Remaining pain in rheumatoid arthritis – Therapeutic performance of different biological treatments and clinical relevance of a recently identified unexplored causative signalling pathway.

Pain in rheumatoid arthritis (RA) is highly debilitating, impacts quality of life and lacks adequate treatment options.

Although biologics have proven benefits on inflammatory disease activity, up to 1 in 5 of the treated patients still report continuous significant problems with pain and fatigue.

Recent extensive experimental work from co-applicant Patrik Ernfors’ research group reveals strong evidence for a causative pain pathway involving the Type 1 interferon (IFN) system (IFN1).

Our proposal includes a translational approach with analysis of patient reported outcomes including remaining pain in an early RA cohort, effects of biologics and potential associations with Type 1 IFN signaling and continous experimental mapping of the background mechanisms of this novel pain signaling pathway.

We will also plan for a RCT with current available IFN-blockade, anifrolumab (Saphnelo) in RA with remaining pain.The proposal has very good potential to answer important questions on effects of biologics on pain and other patient reported outcomes.

The recently identified causative pathway through IFN1 constitutes a potential breakthrough in general pain research, with vast clinical implications.

The increased knowledge will also lay the ground for development of new and specific targeted treatment strategies for remaining pain in RA and other pain conditions.

Thereby the results may have vital importance on future treatment strategies both nationally and in an international perspective.