In 1996, World Arthritis Day was established to raise global awareness about arthritis every year on October 12, with these efforts being led by the Arthritis Foundation. The Centers for Disease Control and Prevention (CDC) defines arthritis as a general collection of conditions that affect the joints, tissues around joints, and other connective tissues. There is no known cure yet, and the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA). Despite being one of the most common diseases in the world, the lasting negative impact of arthritis is often overlooked. According to the World Health Organization, about 528 million people worldwide were living with OA in 2019, with 73% of people being over 55 years old.

In a 2018 survey conducted by the Arthritis Foundation, out of 2,000 adults included, only 7% knew that arthritis was the number one cause of disability in the United States (U.S.). This underscores the importance of raising awareness of the millions of people affected by this debilitating condition worldwide. In commemoration of World Arthritis Day 2024, TFS HealthScience CRO (Contract Research Organization) is joining these efforts by highlighting the remarkable strides made in arthritis research. This article will explore the top five advancements in arthritis research that represent hope for improved quality of life in individuals with this chronic disease.

 

1. Precision Medicine and Personalized Treatment Approaches

The advent of precision medicine, also known as personalized medicine, is not a new concept, especially as new genetic markers are increasingly being discovered for immune-mediated diseases. The approach of precision medicine works by customizing treatment regimens to a patient’s individual characteristics, including their genetics, lifestyle, and accounting for environmental factors. With advances in artificial intelligence (AI) and machine learning (ML), personalized medicine is becoming an important component of treating rheumatic diseases like RA.

Among patients with RA, 5% to 20% are classified as being difficult to treat because they are resistant to all existing treatments, which emphasizes the need for more tailored treatment options. In a 2021 study, ML algorithms were run to report response predictions in rheumatoid arthritis patients with an accuracy of 85.9% (adalimumab) and 79% (etanercept) when using gene expression and 84.7% (adalimumab) and 88% (etanercept) when using DNA methylation. Ultimately, arthritis is a heterogeneous disease that cannot be treated with a one-size-fits-all approach. By analyzing genetic factors, clinicians can better predict which treatments are likely to be most effective in individual patients.

 

2. Innovative Biological Disease-Modifying Therapies

Biologic therapies have emerged as another area of exciting developments in clinical trials for RA and psoriatic arthritis (PsA), another phenotype of the disease. Biologics are a type of systemic therapy that is made up of materials derived from living organisms, such as human antibodies. These drugs are able to target specific inflammatory components of the immune system. Examples of biological disease-modifying antirheumatic drugs (bDMARDS) include monoclonal antibodies that inhibit inflammatory biomarkers such as tumor necrosis factor (TNF), and interleukins 17 (IL-17) and 23 (IL-23): ustekinumab (UST), secukinumab (SEC) or ixekizumab (IXE), respectively.

Other bDMARDS are T-cell co-stimulation inhibitors (e.g., abatacept), IL-6 inhibitors (e.g., tocilizumab and sarilumab), CD-20 depleting antibodies (e.g., rituximab), and IL-1 inhibitors (e.g., Anakinra). With targeted therapies such as these, patients with arthritis are able to experience fewer side effects in addition to greater efficacy. Because there is no cure, disease-modifying therapies are the next best option to help alleviate symptom burden and slow disease progression. As the research into this area continues, we may even find therapies that could potentially stop or reverse joint damage in these patients.

 

3. Regenerative Medicine and Stem Cell Therapy

Regenerative medicine, particularly stem cell therapy, is a frontier in arthritis clinical research that focuses on repairing or replacing damaged joint tissues using the body’s own healing mechanisms. Stem cells are unique cells in the human body that are able to differentiate into specific cell types with distinct functions. The idea of using stem cell therapies in regenerative medicine has existed for decades, showing significant anti-inflammatory, immunomodulatory, and regenerative properties. Several clinical trials have tested mesenchymal stem cell (MSC) therapies in arthritis, using stem cells collected from the bone marrow, umbilical cord, fatty tissue, and synovial membrane.

Studies conducted in patients with osteoarthritis found that MSC therapy led to positive clinical outcomes, with improved joint function, pain level, and quality of life. Although there were fewer clinical trials of using MSC in patients with RA, those that did reported few serious side effects associated with this treatment. With the help of advanced tissue engineering tools, researchers can also develop scaffolds to create more customized cartilage forms using stem cells for these patients (read more about it here!).

 

4. Advanced Imaging Techniques for Early Diagnosis and Monitoring

Although the majority of advancements are focused on expanding the therapeutic landscape of arthritis, there is equally important research on early disease detection that must be acknowledged as well. Early diagnosis and treatment initiation are crucial for preventing irreversible joint damage in arthritis, delaying the onset of disability. Imaging tools like musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) have now become integral in the standard diagnostic work-up and follow-up of patients with this disease.

Traditionally, imaging techniques in rheumatology have been limited due to older methods like X-rays or computed tomography (CT) scans primarily capturing macroscopic anatomic changes in arthritis, which is not ideal for early detection of inflammation. In contrast, MSUS and MRI provide a more comprehensive assessment of soft tissues and a more accurate identification of subtle inflammatory changes that enable rheumatologists to consider timely intervention more often. Capturing earlier visualization of the inflammation underlying arthritis also helps researchers characterize its initial phases in greater detail to assist with closer monitoring of disease progression.

 

5. Gene Therapy and CRISPR Technology

What makes arthritis difficult to treat in many cases is that several mechanisms in the human body can contribute to the inflammation seen in joints of these patients. This heterogeneity is the reason why targeted therapies like precision medicine and biologics are so important to continue developing. Another emerging targeted approach involves using CRISPR/Cas9 gene editing technology to target abnormal cellular processes in arthritis. This mechanism works by directing the Cas9 protein to small non-coding RNAs (sncRNA) that bind to target DNA in cells where that target DNA is subsequently repaired by Cas9 suppressing or deleting gene expressions.

More studies are finding that OA may have associated genetic and epigenetic alterations, which can potentially be targeted using the CRISPR/Cas9 approach. Although the current stage of development is still being conducted in preclinical models. For example, this 2024 study developed a non-viral CRISPR-Cas9, bulk-gene editing method for reducing inflammatory pathway activation in primary human chondrocytes harvested from OA patients. With enough time, such an approach could evolve to the point of being applied in human clinical trials. The main benefit of pursuing genetic approaches with CRISPR-Cas9 technology is that they hold the potential to address the root causes of arthritis rather than just its symptoms.

 

Conclusion

In conclusion, these top five advancements in arthritis research represent opportunities to improve the lives of millions of individuals who are impacted by this disease worldwide. This October 12, on World Arthritis Day, TFS was among several organizations, including the Arthritis Foundation and the American Arthritis Foundation, to reflect upon the remarkable progress this therapeutic area has seen. Although a cure is not within reach yet, breakthroughs in precision medicine, advanced imaging techniques, regenerative medicine, biological therapies, and gene editing technologies will help widen the therapeutic landscape of arthritis. With these developments, patients and their families can look forward to having more customized treatment options that can manage common arthritis types like OA, RA, and PsA, more effectively.

Visit the Arthritis Foundation’s website to learn more about arthritis and how they are driving change for better treatments in the US.

 

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