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Biomarkers and Treatment Plans

Since my diagnosis just over eight years ago, I’ve steadily worked my way through all the biologics except one. Your body can build up a resistance to medications just like it can to disease and mine seems to do an excellent job of it. While a drug might have worked in the beginning, over time I’d need a larger dose until, eventually, it quit being effective at all. In addition, some drugs just didn’t work from the beginning.

Treatment plans for RA are, even in this day and age, largely an exercise in trial-and-error. A rheumatologist will often start with the most common medications and go from there. This is extremely frustrating for those of us who are patients. It can take more than three months for some drugs to be effective. Finding out that it doesn’t work after undergoing months of injections or infusions can be disheartening. It’s not surprising, therefore, that many rheumatologists (and patients!) wish for some kind of screening lab test that could predict which drugs have the best opportunity to work for a particular patient.

I was really encouraged the other day when I read about the use of biomarkers in predicting the outcome of treatment with rituximab (Rituxan). The article is written for physicians and is therefore very technical so I won’t delve deeply into it, but you can read it here if you’re interested. The study discussed the use of two biomarkers were very predictive in the success of using Rituximab. Interestingly, the study revealed which patients were less likely to respond to treatment indicating that a different medication should be used. It’s not much of a stretch to think that it might be possible to use similar testing to figure out which drugs would be most successful for a patient.

Those of us with RA and other inflammatory diseases go through a lot of lab work starting with a slew of tests during the diagnosis phase to actually identify what condition is causing the problems. From there, labs are usually drawn on a regular basis to monitor disease markers and watch for any side effects such as liver damage. The rituximab study was done on data already available so, in this case, additional lab tests wouldn’t have to be done. But even if there was a new lab test developed, it shouldn’t be a huge effort to add it to the regular testing already done.

I would think that insurance companies would cover the test(s) because it would help avoid paying for very expensive drugs that might not work well.

Unfortunately, the problem may be just doing the research. This kind of research takes time and money as well as access to the lab and exam results for a reasonable population of patients. Unless undertaken by pharmaceutical companies (that may be limited to researching only their specific products), the studies would need to be done by universities or other research facilities that are always scrambling for funding.

But we are getting closer. The really good news is that each time we find a new drug that works or how it works for a specific patient, the closer we are to finding the actual cause of RA and other inflammatory diseases. That means we’re getting closer to a cure.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • suann
    3 years ago

    I worked my way through the bio drugs as well, my body seems resistent to all the meds now, predisone will still work some . So I now have the crippling and such,, I hate it, my hands are so ugly with the nodules and the swelling…hate hate hate it

  • Carla Kienast author
    3 years ago

    Thanks for commenting and letting us know what’s going on. I hate that you’re out of current options for biologic drugs, but the good news is that there are some very promising things on the horizon. In the meantime, know that you’re always welcome here to share your story and for encouragement and support as well as a wealth of resources.

  • Tich
    3 years ago

    My rheumy is a clinician as well as associate professor and researcher. So I was pretty disappointed when he told me my RD (Ankylosing Spondylitis) has no biomarkers. He measures my disease activity by the appearance of my eyes, and he consults with my ocular immunologist. But it seemed that he was losing interest when an during an exam between flares he said AS has no blood metrics. I continued the cycle of flares & prednisone treatment along with his TNF inhibitors, and became very impatient with lack of measurable progress. This year I took radon therapy on my own but with his knowing, and the flares have stopped. My eye doc is quite impressed, and I am too. I will continue with biologics until their side effects become difficult to manage. But radon is my friend now.

  • Carla Kienast author
    3 years ago

    Hi Tish: Thanks so much for this information. I had not heard of radon treatments for RA but did some investigation after your comment, and there have been some interesting articles in some prestigious publications about this. That’s the great thing about community, you have the opportunity to share things that might be helpful. Appreciate you taking the time to comment.

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