Treatments for rheumatoid arthritis

At the moment there’s no known cure for Rheumatoid arthritis, so treatment concentrates on stopping or slowing down the damage the condition causes to joints. The good news is that treatments are improving. ‘We’re discovering new ways of tackling rheumatoid arthritis all the time,’ says Abigail Page, Head of Campaigns for Arthritis Care. ‘These are exciting times. Over the last few years we’ve seen many new types of drugs, which work in different ways, offering new hope to people with rheumatoid arthritis”

Medicines

The drugs used to treat rheumatoid arthritis can be broken down into four groups.

Painkillers — also known as analgesics

These may be prescribed as an extra, or top-up painkiller. Paracetamol is one most often used as an addition to other drugs. Other, stronger drugs, such as co-codamol (contains paracetamol and codeine), and tramadol (a stronger painkiller) are also available.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This type of drug includes the well-known aspirin and ibuprofen, as well as others, such as diclofenac. NSAIDs work by reducing inflammation, so cutting down the pain and swelling. There are many different types of NSAIDs, and your doctor should be able to help you find the one that works best for you. These drugs do help ease your symptoms, but they don’t have any effect on the condition itself.

NSAIDs can cause side-effects, including indigestion, high blood pressure, increased risk of heart problems and for a small percentage of people, even bleeding from the stomach. If you experience these problems your doctor may prescribe another drug, such as a proton-pump inhibitor (for stomach side-effects). A newer type of NSAID, known as a COX-2 selective inhibitor, is less harmful to the stomach. These are not without side effects however, and have been linked to increased risk of heart attack, high blood pressure and stroke. If you have any history of these or related conditions, make sure you tell your doctor.

Disease-modifying anti-rheumatic drugs (DMARDs)

These drugs are vital in the fight against rheumatoid arthritis, as they slow down the progress of your condition, so it’s important to start taking them as soon as possible. DMARDs are more effective the earlier they’re taken. The sooner you start taking them, the sooner they can start protecting your joints.

These drugs can take some time before they start working – as long as six months – and you may have to try a few before you find the one that’s right for you. Once you and your doctor do find the DMARD that suits you, don’t be surprised to find that you’ll be taking it for years, maybe even the rest of your life. The most often prescribed include methotrexate, gold injections and sulphasalazine.

Biological therapies

These are the most recent DMARDs. They are called biological therapies because they were developed thanks to a better understanding of how inflammation and joint damage happens in our bodies

Anti-TNFs (Tumour necrosis factor blockers)

These drugs fight inflammation and can work quite quickly on reducing symptoms in some people. The speed at which you respond to them can vary quite a lot, from person to person. Those who respond quickly can find that they can help to ease pain and swelling in one to two weeks.

Anti-TNFs aren’t right for everyone because of their side effects. These can include headaches, nausea, skin rash, wheezing and chest infections. The anti-TNFs most often prescribed include infliximab, etanercept and adalimumab. Etanercept and adalimumab can also be given alongside methotrexate.

B-cell treatment

Another relatively recently developed drug, Rituximab (brand name MabThera) destroys antibody-producing white blood cells known as B-cells. This is important because in people with rheumatoid arthritis some B-cells produce autoantibodies, which are harmful. Autoantibodies are produced by your immune system when it mistakes a part of your body for something that’s threatening. Autoantibodies attack your own cells, tissues and organs. The result is inflammation and damage.

Often, people taking Rituximab also take methotrexate.

Corticosteroids

More commonly known as steroids, these drugs can help to reduce swelling, stiffness and pain. Your doctor will usually only prescribe them for a short while, often when you’re having a flare-up. This is because steroids can have serious side-effects when used for a long time. These include muscle weakness, thinning skin, osteoporosis and weight increase.

Surgery

Some people with severe rheumatoid arthritis may need surgery on badly-affected joints. This can involve either replacement, usually of hip or knee joints, or reconstruction of a joint.

Latest developments

*Scientists at the University of Leeds, lead by arc Professor Paul Emery, have produced a drug tocilizumab (brand name RoActemra). Used alongside an existing drug, methotrexate, it achieved fast and lasting improvements in rheumatoid arthritis symptoms in sufferers who’d tried other drugs without success. Tocilizumab is expected to be given a UK marketing licence in early 2009. It’s hoped that rheumatoid arthritis sufferers will be able to have it prescribed on the NHS.

*Newcastle University scientists have had early success in developing a drug that may beat rheumatoid arthritis. The team, lead by Professor John Isaacs, has taken the first steps towards developing a possible vaccine, using the sufferer’s own white blood cells, that should reduce the body’s immune response. This would stop the body turning on itself and damaging joints. The research still has a long way to go – the vaccine will be tested for the first time in 2009, on a small group of volunteers. It could be five to ten years or more, before the vaccine is generally available.

*The National Institute for Health and Clinical Excellence (NICE) are reviewing their restrictions on the ‘sequential use’ of anti-TNF therapies. These guidelines suggested that patients from England and Wales should only be prescribed one anti-TNF drug, and if that didn’t work, couldn’t switch to a second or third. However, the three treatments work in very different ways, so it’s possible that although one drug hasn’t worked for you, one of the others could be very effective.

Campaigners launched an appeal for patients to be able to try other drugs if the first one didn’t work. In November 2008, Nice agreed to review the situation. The review is expected to take six to twelve months.

*Cambridge scientists have made a breakthrough in understanding how we can control auto-immune responses. Using a modified version of a molecule called Foxp3, which they introduced into immune cells with genetic engineering techniques, they managed to slow down or even reverse the disease process. There’s a lot of research still to be done, but this development could make a dramatic difference to arthritis treatment.

*A study carried out by Finnish researchers has found that women may suffer more as a result of rheumatoid arthritis than men. The researchers believe that this may be because women aren’t as physically strong as men, and so have more severe symptoms.