Pathobiology of Early Arthritis Cohort (PEAC)

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Rheumatoid arthritis (RA) is a diverse disease with some patients suffering from a mild disease while others develop a more aggressive course. At present it is impossible to predict from the outset the final disease outcome. Expert opinion favours the use of aggressive treatment in all patients with early RA including the use of the new biological agents (magic bullets). Given the high costs of these drugs (#10,000/year/patient) and their potential toxicity it is imperative to tailor early treatment to patients most at risk of poor outcome. In some other inflammatory conditions such as kidney diseases specific treatments are guided by the severity of the tissue pathology determined following examination of the tissue under the microscope. We propose to validate and use the same concept to treat patients with RA. Patients would have a small piece of tissue (synovial biopsy) taken from the joint at disease outset that will be analysed for specific features that might give clues on the severity of the disease enabling doctors to target specific therapies to those most in need. This together with studying biological markers in the blood and urine of these patients will enable scientist to investigate potential causes regarding the origin, evolution and treatment of arthritis. It is hoped that the elucidation of key pathways involved in the perpetuation or resolution of inflammation will lead to the development of new drugs (and/or the testing currently available drugs in a better way) that will facilitate induction of remission in the majority of patients. This in turn will result in less joint damage and consequent disability with considerable alleviation of suffering for patients and their family as well as reduction of the health-economic burden on the NHS and society in general.