There’s not much that can beat a debate between international rheumatology heavy weights Professor Ronald Van Vollenhoven and Professor Joseph Smolen. So imagine our delight when we saw the two were going to be debating whether biomarkers in rheumatology are powerful or powderpuff.

Taking the powderpuff side of the debate Professor Smolen said biomarkers were important but currently their value for predicting response – whether to different therapies or deepness – was not visible beyond C-reactive protein and rheumatoid factor.

Instead, clinical assessments in combination with traditional serology in patients with early changes in the clinical state, or the reverse – no changes, are the best predictors of all outcomes, he told the audience.

Clinical disease activity was the best predictor of response to therapy, particularly for early changes.

“Nevertheless, the search must go on – we will eventually find markers, but we will have to find the right ones and ask the right questions, he said.

“Several years ago I wrote a paper that said forget personalised medicine and focus on abating disease activity – I haven’t seen any data since then that would change my mind,” he said.

“I like biomarkers, it is part of my life’s work but they must prove their validity before I can love them,” he concluded.

Picking up the powerful debate Professor Van Vollenhoven said biomarkers will increasingly help achieve personalized treatment.

Newer options of next-generation biomarkers are advancing the field and will allow clinicians to apply a precision medicine approach to patient care.

A commercially available biomarker panel had been shown to help identify patients at risk for radiographic progression and distinguishes MTX-IR patients who are more likely to respond to anti-TNF from those more likely to respond to triple-DMARD therapy.