2020 Volume 32 Issue 4 Pages 304-309
Autoimmune and rheumatic diseases are characterized by multiple organ manifestations but are molecularly and genetically heterogeneous which makes it difficult to manage every case based on one kinetic molecular theory. The appropriate use of molecular-targeting therapies such as biological DMARDs and JAK inhibitors allowed rheumatologists to aim for clinical remission and to control joint destruction in all patients with rheumatoid arthritis. Such therapeutic strategies are applied to the treatment of various rheumatic and autoimmune diseases. However, how to select different targeted therapies to each patient remains unclear and it is necessary to develop new therapeutic strategies involving the differential use of them. We have reported that patients with psoriatic arthritis were classified into four groups based on the expression of chemokine receptors on peripheral T cells by 8-color flow cytometry: Th17-dominant, Th1-dominant, hybrid, and normal type in the FLOW registry. Patients treated with the strategic selection of different biologics based on the phenotypic differences in individuals revealed significantly higher proportion of improvement in arthritis and psoriasis than those who were conventionally treated with biologics. Thus, for the treatment of psoriatic arthritis, therapeutic drugs can be optimized according to pathological conditions through the analysis of peripheral blood lymphocytes. In other words, precision medicine may be possible. The objective of precision medicine is the stratification or subgrouping of patients to improve diagnosis and treatment, which would encourage treatment strategies of various rheumatic and autoimmune diseases with clinical and molecular heterogeneity.
