Integration of synovial pathotypes and serum proteomic modules as determinants of disease progression and therapeutic response in early rheumatoid arthritis
Authors' conclusion
Synovial pathotypes in early RA were associated with distinct circulating proteomic patterns reflecting tissue-level heterogeneity.
Study context
- Population
- Patients with early rheumatoid arthritis (RA)
- Participants
- 147 patients2 independent cohorts
- Exposure
- Synovial pathotypes and pathotype-associated serum proteomic scores vs 6-month clinical outcomes
- Cohort 1n = 25
- Cohort 2n = 122
- Outcome
- Associations between synovial pathotypes, pathotype-associated serum proteomic patterns and clinical outcomes
- Follow-up
- 6 months
Methodological detailstwo independent cohorts, synovial biopsy, serum proteomics (Olink Inflammation panel), exploratory
- Two independent cohorts
- Synovial biopsy
- Serum proteomics (Olink Inflammation panel)
- Exploratory
Main finding
As reported in the abstract
- Lymphomyeloid pathotype associated with higher disease activity, autoantibody positivity and increased synovial immune infiltration
- High Krenn score associated with greater inflammatory burden and higher disease activity
- No significant differences in treatment response according to Krenn score
- Synovial pathotype associated with differences in b/tsDMARD initiation and exploratory 6-month response patterns
- Pathotype-associated serum protein patterns showed differential distributions across histological groups
Observational data: associations, not effects.
Further findings
Serum proteomic scores and treatment response · 6 months
- Higher lymphomyeloid scores among csDMARD responders
- Higher diffuse-myeloid scores among b/tsDMARD non-responders
- Directionally consistent after adjustment in cohort 2, neither statistically significant
- Exploratory
Original publication
Integration of synovial pathotypes and serum proteomic modules as determinants of disease progression and therapeutic response in early rheumatoid arthritis. RMD Open. Published 19 August 2026. doi:10.
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