Good news on rheumatoid arthritis
Rheumatoid arthritis is one of the more depressing diseases. Starting out with low level disability and some discomfort, it slowly grows more severe as time passes. It’s the slowness of the decline that makes it so terrible. There’s little to choose between one day and the next but, when you look back over the last month, you realize you’re another inch down the slope to the joints seizing up. The problem is the slow destruction of the cartilage as the autoimmune system fails to work properly and attacks healthy tissue, generating increasingly severe inflammation. The basic strategy for treatment is to balance physical therapy to maintain some mobility while using different drugs to halt the immune system’s misbehavior and control the pain. But there’s only a certain amount you can achieve through weight loss programs and physiotherapy. At some point, the joints cannot continue to move as before. The statistics show that, after about ten years, the majority of people will have significant disability despite the success of the DMARDs (disease-modifying anti-rheumatic drugs).
One of the key indicators of the inevitable decline is called morning stiffness. As the name suggests, lying down for sleep encourages the body to stop moving. During this period of inactivity, the affected joints and surrounding musculature stiffens. When waking, the body must slowly be coaxed back into mobility again. This can be a painful process. The European League Against Rheumatism (EULAR) has been running a series of trials on a slightly different approach to current practice. The European strategy has been to use a pick-and-mix approach to the DMARDs, looking for the best results on a trial-and-error basis. This has been justified by the inevitable “truth” that “all patients are different”. So, within preset limits, doctors play with different drugs in combination and at different dosages until the best outcome is achieved.
In two trials titled Circadian Administration of Prednisone in Rheumatoid Arthritis (CAPRA), EULAR has been testing a modified-release version of Prednisone. The idea is to take a low dose before going to bed. The tablet is designed not to release the drug until about four hours into sleep with the peak concentration being achieved about two hours later. So,someone going to bed at 10 p.m. will get the maximum effect of the drug at about 4 a.m. which is judged the ideal time if pain and stiffness on waking is to be reduced. The results from the second trial have just been released and confirm the success of the modified-release system. The drug was administered over a twelve week period, with a major short-term improvement in mobility on waking. But what is really significant is the continuing improvement in mobility when participants were allowed to continue taking Prednisone for up to twelve months after the end of the formal trial. It seems clear that the use of this drug alongside the optimized cocktail of DMARDs produces the best overall outcome with morning stiffness reduced and general mobility improved during the day. Given there is no immediate prospect of any drug coming on to the market as a cure for Rheumatoid Arthritis, these trials old out hope for those who currently struggle with pain in the mornings.