Dramatic Treatment Evolving for Arthritis Patients
May 14, 2001 - A drastic new treatment may help some people with severe rheumatoid arthritis when all else has failed. It's not a cure -- and not all patients respond -- but a new study shows that the experimental therapy can greatly improve arthritis symptoms.
"This is still an experimental treatment that should not be routine," study leader Jacob M. van Laar, MD, PhD, tells WebMD. "It may be worth it for some patients, but only in a clinical trial with a good design. One that will be starting soon is the ASTIRA study in Europe." Van Laar is chief of the rheumatology clinic at Leiden University, the Netherlands.
The treatment is based on the fact that rheumatoid arthritis is an autoimmune disease -- that is, the body comes under attack from its own immune system. The idea is to get rid of misguided immune cells and to replace them with new cells that act right. This is done by taking immune cells from the patient and separating out the stem cells -- cells that are capable of becoming immune cells, but which haven't yet had the chance to go wrong.
This is where the drastic part comes in. After the stem cells are safely stored away, the patient gets a strong blast of a toxic drug that wipes out most of the immune system. Then the stored stem cells are transplanted back into the patient, where they grow into new immune cells.
Van Laar and co-workers tried this treatment on 12 patients with active, destructive rheumatoid arthritis that could not be helped by any other treatment, even at maximum doses. Most of the patients entered the study before a new treatment (tumor necrosis factor or TNF blockade) had become available, but two of them had tried this, too, without success.
The treatment was rough: all the patients lost their hair, and had nausea and vomiting from the cell-killing drugs. Nine patients had other serious side effects. But in the end, eight of the 12 patients had significant relief from disease symptoms. Nobody was cured -- seven of these eight patients needed further treatment with antiarthritis drugs. Two of these patients were able to get help from drugs that hadn't worked for them before.