Steroids give new hope to arthritis sufferers

Liz Hunt reports on a breakthrough in treatment for a destructive disease affecting 1 million people

Doctors are hailing a major advance in the treatment of rheumatoid arthritis which should prevent thousands of people developing the severest form of the disease, in which their joints disintegrate.

Low doses of steroid drugs given to people who have had the disease for less than five years can significantly reduce erosion of bone and cartilage, according to a three-year clinical trial. In the treated patients, joint erosion was reduced by more than half when compared with a control group who did not receive the steroids.

The Arthritis and Rheumatism Council (ARC) yesterday launched a campaign to make GPs and rheumatologists aware of the breakthrough so that recently-diagnosed patients can start treatment as soon as possible.

Dr John Kirwan, a consultant rheumatologist at Bristol University who led the research, said: "The exciting thing about these results is that we now have hope of controlling the disease in the long term. For the first time we have a treatment which can alter the underlying process of the disease. Moreover, the drugs used in this treatment are already available.

"We want family doctors to really start thinking about steroids used in this way. Until now, [steroids] have been prescribed to suppress inflammation only in very severe cases and used warily because of side- effects." In high doses, steroid drugs can have severe side- effects.

More than 1 million people in the UK suffer from rheumatoid arthritis and 600,000 are severely affected, and may be disabled. It is an auto- immune disorder in which the immune system attacks the body's own tissues, in this case bone and cartilage. Any joint is vulnerable but especially the fingers, wrists, shoulders, knees, hips and spinal joints in the neck. The disease can occur as a single attack or in progressively severe episodes. Routine treatments, including anti-rheumatic drugs and painkillers, relieve pain and swelling but cannot stop the disease's destructive effects on body tissues.

Dr Kirwan and his team at Bristol Royal Infirmary showed that 7.5mg of the prednisolone (a synthetic version of corticosteroid drugs which are produced naturally by the body) initially reduced pain and swelling. But the real impact was on slowing the underlying progress of the disease and protecting the joints, an effect maintained throughout the course of treatment. The patients were given other drugs to relieve painful symptoms in addition to the steroids.

According to the report in the New England Journal of Medicine, only four of 128 patients who took part in the multi-centre trial suffered side-effects associated with steroid therapy of raised blood pressure, weight gain, and diabetes.

A spokesman for ARC, which funded the work, said: "This is the first time that any treatment has been clearly shown to achieve this. Most benefit is achieved in people who have had the disease for less than two years, but it may also be able to help those who have had it for up to five years, depending on how much damage has already been done to the joints."