Arthritis is a chronic pain condition that affects over 175 million people worldwide. While there are over 100 forms of arthritis, the two most common are osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is known as a “wear and tear” condition that mostly affects people over the age of 55 and is due to joints simply wearing out with time and use.
Rheumatoid arthritis is not quite as straightforward and can affect people as young as 20. While both types of arthritis are painful and can result is diminished activity, fully 50% of those diagnosed with rheumatoid arthritis are unable to work full-time within ten years. Because this condition can develop in a person’s most productive years, the cost of rheumatoid arthritis over a lifetime is high.
Recently, researchers have discovered two new potential treatments that are safe and effective and may actually help slow the progression of the disease.
Rheumatoid arthritis is an autoimmune disorder that occurs mostly in developed countries. Symptoms of RA include:
- Pain and stiffness in the affected joints, especially after periods of rest or inactivity
- Redness and swelling
- Loss of appetite
- General feeling of being unwell (often termed “malaise”)
These symptoms are the hallmarks of rheumatoid arthritis, and researcher Diederik De Cock at KU Leuven in the Netherlands has found a new drug therapy that effectively, safely, and cheaply targets these symptoms early to prevent bone deterioration and loss, slowing the progression of RA. De Cock divided 290 patients with rheumatoid arthritis into three groups and provided the following treatment protocols:
- COBRA Classic (methotrexate, sulfasalazine, and a high first dose of glucocorticoids)
- COBRA Slim (methotrexate and a moderate dose of glucocorticoids)
- COBRA Avant-Garde (methotrexate, leflunomide, and a moderate dose of glucocorticoids)
All three protocols were very effective, with remission achieved for 70% of patients within 16 weeks. The difference was in the side effects. The COBRA Slim treatment utilized half of the medication of the other two and resulted in half as many side effects. This treatment was also much easier to utilize on a daily basis, a factor that could contribute to better patient compliance.
The final plus to this strategy is practical: it’s affordable.
Diederik De Cock pointed out that the affordability of the treatment puts this within reach of many more patients, a bonus for those at the poverty level who experience earlier onset of rheumatoid arthritis:
“Methotrexate is very affordable, as are[steroids]. Implementing this therapy across Flanders would mean substantial savings. At the moment, RA treatment is not yet adequately standardized in Belgium, and this leads to treatment inefficiencies. As a result, more patients require expensive second-line anti-rheumatic therapies known as biologicals, which can cost up to 15,000 euros per year. By comparison, the COBRA Slim strategy costs less than 1,000 euros. In other words, we can treat up to 15 patients for the same price as a year of treatment with a biological.”
Another team of researchers at the La Jolla Institute for Allergy and Immunology, in collaboration with colleagues at the University of California, San Diego, have identified a new drug that targets the cells that are responsible for the destruction of cartilage in joints affected by rheumatoid arthritis. As the body’s immune system signals an “invader” in the joints, cells are triggered to fight that imagined invader. Over time, this results in the deterioration of cartilage in the joints, which causes painful bone contact, pain, and inflammation.
Nunzio Bottini, M.D. Ph.D., associate professor at La Jolla Institute and associate professor of medicine at the University of California, San Diego was the lead author of the study that looked at the activity of fibroblast-like synoviocytes (FLS). The FLS are located in the synovial fluid of each joint and usually provide joint lubrication. When the immune system is triggered, these formerly peaceful cells begin to attack the cartilage, breaking it down. They also cause bone deterioration.
Bottini wanted to find a way to stop the fibroblast-like synoviocytes from inflicting further damage to the joint after inflammation was under control:
“Even if your inflammation is completely under control with the help of current therapies — and they are excellent — the damage to the skeletal structure is not necessarily arrested in the long term because synoviocytes continue to cause damage. And although synoviocytes are considered the main effectors of cartilage damage in rheumatoid arthritis there’s no therapy directed against them.”
Postdoctoral researcher Karen M. Doody, Ph.D, discovered an enzyme known as RPTPσ (receptor protein tyrosine phosphatase sigma) on the surface of FLS. This enzyme is responsible for keeping the FLS in check, blocking it from attacking and destroying cartilage and bone. The team’s goal was to find a way to activate that response in patients with rheumatoid arthritis. The key to this was to remove the biological blocks that prevented the receptor protein tyrosine phosphatase sigma from kicking into action.
The team found that this action resulted in less cartilage damage and a treatment that did not interfere with other treatments for rheumatoid arthritis.
Co-author Gary S. Firestein, M.D., dean and associate vice chancellor of translational medicine and director of the Clinical and Translational Research Institute at UCSD, pointed out that this treatment also doesn’t interfere with the body’s normal, healthy immune response:
“The unique aspect of this approach is the ability to improve symptoms and decrease joint damage while potentially avoiding any negative effects on normal immune responses and susceptibility to infections.”
Bottini pointed out that the end goal for the treatment is complex, long-term, and includes incorporating existing RA treatments:
“The ultimate goal is to use biologics that target synoviocytes in combination with treatments that suppress the immune system, such as methotrexate or anti-TNF, to address all three aspects of rheumatoid arthritis: swollen joints as a result of inflammation, cartilage damage and bone damage.”
The new medications are still in clinical trials, but ask your doctor about these options, in addition to lifestyle ways to manage arthritis!
Image by Expert Infantry via Flickr