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Precision medicine: the precision gap in rheumatic disease

Nature Reviews Rheumatology volume 18, pages 725–733 (2022)Cite this article

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Abstract

For many oncological conditions, the application of timely and patient-tailored targeted therapies, or precision medicine, is a major therapeutic development that has provided considerable clinical benefit. However, despite the application of increasingly sophisticated technologies, alongside advanced bioinformatic and machine-learning algorithms, this success is yet to be replicated for the rheumatic diseases. In rheumatoid arthritis, for example, despite an array of targeted biologic and conventional therapeutics, treatment choice remains largely based on trial and error. The concept of the ‘precision gap’ for rheumatic disease can help us to identify factors that underpin the slow progress towards the discovery and adoption of precision-medicine approaches for rheumatic disease. In a rheumatic disease such as rheumatoid arthritis, it is possible to identify four themes that have slowed progress, solutions to which should help to close the precision gap. These themes relate to our fundamental understanding of disease pathogenesis, how we determine treatment response, confounders of treatment outcomes and trial design.

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Fig. 1: The ‘precision gap’ between treatments for rheumatoid arthritis and for cancer.
Fig. 2: The four main drivers of the precision gap that hinder theragnostic stratification in rheumatoid arthritis.
Fig. 3: Disease assessment and precision biomarkers.
Fig. 4: Potential confounders in rheumatoid arthritis clinical trials and how to minimize them.

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Acknowledgements

J.D.I. is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed in this publication are those of the author(s) and not necessarily of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

    Chung M. A. Lin, Faye A. H. Cooles & John D. Isaacs

  2. Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    John D. Isaacs

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The authors contributed equally to all aspects of the article.

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Correspondence to John D. Isaacs.

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Competing interests

J.D.I. has received research funding from GSK, Janssen and Pfizer, and speaker and/or consultancy fees from AbbVie, BMS, Gilead, Roche and UCB. F.A.H.C. has received speaker fees from AstraZeneca. A.L. declares no competing interests.

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Nature Reviews Rheumatology thanks D. Aletaha, A. Filer and D. Poddubnyy for their contribution to the peer review of this work.

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Lin, C.M.A., Cooles, F.A.H. & Isaacs, J.D. Precision medicine: the precision gap in rheumatic disease. Nat Rev Rheumatol 18, 725–733 (2022). https://doi.org/10.1038/s41584-022-00845-w

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