Breaking down Rheumatoid Arthritis: a blog by Professor Andrew Filer

To highlight Rheumatoid Arthritis Awareness Week, Professor Andrew Filer, co-lead of our Birmingham BRC Inflammatory Arthritis research theme, shines a light on the condition and explains how we’re changing the way rheumatoid arthritis is treated.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a disease in which the immune system turns against the body’s joints, causing chronic inflammation and damage. It affects a massive 1% of the population, so there are well over half a million sufferers in the UK.

RA can have a devastating impact on the people it affects across the age spectrum. For example, imagine you wake up one morning with so much pain, stiffness and swelling in your joints that you cannot even dress or wash yourself – or that you’re a young parent and cannot pick up your child. If your work depends on using your hands, you may even have to change your job.

What are the available treatments for Rheumatoid Arthritis?

Thankfully, treatments for RA are available and are amongst the most advanced in medicine. They range from immune suppressant treatments that turn down the intensity of the whole body’s immune response, to “biologic” therapies that use manufactured antibodies to switch off a specific part of the immune response. However, these are still not optimal, and our patients have major problems we still need to solve.

Why current options are not enough

There are several reasons why we still need new treatments and better tests for RA.

To begin with, all of our current effective treatments have side effects: in particular, they all predispose to infection as a result of turning down the immune system. Also, despite treatment, patients often suffer from disabling “flares” of disease that impact on their quality of life.

It is also important to note that we cannot yet “cure” RA: the arthritis usually only responds to each effective treatment for a limited time, which can range from months to years.

Lastly, we need new tests to tell us which patient will respond to which therapy, so that we can treat them in a more timely, effective and tailored way.

Our research at the Birmingham BRC

At the Birmingham BRC, we have two strategies aimed at solving these problems.

Firstly, we closely follow research cohorts of patients over time, recording their progress and response to treatment. We do this by taking samples of blood and tissue from the joint using special minimally invasive (microkeyhole) ultrasound guided techniques. This new type of testing allows us to understand in detail how each treatment affects the inflamed joint, and what new treatments will help. At the same time, we are designing unique types of clinical trial that bring new treatments to patients faster than before, and allow us to break down traditional barriers that make the development of new treatments slow and expensive.

A unique approach to Rheumatoid Arthritis research

It is this new approach of taking tiny samples from the joint that makes what Birmingham is doing unusual, and has led to exciting new discoveries in RA – it helped us understand how the inflammation in the joint becomes established and then causes damage and flares.

In our unique clinical trials, we take completely new treatments and test them in “basket trials”, comparing the response to a new treatment in many conditions at the same time. For example, we are currently testing a new stem cell therapy in RA, liver disease, lupus and inflammatory bowel disease in the same study. This allows us to bring new therapies to patients more rapidly, and at the same time understand better which patient will respond best to each treatment.

Combining these strategies is what makes our work cutting-edge: we are changing the way RA is treated by understanding how the joint becomes inflamed and why it is so difficult to cure. Using this knowledge, we are designing new treatments for inflammation, bringing them to patients more rapidly and at the same time testing if they work in other inflammatory diseases.