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Contents
Introduction
Around 1000 BC, Indian Hindus believed
that arthritis was a form of serious organic malfunction.
By the fifth century BC, Hippocrates, the ‘Father of Medicine’,
considered it to be caused by poisons in the body which could
be relieved by draining. Only 150 years ago, bleeding to remove
poison was still practised. By 1900, medical opinion had changed
and doctors viewed arthritis as a result of infection. Operations
to remove the teeth, tonsils and appendix to eliminate the
‘offending’ tissue were commonplace. Today we recognise many
forms of arthritis with numerous causes. Rheumatoid arthritis
(RA) is considered to be one of a group of illnesses called
autoimmune diseases, in which the body’s defence system turns
upon itself to cause inflammation and tissue destruction.
As long ago as 1899, aspirin was introduced to treat inflammation,
but it was only about 50 years ago that the pharmaceutical
industry entered the scene in earnest as it began to search
for more powerful and effective alternatives. A breakthrough
came with the pioneering work of Sir John Vane and his colleagues
in the late 1960s, when they discovered how aspirin worked.
From then on, it became possible to take a more rational approach,
generating a large family of aspirin-like medicines which
can ease pain and inflammation.
The search for medicines to prevent the joint destruction
caused by RA was less successful, and most of those used today
were found by chance after their introduction for other diseases.
The first, gold therapy, was initiated in 1928, based on the
belief that RA was related to tuberculosis, where gold salts
had some effect. Since then, an assortment of unrelated medicines
has been introduced, but these are not a cure and their effectiveness
in reducing long-term joint damage remains unclear.
Today there are grounds for optimism as we begin at last
to understand the true nature of RA. These insights are leading
to a range of new biological medicines. Many are the products
of genetic engineering and some are already being used in
clinical trials. Hopefully, these will prove of value in treatment,
but at least they should shed light on the mechanisms of RA
and how new medicines can be developed.
The cost to society of RA is considerable. Detailed studies
in the early 1990s showed that the annual cost of RA was about
£380 million for healthcare services, around £60 million in
laboratory tests, and £40 million in medicines costs. When
indirect costs, such as loss of income, benefits and social
services costs and inflation are added in, today’s annual
bill is likely to be close to £1 billion per year.
This booklet provides some basic information about RA and
describes the contribution being made by the pharmaceutical
industry towards finding new and better treatments for it.
It also seeks to give a glimpse into the future and to describe
why this is an exciting time in RA research - one that offers
new hope for everyone affected by this painful and debilitating
condition.
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