Aggressive arthritis trial brings hope for sufferers

Psoriatic arthritis affects the joints and the skin, causing joint pain and swelling, leading to joint damage and disability over time.

Although better drugs are now available to treat the condition, doctors in Leeds believe that earlier, intensive treatment of the condition could reduce joint damage more effectively, preventing disability.

Now a team led by Dr Philip Helliwell and Dr Laura Coates at Chapel Allerton Hospital in Leeds have been awarded funding of more than 515,000 over three years from Arthritis Research UK to run a clinical trial involving up to 200 patients in Leeds, Bradford and York.

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They will compare intensive early treatment carried out in specialist clinics with the kind of care that patients usually receive, to find out which group of patients does better over a year. Their progress will be measured by sophisticate imaging techniques; ultrasound and magnetic resonance imaging (MRI).

Recruitment has already started in Leeds, while patients at St Luke's Hospital in Bradford, and York Hospital, are now being recruited.

"We think that a tighter, more aggressive treatment of psoriatic arthritis, in which patients are given escalating doses of drugs if their condition is not responding, and see a specialist every month with the aim of controlling their symptoms fully and as soon as possible, will result in a good outcome after 12 months," explained Dr Helliwell, a senior lecturer at the Leeds Institute of Molecular Medicine at Leeds University. The standard treatment is to see a specialist maybe every three months, with less emphasis on early, escalating treatment."

There are already signs that the approach is working, at least in terms of patient and doctor satisfaction.

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"We've already started the study in Leeds and we have found so far that patients like coming back to the clinic every month, even if they are working, because they like the feeling that their disease is being responded to and that they are being treated in a positive manner," added Dr Helliwell.

"We normally can't see them every month because we don't have the time, so we as doctors we like it, too."

If the trial proves that tighter control of psoriatic arthritis is effective, it will be adopted into standard clinical practice around the UK.

Tamra Shepherd, 28, from Wortley, Leeds, was diagnosed with psoriatic arthritis last November and has been on the Arthritis Research UK trial at Chapel Allerton Hospital since January.

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The condition came on very quickly, first affecting her knees and then spreading to other joints.

"It's immensely painful if you cannot get it under control. You wake up in the morning and you cannot move," says Tamra who is studying for a degree in archaeological sciences at Bradford University.

Tamra's uncle suffered from rheumatoid arthritis and at first she thought that was what she had. But she was diagnosed with psoriatic arthritis as all her joints are inflamed and painful. Doctors believe there may be genetic link as her father has psoriosis.

She now take a cocktail of drugs, methotrexate and sulfasalazine.

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"Before I started on the drugs, I could not walk, and my left knee was really swelling up. A couple of months ago, the medication started to kick in. They increased the dosage so I'm still waiting to see if the swelling goes down."

As well as missing some of her studies, Tamra has had to change her lifestyle.

"I used to be very active, I did marshal arts – kung fu, but I can't do that anymore. I cannot walk very well for long distances. I hope to be able to get back to doing more again.

"I've been told that once the swelling goes down it should not be as painful and I should be able to lead a normal life. I'm in pain all the time – between a rock and a hard place – in pain when I move, in pain when I don't.

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"I missed a lot of lectures because I could not get to Bradford – I ride a motorbike but not while my knee is so swollen. I also found it hard to type because my right wrist ballooned. It's been pretty tough."

INFLAMED JOINTS

Psoriatic arthritis causes inflammation in and around the joints.

It usually affects people who already have psoriasis, a skin condition that causes a red, scaly rash, especially on the elbows, knees, back, buttocks and scalp. However, some people develop the arthritis symptoms first, while others never develop the skin disease.

About one in 50 people have psoriasis, and of these about one in seven will develop psoriatic arthritis. Psoriatic arthritis usually affects adults but occasionally children can develop the disease.

People with psoriasis may also have other types of arthritis, such as osteoarthritis or rheumatoid arthritis, but these are not linked to the psoriasis.

www.arthritisresearchuk.org