Table 1.
Summary of the treatment landscape for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)
| Treatment landscape for RA and SLE | Rheumatoid arthritis | Systemic lupus erythematosus |
|---|---|---|
| Treatment goals | Remission (primarily for patients with early RA) and low disease activity (mainly for patients with chronic RA) | Remission (primary target) and low disease activity (alternative target) |
| Treatment options for joint manifestations |
Methotrexate is generally the first treatment choice A wide range of bDMARDs and tsDMARDs are available for patients with inadequate responses, intolerance or contraindications to csDMARDs |
No treatment options with proven efficacy in selectively treating musculoskeletal manifestations but musculoskeletal manifestations were prominent in positive trials of belimumab and anifrolumab Treatment options under investigation Baricitinib Dapirolizumab pegol Rituximab |
| Autoantibody effect on treatment outcomes |
Seropositivity for ACPA is associated with increased clinical response to rituximab and abatacept Seropositivity for RF is associated with increased clinical response to rituximab and tocilizumab Seropositivity for both ACPA and RF is associated with more rapid achievement of remission and higher rates of sustained remission compared to other groups |
Seropositivity for anti-dsDNA antibodies, treatment with ≥ 7.5 mg/day prednisolone and SLEDAI-2 K ≥ 10 are positive predictors of response to belimumab treatment |
| Effect of treatment on autoantibodies titers | Treatment may reduce ACPA and RF titers or result in seroconversion to RF negativity | Belimumab, rituximab, anifrolumab, mycophenolate and prednisolone treatment are associated with a reduction in anti-dsDNA antibody titers |
The main treatment targets and summary of treatments for RA and joint manifestation for SLE are outlined. The effect of seropositivity for autoantibodies on treatment response and the effect of treatment on autoantibody titers are summarized. Data from [2, 8, 30, 90–101]
ACPA Anti-citrullinated protein antibodies, bDMARD biologic disease-modifying antirheumatic drugs, csDMARD conventional systemic disease-modifying antirheumatic drugs, dsDNA double-stranded DNA, RF rheumatoid factor, SLEDAI-2 K SLE Disease Activity Index 2000, tsDMARD targeted synthetic disease-modifying antirheumatic drugs