Improved tests and better support will allow healthcare professionals and people with rheumatoid arthritis to regain control of health, outlines Dr James Bluett

Rheumatoid arthritis is a chronic disease that causes joint swelling and pain, and affects up to 1% of adults in the UK… over 400,000 people. Although rheumatoid arthritis can occur at any age, it peaks between those aged 30 to 50 years old.

We cannot yet cure rheumatoid arthritis, so we aim to keep the disease under control with drugs. Excitingly, people with rheumatoid arthritis now have access to much more effective medication. However, it remains difficult to know which patients will experience the best response with which drugs.

Treatments

Methotrexate is one of our first-choice tablets for people living with rheumatoid arthritis. It is effective in around 50% of those with early rheumatoid arthritis and works well in combination with other treatments.

Unfortunately, methotrexate does not work in everyone.

We also know that it can be difficult to take medication on time and this can cause a poor response to treatment.

In fact, research has shown that up to 40% of patients may struggle to take their methotrexate tablets on time or can forget to take their medication altogether.

For some people for whom methotrexate does not work (or is not suitable) other medications may be available to help control rheumatoid arthritis. Biologic medications, for example, target the immune system to reduce inflammation. A number of different biologic medications are available but it is not always clear which is the best drug for each individual patient.

Improved support

At Manchester Royal Infirmary (part of Manchester University NHS Foundation Trust) we therefore started an ambitious project that aimed to change the way we support people who take methotrexate tablets. Several support tools were provided to patients including:

• Improved staff training;
• Bookmark reminders for patients;
• Use of smartphone apps to help manage medication.

We measured levels of methotrexate in the blood and found that there was an improvement in people taking methotrexate on time from 44% to 83%.

We are now working to see if measuring methotrexate drug levels in the blood could help support patients taking their medication on time.

New testing regimes

Measuring blood levels of other rheumatoid arthritis drugs, such as biologic medications, may help us make early decisions about if the medication is more or less likely to work. That is why we are studying whether measuring drug levels and suggesting changes to biologic medication in patients with rheumatoid arthritis may be of benefit in the future.

Working with people with rheumatoid arthritis and engaging them in research will improve the management of what used to be an extremely debilitating disease. The end goal is to enable people diagnosed with rheumatoid arthritis to live full and active lives.

About the author: Dr James Bluett is a researcher for the NIHR Manchester Biomedical Research Centre (BRC) and senior clinical lecturer and honorary consultant rheumatologist at The University of Manchester

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