  Dr Wechalekar recently earned funding to expand this work further, including funding to appoint a new research scientist to work in the Repatriation General Hospital Rheumatology laboratory.

“Our research aims to treat patients on the basis of what is driving their disease, rather than best guess, which is the current approach,” Dr Wechalekar said.

Patients in the study will be placed in one of two groups: one group receiving traditional oral drug therapy and the other group receiving therapy on the basis of the result of analysis of their joint lining. The latter group will be treated with injectable drugs called biologic disease-modifying anti-rheumatic drugs (DMARDs) or biologics, that are designed to target a particular component of the inflammatory pathway.

Dr Wechalekar said while biologics have been a major therapeutic advance in the treatment of rheumatoid arthritis, they can be associated with an increased risk of toxicity, such as serious infection, and have relatively poor rates of remission and improvement in function.

“Rheumatoid arthritis is a diverse and complex disease, so one explanation for these low response rates may lie in the current non-targeted, best-guess, or ‘trial and error’ use of biologic DMARDs,” Dr Wechalekar said.

“Our target and treat approach, where treatment decisions are based upon individual patient factors such as synovial biopsy findings, could provide rationale for the choice of biologics. We propose that this personalised use of biologic DMARDs has the potential to improve disease outcomes in rheumatoid arthritis, and thereby improve short and long term morbidity and disability.”

The study is currently recruiting for patients. For more information, contact Dr Mihir D Wechalekar, Rheumatology Consultant, Rheumatology Unit, Repatriation General Hospital. Phone 8275 1819, Fax 8374 4276.

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