A personalized medicine approach to biologic treatment of rheumatoid arthritis: a preliminary treatment algorithm

Rheumatology (Oxford). 2012 Apr;51(4):600-9. doi: 10.1093/rheumatology/ker300. Epub 2011 Sep 2.


RA is a syndrome consisting of different pathogenetic subsets in which distinct molecular mechanisms may drive common final pathways. Recent work has provided proof of principle that biomarkers may be identified predictive of the response to targeted therapy. Based on new insights, an initial treatment algorithm is presented that may be used to guide treatment decisions in patients who have failed one TNF inhibitor. Key questions in this algorithm relate to the question whether the patient is a primary vs a secondary non-responder to TNF blockade and whether the patient is RF and/or anti-citrullinated peptide antibody positive. This preliminary algorithm may contribute to more cost-effective treatment of RA, and provides the basis for more extensive algorithms when additional data become available.

MeSH terms

  • Algorithms*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Biological Products / therapeutic use*
  • Biomarkers / metabolism
  • Drug Resistance
  • Humans
  • Precision Medicine / methods*
  • Treatment Failure
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Antirheumatic Agents
  • Biological Products
  • Biomarkers
  • Tumor Necrosis Factor-alpha