South Africa: New treatments bring hope to autoimmune disease patients
New treatments are bringing hope to thousands of patients suffering from autoimmune diseases (AIs). There are over 80 autoimmune diseases1 which develop when the body’s immune system mistakes healthy cells for harmful foreign ones and attacks them2. Autoimmune diseases can affect almost any type of tissue, structure, function or system of the body, including the skin, joints, brain, glands, cardiovascular system, endocrine system, and digestive tract.2
Dr Bloch, physician and specialist gastroenterologist at Vergelegen MediClinic in Somerset West says some of the most common AIs include Rheumatoid Arthritis (RA); Ankylosing Spondylitis (AS); Crohn’s Disease; Psoriatic Arthritis (PsA); and Psoriasis. He adds that these conditions are caused by an inflammatory reaction in the body – whether of the joints and bones, gastrointestinal tract or skin.
“Until the introduction of biologic treatments, therapeutic options for AI patients were relatively limited,” explains Dr Bloch. “But in recent years, advances in the understanding of immune-mediated disorders, combined with progress in biotechnology have led to the development of novel drug therapies.”
What causes the immune system to go wrong?
Although medical science doesn’t conclusively point to what causes the immune system to mistakenly attack its own tissues and cells, experts believe that genetics plays a significant role. “It would appear that there is a strong genetic component to these diseases,” says Dr Bloch. “We still have limited understanding of what triggers different autoimmune diseases although it could be a virus, certain bacteria, stress or a combination of factors.”
Why are the effects of autoimmune diseases so devastating?
Dr Bloch says many autoimmune diseases are literally crippling and many patients feel isolated and alone. “Many people suffering from Crohn’s disease, for example, are depressed and find it difficult to be productive in the work place,6” says Dr Bloch. “Crohn’s disease has a negative impact on a person’s quality of life, with flare-ups of the disease often leading to hospitalisation and surgery.6”
Another AI which causes emotional and physical effects is psoriasis. Those with the disease develop a skin disorder recognised by patches of raised red sores (lesions) covered by silvery-white scales (plaques) that most frequently form on the elbows, knees, lower back and scalp, although it can occur anywhere on the body.
Psoriatic lesions are visible to others and may have emotional and relational consequences that go far beyond the skin3. People may be embarrassed by the appearance of their skin, feel stigmatised and socially withdrawn, or alone.4 Furthermore, psoriasis is often associated with a lack of self-esteem, as well as increased risk of depression, which can affect as many as 6 out of 10 people.”5
Psoriatic arthritis (PsA), a chronic and progressive form of inflammatory arthritis, occurs in as many as 3 out of 10 people suffering from psoriasis and can affect many areas of the body, including the fingers and spine. Inflammation in the area where a tendon and ligament attaches to bone (e.g.Achilles tendon) is also common in PsA. A significant proportion of people with PsA experience difficulty with simple day-to-day activities such as changing clothes or just having a bath,7,8.
Patients suffering from Ankylosing Spondylitis, a common inflammatory rheumatic disease that affects the spinal area, suffer from lower back pain, spinal stiffness and loss of movement in the spine, meaning they can find it difficult to bend forward, backward or sideways. In more severe cases, the ability of the chest to expand with breathing may also be restricted.9
Rheumatoid Arthritis (RA) mostly affects small joints, particularly those of hands and feet, but other parts of the body can also be affected. The synovial membranes, which line the joints, become inflamed. Joints become swollen and sore, resulting in restricted movement, stiffness and extreme pain. These symptoms are often worse first thing in the morning. Some people also experience flu-like symptoms, a feeling of being generally unwell and weariness.10,11
“You can imagine how having an AI like one of these affects patients’ quality of life,’ says Dr Bloch.
Is there a cure?
In recent years, scientists have discovered that an immune system protein called TNF (tumour necrosis factor) is a major contributor to the reaction that causes inflammation in the body.10,12
“Disease-modifying agents are available that specifically target factors in the body that cause inflammation,” says Dr Bloch. “The introduction of TNF-a blockers is seen as the most substantial development in the treatment of many of these diseases in the past few years.”9
The success of these TNF-a blocking agents has fundamentally altered the way doctors treat AI patients.
“These new treatments, particularly those that inhibit inflammatory-causing TNF, have proven to be highly effective in patients with some of these diseases,” says Dr Bloch. “They have given some patients a new lease on life as they’re able to socialise and go about many of the daily activities that many of us take for granted.”
To raise awareness of autoimmune diseases and to unite and support sufferers, international pharmaceutical company Abbott Laboratories has launched a global initiative ‘Join the Fight against Autoimmune Diseases’. To find out more about this campaign please contact Dean Krawitz on 011 326 3428 or 083 768 1433,dean@eventevolution.co.za.
REFERENCES
1. National Institutes of Health (NIH). Autoimmune Diseases Coordinating Committee (ADCC). Progress in Autoimmune Diseases Research. Report to Congress. March 2005.
2. Better Medicine.com. What are autoimmune diseases? Medical Reviewer: Williams, Robert, MD. Available at: http://www.localhealth.com/article/autoimmune-diseases-1 Last accessed: 14-05-2012.
3. Naldi L, Raho G. Emerging drugs for psoriasis. Expert Opin Emerging Drugs 2009; 14(1):145-163.
4. Nestle FO, Kaplan DH, Barker J. Mechanisms of disease – psoriasis. NEJM 2009; 361(5): 496-509.
5. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2008; 58:826-850.
6. Loftus EV, Feagan BG, Colombel J-F, Rubin DT, Wu EQ, YuAP, et al. Effects of Adalimumab Maintenance Therapy on Health-Related Quality of Life of Patients With Crohn’s Disease: Patient-Reported Outcomes of the CHARM Trial. Am J Gastroenterol 2008; 103: 1-10.
7. Mease PJ, Menter MA. Quality-of-life issues in psoriasis and psoriatic arthritis: Outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol 2006; 54:685-704.
8. Mease P. Current Treatment for Psoriatic Arthritis and Other Spondyloarthritides. Rheum Dis Clin N Am 2006 (suppl 1): 11-20.
9. Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369: 1379-1390.
10. Rheumatoid Arthritis. National clinical guideline for management and treatment in adults. Royal College of Physicians 2009.
11. Mayo Foundation for Medical Education and Research. 2009. Rheumatoid Arthritis. Available from www.mayoclinic.com/health/rheumatoid-arthritis. Accessed 21/10/2010.
12. Medicine Net 1996-2010. Rheumatoid Arthritis. Available from www.medicinenet.com/rheumatoid_arthritis. Accessed 22/10/2010.
