Rheumatoid arthritis and the pharmaceutical industry

Medicines for pain control

Pain is the most commonly experienced symptom of any disease and two in every five people have recurring pain when monitored over a six-month period. Over 3.5 per cent have severe, persistent pain accompanied by major disability. Many of these people have RA.

Everyone with RA experiences pain to some extent and its management is an important part of treatment. In many cases, NSAIDs give adequate control, but some people experience breakthrough pain when additional pain killers (analgesics) are required. An unfortunate few with severe arthritis may experience very severe pain which is hard to control and for whom adequate medicines have yet to be developed.

Simple analgesics lack anti-inflammatory activity and act in a different way from NSAIDs. Many, including paracetamol and codeine, will already be very familiar. Others include tramadol, from Searle, for moderate to severe pain, especially at night, and benorylate, from Sanofi Winthrop, which is broken down in the body into two parts which help control both pain and inflammation.

One hopeful new approach is the identification by Zeneca of ZD4953. This compound, now in Phase II clinical trials, is especially targeted at pain associated with muscle, bone and skeletal disease, an area in which Novartis are also working.

An alternative to seeking new analgesics is to try to improve existing ones. One company, Napp, has specialised in developing novel kinds of tablets and capsules which affect the way medicines are released into the body, making them more effective. Examples are tablets containing a combination of ibuprofen and codeine, in which the two component parts boost each other and special forms of slow-release morphine and dihydrocodeine which help people with severe pain who seem unresponsive to other medicines. Despite these efforts, there are still significant gaps in the control of inflammatory pain in RA, especially in advanced illness.