A collaborative research initiative, the ARCADIA consortium, aims to advance the understanding of long-lasting drug-free remission for individuals with inflammatory arthritis. This effort involves multiple research institutions, including the University of Bristol.
Funding and Objectives
Arthritis UK has provided £3 million in funding for the ARCADIA consortium. The initiative brings together inflammatory arthritis researchers from the UK and Italy. Its primary objective is to define when remission has been achieved, which could inform decisions about safely discontinuing medication in the future.
Currently, there is no accurate biological test to determine when a patient with inflammatory arthritis is truly in a state of disease-free remission. This absence of definitive markers means treatment decisions are made without a complete understanding of whether the arthritis has been resolved at the joint level. Consequently, some individuals may remain on treatment unnecessarily, while others experience relapse shortly after stopping medication.
Participating institutions include the Universities of Birmingham, Bristol, Glasgow, Liverpool, Newcastle, and Oxford, along with University College London Great Ormond Street Hospital, Kings College London, and Università Cattolica del Sacro Cuore. These teams will conduct clinical studies to accurately identify the true absence of disease.
Inflammatory Arthritis Overview
Inflammatory arthritis encompasses conditions such as rheumatoid arthritis and juvenile idiopathic arthritis (JIA). These conditions collectively affect over 1% of the population, impacting individuals across all age groups, from childhood to later life. The disease involves the immune system mistakenly attacking joints, leading to inflammation characterized by swelling, stiffness, and pain. This can result in significant functional impairment and, in some cases, long-term disability.
Patients have reported concerns regarding the persistence of symptoms like pain and fatigue despite treatment, the side effects associated with long-term medication, and uncertainty about when it is safe to discontinue treatment.
Research Approach and Expert Statements
Professor Adam Croft, principal investigator of the study and Arthritis UK Professor of Rheumatology at the University of Birmingham, stated that the current method for determining remission is inadequate. He noted that many patients, despite achieving symptomatic remission with treatment, experience relapse upon stopping medication, suggesting that the underlying causes of the disease may persist.
Professor Athimalaipet Ramanan, Honorary Professor at Bristol Medical School, indicated that the grant will facilitate precision medicine research in children with arthritis within ARCADIA. This will involve developing novel therapies using adaptive designs and investigating biomarkers to predict treatment response.
Professor Lucy Wedderburn of University College London emphasized the importance of this research in reducing the treatment burden, particularly for children, whose well-being can be significantly impacted by ongoing medication and side effects.
Patient input is integral to the study design. Dr Marie Falahee of the University of Birmingham reported that patient partners consider the current definition of remission too narrow, as it often overlooks overall well-being and the side effects of long-term treatments. The ARCADIA project will collaborate with patient research partners to integrate patient priorities into a new definition of remission.
Patients aged across the spectrum will be recruited in the UK and Rome. Tissue samples will be collected using ultrasound-guided methods to minimize discomfort. These samples will be analyzed to differentiate between diseased and healthy joints and to explore mechanisms for restoring diseased tissue to a healthy state.
Expected Outcomes
The research is expected to produce tools that accurately predict the risk of relapse, enabling informed treatment decisions for patients and physicians. Furthermore, the study aims to enhance the understanding of inflammatory arthritis, which is considered crucial for the development of new treatments and progress toward a cure.
Deborah Alsina MBE, Chief Executive of Arthritis UK, noted that a foundational understanding of inflammatory arthritis's root causes is currently lacking. She stated that existing treatments primarily address symptoms, and this research aims to provide a deeper understanding that can accelerate the discovery of new therapies.