'Clearly Toward 'omics'

In a Clinical Chemistry Q&A, the National Institute of Arthritis and Musculoskeletal and Skin Diseases' Michael Ward says that for genetic markers of autoimmune diseases like rheumatoid arthritis to be used in clinical practice, they "should provide unique information about prognosis or treatment response not provided by other more readily available and less expensive sources, be it the clinical history or examination, or more commonly used laboratory tests." He notes that while markers of potential drug toxicity are already being used in some cases, currently "no genetic markers are used clinically for prognosis or to guide treatment decisions." Plus, Ward adds, "heterogeneity in symptoms, signs, and responses to treatment among patients of the same genotype will complicate these efforts."

However, to Ward's mind, "the trend in the diagnostics in autoimmune diseases is clearly toward 'omics." And so, as the technologies advance, "it may be possible to identify specific autoantibody profiles, for example, that could lead to more accurate or earlier diagnosis," he says, adding that at the same time, "treatments will increasingly be individualized and chosen on the basis of knowledge of the prime mediators of inflammation in a particular patient."