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  • Review Article
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The promise of precision medicine in rheumatology

Nature Medicine volume 28, pages 1363–1371 (2022)Cite this article

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Abstract

Systemic autoimmune rheumatic diseases (SARDs) exhibit extensive heterogeneity in clinical presentation, disease course, and treatment response. Therefore, precision medicine — whereby treatment is tailored according to the underlying pathogenic mechanisms of an individual patient at a specific time — represents the ‘holy grail’ in SARD clinical care. Current strategies include treat-to-target therapies and autoantibody testing for patient stratification; however, these are far from optimal. Recent innovations in high-throughput ‘omic’ technologies are now enabling comprehensive profiling at multiple levels, helping to identify subgroups of patients who may taper off potentially toxic medications or better respond to current molecular targeted therapies. Such advances may help to optimize outcomes and identify new pathways for treatment, but there are many challenges along the path towards clinical translation. In this Review, we discuss recent efforts to dissect cellular and molecular heterogeneity across multiple SARDs and future directions for implementing stratification approaches for SARD treatment in the clinic.

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Fig. 1: Molecular mechanisms and signatures may differ according to disease stages.
Fig. 2: Potential tailored treatment regimens based on recently identified molecular subgroups.

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Acknowledgements

We thank S. Slight-Webb for critical review of the manuscript. We would like to thank the scientists in the Accelerating Medicines Partnerships in RA/Lupus and in Autoimmune and Immune Mediated Disease Networks, along with the NIAID Autoimmunity Centers of Excellence Network. This work is supported by NIH grants P30AR073750, U54GM104938, UC2AR081032, UM2AR067678, and UM1AI144292.

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Authors and Affiliations

  1. Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA

    Joel M. Guthridge, Catriona A. Wagner & Judith A. James

  2. Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Joel M. Guthridge & Judith A. James

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  1. Joel M. Guthridge
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  2. Catriona A. Wagner
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  3. Judith A. James
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Guthridge, J.M., Wagner, C.A. & James, J.A. The promise of precision medicine in rheumatology. Nat Med 28, 1363–1371 (2022). https://doi.org/10.1038/s41591-022-01880-6

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