Precision Medicine and the Pursuit of Remission in RA and PsA, with Arthur Kavanaugh, MD

As therapeutic options continue to expand in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), the question increasingly shifts from what we can use to how we choose. RheumatologyLive sat down with Arthur Kavanaugh, MD, Professor of Medicine and Director of the Center for Innovative Therapy at the University of California, San Diego, at the 2026 Rheumatology Winter Clinical Symposium, held in Maui, Hawaii, on February 11–14, to discuss one of the field’s most persistent ambitions: precision medicine.

Despite frequent discussion of personalized care, Kavanaugh acknowledged that true precision medicine remains aspirational. Clinicians still lack reliable tools to predict which therapy will work best for a given patient. Treatment selection is often guided by practical considerations such as patient preference, route of administration, comorbidities, and avoidance of known side effects rather than biologically driven prediction. While emerging biomarkers show promise, statistical significance alone is not enough. To meaningfully inform care, predictive markers must demonstrate strong clinical impact and apply broadly across patient populations.

At the same time, the field has made measurable progress in defining treatment goals. Both RA and PsA management strategies have increasingly embraced remission rather than low disease activity as the target. Kavanaugh emphasized that framing the goal as restoring patients to how they felt before disease onset can be transformative in the clinic. While remission is not achievable in every case, it is attainable more often than in prior decades, reflecting advances in early diagnosis, treat-to-target strategies, and expanded therapeutic classes.

The evolution from celebrating modest symptom improvement to pursuing full remission marks a cultural shift in rheumatology. Earlier eras focused on incremental gains because expectations were limited by available therapies. Today, improved outcomes have raised the bar. The ambition to do better continues to drive research into biomarkers, stratification tools, and optimized sequencing.

“Many years ago, if we got any improvement, that was great, just [getting patients to] feel better, that was more than we could hope for in some cases. So now we really want to get everybody to be as good as they could possibly be,” Kavanaugh said.

Kavanaugh’s disclosures include Abbvie, Amgen, BMS, Lilly, Janssen, Novartis, PFizer, and UCB.

References

1. Cush J, Kavanaugh A. Rheumatology 2025: Year in Review. New developments in RA. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.

2. Ruderman E, Kavanaugh A. Rheumatology 2025: Year in Review. What’s new in PsA. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.