The ARCADIA consortium, backed by £3 million in funding from Arthritis UK, is uniting top researchers from the UK and Italy to tackle a critical question in inflammatory arthritis treatment: “When has remission been achieved?” This groundbreaking study could pave the way for patients to safely discontinue their medications at the right time in the future.
Currently, there is no reliable biological test to determine when a patient with inflammatory arthritis is truly in remission. This uncertainty forces clinicians, patients, and their families to make treatment decisions without a full understanding of whether the disease has been resolved in the joints. As a result, some patients remain on treatment unnecessarily, while others discontinue their medication only to experience a rapid relapse.
Collaborative Efforts Across Leading Institutions
Researchers from the University of Birmingham are collaborating with several prestigious institutions, including the Universities of Glasgow, Newcastle, Oxford, Bristol, and Liverpool, as well as University College London Great Ormond Street Hospital, Kings College London, and Università Cattolica del Sacro Cuore. Their goal is to conduct clinical studies that accurately determine the true absence of disease.
Inflammatory arthritis encompasses various conditions, such as rheumatoid arthritis and juvenile idiopathic arthritis (JIA), affecting more than 1 in 100 people, including children and adolescents. The disease can significantly impact daily life and sometimes leads to long-term disability, as the immune system mistakenly attacks the joints, causing inflammation, swelling, stiffness, and pain.
Patient-Driven Research
This research initiative was inspired by patients who expressed their desire for long-term freedom from inflammatory arthritis. They shared frustrations over persistent symptoms like pain and fatigue despite treatment, reported side effects from long-term medication use, and voiced concerns about when it is safe to stop treatment.
Professor Adam Croft, the principal investigator of the study and Arthritis UK Professor of Rheumatology at the University of Birmingham, stated, “Many people with inflammatory arthritis undertake treatment, usually for many years, to control their disease. Increasingly these drugs eliminate the noticeable symptoms of arthritis, and this is often called remission. However, we know that many people who are in remission and stop their medications quickly experience a relapse.”
He emphasized that current drugs fail to alter the underlying causes of the disease, suggesting that the definition of remission needs to be revised to guide treatment decisions effectively.
Tools for Informed Treatment Decisions
The research team aims to develop tools to accurately assess the risk of relapse, enabling patients and physicians to make informed treatment decisions. This advancement would benefit individuals like Catherine Wright, a 52-year-old from Belfast who has lived with arthritis for 50 years since being diagnosed with JIA and uveitis at 18 months.
“I have found a biologic that is working well, and I am physically active and enjoying life to the full. But I have been on a variety of different drugs over the years and have had many joint injections, and the side effects haven’t been pleasant,” Wright shared. “So, the idea of a permanent long-lasting remission is very exciting indeed. Research is all about hope, and this is giving me hope.”
Currently, the treatment approach for inflammatory arthritis focuses on early and intensive intervention to control symptoms. This often requires patients to take multiple drugs, sometimes administered through hospital infusions or regular injections, necessitating frequent blood tests and monitoring for side effects.
Challenges in Pediatric Treatment
Professor Lucy Wedderburn of University College London Great Ormond Street Institute of Child Health highlighted the challenges faced by young patients. “Despite considerable advances in the treatment of inflammatory arthritis over the past two decades, little progress has been made towards addressing the problem of when young people can safely stop their medication,” she said.
This issue significantly affects the well-being of young patients and their families, as ongoing medication and side effects can take a toll, particularly on children.
Katie Eldridge, a 30-year-old from Kent, shared her experience: “I’ve been declared in remission twice before and taken off medication. I then hit stressful periods in my life, and my arthritis flared straight back up. This happened during my A-levels and in my mid-20’s just before COVID.”
Exploring Patient Perspectives
The study will recruit patients across the UK and Rome, collecting tissue samples at various stages of disease, treatment, and remission. These samples will be analyzed to understand the differences between diseased and healthy joints and to explore ways to restore diseased tissue to a healthy state.
Dr. Marie Falahee, a Lecturer in Behavioural Rheumatology at the University of Birmingham, noted, “As part of ARCADIA, we will investigate patient perspectives and collaborate with patient research partners to ensure that a new definition of remission better serves the priorities of all people with inflammatory arthritis.”
Beyond guiding treatment decisions, the study’s outcomes are expected to significantly advance the understanding of inflammatory arthritis, facilitating the development of new treatments and accelerating the search for a cure.
Deborah Alsina MBE, chief executive of Arthritis UK, emphasized the importance of this research: “The crux of the matter is we still lack an understanding of the root causes of inflammatory arthritis, which is not only impeding our ability to define remission but also our ability to find a cure.”
“While there have been significant advances in treatment with the discovery of biologics in recent decades, we are still treating symptoms. To put it another way, it is like spraying the weeds in the garden, but the roots remain out of sight in the soil,” Alsina added.
The five-year research study is set to commence this autumn, marking a significant step forward in the quest to redefine remission and improve the lives of those living with inflammatory arthritis.
