Ask the expert: Arthritis

What is arthritis?

Arthritis isn’t a single disease. Some forms of arthritis such as osteoarthritis, arise due to age or injury. But other arthritic diseases including rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, and gout belong to a group of conditions termed immune-mediated inflammatory diseases.

In these cases, our immune system has turned against us by promoting joint inflammation and destruction of the cartilage and bone. Patients with these forms of arthritis often display other complications affecting fatigue, mood, depression, sleep, and cardiovascular risk.

Why does immune-related arthritis affect some people and not others?

Our immune system is designed to protect us from infection and is essential for health. In immune-mediated inflammatory diseases the control of these processes becomes lost, and our immune system fails to protect us and, instead, promotes outcomes contributing to disease. Why does this happen? There are multiple reasons. Genetics can predispose us to disease. Environmental factors such as smoking and prior infections are also important. Obesity and gender are also contributing factors, with women 2-3 times more likely to develop rheumatoid arthritis.

What treatments are currently available?

Early diagnosis is an essential part of the treatment process. Doctors now have access to a wide range of drugs and with the correct treatment, patients can respond well to therapy. This includes therapies known as Disease Modifying Anti-Rheumatoid Drugs (DMARDs), which target the immunological processes affecting joint disease and inflammation. Some patients respond well to these therapies, while others either struggle with side effects or show no improvement. Here, DMARDs may be combined or replaced with more advanced drugs. These work on specific biological molecules or immune cells that promote adverse immune outcomes and disease progression. These drugs lead to improvements in joint disease and improve quality of life for patients.

How likely is it that a cure will be found?

There have been significant advances in the diagnosis, management, and treatment of arthritis. However, some forms of arthritis prove more challenging to treat than others. We have some fantastic biological drugs which have dramatically improved the treatment of rheumatoid arthritis. For some patients it can simply help to control symptoms, but for others it can work so effectively they go into remission. However, predicting who will respond best to a particular drug is still a considerable challenge. Understanding the basis of treatment response is a rapidly moving and exciting branch of investigation.

What does research at Cardiff focus on?

Arthritis research in Cardiff is multidisciplinary. Research ranges from laboratory bench work to investigations that include the introduction of clinical innovations into routine practice. We are interested in the mechanisms that promote different forms of joint disease in patients with rheumatoid arthritis.

The research aims to understand how disease processes impact arthritis progression, severity, and the response to therapy. However, our studies also extend beyond the joint and consider the broader consequences of arthritis. Together with specialists in pain, mental health, and endocrinology, we explore how the disease affects mood, fatigue, depression, and cardiovascular disease. Here, our immunology researchers show significant links with our neuroscience colleagues.

What does the future hold for arthritis?

During the last 20-25 years, doctors have rapidly moved from a reliance on steroids and chemical agents, to highly advanced drugs based on monoclonal antibody technologies, protein engineering and synthetic drugs. We now have large amounts of data explaining how these drugs behave in routine clinical practice. This information is invaluable and aids the design and development of next generation therapies.

Technological developments are also rapidly advancing our ability to detect genetic traits in combination with immune responses, changes in metabolism, and other biological processes. Collectively, these approaches contribute to a precision medicine strategy by providing doctors with the tools to quickly assess and tailor therapy for an individual patient’s disease. Here, the development of mobile apps and miniaturised diagnostic tools, akin to the lateral flow tests for pregnancy or COVID-19, will allow patients to self-monitor for a more informed discussion with their doctor. We may also see more involvement from clinicians and healthcare professionals from other disciplines such as psychology and endocrinology.

Considerable research is still needed, but the contribution of mathematicians, computer scientists, engineers and other specialists could also significantly advance many of these innovations. Based on the remarkable progress made over the past two decades and the pace of clinical and biotechnology research, we should have considerable optimism about the future.