Doctors diagnosed it as rheumatoid arthritis. “And I thought that life as I knew it, was over,” said Moore.

He got his life back after by enrolling in a clinical trial of one of the drugs and drug combinations that are revolutionising the treatment.

The disease

Rheumatoid arthritis is the world’s most common autoimmune disease, striking up to 1 in 100 in course of a lifetime. It is most often diagnosed in people ages 30 to 60 but it can occur at any time, including childhood. As with other autoimmune diseases, women are three to four times likelier than men to develop rheumatoid arthritis. The disease causes chronic joint inflammation and progressive destruction of cartilage at the ends of bones, which can result in an inability to use the affected joints. Other effects include fatigue, malaise, anaemia and damage to organs throughout the body, including the cardiovascular system. Untreated, 20 to 30 per cent of people become permanently disabled within three to five years of diagnosis. Life expectancy may be reduced by as much as 15 years, with half of patients succumbing to cardiovascular disease.

A therapeutic revolution

Doctors traditionally treated the symptoms of rheumatoid arthritis, usually with anti-inflammatory and pain-relieving medications. But the underlying destruction of tissues continued, leading to chronic disability and premature death.

Today, the goal today is suppression of the disease and prevention of progressive joint destruction by treating patients early with synthetic or biologic agents called disease-modifying antirheumatic drugs.

Though he did not know it at the time, Moore was randomly assigned to the study group that every two weeks self-injected a biologically derived drug called Humira, which acts to block a protein involved in the inflammation associated with rheumatoid arthritis. Humira is one of six federally approved biologic treatments for the disease. Three other biologic remedies are nearing approval by the Food and Drug Administration.

“Within days, my symptoms declined to nearly zero,” Moore said, “and I’ve had no symptoms since.” He has continued the injections of Humira and participates in a registry of patients to help assess the drug’s long-term benefits and risks.

Combining treatments

The costly biologic drugs are often used in combination with cheaper synthetic disease-modifying drugs taken orally, like methotrexate. In some cases, oral medications are all that patients need to keep symptoms and joint destruction under control.

But clinical trials have shown that in patients facing moderate to severe disease, combining treatments often result in fewer symptoms and less destruction of joints, especially if therapy begins early.

In a study published July 16 in The Lancet, researchers in Leeds, England, reported that among 542 patients randomly assigned to receive either methotrexate alone or in combination with Enbrel, another biologic agent, those receiving the combination were almost twice as likely to become symptom free and more likely to show no X-ray signs of progressive joint destruction a year later.

In a commentary with the Lancet report, Dr Joel M Kremer, a rheumatologist at Albany Medical College, said it was important to consider the long-term consequences and costs of the disease when deciding how much to spend on therapy.

But inadequately treated rheumatoid arthritis typically leads to a need for multiple joint replacements, lost productivity, lost tax revenue and a greatly diminished quality of life, as well as an increased risk of life-threatening infections and cardiovascular disease, he added. “Most patients diagnosed at age 45 will be disabled in five or six years,” Kremer said. “You have to consider what it costs to fix a bridge against what it will cost when the bridge collapses.”

A tailored approach

While not everyone with rheumatoid arthritis responds to the new treatments as vividly as Moore did, many large studies have shown there is no longer any reason for pessimism. But it is vitally important to begin treatment early.

The recent therapeutic developments, Kremer said, mean doctors in general practice need to remain alert to symptoms of the disease in its early stages and quickly refer patients to rheumatologists who can prescribe up-to-date treatment before irreparable damage to joints occurs. Treatment is most effective if begun within one year after symptoms appear.