Intensive treatment for inflammatory arthritis

Research funded by Versus Arthritis showed that early intensive treatment for inflammatory arthritis, started within 12 weeks of symptom onset, increases the likelihood of the disease going into remission, as well as reducing pain and long-term joint damage.

Rheumatoid arthritis is an autoimmune condition in which the immune system attacks the joints, causing pain, swelling and stiffness in joints. It affects around 400,000 adults aged 16 and over in the UK.

The development of biological therapies has transformed the treatment of rheumatoid arthritis, but there has been much debate over how and when to use these drugs.

Traditionally, the approach with biological therapies has been conservative, and treatment was only escalated as symptoms progressed. However, this delayed access to medication which could help earlier on in treatment of rheumatoid arthritis and led to increased joint damage and reduced quality of life for patients, as the disease was allowed to proceed.

A new approach to treatment was needed to make sure that people had better access to effective treatments early on in their disease.

Versus Arthritis funded research at the University of Leeds, led by Professor Paul Emery, which showed that treating patients within 12 weeks of symptom onset is crucial to prevent pain and reduce the risk of long-term joint damage and disability.

Biological therapy was shown to be safe and effective for patients with very early disease, with significant benefits observed after eight years without the need for continued treatment. A similar aggressive approach has subsequently been shown to also be effective for psoriatic arthritis.

With support from the National Institute of Health Research (NIHR), European Commission and Medical Research Council (MRC), Versus Arthritis then funded research which identified why some people with rheumatoid arthritis are not seen within the 12 week treatment window.

This research, led by Professor Karim Raza at the University of Birmingham, identified underlying reasons for these delays, including:

• Patients are slow in seeking help from their GP – particularly for patients of South Asian origin.
• GP are slow referring the patient.

Together, these findings have transformed the standard management of rheumatoid arthritis. Our research highlighted the importance of starting early, intensive treatment within 12 weeks of symptom onset. As a result, the focus of treatment for rheumatoid arthritis has changed from a ‘watch and wait’ approach to one focused on early diagnosis and aggressive treatment, with the aim of disease remission as opposed to symptom management. By also understanding the reason for delay in treatment, we can help to put in measures to prevent this.

Together, these key findings have informed guidelines for treating rheumatoid arthritis developed by national bodies including the National Audit Office, the National Institute for Health and Care Excellence (NICE), and the Arthritis and Musculoskeletal Alliance. All of these bodies recommend early referral and early and aggressive treatment.

Outside of the UK, the evidence has also informed the joint European and American Guidelines.

In 2013, our policy team and the British Society for Rheumatology, worked with the Department of Health to develop a best practice tariff for people with rheumatoid arthritis.

As a result, people with inflammatory arthritis should expect to:

• be seen by a rheumatologist within three weeks of being referred by their GP
• receive diagnosis and start treatment within six weeks of GP referral.

It’s estimated that early treatment of rheumatoid arthritis is associated with annual productivity gains to the UK economy of £6.2 million. This more than outweighs the estimated additional annual cost of £2.2 million to the healthcare system.