Why remission is not enough: underlying disease mechanisms in RA that prevent cure

Area of Science:

• Rheumatology
• Immunology
• Inflammatory Diseases

Background:

• Cure is the ultimate goal for rheumatoid arthritis (RA) treatment, but has only recently become an achievable target.
• Significant research is needed to define 'cure' for RA and understand why it remains rare.

Purpose of the Study:

• To define the differences between remission and cure in rheumatoid arthritis (RA).
• To identify key factors (drivers) hindering the achievement of a cure for RA.
• To propose strategies for targeting these drivers to improve the likelihood of curing RA.

Main Methods:

• This review defines remission and cure in RA.
• It discusses underlying factors (drivers) that prevent cure, including immune activation and non-articular influences.
• It presents potential strategies to target these drivers.

Main Results:

• Remission and cure are distinct goals in RA management.
• Drivers of sustained immune activation and cytokine production impede RA cure.
• These drivers include adaptive immune system activation, mesenchymal tissue priming, and remote factors.

Conclusions:

• Targeting identified drivers could complement current therapies like cytokine inhibition.
• Developing strategies to overcome these obstacles is crucial for advancing towards a potential cure for RA.
• Further research is needed to refine the definition of cure and develop effective curative strategies for RA.