Precision medicine and the chaos theory in rheumatoid arthritis.
(2026) Annals of the rheumatic diseases — Vol. 85, n° 2, p. 235-237 (2026)
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- (en) Predicting what the future holds is a quintessentially human aspiration. Beyond the purview of mystics, pragmatic prognostication has long preoccupied physicians. In the fifth century BC, Hippocrates stated: ‘The best physician is one who can prevent and predict’. Some 2500 years later, the concept of ‘precision medicine’, ie, the ability to tailor treatment decisions based on accurate biomarkers, remains the holy grail in many medical specialties including rheumatology. Disappointingly, despite intensive efforts, this concept has proven challenging to translate into practice in the field of inflammatory rheumatic diseases (iRMDs). As therapeutic options have increased over the 3 last decades across a variety of iRMDs and modes of action, the notion of ‘the right drug for the right patient at the right time’ has attracted increasing interest—with enhanced expectations—from physicians and patients alike. Enticed by breakthrough advances in oncology, the rheumatology community has expended tremendous work and resources into gathering clinical, serologic, radiologic, pharmacologic, histologic, genetic, epigenetic, transcriptomic, metabolomic, proteomic, and other data to build predictive models. As these highly effective new therapies interfere with general inflammatory principles (rather than truly separate mechanisms operating in different patient subsets), precision medicine continues to be a challenge. [...]
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Citations
Triaille, C., Durez, P., Smolen, J. S., McInnes, I. B., Lauwerys, B., & Limaye, N. (2026). Precision medicine and the chaos theory in rheumatoid arthritis. Annals of the rheumatic diseases, 85(2), 235-237. https://doi.org/10.1016/j.ard.2025.07.005 (Original work published 2026)