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Europe PMC team

 | 14 May 2014


Reforming rheumatoid arthritis treatment: a step in the right direction

Image Source: Serial/Trash
There is good news
for rheumatoid arthritis sufferers: scientists are a step closer to predicting which
patients will benefit the most from a particular type of drug using just a
urine sample.
Imagine being in pain
whilst carrying out routine, daily tasks such as opening a door, reaching for
something in the cupboard, or writing. On top of this, imagine that this pain
often comes on quickly and intensively, but not being able to predict when this
will happen. This is what thousands of people with rheumatoid arthritis have to
cope with every day.
Usually, the cells of
your immune system protect your body from invasion by harmful viruses and
bacteria, acting as your body’s army. Rheumatoid arthritis occurs when some of
these immune cells start to attack your own cells, specifically in the healthy
tissue around your joints. This results in the affected joint and surrounding
area becoming swollen, painful and stiff. These symptoms often intensify very
quickly and without warning, resulting in severe discomfort for the person
concerned. What causes these sudden ‘flares’ and the onset of the disease in
general is still largely a mystery.
There are currently
several different types of drugs available to treat the symptoms of rheumatoid
arthritis. Unfortunately, it can take a period of trial and error to find out
which drug works the best to reduce symptoms in each patient. Doctors and
scientists are currently trying to find out why some drugs work very well in
some people, but not in others. This research is important as it will ensure
that in the future, patients are more likely to be given a drug that works the
best for them; wasting less time than trying treatments by trial and error.
TNF-alpha inhibitors
are a group of drugs currently used to treat moderate to severe rheumatoid
arthritis. TNF-alpha is one of the proteins responsible for creating the
swelling and pain in joints affected by rheumatoid arthritis. These drugs block
the TNF-alpha protein, and so in turn reduce the symptoms associated with
rheumatoid arthritis. They work very well in reducing symptoms in some
patients, but do not work for many others. This latest research reveals a potential
way to identify which people with rheumatoid arthritis are most likely to
respond well to the TNF-alpha inhibitor drugs, by looking at their urine.
Image Source: Shutterstock Copyright: MILA Zed 
The researchers
decided to see if they could find any differences in the amounts of certain
molecules in the urine of rheumatoid arthritis patients who responded well to
the TNF-alpha inhibitors, compared to the urine of those who did not respond well.
They chose to look at the patients’ urine as a similar approach has already
been successful with other diseases. Obtaining a urine sample is also very
quick, easy and not intrusive to the patient.
Sixteen rheumatoid
arthritis patients were chosen to participate in the study. They each gave a
urine sample before commencing treatment with one of two TNF-alpha inhibitor
drugs, which continued for one year. After this time, a doctor assessed the
patients and decided, based on their symptoms, who had responded well and who
had not. At the same time, scientists analysed the urine samples the patients had
given at the beginning of the study. They did this using a technique called
nuclear magnetic resonance spectroscopy. This takes advantage of the notion
that different molecules behave differently when they come into contact with a
magnetic field. When a magnetic field was applied to the urine samples, all the
different molecules in the urine separated and a machine identified exactly
which molecules were present, and in what amounts.
Three different computer
programs analysed the results to make sure the final conclusions were accurate.
In the patients who responded well to the TNF-alpha inhibitor drugs, all three
computer programs agreed that these patients had more histamine, glutamine and
xanthurenic acid molecules in their urine, but less ethanolamine molecules,
compared to those who did not respond well. These findings mean that, if this
test was used in the future, a doctor could take a urine sample from a
rheumatoid arthritis patient to help him or her decide if the TNF-alpha inhibitor
drugs are likely to ease the symptoms of the patient.
This study was small,
so the next step is to test these findings on a larger group of rheumatoid
arthritis patients. These initial findings are exciting though, and not just
for those patients who are most likely to benefit from the TNF-alpha
inhibitors. For patients where the drugs are not likely to work, this will be
known quickly, and an alternative can be suggested instead. This means that
each patient is more likely to receive a treatment that helps his or her
symptoms as quickly as possible; something which is invaluable.

This summary by Elizabeth McAdam was shortlisted for Access to Understanding 2014 and was awarded second prize. It describes research published in the following article, selected for inclusion in the competition by the Arthritis Research UK:

PMCID: PMC3715109
S.R. Kapoor, A. Filer, M.A. Fitzpatrick, B.A. Fisher, P.C. Taylor, C.D. Buckley, I.B. McInnes, K. Raza & S.P. Young.
Arthritis & Rheumatism (2013) 65(6), 1448-1456.

Access to Understanding entrants are asked to write a plain English summary of a research article. For Access to Understanding 2014 there were 10 articles to choose from, selected by the Europe PMC fundersThe articles are all available from Europe PMC, are free to read and download, and were supported by one or more of the Europe PMC funders.

Look out here and on Twitter @EuropePMC_news for further competition news and other Europe PMC announcements.   

One comment on "Reforming rheumatoid arthritis treatment: a step in the right direction"

This is such great news!! This study sounds incredibly promising to rheumatoid arthritis sufferers everywhere. It would be so convenient and easy to assess how well the TNF-alpha inhibitors worked on a given patient though a simple urine test. Hopefully larger studies will be conducted soon and further this great breakthrough. I recently read an article about some healthy habits that rheumatoid arthritis patients can implement to improve their health. Between habits like this and improving medical breakthroughs, the lives of patients everywhere will continue to improve with time!

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