[전문의 칼럼]Treatment of rheumatoid arthritis, expectations for ‘precision medicine’ tailored to each patient | Dong-A Ilbo

Bae Sang-cheol, Distinguished Professor, Hanyang University Rheumatology Hospital

Bae Sang-cheol, Distinguished Professor, Rheumatology Hospital, Hanyang University Rheumatoid arthritis is not simply inflammation within the joints, but an immune disease caused by abnormalities in the immune system.

Unlike degenerative arthritis, which is mainly caused by joint aging, the synovial membrane proliferates like a benign cancer due to an incorrect immune response, and various inflammatory substances are released, destroying cartilage and bone.

About 30 years ago, about 30 out of 100 rheumatoid arthritis patients had disabilities 10 years after the onset of the disease, but recently, treatment has advanced to the point where early and appropriate treatment rarely causes disabilities. Rheumatoid arthritis is a disease caused by poor immune regulation, so in principle, it is treated with medical drugs. Recently, injectable treatments and various biological agents made using genetic engineering techniques are widely used. It is much more effective than existing drugs, so it is receiving a green light for the treatment of rheumatoid arthritis. In addition, ‘JAK inhibitors’, which have similar effects to biological agents but can be ingested rather than injected, have been released, broadening the range of choices. It can truly be said to be a ‘renaissance period in the treatment of rheumatoid arthritis.’

However, new treatments have the problem of being expensive and requiring constant use. Also, it is still not effective for some patients. A so-called ‘precision medicine treatment approach’ that predicts the effect before treatment and selects the appropriate drug for the patient is needed.

Currently, precision medicine is mainly used in the cancer field. However, the need for precision medicine has recently emerged in the treatment of rheumatoid arthritis caused by abnormalities in the immune system, and researchers around the world are conducting related research. Using precision medicine, it is possible to predict the prognosis or drug response of rheumatoid arthritis patients in advance and select appropriate treatment intensity and drugs. Furthermore, from a preventive perspective, people who are at high risk of developing rheumatoid arthritis can delay or prevent the onset of rheumatoid arthritis by practicing preventive management methods such as quitting smoking, managing periodontitis, and exercising, and by being prescribed appropriate medications.

This is not something in the ‘distant future’. The ‘Rheumatology Precision Medicine Clinic’, which can provide customized health care, disease prevention, accurate diagnosis, and effective treatment to individuals, is a ‘near future’ that will soon come.

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