Unmet needs remain in rheumatology

Defining unmet needs that can stimulate research into understanding diseases better and lead to the development of new targeted therapies, disease prevention and ultimately cure remains a priority in rheumatology.

Rheumatology is a field of medicine that studies and treats people with various conditions that affect their joints, bones, tendons, ligaments and muscles – and often also other organs. Many of these diseases are autoimmune conditions that can cause inflammation in the body. There are more than 200 rheumatic diseases, including rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and connective tissue diseases, including systemic lupus erythematosus.

We already know a lot about rheumatology because the diseases have been well studied over the years, but there are still large gaps in understanding, especially for conditions that are less common. Once a year, experts come together at the Targeted Therapies meeting to look at the rheumatology field and see where more could be done. The meeting promotes innovation and collaboration within all areas of rheumatology and also interactions with experts from other disciplines.

What did the authors hope to achieve?
The authors wanted to update everyone in the group, and to agree where more work needs to be done. The purpose was to work together to agree on a list of the most important needs in rheumatology. They hope that by sharing this information, it will help to move the field forward to find new treatments, and to help improve the lives of people with these diseases.

How was the report written?
More than 100 leading experts in the field came together to discuss what needs there are in rheumatology. They were split into five groups and asked to consider what advances had been made in the past year in either rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus or connective tissue diseases. They were then asked what work still needs to be done to better understand the area, what medicines are still needed, and how people with the diseases can be better cared for.

What are the main findings of the report?
The experts agreed that there is still a big gap in understanding how and why people with the same disease can be affected differently or respond to the same therapy differently. There seem to be groups of people within each disease that are different, but at the moment it is difficult to identify them and target them with specific treatments. There is a need to develop tools to predict how well someone will respond to a particular treatment. The experts also agreed that there is a need to develop ways to identify disease early on, to prevent disease, and to cure disease. The ability to better manage associated diseases (called comorbidities) was highlighted. They also wanted to see new and affordable treatments being developed.

What are the limitations of the report?
The report is based on the opinions and knowledge of the people who took part in the meeting, so it is possible that there is information that has not been considered. However, the report is intended as a guide for basic and clinical researchers and other people working in the field, and it should be used alongside other guidelines and recommendations.

What do the authors plan on doing with this information?
The report will be shared with teams working in rheumatology. It is hoped this will help to shape the research that is done in the future. The experts will meet again next year to see what has moved on, and where there are any new needs in the field.

What does this mean for me?
If you have a rheumatic disease, you may find it comforting to know that there are many doctors and experts who are dedicated to understanding your disease and finding the best way to diagnose and treat it. This report might help to drive research that develops new medicines, or ways of looking after people with diseases like

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Date prepared: June 2019
Summary based on research article published on: 2 February 2019
From: Winthrop K, et al. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018. Ann Rheum Dis 2019;78:872–878. doi:10.1136/annrheumdis-2018-214280

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