The Use of Synovial Biopsies in Predicting Response to Biologic Therapy in Rheumatoid Arthritis Patients (SYBRA)
Rheumatoid Arthritis
About this trial
This is an interventional treatment trial for Rheumatoid Arthritis focused on measuring Rheumatoid Arthritis, Synovial biopsy, Biologic therapy
Eligibility Criteria
Inclusion Criteria:
- Subject should be capable of consent
- Age 18 and older
- Classified as rheumatoid arthritis as per EULAR/ACR criteria 2010
- Failed one DMARD (Methotrexate, leflunomide, Sulfalsalazine, hydroxychloroquine)
- Can be on steroid dose <7.5mg
- Quantiferon negative
- Hepatitis B, C negative
- No recent history (<5y) of malignancy
Exclusion Criteria:
- Overlap syndrome
- Previously treated with a biological medication
- Heart failure NYHA III/IV
- Active tuberculosis
- Active infections
- Previous history of DVT, PE, or Stroke
- Other significant comorbidities that will prevent them from taking any biologic medication as per EULAR guidelines on treating rheumatoid arthritis 2020.
- Pregnancy
Sites / Locations
- Abu Dhabi Stem Cells Center
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Group A (Anti-TNF)
Group B (JAK inhibitor)
Group C (Anti-TNF or JAK inhibitor)
Rheumatoid arthritis patients that have failed DMARD therapy will undergo a synovial biopsy under ultrasound guidance and sterile technique. Upon analysis of the sample, patients that are falling into the diffuse myeloid phenotype will be assigned to receive anti-TNF medication at the discretion of the treating physician.
Rheumatoid arthritis patients that have failed DMARD therapy will undergo a synovial biopsy under ultrasound guidance and sterile technique. Upon analysis of the sample, patients that are falling into the lymphoid- myeloid phenotype will be assigned to receive JAK inhibitor medication at the discretion of the treating physician.
Rheumatoid arthritis patients that have failed DMARD therapy will undergo a synovial biopsy under ultrasound guidance and sterile technique. Upon analysis of the sample, patients that are falling into the pauci-cellular phenotype will be randomized to either anti-TNF or JAK inhibitor medication 1:1.