Adult inflammatory arthritis CSG

Welcome to the website of the Arthritis Research Campaign Clinical Studies Group (CSG) for Adult Inflammatory Arthritis.  As chairman of the Group I am tremendously excited by the opportunities that lie ahead. The task for myself and my Steering Group is to develop a quality agenda for research into inflammatory arthritis. Other subgroups will deal with seronegative spondyloarthropathy and crystal arthritis and the main focus of this CSG will be rheumatoid arthritis and undifferentiated arthritis.  However, the agenda will in large part be driven by the rheumatological community and consideration will be given to any research ideas that fall within our remit (see Commissioning studies).

During the past fifteen years there has been a revolution in the management of RA.  The introduction of biologic therapies but also the earlier and more aggressive use of methotrexate (MTX) have greatly improved the outlook for patients.  A number of other important studies have suggested regimes for the management of early RA, such as the COBRA study, the FinRA-Co study, and the impressive Best study – which illustrates the potential novelty of academically commissioned clinical research.  Some studies have even suggested that ultra-aggressive early treatment may lead to a subsequent sustained remission on DMARD monotherapy (Quinn study). In established RA there have also been landmark studies such as the triple therapy study of O’Dell and the Ticora study.

These pioneering studies have provided important messages to practising rheumatologists but there remain areas of significant uncertainty and, at present, there is no agreed algorithm for the management of early RA.  In part, this is consequent on the continued lack of good prognostic markers with which to tailor therapy for the individual patient.  However, most studies have provided more questions than answers.  For example:

  • If ultra-aggressive early therapy switches off RA, how long must this be administered for? 
  • Is it possible to induce true immune tolerance in early RA, as appears to be the case in type 1 diabetes? 
  • Should all patients initially receive step-down prednisolone therapy to control inflammation and prevent damage (Best study)? 
  • Are the different classes of currently available biologic therapy equally effective and safe, and when should they be introduced in the treatment algorithm? 
  • Are there biomarkers that can tell us which biologic therapy is best for the individual patient? 

These and similar questions are difficult to answer at local or regional level, and many will not be answered by industry-sponsored studies.  Therefore it will take a co-ordinated, national approach to, firstly, define the most important questions and, secondly to design studies that can provide definitive answers to them.

Developing Infrastructure

My first task has been to develop a small steering committee.  I have incorporated a range of expertise and knowledge, and our task will be to keep abreast of the current research agenda in inflammatory arthritis, ‘horizon scan’, talk to our constituency (rheumatologists, AHPs, patients and carers), and to be receptive to ideas and suggestions.  Where required, subgroups may be formed to focus on specific potential research areas. For example, an early arthritis subgroup has been formed under the chairmanship of Professor Chris Buckley and Dr Adam Young. An overall priority will be to ensure that the community at large senses ownership of the end research: networks only work where there is collaboration and co-operation from the key players.  The other important constituent is Industry.  The UK clinical community has been slow at delivering in the clinical trials arena and some pioneering Industry-sponsored studies now exclude UK investigators.  The development of a thriving research network provides an opportunity to reverse this trend.  Key industry representatives will be kept abreast of developments in order that they approach the Study Group when considering implementing trials of their products.

Please click here for the minutes from our recent teleconference (March 2008).

 

Contact details

For all enquiries and additional information, please contact: Professor John Isaacs, chair of the adult inflammatory arthritis CSG or Ms. Sandra Wilkinson.

 

Meetings

Strategy meeting on anti-TNF failures

A meeting was held on Monday 7th January 2008 at arc Epidemiology Unit, Manchester University to discuss the question of ‘where next for the patient who has failed their first anti-TNF therapy’. This was not a conference or symposium but a workshop in which attendees were expected to actively contribute their views. The main aim was to determine, in broad terms, the key questions. These are likely to address which specific agents to study in this patient group, the key outcome measures and any allied translational studies that could take advantage of this unique opportunity. Further details can be downloaded here.  The minutes from this meeting are now available.