PATIENTS newly diagnosed with rheumatoid arthritis (RA) may benefit from a personalised treatment approach based on their B-cell profile, according to a new study.
Researchers from the NORD-STAR trial found that two specific B-cell subsets, transitional B cells and CD21⁻ PD-1⁺ B cells, measured at diagnosis were significantly associated with remission at 24 weeks, regardless of treatment type.
Involving 70 early RA patients from two Swedish sites and 28 healthy controls, the study aimed to uncover predictive biomarkers of treatment response. All RA patients received methotrexate (MTX) alongside either prednisolone, anti-TNF therapy (certolizumab pegol), abatacept, or tocilizumab.
Patients who reached remission, defined by a Clinical Disease Activity Index (CDAI) score ≤2.8, had higher baseline levels of transitional and CD21⁻ PD-1⁺ B cells. When combined, these B-cell populations predicted remission with a specificity of 86% and a sensitivity of 59%.
Notably, a negative correlation was found between transitional B-cell levels at diagnosis and disease activity at 24 weeks in patients treated with MTX and prednisolone or anti-IL-6R therapy, further supporting the cells’ potential as prognostic markers.
“There are currently no validated biomarkers to guide treatment decisions in early RA,” the authors wrote. “These findings suggest that measuring B-cell subsets at diagnosis could help identify patients most likely to achieve remission with standard therapy.”
While the study was limited by its small sample size, it opens new possibilities for personalised RA treatment and highlights the clinical value of immune profiling at diagnosis. Future research with larger cohorts may validate B-cell biomarkers and improve outcomes for patients newly diagnosed with RA.
Reference
McGrath S et al. Transitional and CD21− PD-1+ B cells are associated with remission in early rheumatoid arthritis. BMC Rheumatol. 2025;DOI: 10.1186/s41927-025-00487-x.
