Pathobiology of Early Arthritis Cohort (PEAC)

类风湿性关节炎（RA）是一种多样的疾病，一些患者患有轻微的疾病，而另一些患者则发展为更严重的疾病。目前还不可能从一开始就预测疾病的最终结果。专家意见赞成对所有早期RA患者采用积极治疗，包括使用新的生物制剂（魔弹）。鉴于这些药物的高成本（每年每名患者10,000美元）及其潜在毒性，必须针对预后不良风险最高的患者量身定制早期治疗。在其他一些炎症条件下，如肾脏疾病，具体的治疗是根据显微镜下组织检查后确定的组织病理学的严重程度来指导的。我们建议验证并使用相同的概念来治疗RA患者。患者将在疾病开始时从关节上取一小块组织（滑膜活检），分析其特定特征，这些特征可能为疾病的严重程度提供线索，使医生能够针对最需要的人进行特定治疗。这与研究这些患者血液和尿液中的生物标志物一起，将使科学家能够调查有关关节炎的起源，演变和治疗的潜在原因。人们希望，对炎症持续或消退的关键途径的阐明将导致新药的开发（和/或以更好的方式测试现有药物），从而促进大多数患者的缓解。这反过来将减少关节损伤和由此造成的残疾，大大减轻患者及其家属的痛苦，并减轻国民保健制度和整个社会的健康经济负担。

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.