This study will be an open label observational prospective study assessing the clinical efficacy of antiTNFα therapy and the alteration/impact on the synovial tissue, with specific regard to lymphoid aggregation, over a period of 12 months in patients with rheumatoid arthritis. Rheumatoid arthritis (RA) is one of the most important chronic inflammatory disorders in the UK. It affects approximately 1% of adults and causes considerable morbidity, substantially reduces quality of life and has a significant mortality. It results in large direct medical costs as well as extensive indirect social costs. Despite the significant therapeutic progress following the introduction of antiTNFα, a cure for RA is still elusive. At present the reasons for the variation in clinical response are not known. The main aim of this study is to test the hypothesis that there are distinct molecular and cellular phenotypes present within the synovial tissue that define specific disease subsets and provide characteristic prognostic implications. In particular, the aim is to assess the relationship between the presence of ectopic lymphoneogenesis (ELN) within the rheumatoid synovial membrane and response to antiTNFα therapy.
Study Type
OBSERVATIONAL
Enrollment
24
Ultrasound guided synovial biopsy of inflamed joint
Therapy will include, but not limited to Etanercept, Certolizumab Pegol, Adalimumab and Infliximab
Rheumatology Department, Mile End Hospital, Barts and The Royal London NHS Trust
London, London, United Kingdom
Correlation of change in synovial ectopic lymphoneogenesis with EULAR response criteria using DAS28
Time frame: Baseline and 12 months
Disability and health status assessed using the HAQ questionnaire
Time frame: Baseline and 12 months
X-ray progression
Progression of x-ray damage of hand and feet using modified van der heidje / sharp score
Time frame: Baseline and 12 months
Change in synovial histomorphology with treatment
Time frame: baseline and 3 months
Correlation of peripheral blood lymphocytes including, Treg markers and, B cell subsets
Time frame: baseline and 12 months
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