Rheumatoid Arthritis currently affects around 35,000 people in Scotland. It causes joint pain, swelling and stiffness, affecting a patient’s mobility and interfering with their quality of life and ability to work. Patients may need long-term treatment to control their symptoms and reduce joint damage.
Despite the fact that treatment options have improved in the last 20 years, the UK National Audit Office estimates that rheumatoid arthritis costs the NHS around £560 million every year. A significant part of this cost is down to failed treatments.
Professor Iain McInnes of the University of Glasgow explains how a precision medicine project being carried out by Stratified Medicine Scotland Innovation Centre could help both patients and the NHS.
“Rheumatoid arthritis is a cruel disease which can have a dramatic effect on a patient’s mobility,” says Iain. “It can cause difficulty caring for children, reduced participation in hobbies, and it can put a strain on their personal relationships. People with rheumatoid arthritis are less likely to be in work, and even when they are at work, they are often not terribly effective or productive.
“When someone first gets a diagnosis of rheumatoid arthritis, they’ll often be prescribed a medicine known as methotrexate (MTX),” Iain explains. “It is generally accepted as a good medicine to use as it is cheap, and it has been in clinical practice for many decades. However, only 30-40% of patients respond sufficiently well to it. The remainder either fail to respond at all, have a moderate response or may perhaps suffer side effects such as nausea, vomiting or more rarely liver damage. These patients then have to be directed to other therapies.”
Iain is currently leading a team from the University of Glasgow working on a project in partnership with SMS-IC and clinicians from NHS Greater Glasgow and Clyde. The project aims to develop a blood test to predict which patients will not respond well to MTX. This means they can bypass this treatment option and go straight to a different therapy.
“At the moment, we roll the dice and go for a treatment that is most likely to help based on the population average,” explains Iain. “In future, we would like to be say to a patient with more certainty, “we know you are likely to do well on this particular drug, and for that reason we think this is the best option for you.
“There will be multiple benefits from this approach. If we know who is not going to respond to our normal first choice treatment, we can get them onto alternative drugs sooner, which will prevent them suffering the effects of this disease for any longer than they have to. The quicker they are treated effectively, the quicker we can slow down the damage that is being caused to their body by the rheumatoid arthritis. This will lead to fewer patients needing multiple medical appointments just to find a treatment that works, and fewer patients needing joint replacement surgery due to damage at a later stage –in essence it will mean less misery all round.
“Our catchphrase for precision medicine is ‘the right medicine for the right person at the right time’. In a perfect world – and we are not there yet - we would be able select from a range of different medicines based on the blood test that we are developing. This test would tell us that Mrs Smith needs the red drug, while Mr Jones needs the blue drug and Mrs Singh needs the green drug.
“Precision medicine will undoubtedly save the NHS money, but there is also the issue of simply doing the right thing – why should patients have to suffer unnecessarily? If we have a way of getting people onto the right medicine for them more quickly, then why should we wait?
“We are not quite finished the project yet – the first round will finish this summer - but if we do feel that there are signs of success, that we will be able to predict how people will respond to MTX, we will then be looking for opportunities to work in partnership with industry SMEs to develop this project further over the next year.
“SMS-IC were the organisation that brought this project into existence,” says Iain. “They provided funding, they coordinated with us, and they provided some of the hardware to do the sequencing of genes that we needed. They have been a very important central part of the whole operation.”