A PATIENT developing rheumatoid arthritis (RA) today should be able to live a relatively normal existence because of new drug treatments, a leading expert in the field has said.
Prof John Isaacs, professor of clinical rheumatology at Newcastle University, said there was a “brave new world” of drug treatments available to sufferers which were not available 20 years ago.
“The message is, for a young person developing RA today there are a lot of good options,” he said.
“There is no reason at all why somebody developing it should not be able to lead a normal life, keep their job and lead a relatively pain-free, if not a pain-free, existence.”
Prof Isaacs has been working over the past 20 years on the potential of immunotherapies to treat RA. He visited Galway and Dublin to brief doctors about advances in the field of treatment of the disease recently.
RA is an autoimmune disease, in which the body’s own immune system attacks healthy tissue, resulting in joint damage and chronic inflammation. Most sufferers are in their 40s and 50s, unlike the more common osteoarthritis which tends to affect older people.
RA affects about 1 per cent of the adult population in the Republic and can be costly for individuals and employers.
There is no known cure for RA, so the ultimate goal of all treatments is remission where patients are largely free of the pain and fatigue which characterise the disease. It is critical to begin treatment early because after two years, up to 70 per cent of people with RA have X-ray evidence of bone disease.
Prof Isaacs said the use of biologic drugs, which are grown in tissue cells, have shown very promising results and, if given to patients in the early stage of the disease, can lead to remission. He said there were four such drugs at the moment which address the imbalances in blood cells that lead to RA, help to reduce the inflammation and progression of it in the joints and throughout the body.
Prof Isaacs said one particular drug, RoActemra, had shown in advance trials that it is successful in getting 30-35 per cent of patients into remission. He was one of the key investigators into the drug, from the beginning.
“One of the problems with rheumatoid is that it is a mixture of different diseases which all look the same. Often, we can’t match the right drugs to the right patients so we end up having to cycle patients through various drugs. To a certain extent, it is trial and error.
“It [RoActemra] is a new option because it works in a different way from all the others. At worst it gives them another chance. The quality of response to this drug seems to be better in some ways than the other drugs.”
However, such biologics are much more expensive than traditional disease-modifying anti-rheumatic drugs (DMARDS), anti-inflammatory drugs such as cortisol and non-steroidal anti-inflammatory drugs which are most commonly used to treat the disease.
Prof Isaacs said the expense of such drugs meant they were being used after less expensive chemical-based drugs were first tried. He said research was now “turning things on its head” by advocating giving the expensive drugs first at the critical early stage of the disease and using cheaper drugs once remission is achieved.
“If we give the drugs early on in the disease, we may be able to stop them after a year or so and control the patient symptoms on more conventional drugs.”
