Liquid biopsies to guide therapeutic decisions in rheumatoid arthritis

  • Roxana Coras
    Department of Medicine, School of Medicine, La Jolla, California

    University of California San Diego, San Diego, California

    Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
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  • Rekha Narasimhan
    Department of Medicine, School of Medicine, La Jolla, California

    University of California San Diego, San Diego, California
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  • Monica Guma
    Reprint requests: Monica Guma, Division of Rheumatology, Allergy and Immunology, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0663.
    Department of Medicine, School of Medicine, La Jolla, California

    University of California San Diego, San Diego, California

    Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
    Search for articles by this author
      Rheumatoid arthritis (RA) is a systemic, immune-mediated inflammatory disease that has transitioned from a debilitating disease to a chronic, controllable disease. This has been possible due to the introduction of new treatment strategies like “treat-to-target,” in which the clinician treats the patient aggressively enough to reach low disease activity or remission, and the introduction of new therapeutic agents, such as biological therapies, which can lead to the prevention of damage by early diagnosis and initiation of treatment. Attention is now being directed toward identifying the optimal treatment for each patient, one that will be the most efficient and have the least number of side effects. Much work has been done to find serologic and synovial biomarkers of response to various RA treatments. Proteomics, genomics and, in the past few years, metabolomics, have all been used in the quest of identifying these biomarkers. Blood-based liquid biopsies provide a minimally invasive alternative to synovial biopsies to identify cellular and molecular signatures that can be used to longitudinally monitor response and allow for personalized medicine approach. Liquid biopsies are comprised of cell-free DNA, immune circulating cells, and extracellular vesicles, and are being increasingly and successfully used in the field of oncology for diagnosis, progression, prognosis, and prediction of response to treatment. Recently, researchers have also begun investigating the usefulness of liquid biopsies in the field of rheumatology; in this review, we will focus on the potential of liquid biopsy blood samples as biomarkers of response to treatment in patients with RA.


      cfDNA (circulating cell-free DNA), CIC (circulating immune cells), DMARDs (disease-modifying disease drugs), ExV (extracellular vesicles), FLS (fibroblast-like synoviocytes), IFN (interferon), IL (interleukin), NSAIDs (nonsteroidal anti-inflammatory drugs), RA (rheumatoid arthritis), TNF (tumor necrosis factor)
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