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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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