Genetic profiling of synovial biopsies predicts lack of therapeutic response to biologics in patients with rheumatoid arthritis better than a model using only tissue pathology or clinical factors, a study shows.

UK researchers say their findings could pave the way for routine use of gene expression models for optimal selection of rituximab and tocilizumab treatment in this clinical setting.

“We believe this study is a paradigm shift in precision medicine in RA [rheumatoid arthritis],” said study authors and rheumatologists Dr Costantino Pitzalis and Dr Myles Lewis, from Queen Mary University of London.

The team had previously shown that patients with RA who had a low or absent synovial B cell molecular signature had a lower response to the anti-CD20 monoclonal antibody rituximab compared with tocilizumab, an anti-interleukin-6 receptor monoclonal antibody.