The future of rheumatoid arthritis: how genes, lifestyle and environment factor in

All epic journeys have to start somewhere, but sometimes the beginning of the road is not so smooth.

When Dr. Ronald van Vollenhoven, a Dutch researcher, arrived at Stanford University in the early 1990s, he was energized by a new challenge.

He’d spent the last several years in a lab at Cornell University studying the immune system, and now he had landed a fellowship that would allow him to apply his knowledge in the real world, treating patients with rheumatoid arthritis (RA).

After his first few weeks of training, Van Vollenhoven realized how difficult the job would be. He was disheartened by how many waiting rooms he saw filled with people experiencing serious pain and crippling joint damage that left them dependent on wheelchairs, crutches or braces.

While doctors and researchers knew quite a bit about rheumatoid arthritis at that time, they still only had a few tools available to help patients.

But changes were on the horizon.
 

A better option: biologics

By the early 2000s, with the advent of biologic medicines — new, more complex medicines manufactured using living cells — those waiting rooms began to look a lot different.

“There was an incredible change in how rheumatology was practiced and what rheumatology was like in the clinic. It was a very exciting time,” Van Vollenhoven says. “Today, if you walk into a waiting room in a clinic and you look around, on some days you start wondering if the patients came to the right place because they all look so healthy.”

The use of biologics made it possible for doctors to better manage RA patients’ symptoms and even slow down the disease’s progression.

But this transformation in treating RA left Van Vollenhoven and many others thinking: What could be next? How can we do more to get ahead of RA?

Looking at what’s on the horizon

For many in the scientific community, unlocking a deeper understanding of the patient, the impact of the environment and the disease may spur the next advance in treating RA. Today, scientists know more about RA than they did 30 years ago, but the cause of the disease is still officially unknown.¹

One major area of focus is how genetics could play in helping to get ahead of RA.

“We all have genetic traits that make us who we are. Some of these genes have mutations, which can lead an individual to be predisposed to a disease,” says Lisa Olson, vice president of immunology research, AbbVie. “But compared to cancer — where you can sequence a tumor and compare it to normal tissue to see what is different — it can be much more difficult to determine which genes are responsible in a complex disease like rheumatoid arthritis.”

Understanding the role of gene mutations will not explain it all; environmental and lifestyle decisions are also likely involved in whether an individual develops RA.

Certain environmental or lifestyle components — like obesity, diabetes and cigarette smoking— can play a role in development or progression of a disease.² Many scientists argue that exposure to environmental factors like these could trigger the onset of RA in people who are more likely to develop the disease because of their genetic profile.

As the broader scientific community is working to understand the origins of RA to help get ahead in treating the disease, clinicians and researchers are also looking for ways that the disease could be identified and treated earlier.

Finding biological markers that help identify the presence of disease is an active area of interest in RA. Across many other fields of medicine like oncology and neurology, biomarkers are used to diagnose disease and help select the right treatments for patients.

“My vision is that one day we’ll have many treatment options and the ability to match the right patient to the right medicine,” Olson says.

While a number of different biomarkers are being investigated in RA, they aren’t yet robust enough to help answer the question of whether a patient should receive one medicine or another.³

But biomarkers can do much more; measuring biomarkers can also let researchers know whether or not a medicine is working as intended and allow them to more quickly identify patients who are a good fit for clinical studies.

Having an answer for every person with RA is the ultimate pursuit.

“There are definitely exciting developments and new research happening every day,” Van Vollenhoven says. “And we won’t be completely happy until the last patient is doing very well.”