Singapore scientists pave way for better juvenile arthritis diagnosis and treatment outcome prediction

July 14, 2017

A team of scientists and doctors from the SingHealth Duke-NUS Academic Medical Centre (AMC) has uncovered a new group of regulatory T (Treg) cells and DNA features associated with juvenile idiopathic arthritis (JIA), the most common form of arthritis among children under the age of 16. Their findings could potentially enhance diagnosis of the disease and prediction of therapy outcomes for improved treatment successes.

Results of their studies were published in the Annals of Rheumatic Diseases and Proceedings of the National Academy of Sciences.

JIA is a disease of the immune system that causes inflammation leading to pain, stiffness and swelling in patients' joints. It affects around one in 1,000 children in the world.

Juvenile arthritis has no cure and young patients can only alleviate pain or prevent joint deterioration through use of medication or therapy. In advancing care for JIA, researchers are keen to identify the culprit cells or genetic signatures behind the disease in order to tackle it.

1st discovery: Inflammation-associated Treg Cells

In its first discovery, the SingHealth Duke-NUS AMC research team identified a previously unknown group of Treg cells that is associated with inflammation in JIA. Treg cells are a subset of that regulate the body's immune system. When the body has an imbalanced number of Treg cells, its immune tolerance can fail and experience autoimmune disorders such as arthritis.

The team found that the identified Treg cells play a role in JIA progression. During the active disease stage of JIA, these cells expand, grow in number, re-circulate through inflamed areas of patients' body, and migrate to the connective tissue of patients' joints. Additionally, a larger quantity of these cells can be found in JIA patients who cannot control arthritis inflammation and are unresponsive to therapy as compared to those who are.

"Clinicians could potentially use this novel group of cells as a marker to diagnose JIA in patients, as well as to predict or monitor patients' responsiveness to therapy. Importantly, these are readily detectable in patients' bloodstream, allowing for any clinical tests to be minimally invasive and pain-free for patients," said Professor Salvatore Albani, Director, SingHealth Translational Immunology and Inflammation Centre (STIIC), Professor, Duke-NUS Medical School and Senior Clinician Scientist, KK Women's and Children's Hospital (KKH), who is the principal investigator of the study.

2nd discovery: Patients' DNA affects JIA treatment outcomes

Currently, only about one-third of JIA patients get better after medication or therapy, while the rest continue to see their condition flare up even after .

To accurately predict treatment outcomes, the research team studied JIA patients' treatment responses and found that epigenetics - or individuals' DNA and the way each body uses its genes - determined one's clinical "fate". In other words, the key is not in individuals' genetic make-up but rather, in how their bodies employ genes. Even patients with identical genetic backgrounds could experience different clinical outcomes based on their DNA features that activate genes differently.

One of the research paper's co-author, Associate Professor Thaschawee Arkachaisri, Head & Senior Consultant, Rheumatology and Immunology Service, KKH and Associate Professor, Duke-NUS, said "These discoveries could enable doctors to predict treatment responses and personalise treatment for patients. This is especially relevant for difficult JIA cases which may require more complex therapies, and is important to help save time and money, prevent treatment complications and ultimately, improve care outcomes."

The team's findings are also relevant for adult rheumatoid arthritis, a similar autoimmune condition that affects one in 100 adults in the world.

Explore further: How a few drops of blood led to a breakthrough in immunology

Related Stories

How a few drops of blood led to a breakthrough in immunology

July 5, 2017
Scientists from the Research Institute of the McGill University Health Centre (RI-MUHC) may have cracked the code to understanding the function of special cells called regulatory T Cells. Treg cells, as they are often known, ...

Scientists discover new mechanism that leads to inflammation in rheumatoid arthritis

March 2, 2017
New research findings published in the Journal of Leukocyte Biology, suggest that synovial CD4+ T cells that produce IL-21 contribute to joint inflammation by activating synovial fibroblasts in rheumatoid arthritis patients. ...

Study links immune responses to intestinal microbes with rheumatoid arthritis

June 26, 2017
In patients with rheumatoid arthritis (RA), self-reactive T cell responses cause inflammation and progressive damage to synovial joints. Although genetic risk factors for RA have been identified, environmental causes are ...

Preventing too much immunity

December 27, 2016
Scientists at the Immunology Frontier Research Center (IFReC), Osaka University, Japan, report a new molecular mechanism that could explain the cause of some autoimmune diseases.

New tool for prognosis and choice of therapy for rheumatoid arthritis

March 23, 2017
In rheumatoid arthritis, antibodies are formed that affect the inflammation in the joints. In an article published today in the journal Annals of the Rheumatic Diseases, researchers at Uppsala University show that antibodies ...

Specific immune cells predict bowel cancer outcomes

March 6, 2017
A pilot study by University of Otago researchers suggests that people with colorectal cancer that have a certain type of immune cell in their tumour may have increased survival rates.

Recommended for you

Study shows prevalence of knee osteoarthritis has doubled since World War II

August 14, 2017
The average American today is twice as likely to be diagnosed with knee osteoarthritis than in the years before World War II, Harvard scientists say, but that increase can't be blamed on the reasons most might think.

Researchers find arthritis drug could treat blood cancer patients

August 3, 2017
Blood cancer sufferers could be treated with a simple arthritis drug, scientists at the University of Sheffield have discovered.

Fluid in the knee holds clues for why osteoarthritis is more common in females

June 26, 2017
Researchers have more evidence that males and females are different, this time in the fluid that helps protect the cartilage in their knee joints.

Biologics before triple therapy not cost effective for rheumatoid arthritis

May 29, 2017
Stepping up to biologic therapy when methotrexate monotherapy fails offers minimal incremental benefit over using a combination of drugs known as triple therapy, yet incurs large costs for treating rheumatoid arthritis (RA). ...

Drug for refractory psoriatic arthritis shows promise in clinical trial

May 24, 2017
In a pivotal phase-3 clinical trial led by a Stanford University School of Medicine investigator, patients with psoriatic arthritis for whom standard-of-care pharmaceutical treatments have provided no lasting relief experienced ...

Cross-species links identified for osteoarthritis

May 17, 2017
New research from the University of Liverpool, published today in the journal npj Systems Biology and Applications, has identified 'cell messages' that could help identify the early stages of osteoarthritis (OA).

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.