Centre for Arthritis and Rheumatic Diseases
The Research Challenge:
Rheumatic and musculoskeletal diseases (RMD) affect up to 60% of the 120 million EU citizens, at an estimated cost of €240 billion with direct costs of 2% EU GDP. Arthritis is a leading cause of joint deformity and disability that affects 15% of the population, 2% suffer from inflammatory (IA). Systemic RMD such as vasculitis e.g. Giant Cell Arteritis, and systemic lupus erythematosus may also be severe causing significant morbidity and increased mortality. RMD also reduce mobility and quality of life, thereby increasing social isolation, and is associated with significant co-morbidities including atherosclerosis, cardiovascular disease, diabetes and obesity.
Targeted biotherapeutics have significantly improved outcomes of RMDs, however responses may be sub-optimal or associated with adverse events. RA provides an ideal ‘model’ for a personalised medicine approach. Methotrexate (MTX) is the disease modifying anti-rheumatic drug (DMARD) of first choice; patients responding inadequately to MTX, in Ireland, are eligible for anti-TNF agents, B-cell depleting therapy – rituximab (RTX), the anti-IL-17 and anti-IL-6 receptor blocking drugs – or small molecule inhibitor – tofacitinib. At 2 years, a significant non-response rate is well established for these agents. However, if introduced early, biologic DMARDs consistently produce better long-term outcome including joint damage, disability and employment. Currently, it is impossible to predict who will develop severe, erosive disease or who will respond to treatment. These drugs are very expensive, therefore ‘trial and error’ is not a cost-effective strategy. There is major need for smart and safe use of effective drugs for treatment of IA. This is important, in the context of EU and global healthcare, delivery in a hospital setting has become increasingly expensive. Therefore, identifying those patients most likely to respond and not develop toxicity would improve the cost-benefit.
What we are doing:
To develop a scientific rationale for choosing the right therapy for the right patient with IA and GCA, thus a personalised medicine strategy approach for the treatment of these complex diseases, thereby reducing costs, unwanted toxicity and innovate commercial diagnostics.
Who we are:
- Prof Douglas Veale – Consultant Rheumatologist
- Prof Eamonn Molloy – Consultant Rheumatologist
- Dr Anne-Barbara-Mongey – Consultant Rheumatologist
- Prof Ursula Fearon – Molecular Rheumatology Trinity College Dublin
For more information on the Centre for Arthritis and Rheumatic Diseases (CARD) visit CARD
For more information on our Translational Rheumatology Research visit Molecular Rheumatology