The following article is produced by kind permission of the Eastern Daily Press
HEALTH: Charity calls for introduction of anti-TNF therapy to be speeded up
'Arthritis treatment 'has dramatic effect'
by Mark Nicholls - Health Correspondent

A medical research charity is calling for the introduction of a revolutionary new treatment for arthritis patients to be speeded up. Trials, many of them conducted in Norfolk; have already proven that anti-TNF therapy has a dramatic effect on people with arthritis, particularly ankylosing spondylitis (AS), which affects young men. The Arthritis Research Council (ARC) - which backs research and clinical trials into arthritis across Norfolk - wants to see it introduced nationally.

Patients with severe disease, around 10pc of AS sufferers, are known to benefit enormously from anti-TNF therapy, which has been licensed for AS since 2003. But it is not expected to be reviewed by Nice (National Institute for Health and Clinical Excellence) until February 2007.

The charity is calling for that process to be brought forward and is raising the issue during its winter awareness week, which starts today. Because anti-TNF therapy is still -riot approved by Nice for 'the treatment of AS, even though it has been licensed since 2003, hospitals and primary care trusts (PCTs) do not have to fund the treatment, which costs around £10,000 per patient per year. But it has been recommended for use in Scotland. The charity points to the benefits of anti-TNF therapy by highlighting the progress of father-of-two Simon Rhodes, 37, from Wymondham, who was diagnosed with AS at age 19. Two-and-a-half years ago, when his AS was very active and he was in a lot of pain, he was put on anti-TNF therapy.
The dose was increased a year ago and now his condition is stable, there is no tailing-off effect and he feels "pretty good". His pain has been reduced, and he has more energy, even resuming playing golf. AS is one of the few types of arthritis to affect more men than women and to occur in people in their late teens and early 20s.

Around 60,000 people in the UK are affected. The main symptoms are excruciating pain in the lower back, which leads to progressive stiffness, restricted movement and lack of mobility. It also causes crippling fatigue. But according to the ARC, whose scientists developed anti-TNF therapy in the1990s, although some trusts are making funding available, the overall picture is very patchy, leaving many people with AS unable to access drugs which could transform their lives. Prof Paul Wordsworth, of ARC, said: "We would urge Nice to speed up its approval process so other people can benefit from the extraordinary transformation that these drugs can bring to AS patients. "We are having to battle for every patient and it's completely inappropriate to apply the Nice guidelines in this way; to exclude clinicians from using proven and licensed agents which have very good trial data."

The charity says some rheumatologists get round this by putting patients on clinical trials of anti-TNF, with the trusts picking up the bill for the drug once the trial is finished. Many medics would like PCTs and hospitals to make an interim decision to fund the drugs to tide them over until Nice approves them. With Norfolk widely recognised as an area for clinical trials in arthritis, a number of patients are already benefiting from anti-TNF therapy for AS and other arthritic conditions. They include mother-of-two Diane Barwick, from Fundenhall, who has rheumatoid arthritis. A patient at the Norfolk and Norwich University Hospital rheumatology department, she has been able to regain her life, and go back to work, instead of being condemned to a life of pain, disability and dependence on others.

Ms Barwick developed rheumatoid arthritis suddenly in 1992 within hours of giving birth to her premature twins. Standard treatments for the condition did not control her symptoms. In 2004, she was treated with Humira, one of the anti-TNF therapies, and the change was dramatic: within a few weeks she was cutting down trees, trimming hedges and doing DIY at home. Rheumatoid arthritis affects 600,000 in the UK and costs the NHS up to £1.7bn a year.

The rheumatology department at the N&N is one of the leading units in the UK and proactively identifies patients early who would benefit from this revolutionary group of new 'biologic' or anti-TNFs therapies. Margaret Somerville, clinical (research) manager in rheumatology at the N&N, said it is not unusual to see dramatic improvements even within a few hours or days.
She said: "Often responses to these treatments are life changing, with patients who were previously having to use wheelchairs being able to walk and return to a normal life again. "The emotional response to being able to do even simple tasks again, like baking a cake, picking up your child in your arms, or simply going to the loo without assistance is heart-wrenching."

(Originally printed in the Eastern Daily Press on 3rd January 2006)