Roy Fleischmann, MD: Hurdles to Optimizing RA Therapy

Speaking ambitiously, determining the right tests and initial therapies for patients with rheumatoid arthritis (RA) could become optimized. Of course, that’s an ambition that’s yet to be reached.

In an interview with MD Magazine® while attending the American College of Rheumatology (ACR) annual meeting in Chicago, IL, this month, Roy Fleischmann, MD, a clinical professor from the University of Texas Southwestern Medical Center, explained how some of the meeting’s forward-thinking discussion on test and treatment optimization may still be just out of reach—albeit a still important conversation to have.

MD Mag: Is there an ideal RA patient for JAK inhibitor following failure to treat with methotrexate?

Fleischmann: Absolutely, the ideal patient is someone who could afford the drugs, which we can pre-determine, and then someone who responds. But we don’t know who that patient is. So the holy grail, in rheumatology—we have lots of drugs that work, but we don’t know which drugs are going to work in which patient, and not every drug works in every patient. So, the holy grail is to be able to do a blood test or something where you can actually find out which drug will work, which drug will be safe. That, we don’t have.

Along with Synovial tissue testing, what other tests should be considered to optimize RA patient therapy?

I’m not sure what should be tested. I am aware of these very, very preliminary reports, but I can tell you that getting synovial tissue from the patient is not easy. In a daily practice, if a patient comes in and says they want you to test their synovial tissue, I’ll say, “Please see my brother he’s down the hall, he’s a psychiatrist.”

It’s really hard to do, and then the question is, do I as a practitioner have the ability to test that synovial, and the answer is no. But these are still experiments that should be conducted, because what will eventually come is a blood test will come out. Something will come out that you’ll be able to do. I think these are important. We know that different drugs affect the synovium in a different way and that may be part of the answer. I don’t know if it’s going to be the whole answer, I don’t know what the answer is going be, but it may be part of the answer.