MedUni Vienna researchers Daniel Aletaha and Josef Smolen were invited to write a “review” on the status of rheumatoid arthritis in the latest edition of the prestigious medical journal “JAMA” to coincide with World Arthritis Day on 12 October. The main positive finding: in recent years there has been a significant improvement in outcomes for sufferers. “80% of sufferers can lead a normal life with the aid of medication. In the past, rheumatoid arthritis meant being condemned to a wheelchair,” says arthritis expert Daniel Aletaha from the Department of Medicine III, (Division of Rheumatology).
This progress has been achieved by innovative techniques for measuring the disease and newly available drugs, as well as better management of rheumatoid arthritis. Now only 20% of sufferers are “refractory” and still suffer serious flare-ups, despite treatment. Says Aletaha: “Thirty years ago this figure was still 50%. Just as new drugs have changed HIV from a lethal disease into a chronic one, new treatments for rheumatoid arthritis have meant that, although it is still a chronic disease, it no longer causes permanent damage and hardly puts anyone into a wheelchair.”
The aim in treating rheumatoid arthritis is to reduce the activity of the disease by more than 50% within 3 months and to achieve freedom from joint pain and swelling within 6 months.
Personalised medicine – or precision medicine – plays a really important role in rheumatoid arthritis. That means it is now possible to determine more accurately than ever before which treatment will work best and most quickly for each patient – and which treatments are less suitable. New drugs, which unlike widely used biologic drugs can be taken as tablets, so-called 'small molecules', have become attractive options – especially from the patient's point of view. In the spirit of precision medicine, these treatments are tailor-made to supress specific molecules inside a cell.
This increases the number of alternatives available to doctors: “The choice of drugs – whether biologic drugs or small molecules – that we now have at our disposal is much bigger than it was about 10 years ago,” emphasises Aletaha. “And this enables us to more accurately predict which treatment will be most suitable, if the standard method no longer works – ideally personalised to the individual patient. The standard approach is to start treating RA with methotrexate. If the disease breaks through, despite the treatment, its management must be reassessed.
MedUni Vienna as Europe's top rheumatology center
“Having already been asked to write a review in the Lancet in 2016, the fact that we are again being invited to review the current status of the disease underscores MedUni Vienna’s excellent international reputation in the matter of rheumatoid arthritis,” says Aletaha. Vienna’s Rheumatology Department is regarded as “the” leading center in Europe. For many years now, Department Head Josef Smolen, who retired at the beginning of October, has been the most cited rheumatologist in the world and Daniel Aletaha is the most cited next-generation rheumatologist. “We know how rheumatoid arthritis works, how to diagnose it quickly, assess it and provide the best treatment.
About rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease that primarily affects women (approximately two thirds of those affected) and is usually diagnosed between the ages of 40 and 70. Approximately half a percent of the world’s population is affected by rheumatoid arthritis. The disease causes inflammation of the joints, resulting in swelling and functional impairment. If left untreated, it leads to gradual destruction of the joints and the surrounding bone, causing misalignment, malformation and progressive permanent disability.
Service: JAMA/Review
„Diagnosis and Management of Rheumatoid Arthritis. A Review.“ D. Aletaha, J. Smolen. JAMA, October 2018. JAMA. 2018;320(13):1360-1372. doi:10.1001/jama.2018.13103.
Link: jamanetwork.com/journals/jama/fullarticle/2705192