Two-pronged attack on rheumatoid arthritis

December 4, 1998

An innovative two-pronged attack to prevent the progress of rheumatoid arthritis is being pioneered by scientists at the University of Leeds.

In rheumatoid arthritis the body's immune system attacks the patient's joints, which become damaged and inflamed.

Scientists have seen from studies on mice that treatments directed at T-cells, a type of white blood cell that is often assumed to control the body's immune system, result in long periods of remission. But such treatments, say researchers, have been found to have only limited success in humans.

Now John Isaacs, senior lecturer in rheumatology at Leeds University, and clinical research fellow Ann Morgan, believe the high degree of inflammation found in the joints may be acting to counter the effects of the anti T-cell therapy in humans.

They are therefore experimenting with a combination of two biological drugs - one to turn off the T-cells as before and the other directed against a molecule that is important in the inflammatory process, tumour necrosis factor alpha (TNF-alpha).

"As far as we are concerned we are the only group to be using two biological approaches in combination," says Dr Morgan. "Rheumatoid arthritis has a massive inflammatory response. There's such a lot of inflammation we may be asking too much of the T-cell treatment. It should have a stronger effect when given in this way because it is no longer battling against the inflammation."

Dr Morgan is expected to tell this week's British Society for Immunology meeting the results of initial and limited patient trials.

The team gave five patients a combination of both drugs for a week. It had a dramatic effect on reducing rheumatoid arthritis, although this only lasted from two to ten weeks. There were no major side-effects.

The course was then extended for up to three months. Only three patients have so far received this therapy. However, one who had not responded to previous treatments has shown remarkable improvement. She has not needed treatment for 32 weeks since the initial course. Symptoms returned to the other two patients four to six weeks after the course ended. Both have since responded to conventional treatment which had previously had no helpful effect. Side-effects are being studied.

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