There are about 750 000 sufferers Rheumatoid Arthritis (RA) sufferers in the UK. The origin of the disease is obscure but is generally believed to be genetically linked in families. Some common features of the disease are: pain & stiffness in the mornings sometimes lasting over an hour; the joint begin to swell especially in the hands and feet, which can eventually lead to gross deformity in these areas.

The primary troublemaker in RA is a dominant pro-inflammatory cytokine called TNF (Tumour Necrosis Factor). The presence of this substance stimulates the synovial cells, within the joints, to produce enzymes that attack the body.

It is not a life threatening disease, and in some cases this chronic illness can spend a long time in remission. However, when the disease is active, the condition can be very painful affecting the quality of life and in one out of every 20 people disability occurs. RA is more commonly found in older people but it can strike at any age, the youngest patient was an 8 week old baby but this is an extremely rare occurrence. Also, women are far more likely to be affect by this disease with the current statistics suggesting a ratio of 2 or 3 women to 1 man.

Much can be done to improve the condition:

• Regular exercise e.g. swimming or hydrotherapy (if lucky);
• Occupational therapy to help with strength and posture as well as advice on devices around the home;
• Diet can also help including food supplements like Glucosamine.

Medically, there are variety of treatments available, e.g.

• painkillers
• anti-inflammatory drugs
• joint injections
• and disease-modifying drugs

Alternatives to medical intervention are acupuncture, homeopathy, reflexology, electromagnetic radiation and gadgets such as T.E.N.S machines (Transcutaneous Electrical Nerve Stimulation) which offer pain relief by stimulating the brain to produce natural pain killers: endorphins "A Natural High".

Conventional medical treatment has been generally through the use of disease-modifying drugs such as Methotrexate, Sulphasalazine, Gold injections, Hydrxychloroquine, Cyclosphamide, and Cyclosporin given in conjunction with the oral steroid Prednisolone. More recently, Aravare has become available where the active ingredient is Leflunomide. In some cases injections of steroids such as Methylprednisolone will make a difference in a reasonably short time. But with most of these treatments there are some reasonably nasty side effects.

As most treatments are based on steroids, some of the most common side effects are weight gain, osteoporosis, immune system suppression, water retention, and hypertension (high blood pressure). Methotrexate and Leflunomide, in particular, interfere with liver function and can in some cases cause irreversible liver damage and sometimes kidney damage as well. Most of the side effects occur within the first few weeks of starting a treatment but blood monitoring must continue throughout the course of treatment.

None of the currently available drugs prevent inflammatory flare-ups, so RA patients need frequent blood tests to ensure that they are not anaemic and to ensure that both liver and kidney functions are normal.

In June 2000 a new drug ENBREL was licensed for use in the England & Wales. Its active ingredient is ETANERCEPT. This drug has resulted in spectacular clinical results, resulting in patients treated with this disease-modifying drug being able to resume normal life again, including returning to work. The drawback to ENBREL is that each injection (one injection twice a week) costs the NHS £162.50. The cost effectiveness has yet to be evaluated by the National Institute for Clinical Excellence (NICE) so there is no guarantee that funding will be made available. The National Institute for Clinical Excellence was set up as a Special Health Authority for England and Wales on 1 April 1999. In Scotland there is the SMC Scottish Medicines Consortium.

However, Etanercept is the only drug available that has been specially engineered to block the action of the TNF cytokine. If the drug is injected directly into the joint the biochemistry of the cells is rendered null and void. However, extra funding has not been made available to the NHS in order to treat patients with this new disease-modifying drug.

If you, like us, believe that more RA sufferers should be given the opportunity to improve their quality of life please click on the "Sign our Petition" button below and help us to persuade the Government to ask NICE for better support.