by Robert Matthews, Science Correspondent for Electronic Telegraph
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."
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