Biopsy of inflamed tissues: new perspectives for rheumatoid arthritis

Studying synovial tissue inflammation

Research underway at various Italian and international universities focuses on the useful indications derived from synovial tissue biopsy. This study could predict disease remission and how to maintain it over time, offering new treatment possibilities for patients who do not achieve remission despite advanced drug therapies.

Research objectives

The main objective of these studies, supported by the Italian Foundation for Arthritis Research (FIRA), is to provide more effective solutions for patients with rheumatoid arthritis who do not achieve disease remission despite the various treatments available. This approach is based on studying synovial tissue inflammation, which could predict remission and maintain it over time.

Challenges in managing rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disease affecting about 1% of the population, causing joint pain and swelling. Despite the numerous available drugs, not all patients achieve sustained clinical remission. Current therapies show unsatisfactory remission rates: conventional drugs guarantee remission in 40-50% of patients, while biologics in 40% of the rest. Only 10-20% of patients achieve prolonged remission without drugs for more than two years.

New frontiers of research

Recent studies, supported by FIRA, have shown that different profiles of synovial inflammation are associated with different responses to pharmacological treatments. In particular, studies on cohorts of patients in Italy and England have highlighted that the degree of synovitis correlates with the response to methotrexate, one of the first-line therapies.

Histological and genetic analyses

Histological analyses of synovial tissue allow objective quantification of inflammation, while advanced techniques can analyze the genetic signature of individual cells. These studies pave the way for new tools to address disease heterogeneity, increasingly approaching precision medicine in managing rheumatoid arthritis.

Ongoing multicenter studies

A new multicenter study, supported by FIRA, involves several universities in Italy, Spain, and the United Kingdom. This study is evaluating the predictive power of multimodal analysis of synovial tissue in patients with clinically remitted rheumatoid arthritis. The goal is to guide therapeutic choices to eliminate the risk of disease recurrence when pharmacological treatment is reduced or stopped.

Future perspectives

In recent years, many strides have been made in managing rheumatological diseases. Studying the molecular profile is an important tool for achieving increasingly personalized and effective treatments. It is hoped that these results can soon be translated from research to patient care.