Overview: imaging, biomarkers and arthritis

Excerpt

The recent introduction of effective structure-modifying therapies for rheumatoid arthritis (RA) has changed the way that rheumatologists manage patients with RA, and this has created new demands on imaging and biochemical markers both in clinical practice and in clinical research. Among other things, it has shifted therapeutic strategy towards early, aggressive treatment before the onset of erosive joint damage in order to prevent irreversible functional disability. Additionally, it has made it unethical to withhold active therapy and therefore to perform true placebo-controlled clinical trials. This has necessitated using active comparator study designs instead, which require more patients, more clinical sites and longer studies to test the efficacy of putative new therapies. This adds time and cost to drug development, which slows progress and potentially raises the cost of new therapies that do get approved. Enriching study populations with rapidly progressing patients may offset some of this effect, but this necessitates the availability of prognostic markers that can accurately identify which patients are most likely to develop erosive damage and functional disability. This can be challenging in early RA, as 30% or more of the patients in early RA cohorts do not progress. Early prognosticators are also needed by clinical practitioners to determine which patients need aggressive treatment before the narrow window of opportunity for containing erosive disease closes. …