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New Day Coming for Rheumatoid Arthritis Sufferers

Oct. 30, 2000 (Philadelphia) -- The media has reported that a "cure" for rheumatoid arthritis is in the wings. Should people who live with this debilitating illness expect to take one magic treatment and live life as if their joints had never been swollen, tender, and eventually damaged? Such a cure is not on the horizon, but new therapies are offering more complete relief to those suffering from this chronic condition.

The news regarding treatments for rheumatoid arthritis is not perfect, but it's very good. If the promise seen in recent studies holds out in larger trials, patients will enjoy considerable improvement and less disability, according to several researchers speaking here at the annual meeting of the American College of Rheumatology.

B-lymphocytes are blood cells that can form antibodies to fight off invaders of the body. However, in people with rheumatoid arthritis, those antibodies attack healthy tissue, such as the joints. The B-lymphocytes get caught up in this vicious cycle, creating antibodies that play a role in the onset and continuation of the disease, and one new treatment depletes the body of these B-lymphocytes.

Mabthera, a medication that removes B-lymphocytes, has been used safely in the treatment of lymphoma, a form of cancer. In a small study of patients with rheumatoid arthritis, it has been linked to remission of the disease in some patients, says Jonathan C.W. Edwards, MD.

In this study, Edward and colleagues used a combination of Mabthera with other medications that reduce inflammation. The rationale is that complete B-lymphocyte depletion removes the abnormal B-lymphocytes. The hope is that the abnormal cells would then be replaced by healthy cells when B-lymphocytes are replenished. The researchers hope the body "forgets" how to make the unhealthy cells.

However, reversal of the disease is effective only to a certain point, says Edwards, a rheumatologist and professor of medicine at University College in London. It would be impossible for a person whose joints have been ravaged by rheumatoid arthritis for many years to be restored as if he or she had never had the illness, he says.

Edwards and colleagues reported data from five patients. All of the participants had lived with the illness for an average of 22 years. The subjects were no longer experiencing any benefit from conventional medications.

All of these patients had achieved at least 50% remission of their illness, and three had a 70% remission, reports Edwards. Two had further attempts at treatment. Although three subjects have relapsed, they have enjoyed "as good or better" responses with the experimental treatment. Of a larger group being followed, only two have had no response to treatment. And none of the patients has resumed taking conventional medications. For some patients, the relief has been dramatic enough that they are returning to activities such as working out in the gym and gardening.