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Rheumatism, there are now good therapies

  1. The best experts and scientists screen the most common diseases among people over 50. What are the most hopeful developments in diagnosis and treatment? We ask Prof. Paul-Peter Tak about the future of rheumatism.

Preventive diagnosis

  1. "The latest developments concern the most serious form of rheumatism: rheumatoid arthritis (RA) or inflammatory rheumatism. In this autoimmune disease the immune system turns against the body and the inflammatory cells accumulate in the joints Once damage has occurred in the joints is irreparable. We have recently been able to identify and control people with a 25 percent increased risk of RA with a test. These are patients with painful joints and a positive blood test for rheumatoid factors, the so-called anti-ccp substances. At the AMC, we are now investigating whether we can prevent RA in them using this test. In a major study, we give them a one-off medication. In this way we try to prevent them from getting RA and having to take the medication later on. Subjects can still participate in this study. " Benefit patient: "Very early detection of RA. And therefore early treatment, so that possibly much less medication will be needed later and damage to the joints is prevented. Painful, swollen and deformed joints: we hardly see these anymore in our patients in the clinic. Moreover, early treatment probably reduces the greater risk of cardiovascular disease that you have as an RA patient. "

  2. "The latest developments concern the most serious form of rheumatism: rheumatoid arthritis (RA) or inflammatory rheumatism. In this autoimmune disease the immune system turns against the body and the inflammatory cells accumulate in the joints Once damage has occurred in the joints is irreparable. Recently, we have been able to identify and control people with a 25 percent increased risk of RA with a test. These are patients with painful joints and a positive blood test for rheumatoid factors, the so-called anti-ccp substances. At the AMC, we are now investigating whether we can prevent RA in them using this test. In a major study, we give them a one-off medication. In this way we try to prevent them from getting RA and having to take the medication later on. Subjects can still participate in this study. " Patient benefit: "Very early detection of RA. And thus early treatment, so that possibly much less medication will be needed later and damage to the joints is prevented. Painful, swollen and deformed joints: we hardly see these in our patients in the clinic anymore. Moreover, early treatment probably reduces the greater risk of cardiovascular disease that you have as an RA patient. "

More powerful medicines

  1. "New - and hardly done in other hospitals - is that we offer a tailor-made therapy: based on the patient's profile (complaints, blood test data, genetic factors and how severe the disease is) we determine the best treatment for this individual patient. We always start with traditional anti-inflammatory drugs, such as methotrexate, as soon as possible. But in two thirds of the patients these drugs are not effective enough. For them we have so-called biologicals: new medicines that are made with biotechnological techniques. They are relatively expensive drugs - often costing more than € 15,000 per patient per year - that very powerfully suppress the destructive effect of the immune system. They work in 60 to 70 percent of RA patients. There are different types, each with its own effect. Some must be self-administered by the patient with an injection pen or pre-filled syringe, for example adalimumab (brand name Humira) or etanercept (Enbrel). It is also possible that biologicals are administered with an infusion in the hospital: infliximab (Remicade), rituximab (Mab Thera), abatacept (Orencia) or tocilumab (RoActemra). In patients who do not respond sufficiently to one substance, we may be able to combine biologicals with each other, but we only do that in a research context. " Benefit patient "Less joint damage and better functioning in daily life. Not so long ago, people became disabled due to this chronic joint inflammation and had an increased risk of dying prematurely. With the new drugs we can calm RA and very well control it. to hold. There are also disadvantages. Biologicals affect your immune system; you are less protected against infections, which can be dangerous in some cases. You will also need to inject yourself or go to the hospital regularly for an IV, depending on the drug, every two or four weeks, or once a year. "

  2. "New - and hardly done in other hospitals - is that we offer a tailor-made therapy: based on the patient's profile (complaints, blood test data, genetic factors and how severe the disease is) we determine the best treatment for this individual patient. We always start with traditional anti-inflammatory drugs, such as methotrexate, as soon as possible. But in two thirds of the patients these drugs are not effective enough. For them we have so-called biologicals: new medicines that are made with biotechnological techniques. They are relatively expensive drugs - often costing more than € 15,000 per patient per year - that very powerfully suppress the destructive effect of the immune system. They work in 60 to 70 percent of RA patients. There are different types, each with its own effect. Some must be self-administered by the patient with an injection pen or pre-filled syringe, for example adalimumab (brand name Humira) or etanercept (Enbrel). It is also possible that biologicals are administered with an infusion in the hospital: infliximab (Remicade), rituximab (Mab Thera), abatacept (Orencia) or tocilumab (RoActemra). In patients who do not respond sufficiently to one substance, we may be able to combine biologicals with each other, but we only do that in a research context. " Benefit patient "Less joint damage and better functioning in daily life. Not so long ago, people became disabled due to this chronic joint inflammation and had an increased risk of dying prematurely. With the new drugs we can calm and very well control RA to hold. There are also disadvantages. Biologicals affect your immune system; you are less protected against infections, which can be dangerous in some cases. You will also need to inject yourself or go to the hospital regularly for an IV, depending on the drug, every two or four weeks, or once a year. "

Gene therapy for the future

  1. "If the rheumatoid arthritis remains active in a number of joints, despite treatment with biologicals, we could apply local gene therapy. Here we introduce a piece of DNA into a cell in the affected joint. This produces a protein that helps inhibit inflammation. We expect to test this therapy in patients in a year or two. " Patient benefit: "When other therapies don't help enough, gene therapy could be a solution."

  2. "If the rheumatoid arthritis remains active in a number of joints, despite treatment with biologicals, we could apply local gene therapy. We introduce a piece of DNA into a cell in the affected area. joint. This produces a protein that helps inhibit inflammation. We expect to test this therapy in patients in a year or two. " Benefit patient: "When other therapies don't help enough, gene therapy could be a solution."

Diagnosis

  1. "In case of joint complaints, see the rheumatologist as soon as possible. RA must be recognized and treated quickly. The sooner you are treated, the better the prognosis. Available. " Prof. Paul-Peter Tak is professor of rheumatology and head of Clinical Immunology and Rheumatism at the Academic Medical Center (AMC) in Amsterdam. The AMC is researching the prevention of RA in people who only have pain complaints and rheumatoid factors in the blood. New therapies are also being tested in patients with both early and long-standing RA. Care book Systemic lupus erythematosus (SLE) € 19.95 A



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