Benaroya Research Institute at Virginia Mason (BRI) is waging a comprehensive fight against rheumatoid arthritis (RA). “During the last 15 years, treatments for RA have improved enormously with new therapies,” says BRI President Jane Buckner, MD, who is leading this work.

“But it is a chronic disease and if left untreated results in pain and permanent disability. There is no cure. Current treatments are expensive, may have risks and side effects and may stop working. We want to find ways to treat people early and target only the cells that cause the disease and, eventually, prevent the disease.”

RA is an autoimmune disease caused when the immune system mistakenly attacks the membrane that lines the joints. About 1.3 million people in the United States have the disease—almost 1 percent of the nation’s adult population.

“To prevent disease, you need to know who is going to get the disease, when will they get it and how will they get it,” says Dr. Buckner. Since 2002, BRI has collaborated with the University of Colorado, Denver, on SERA (Studies of the Etiology of Rheumatoid Arthritis), which is focused on understanding how RA starts and progresses. Scientists study relatives of people with RA who volunteer to give their blood and medical histories and follow those who have genes and autoantibodies (ACPA and RF) that are highly related to RA. Researchers found the disease begins years before clinical signs and symptoms are apparent and is initiated through activation of certain proteins in the joints.

“Our findings suggest that we could intervene in this disease before it develops,” says Dr. Buckner. “We are now studying which cells would be good targets for preventing disease or providing early therapy. This sets the stage for clinical research trials in preventing RA.”

Knowing the Right Treatment

“Physicians now have the tools to make a good diagnosis of RA and we have many choices for medications,” says Dr. Buckner. “But our difficulty is choosing the right drug for the right person. We are sometimes guided by patient preference, cost or contraindications, but with the majority of patients we just select a drug based on our experience, and if it does not work we move to another medication. This can take time, time in which patients continue to suffer with arthritis. We want to be able to pick the most effective drug early on. This would prevent further destruction of the joints and alleviate pain more quickly.”

Through earlier research, BRI discovered the destructive T cells that drive RA. Scientists are now studying these specific T cells in the joint to see how they change with disease activity and therapy. “If we can observe the patient’s immune response to a drug soon after a therapy starts, we can determine if it’s working or not,” says Dr. Buckner. BRI, Virginia Mason Medical Center and the Veterans Administration Puget Sound Health Care System are studying a broad population of individuals with RA in this study.

Predicting Drug Response

There are six classes of RA drugs, and some people respond to the medications and some people don’t. Some will work for a limited time and then become ineffective. Physicians, scientists and the pharmaceutical industry are joining together to predict patient drug responses ahead of providing treatment. This would allow physicians to prescribe the right drug before treatment even begins.

Joining a Biorepository

All of this work is supported with samples from the BRI Rheumatic Disease Registry and Biorepository. Thank you to our volunteers who donate blood samples and provide health information to support research.