Why some RA patients don’t respond to conventional therapies
If your patient has tried and failed multiple RA treatments, their disease may be driven by autoinflammation.1,2
RA exists along a spectrum.
Though RA is primarily defined as an autoimmune disease, the distinction between autoimmune and autoinflammatory disease isn’t clear cut. Because there are various interactions and similarities between the innate and adaptive immune systems, they may be viewed as two ends of the same spectrum.3,4 Some patients have RA that is closer to the autoinflammatory end of that spectrum.1
Where does your patient’s RA fall?
Understanding which end of the spectrum your patient’s disease leans toward can be challenging, but there are key clues to watch for. Along with treatment history, you may want to consider any elevated acute-phase reactants and extra-articular signs of inflammation, including 1,5-7:
- Muscle weakness
- Keratoconjunctivitis sicca or dry eye
Steroid resistance can be a telling clue.
Since RA is typically considered an autoimmune disease, therapies targeting the adaptive immune system (like steroids) are often prescribed. But autoinflammatory disease isn’t usually well controlled by these types of therapies.6 There may be several factors at play, including8,9:
of cytokines that
of steroid receptors9
Could your patient’s difficult-to-treat RA be driven by autoinflammation?