RhEumatoid Arthritis SynOvial tissue Network (REASON)

 描述（由申请人提供）：我们对类风湿性关节炎（RA）发病机制的免疫学和遗传学机制的理解已经取得了实质性进展。虽然传统的疾病缓解抗风湿药物（DMARDS）是有效的，但超过65-75%的患者对这些治疗没有反应。即使联合抗TNF治疗，也不超过50%的患者达到缓解。多达50%的抗TNF难治性患者也是二线治疗的不充分应答者。更引人注目的是，24%的RA患者甚至没有表现出对任何治疗的最低水平的反应。因此，鉴定可能对抗TNF治疗或其他生物治疗有反应的患者将在医学上和经济上极大地有益于患者。然而，由于以下事实，在RA中缺乏生物标志物来确定针对给定患者的最有效疗法： 在美国，很少有医疗实践检查滑膜组织，因为这需要活检，而活检在医学上可能不是必需的。在过去的几年中，超声技术已成为美国流变学实践中的重要工具。最近，微创超声引导下的滑膜活检显示出很大的希望，因为与该手术相关的并发症很少甚至没有。虽然这种方法在整个欧洲被广泛接受，但在美国还没有成为风湿病学家的普遍做法。为了解决美国这一未满足的需求，我们组建了一个由领先的学术风湿病学团体组成的联盟，其中包括亚拉巴马伯明翰大学、哥伦比亚大学、马约诊所、华盛顿大学、密歇根大学和西北大学，以形成风湿性关节炎滑膜组织网络（REASON）。因此，我们将在美国创造新一代的风湿病学家，他们将进行微创超声引导的滑膜活检，这对于从RA的所有阶段（早期，建立，DMARD或生物学反应不足）的患者中获得滑膜组织至关重要。这些组织将由REASON技术中心的研究人员进行分析，他们将使用这些材料进行翻译研究，以确定可能预测治疗反应的新途径和潜在生物标志物。

 DESCRIPTION (provided by applicant): Substantial advances have been made in our understanding of the immunologic and genetic mechanisms that contribute to the pathogenesis of rheumatoid arthritis (RA). Although traditional disease modifying anti- rheumatic drugs (DMARDS) are effective, over 65-75% of patients do not respond to these therapies. Even with combination with anti-TNF therapy, no more than 50% of patients achieve remission. As many as 50% of anti-TNF refractory patients are also inadequate responders to second-line therapies. More strikingly, 24% of RA patients do not even demonstrate a minimal level of response to any therapy. Thus, identifying patients that may respond to anti-TNF therapy or other biologic therapies would greatly benefit the patient medically and economically. However, there is a lack of biomarkers in RA to identify the most effective therapy for a given patient due to the fact that few medical practices in the United States examine synovial tissue, as this requires a biopsy, which may not be medically necessary. Over the past several years ultrasound technology has become an important tool in the practice of rheumatology in the United States. Recently, minimally invasive ultrasound guided synovial biopsies have shown great promise, as there are minimal to no complications associated with the procedure. While this procedure is widely accepted throughout Europe, it has not become a common practice for rheumatologists in the United States. To address this unmet need in the United States, we have assembled a consortium of leading academic rheumatology groups which include the University of Alabama Birmingham, Columbia University, Mayo Clinic, Washington University, University of Michigan, and Northwestern University to form the RhEumatoid Arthritis SynOvial tissue Network (REASON). Thus, we will be creating a new generation of rheumatologists in the United States who will perform minimally invasive ultrasound guided synovial biopsies that is critical for obtaining of synovial tissue from patients at all phases of RA (early, established, DMARD or biologic inadequate response). These tissues will be analyzed by researchers at REASON technology sites who will use this material for translational studies to identify novel pathways and potential biomarkers that might predict therapeutic response.