ArticleAnnals of the rheumatic diseases2019
Synovial tissue signatures enhance clinical classification and prognostic/treatment response algorithms in early inflammatory arthritis and predict requirement for subsequent biological therapy: results from the pathobiology of early arthritis cohort (PEAC).
Article in Annals of the rheumatic diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 75 papers.
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Who cites it
75 citing papers in PubMed, 123 citations in OpenAlex.
- Deep molecular profiling of synovial biopsies in the STRAP trial identifies signatures predictive of treatment response to biologic therapies in rheumatoid arthritis.Nature communications · 2025Trial
- Rituximab versus tocilizumab in rheumatoid arthritis: synovial biopsy-based biomarker analysis of the phase 4 R4RA randomized trial.Nature medicine · 2022Trial
- When inflammation is not the driver: Pauci-immune synovitis and the stromal basis of refractory arthritis.EULAR rheumatology open · 2026Review
- Article
- Diagnostic, prognostic and therapeutic biomarkers in rheumatoid arthritis.Nature reviews. Rheumatology · 2026Review
- Article
- P2X7R of synovial fibroblasts is a potential therapeutic target associated with refractory rheumatoid arthritis.Science advances · 2026Article
- Bridging the gap: combining treat-to-target and difficult-to-treat strategies in the management of rheumatoid arthritis.Nature reviews. Rheumatology · 2026Review
- Revisiting osteoarthritis as an inflammatory disease: characterization of synovitis grading and synovial pathotypes in surgical specimens.Arthritis research & therapy · 2026Article
- Spatial patterning of fibroblast TGFβ signaling underlies treatment resistance in rheumatoid arthritis.Nature immunology · 2026Article
- Pathogenic Drivers of Difficult-to-Treat Rheumatoid Arthritis: Synovium and Beyond.International journal of molecular sciences · 2026Review
- The value of contrast-enhanced ultrasound in synovial pathotypes of rheumatoid arthritis: an exploratory study.European radiology · 2026Article
- Emerging Therapeutics in Rheumatoid Arthritis.Current rheumatology reports · 2026Review
- From Systemic Autoimmunity to the Local Immune Niche of the Synovium: New Insights into the Development of Rheumatoid Arthritis.Journal of inflammation research · 2026Review
- Predictive biomarkers for precision treatment in rheumatoid arthritis: are we there yet?Frontiers in pharmacology · 2026Review
- Rheumatoid Arthritis: Biomarkers and the Latest Breakthroughs.International journal of molecular sciences · 2025Review
- Location and amount of joint involvement differentiates rheumatoid arthritis into different clinical subsets.NPJ digital medicine · 2025Article
- Synovial MS4A4A correlates with inflammation and counteracts response to corticosteroids in arthritis.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- Precision medicine in rheumatoid arthritis-associated interstitial lung disease: current evidence and future directions.Current opinion in pulmonary medicine · 2025Review
- Synovial infiltrating immune cell heterogeneity associated with synovitis severity and systemic disease activity in rheumatoid arthritis: a cross-sectional study.Clinical rheumatology · 2025Article
15 more citing papers are in PubMed but not listed here.
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Authors and funding
18 authors at 8 institutions in 2 countries.
Funding
Abstract
objectiveTo establish whether synovial pathobiology improves current clinical classification and prognostic algorithms in early inflammatory arthritis and identify predictors of subsequent biological therapy requirement.
methods200 treatment-naïve patients with early arthritis were classified as fulfilling RA1987 American College of Rheumatology (ACR) criteria (RA1987) or as undifferentiated arthritis (UA) and patients with UA further classified into those fulfilling RA2010 ACR/European League Against Rheumatism (EULAR) criteria. Treatment requirements at 12 months (Conventional Synthetic Disease Modifying Antirheumatic Drugs (csDMARDs) vs biologics vs no-csDMARDs treatment) were determined. Synovial tissue was retrieved by minimally invasive, ultrasound-guided biopsy and underwent processing for immunohistochemical (IHC) and molecular characterisation. Samples were analysed for macrophage, plasma-cell and B-cells and T-cells markers, pathotype classification (lympho-myeloid, diffuse-myeloid or pauci-immune) by IHC and gene expression profiling by Nanostring.
results128/200 patients were classified as RA1987, 25 as RA2010 and 47 as UA. Patients classified as RA1987 criteria had significantly higher levels of disease activity, histological synovitis, degree of immune cell infiltration and differential upregulation of genes involved in B and T cell activation/function compared with RA2010 or UA, which shared similar clinical and pathobiological features. At 12-month follow-up, a significantly higher proportion of patients classified as lympho-myeloid pathotype required biological therapy. Performance of a clinical prediction model for biological therapy requirement was improved by the integration of synovial pathobiological markers from 78.8% to 89%-90%.
conclusionThe capacity to refine early clinical classification criteria through synovial pathobiological markers offers the potential to predict disease outcome and stratify therapeutic intervention to patients most in need.
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