Helping people with rheumatoid arthritis: increasing quality of life and reducing disability

Academics: Professor P. Emery, Professor P. Conaghan, Dr J. Devlin, Dr A. Gough, Professor A. Tennant and Dr R. Wakefield, Faculty of Medicine and Health

Leeds researchers pioneered early diagnosis and treatment for patients with rheumatoid arthritis (RA). This approach transformed management of the disease and is now standard practice for patients worldwide.

RA is a chronic, systemic, inflammatory joint disease, affecting 600,000 people in the UK and is the largest cause of treatable disability in the Western world. RA represents a major economic burden, with one in five employed patients having to stop work within 12 months and treatment costing the NHS around £560 million each year.

Ambitious innovation

Traditionally treatment consisted of managing patients’ symptoms as they progressed. Leeds researchers turned this on its head, conducting seminal studies and proposing a treatment model driven by early diagnosis and aggressive therapy with the aim of achieving disease remission rather than just reduction of symptoms.

The multi-disciplinary group demonstrated the consequences of incomplete suppression of inflammation in early RA, with patients suffering irreversible joint damage, resulting in pain and long term disability. Using biologic therapy (stimulating the body’s immune system to fight disease) for the first time, they established that early diagnosis and treatment results in the suppression of inflammation and leads to higher rates of remission. Trials then showed that remission can be sustained without the use of expensive biologics.

Impact on health and welfare

The Leeds group proved the need to treat for remission and not just symptom reduction. Their findings have had a major impact on how RA is viewed, diagnosed and treated, leading to substantial improvements in patients’ health and quality of life and reduced financial costs, both within the UK and internationally.

National Institute for Clinical and Health Excellence (NICE) guidelines recommend urgent treatment for RA and early referral is now expected by patients. Whilst treating early is associated with an annual cost of £2.2 million, these costs are more than offset by improved quality of life and direct productivity gains of around £4 million.

Early, aggressive treatment is part of the joint European and American Guidelines, directly influencing the care of more than 11.4 million people.

It is important that treatment is started early to minimise damage to joints, and there is increasing evidence that aggressive treatment very soon after the onset of symptoms can lead to remission.

The National Audit Office’s guidelines on the management of RA
Funder: Arthritis Research UK