The Future Possibility of the Effective Treatment and Cure for Rheumatoid Arthritis

If we break the term down into its’ components, ‘rheumatoid’ comes from the word rheumatism which is a musculoskeletal illness; ‘arthr-’ refers to joints and ‘-itis’ refers to the inflammation in joints, muscles and surrounding tissues. Rheumatoid arthritis is a chronic inflammatory disorder which mainly affects the joints but can also affect other organ systems like the lungs and the skin. A musculoskeletal illness is a disorder that mainly affects the muscles, bones and joints. The likelihood of developing one increases with age, but it can also depend on the activities that one does. Symptoms include pain, stiff joints and swelling around a particular joint.

Rheumatoid Arthritis is an autoimmune disease that is usually activated by genetic vulnerability and an environmental factor. An autoimmune disease is when the body's immune system attacks and destroys healthy body tissue since the body recognises the tissue as a foreign substance. The body’s immune system consists of blood cells which help protect the body from harmful substances such as bacteria, toxins and viruses. The B cells stimulate the proliferation and production of antibodies that has a complimentary shape to the antigen that is detected on the cell surface membrane of the pathogen. With the presence of the autoimmune disorder, the immune system can not differentiate between healthy tissue and antigens.

As a result, this triggers an immune response that destroys tissue cells around the joints. The exact cause of autoimmune disorders is unknown. Some doctors claim that “some microorganisms (such as bacteria or viruses) or drugs may trigger changes that confuse the immune system.” This may happen more often in people who have a genetic predisposition that make them more prone to developing autoimmune disorders. An autoimmune disorder does not only result in the destruction of body tissue but may also include the abnormal growth of an organ or changes in the organ’s function.

When the T-helper cells and antibodies reaches the joints during the immune response, they release cytokines which are small proteins with a specific function to bring more macrophages to the joints. These macrophages also secrete cytokines (such as interleukin 1 and 6), and together with the cytokines secreted from the T-helper cells, these stimulate the synovial cells in the synovium to thicken. The synovium is a layer of cells that cover the inside of the joint capsule and form a membrane. The cells of the synovium produce a small amount of thick fluid called synovial fluid that helps nourish the cartilage and keeps it moist. The synovium has a tough outer layer called the capsule. The proliferated synovial cells then create a pannus which is made up of scarred tissue. If this is left untreated, then overtime the pannus can damage the cartilage, which is a soft connective tissue in the joints, and can also erode bone.

On top of this, the synovial cells can also secrete proteases which can break down cartilage too. Eventually, the inflammation becomes long lasting and this causes angiogenesis around the joint, (the formation of new blood vessels a process which is essential for healing, growth, development, and maintenance.) This encourages more inflammatory cells to arrive. Since this disease is progressive and symmetrical, multiple joints on both sides of the body becomes inflamed and gradually inflamed.

The inflammatory cytokines don’t just stay in the joints, they can leave the area and travel through the bloodstream and damage other organ systems, for example: the cytokines released by interleukins 1 or 6, can also travel to the brain and cause fever, and also in the lungs, the cytokines can cause fibroblasts causing fibrotic scar tissue which makes alveolar gas exchange even harder – having shortness of breath is a symptom of this.

As the disease worsens, it can affect larger joints such as shoulders and elbows. During flares or sudden worsening of the disease, the infected joints get extremely swollen, warm, red and painful. They can also get very stiff, especially in the morning (after periods of inactivity.) With this autoimmune disease, come deformities.

Here are a few examples:

To see whether one has rheumatoid arthritis, they may go through a series of blood tests to check for the presence of specific antibodies that are produced by the T helper cells – for instance the Rheumatoid Factor Antibody and the Anti-Citrullinated Peptide Antibody. Also, if a patient undergoes x-ray imaging on an area, the doctor would usually look for areas where there is a lower bone density around the joints, soft tissue swelling and small bone erosions. In order to treat rheumatoid arthritis, there are three approaches:

• Biological Treatments
• Physiotherapy
• Surgery

Biological treatments do not cure this disease, but it rapidly slows down it’s progression, and they seem to have fewer side effects. Biologic disease-modifying antirheumatic drugs (DMARDs) are made using biotechnology. They are genetically engineered to act like natural proteins in your immune system. Available biologics includes: Ocilizumab (Actemra), Certolizumab (Cimzia), and Etanercept (Enbrel). Most of these treatments are given via an injection and they work by interrupting immune system signals involved in the damage of joint tissue. With physiotherapy, it helps to increase the amount of physical activities a patient does, although it does not reduce the progression of the disease. In general, we can say that patients with RA need a high-intensive exercise program which is aimed at improving aerobic capacity, strength and endurance. This program can be completed coordination exercises. Sometimes the therapist chooses to start with a moderate-intensive exercise program and then build it up.

The duration and intensity of the exercises should be based on how severe the patient’s condition is. A physiotherapist may also be able to help with relieving the inflammatory pain by using heat or ice packs. In severe cases, physiotherapy or biological treatment may not be very effective in manging the symptoms of rheumatoid arthritis so surgery is also an option for patients to turn to. For the stiff joints in the hand; there are surgeries to relieve pressure on a nerve in the wrist, releasing tendons in the fingers to treat the deformities, another surgery could include the removal of inflamed tissue from the joints, this called Arthroscopy. Finally, there are joint replacement surgeries that are available for one to get hip, knee or shoulder joint replacements – these are called arthroplasties.

According to several doctors such as Dr John McDougall, he has several books and has posted several videos on YouTube on how his patients have been cured from rheumatoid arthritis. His cure is simply cutting all dairy and meat products from the patient’s diet and encouraging them to go on an all starch-based diet. This is proved to be highly effective compared to the usual drug prescribed by doctors – Methotrexate. That is due to the side effects that methotrexate holds for example hair loss, and the fact that one must take the drug everyday for a long period of time. Almost all his patients have claimed to be ‘cured’ of this disease, however I see that as incorrect. In my opinion, I believe that what Dr McDougall has done is managed the symptoms of rheumatoid arthritis (for example the flare ups, the swelling and the stiff joints) very well.

That is because there is no empirical evidence to support the fact that the T helper cells that cause this immune response against the joint tissue has secreted less cytokines. To find the cure for rheumatoid arthritis will be very difficult if the true cause of it remains unknown. Most of the drugs that have been approved of and are being distributed mostly have the aim of inhibiting joint damage. At the Arthritis Research UK Tissue Engineering Centre, researchers are studying ways to improve cartilage repair by implanting stem cells. The charity believes that stem cells, as the body’s inbuilt repair kit, could act as cartilage rejuvenators. The team is examining lots of areas, including identifying the best type of stem cells to use, and the most effective way to grow stem cells in the joints to create strong, durable and flexible cartilage.

With my personal experience of shadowing doctors on a ward and in a clinic, treatments for rheumatoid arthritis has drastically improved the welfare of patients, when I performed exercises on the patients to check for stiffness and pain, there was rarely any, meaning that the treatment and management was very effective. However, their check-ups are very often and from what I have seen, their conditions have seemed to come to a halt. It is not improving or worsening, only the symptoms are being alleviated. I asked the doctor I was shadowing (Dr Stratton) whether he felt as if there would be a cure and he replied “If there was to ever be a cure, where we are right now in terms of progress is very distant, there are several obstacles holding us back from determining the actual cause of this chronic disease.”

In conclusion, I believe that there will be eventually be a cure for rheumatoid arthritis. As technology is progressing, so is medicine alongside it, so in the future, finding the true cause of the autoimmune response towards the healthy joint tissue. So, with more advanced technology, researcher and doctors are more inclined to produce more significant results when testing different theories of the cause. This would then lead to better treatment of the joints and management of each symptom.