Right drug, right patient, right time: aspiration or future promise for biologics in rheumatoid arthritis?
Personalised biologic DMARD assignment is still a pipedream. Given that the ACR 20/50/70 responses are not dissimilar regardless of your choice of the first targeted DMARD in RA patients with an inadequate response to MTX, just give anything a trial for 1-2 weeks. If patient responds, continue. If not, switch.
Seropositive vs seronegative RA are probably distinct diseases where pathogenesis, treatment responses and outcomes are quite different.
Previous studies suggest that seropositive RA represents an inappropriate humoral response, and may respond better to B-cell depletion and T-cell costimulation blockade, but may confer a poor prognosis with regards to drug-free remission (DFR).
This study suggests that seropositivity favours early treatment response, and the negative impact on DFR wanes with time.