Rheumatoid Arthritis- crystal ball gazing

Let us look at a hypothetical situation today. I’ve just diagnosed a patient to have Rheumatoid Arthritis. I ask for some specific investigations. A few of them are genetic markers, others cytokine biomarkers. I send a sample for protein biomarker microchip analysis. The patient walks into the clinic a week later. I click on the system, his reports are already in & there you go—-I can look into the future…..

The system gives me all the answers:
1)Is she going to have an aggressive disease?
2)Will she respond to methotrexate? Leflunomide?
3)Will she do well with the basic DMARDs or she would require a biologic agent?
4)If yes, which is the biologic agent she is most likely to respond to?

Great! Work done! The best I can expect to have for a patient. With advances in basic sciences & technology, this situation can be envisioned in the near future.

We already have a few clues:
1)Anti CCP antibody definitely gives us a clue to the aggressiveness of one’s RA.
2)HLA-DRB4 (a genetic marker) does help to know the aggressiveness of one’s RA.
3)We do have a few genetic markers to predict responsiveness to Methotrexate. However, they have been studied only in the Dutch patients till date.
4)There are a few biomarkers to help predict response to Enbrel.
5)Again, we have a few markers to help predict response to Rituximab (Rituxan/ Mabthera).

We have still not perfected the said markers & techniques, but what we know for sure as of now is:
1)RA has to be treated with a combination of DMARDs instead of a single drug.
2)RA requires aggressive management right from the beginning for a better outcome down the line.
3)No RA (even seronegative RA) should be underestimated as mild RA & taken lightly.