Rheumatoid arthritis research optimistic but not a breakthrough

DALLAS Kathryn Miller knows to be skeptical after hearing that a cure has been discovered for rheumatoid arthritis.

"You always want to believe there's a miracle out there," says the 29-year-old Dallas architect, who was diagnosed with the condition at age 3. "Until I hear the word 'cure' from my own doctor, I'm not going to believe it."

But she and other rheumatoid arthritis patients were left hanging until their doctors returned from the annual meeting of the American College of Rheumatology in Philadelphia, where the supposed cure was discussed Oct. 30. Many had to turn to the Internet for more information on the medication that seemed to cause an unexpected remission of the disease in a group of English patients. What they found in the fine print of the study quickly tempered their enthusiasm, she says.

The treatment had involved only five patients, which was clearly not a large enough group to offer conclusive proof of a major breakthrough. Also, other researchers would point out that there was no control group with which to compare the study's promising results. And the five patients had been given other treatments, including steroids and chemotherapy, which could have contributed to their improved conditions.

"It was interesting research," notes Dr. Stanley Cohen, a Dallas rheumatologist and researcher who attended the meeting. "But it was not a breakthrough."

Cohen says the exaggerated response to the study reminds him of the way the media overplayed the results of studies that showed promise of treating other chronic conditions in the 1980s, but the treatments later were found not to work.

"It's a complete disservice," he says of the press reports that raise the possibility of a cure for rheumatoid arthritis. "The horse got out of the barn too early. It should not happen that way."

Still, Cohen says he remains hopeful that the research might lead to better treatments for people who have rheumatoid arthritis, a condition that afflicts 1.2million Americans, most of them women.

The chronic disease causes pain, stiffness, swelling and loss of function in the joints as well as inflammation in other body organs. While the cause is unknown, research indicates that certain people inherit a tendency to develop the condition.

Cohen says the study by Dr. Jonathan C. Edwards, a British rheumatologist, represented a "novel" approach to treating the disease. The treatment targets the faulty way in which a patient's immune system attacks its own healthy tissue.

His study involved a three-week treatment with Rituxan, a three-year-old cancer drug developed by Hoffman-La Roche to treat non-Hodgkins lymphoma. The drug attacks a type of white blood cell called B-lymphocytes, depleting their number enough to bring about a significant degree of remission in all five rheumatoid arthritis patients, Edwards says. Three remained in remission after a year, and the other two for seven and nine months. The pair underwent a second treatment and were in remission again.

While the study holds out hope that the cancer drug could restore damaged tissue in some rheumatoid arthritis patients, it also indicates that it might not be possible to regenerate tissue that has been ravaged by the disease for many years. The patients in the study have had rheumatoid arthritis for an average of 22 years.

Edwards also reports that 10 additional patients are being followed in another study and that some of them have reported feeling well enough to be able to work in their gardens and return to the gym. A formal, controlled study will follow.

Cohen notes, however, that it will take time to determine whether further studies will result in new treatments for rheumatoid arthritis.

"We've been down this road many times before with studies that are illuminating in small groups but that don't necessarily hold up in randomized trials," he says. "We need to remember that it takes maybe two to four years of testing on hundreds or even thousands of patients before any treatment gets to the marketplace."


Facts about RHEUMATOID arthritis

· One of the most common forms of arthritis

· Affects 2.1 million Americans, mostly women

· Between 30,000 and 50,000 U.S. juveniles also stricken

· Causes inflammation in lining of joints and internal organs

· Can invade and damage bone and cartilage

· Symptoms include joint swelling, difficulty moving, loss of appetite, fever and loss of energy

· Considered an autoimmune disease because the body's immune system attacks healthy tissue

· Has no cure, but there are many new treatments to ease the pain

SOURCE: Arthritis Foundation,
North Texas Chapter