The TREMERA study focuses on patients with newly diagnosed, untreated, rheumatoid arthritis
(RA). Recent international treatment recommendations emphasise the need to diagnose RA early
and start treatment immediately (this being associated with better response rates); and to
aim for the goal of remission i.e. the absence of signs and symptoms of active inflammatory
disease activity which is associated with better outcomes for the patient. Remission is more
achievable with significant treatment advances that have been made in the form of highly
effective biologic therapies. Tocilizumab (TCZ) is a newly introduced biologic drug that is
used in established RA. The TREMERA study primarily aims to investigate the biological
changes seen in blood and tissue following TCZ therapy this will contribute to a better
understanding of how the drug works as well as disease processes; and will also identify
whether administering a biologic drug such as TCZ can also switch off immunological
parameters associated with a disrupted immune system of RA. The study will assess the
effectiveness of TCZ given on its own or in combination with methotrexate (MTX; a standard
therapy usually given with biologic treatments)in patients with early onset RA to determine
the proportion that achieve remission. This study also aims to find out how quickly remission
can be achieved with TCZ and the depth of remission achieved. This will be done using usual
clinical assessment but also imaging such as ultrasound and magnetic resonance imaging (MRI)
which can detect inflammation not apparent on clinical assessment.