More children with juvenile rheumatoid arthritis are experiencing remission of their symptoms, thanks to new biological therapies, but the remission is not well-understood. A new study published today in Arthritis Research & Therapy provides the first genomic characterization of remission in juvenile rheumatoid arthritis patients.
"It turns out that even though these children in remission appear to be perfectly normal and symptom-free, their immune systems are still perturbed," says James N. Jarvis, MD, clinical professor of pediatrics in the University at Buffalo School of Medicine and Biomedical Sciences and the study's lead author.
The study notes that 35-50 percent of children with juvenile rheumatoid arthritis achieve remission while being treated with the standard treatments, methotrexate or methotrexate in combination with biopharmaceuticals.
"Our study provides some insight into why so many children in remission experience disease flares even when their disease has been stable for weeks or months, and why 50 percent of children who try to come off medication experience disease flares within two to six months," Jarvis says.
The research was conducted at the University of Oklahoma Health Sciences Center by Jarvis and co-authors, and was supported by the National Institutes of Health, the Oklahoma Center for the Advancement of Science and Technology and the Arthritis Foundation, which continues to fund Jarvis' research in this area. Some members of the team, including Jarvis, now work at UB's Clinical and Translational Research Center (CTRC).
The study compared gene expression profiles from two independent cohorts of 14 patients each, all in remission from juvenile rheumatoid arthritis, to those of 15 healthy controls. The patients were on two different medication regimens. Patients were followed every two to three months for at least a year.
"Remission, of course, is our goal," says Jarvis. "I like to say it's hard to get somewhere when you don't know where 'somewhere' is. My lab is trying to build a 'genomic roadmap' for what remission is and exactly how we get there. That way, we can find a way to get these children into remission more quickly and for longer periods."
The new study confirms preliminary research by Jarvis, suggesting that remission experienced by patients with juvenile rheumatoid arthritis on medication is not a "return to normal" but is, instead, a distinct biologic state. The study finds that this distinct biologic state results from pro-inflammatory responses being counter-balanced by anti-inflammatory responses caused by gene expression changes that medication induces.