Sunday 29 October 2000
by Robert Matthews, Science Correspondent
THE first evidence of a safe and effective cure for rheumatoid arthritis, the crippling disease that affects more than 750,000 people in the United Kingdom, is to be unveiled tomorrow by British scientists.
Until now doctors have been able to offer only limited pain relief. Now a team of researchers at University College, London, has identified drugs that produce significant improvements in patients. In results to be announced at an international scientific conference tomorrow, the team will show that patients see a dramatic improvement after a single treatment, with some apparently cured of the disease completely.
The success with patients treated so far - all of whom had failed to respond to any standard therapy - has been so impressive that an international trial of the treatment is now under way.
Richard Gutch, the chief executive of Arthritis Care, a charity, said last night: "This sounds like one of the new biologic treatments for rheumatoid arthritis which we feel represent a very exciting breakthrough. Although they are not necessarily going to be appropriate for all people with arthritis, certainly those with more severe rheumatoid arthritis would benefit greatly. Drug budgets should be increased to allow for that."
The scientists believe that they have discovered what causes the body's defences mistakenly to attack healthy joints and tissue. The breakthrough focuses on the role of so-called B-cells, white blood cells that defend the body against viruses and bacteria by making antibodies. Although these antibodies are made at random by B-cells, most of them prove useful against some microbe or other.
Every so often, however, the B-cells accidentally make antibodies that attack healthy tissue. Worse still, some of these errant antibodies also trigger the production of copies of themselves. The result, according to the University College team, is a huge self-sustained attack on joints and tissue, which appears in the sufferer as rheumatoid arthritis.
Professor Jonathan Edwards, who is leading the research team, told The Telegraph: "It probably takes just one genetic mistake in a lifetime to trigger this reaction but once it gets going it becomes a vicious circle."
Prof Edwards and his colleagues believe that they have found a way to break the circle, using drugs that seek out and destroy B-cells. He said: "Unlike with other cells in the immune system, most people can live without any B-cells for a while. By the time we reach adulthood we have already made most of the antibodies we need."
After a single treatment to wipe out all the B-cells, the body responds by making fresh ones. The chances of these new B-cells making the same mistake as their predecessors, however, thereby triggering a return of rheumatoid arthritis, is small.
According to Prof Edwards, results from the 20 patients treated so far have been extremely encouraging. He said:."After 18 months the first five patients - who have had rheumatoid arthritis for an average of 20 years - now have only some residual pain from the damage already done. They have returned to leading a more or less normal life, with one going to the gym and one taking up gardening for the first time in ages. So far, of the total of 20 patients only two have had no benefit at all."
These initial findings - about to be published in Rheumatology, the leading journal - will be announced tomorrow at the annual meeting of the American College of Rheumatology. Until now doctors could offer one sufferer, Marion Selfe, aged 61, from Enfield, nothing beyond painkillers. She said: "I'm really excited by the new research."
Mrs Selfe, who has suffered with the disease since 1965, losing the use of her wrists and now in need of an artificial elbow joint, went on: "Not all drugs work for everyone but without all the hard work of these scientists there wouldn't be any treatment at all." Prof Edwards and his team believe that their B-cell-based therapy might also offer hope to patients with other auto-immune diseases, such as Crohn's disease, lupus and even multiple sclerosis.
Prof Edwards said: "If our explanation is right, auto-immune diseases may be like bugs in a computer program. If you happen to press certain keys in a particular order it crashes. The solution is to turn everything off and start up afresh - which in this case means using drugs to eliminate all the B-cells."
The team is hoping to refine the therapy by targeting only the errant
B-cells. Prof Edwards said: "This would allow us to use a rapier rather
than a bludgeon. Even so, on the basis of the data we have we now believe
it is typically possible to keep people completely well for at least a
year, with virtually no side-effects."