New international studies have revealed how genetics could explain why different environmental exposures can trigger the onset of different forms of rheumatoid arthritis.

As our joints succumb to wear and tear, chronic pain becomes more of an issue for people in their later years, restricting movement, sparking depression and disrupting sleep.

That is why researchers are increasingly focusing not just on finding medical therapies and cures for the various forms of the condition
but also on ways to help people better live with the symptoms.

Much of the medical research focuses on what triggers the condition, as a way of helping the development of medical treatments, and researchers are continually making encouraging breakthroughs.

Take some recent announcements. For example, a new international study has revealed how genetics could explain why different environmental exposures can trigger the onset of different forms of rheumatoid arthritis.

The team at the Arthritis Research UK Centre for Genetics and Genomics at The University of Manchester, part of an international consortium involving scientists from 15 academic institutions, believe their findings could have important implication for the way that rheumatoid arthritis is diagnosed and treated.

They say that more accurate clinical testing is now needed to better identify the less-well understood type of rheumatoid arthritis to prevent it being misdiagnosed. Rheumatoid arthritis is a serious inflammatory form of arthritis, affecting almost 400,000 people in the UK alone, causing painful, swollen joints, and in severe cases, considerable disability.

The condition is known to have strong genetic and environmental components and it was already known that a proportion of rheumatoid arthritis patients test positive for autoantibodies, while 30% remain seronegative.

The researchers have now better defined the genetic distinction between the two disease subtypes seropositive and seronegative rheumatoid arthritis and established that different genetic variants of a protein that plays a vital role in how the body’s immune system fights infection are associated with the two forms of rheumatoid arthritis.

This provides clues to the theory that exposure to different infectious agents, such as bacteria or viruses, trigger the different forms of rheumatoid arthritis in some people.

Dr Steve Eyre, from the genetics and genomics centre, said: “We recognise that rheumatoid arthritis is a complex disease that can have variable presentation and outcomes for different people, in particular in the way they respond to treatment.

These findings add to our ability to genetically define subtypes of rheumatoid arthritis which is an important step towards selecting the best treatment for each patient.

Centre director Professor Jane Worthington said: “Now that we have established a genetic basis for these two types of rheumatoid arthritis, we hope it will lead to patients receiving a swifter, accurate diagnosis and more appropriate, targeted treatment. These findings have opened the door to a better understanding of seronegative rheumatoid arthritis.”

Elsewhere, a new clinical trial has underlined the benefits of a promising new therapy option for patients with rheumatoid arthritis.

The two-part phase II study was led by the Medical University of Vienna in Austria to assess the safety and efficacy of sirukumab – an anti-interleukin-6 monoclonal antibody – among patients affected by active rheumatoid arthritis despite prior methotrexate therapy.

In the first part of the trial, 36 patients received either sirukumab or a placebo every fortnight for ten weeks. Part two saw 151 subjects receive either sirukumab for a full 24 weeks, or be given a placebo for ten weeks before switching to sirukumab for the remainder of the study.

Results published in the Annals of the Rheumatic Diseases revealed that 26.7 per cent of sirukumab patients were able to meet the study’s primary response rate goal, in terms of improvement in tender or swollen joints and symptoms including pain and disability. This compared to 3.3 per cent of those in the control group.

Greater improvements in disease activity levels were seen at week 12 with sirukumab across both parts of the trial, while adverse events were shown to be similar for sirukumab-treated and placebo-treated patients across the entire trial, underlining its safety.

Arthritis Research UK said it would be interesting to see how the drug performed in a phase III trial, which would involve a considerably larger number of patients. Sirukumab is being developed by GlaxoSmithKline and Janssen.government residential home beds and establishing Management Centres responsible for guidance and monitoring care providers in each region.