My name’s David Scott. I’m a consultant rheumatologist at the Norfolk and Norwich University Hospital and an honorary professor at the University of East Anglia. Rheumatoid arthritis is a chronic destructive disease of the joints. It classically involves the small joints of the hands and feet first. It affects women more commonly than men, classically starts in the fifth and sixth decades of life, affects just under one per cent of the population. The most common complaint is pain, pain in the joints. Inflammatory pain, by that I mean the pain associated with rheumatoid.
As opposed to osteoarthritis, is characteristically associated with marked stiffness of the joints. The joints are stiffest when they’ve been rested, so particularly first thing in the morning and with any periods of rest. The next thing that they complain of is swelling of the joints and loss of function of the joints. So it’s often in the hands, the hands are painful. The typical joints, these knuckle joints become inflamed and swollen. They become stiff in the mornings, patients get up and have to put their hands in hot or cold water to get them moving.
And find they’re becoming weak and not able to function so well. We use a combination of treatments. Simple analgesics like paracetamol are used to treat the pain, but that just treats your feeling of pain. Antiinflammatory drugs, which are commonly used, obviously treat the symptoms of stiffness and swelling but don’t affect the process of the disease. Patients who have any evidence that they’re likely to damage joints, and even very early in treatment, and I mean within weeks, not months or years, the most commonly used diseasemodifying drug is Methotrexate.
That’s been used for 30odd years in rheumatoid arthritis and is a very effective drug. Others, such as gold injections, are used much less frequently now, and there are four or five of these diseasemodifying drugs. These drugs, by their definition, slow down the process of damage and can be very effective. But we have a new class of drugs called biologic agents and there is a move in this country and elsewhere to use these drugs earlier. The problem with drugs is they have side effects. The problem with the biologics is they’re expensive.
And we have to use them for the patients who need them, but we certainly like to, in any person who might have the potential for damaging arthritis, to use these drugs early because these are even more effective than the diseasemodifying drugs and can in almost every case stop the destructive process that underlines rheumatoid arthritis. Once diagnosed, it’s usually a diagnosis you have to live with for the rest of your life, so there are other factors that are very important. There are selfhelp organisations. There is a charity called the National Rheumatoid Arthritis Society, or NRAS,.
Which has helplines that can teach people more about the disease. We use our nurse practitioners to do the same sort of thing. It can go into remission and patients can lead a very normal life, but currently our understanding is that patients, even though apparently in remission, ie with no symptoms but on drugs, if you stop the drugs all the evidence will suggest that in most patients the arthritis will come back. Many patients who are at a working age who develop rheumatoid arthritis give up their jobs simply because the arthritis causes.