Biomarkers to guide clinical therapeutics in rheumatology?

Abstract

Purpose of review The use of biomarkers in rheumatology can help identify disease risk, improve diagnosis and prognosis, target therapy, assess response to treatment, and further our understanding of the underlying pathogenesis of disease. Here, we discuss the recent advances in biomarkers for rheumatic disorders, existing impediments to progress in this field, and the potential of biomarkers to enable precision medicine and thereby transform rheumatology. Recent findings Although significant challenges remain, progress continues to be made in biomarker discovery and development for rheumatic diseases. The use of next-generation technologies, including large-scale sequencing, proteomic technologies, metabolomic technologies, mass cytometry, and other single-cell analysis and multianalyte analysis technologies, has yielded a slew of new candidate biomarkers. Nevertheless, these biomarkers still require rigorous validation and have yet to make their way into clinical practice and therapeutic development. This review focuses on advances in the biomarker field in the last 12 months as well as the challenges that remain. Summary Better biomarkers, ideally mechanistic ones, are needed to guide clinical decision making in rheumatology. Although the use of next-generation techniques for biomarker discovery is making headway, it is imperative that the roadblocks in our search for new biomarkers are overcome to enable identification of biomarkers with greater diagnostic and predictive utility. Identification of biomarkers with robust diagnostic and predictive utility would enable precision medicine in rheumatology.

Mechanisms of central tolerance for B cells

“…Serological analysis has established that certain autoantibody profiles are diagnostic for, and sometimes predictive of, diseases such as SLE, rheumatoid arthritis and type 1 diabetes 117 . For many years, researchers have attempted to identify and enumerate autoreactive B cells using techniques such as Epstein–Barr virus transformation 118 , tracking the usage of V genes that are biased to be autoreactive 119 , and flow cytometry or cloning approaches 120,121 .…”

Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies

“…As the inflammatory markers ESR and CRP are not specific to RA, they cannot be expected to be highly predictive. Therefore, novel mechanistic biomarkers that are directly involved in the disease pathogenesis are being increasingly investigated [19]. …”

Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis

“…In the second group, the disease development is associated with the changes in proteins that are detected by proteomics, defining the clinical disease markers, which indicate state of progression, severity and location of the disease [10]. In the third group, the treatment of a disease may point out therapeutic biomarkers, associated with a specific changing pattern after the drug administration [11]. Taking together these observations, a combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment.…”

“…Taking together these observations, a combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers [7][8][9][10][11], a significant amount of this information is not integrated on standard clinical care.…”