Synovial macrophage subsets may predict RA flare risk
medwireNews: Different subsets of macrophages in the synovial tissue could help predict whether patients with rheumatoid arthritis (RA) will experience flares following treatment discontinuation, researchers report in Nature Medicine.
The team used single-cell transcriptomics to evaluate synovial tissue macrophages from healthy controls (n=10), and also from RA patients who were treatment-naïve (n=45), in active disease despite treatment (n=31), or in remission on treatment with a tumor necrosis factor (TNF) inhibitor plus methotrexate (n=36).
Stefano Alivernini (Università Cattolica del Sacro Cuore, Rome, Italy) and colleagues report that macrophages from the healthy controls were mostly positive for the markers MerTK and CD206, and RA patients in remission versus active disease had a “substantially increased” proportion of macrophages with these markers, suggesting that these cell populations could “characterize distinct clinical phases of RA.”
Among the patients in remission, 22 tapered and discontinued TNF inhibitor treatment, and half of these flared within 6 months. People who flared had a significantly lower proportion of MerTK- and CD206-positive cells at the time of treatment change than those who remained in remission. And logistic regression analysis showed that having at least a 2.5-fold lower proportion of MerTK- and CD206-positive versus negative cells was an independent predictor of flare risk, as was having no more than 47.5% of cells positive for these markers.
“If validated with additional remission studies, this could potentially be incorporated within personalized protocols for the management of patients with RA in sustained ‘cellular’ remission to aid management of […] therapeutic discontinuations,” say Alivernini and team.
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