The debilitating aches and pains of rheumatoid arthritis may eventually be a thing of the past, according to a pilot study of a new treatment described Monday at the annual meeting of the American College of Rheumatology in Philadelphia. Standard drugs may keep the disease in check, but they rarely result in complete remission, and patients must almost always take them continuously. The new treatment, however, offered relief to patients who had had arthritis for an average of 22 years and had become resistant to standard medication. The treatment involves removing the body¿s B lymphocytes, or antibody-manufacturing cells. In rheumatoid arthritis, these cells produce abnormal antibodies called rheumatoid factors. Additionally, recent research suggests that some of the faulty B cells self-perpetuate, leading to a vicious cycle of disease. The B cell depletion approach, Jonathan C. W. Edwards of University College London and his colleagues argue, therefore makes good sense because it targets the root of the problem.

Patients were treated with B cell removing drugs, including a new "biologic" drug called Mabthera. (Getting rid of B cells does not put the body at risk for infection because the blood still harbors sufficient amounts of antibody, and the cells regrow quickly, returning to normal levels after about three months.) After 18 months all of the first five subjects experienced 70 percent improvement--the best level that can be expected from long-standing arthritis. Three of these individuals attained this level after a single course of treatment; the other two had additional courses of therapy. All five, the researchers report, are now leading basically normal lives, going to the gym and gardening, among other things. A second group of five showed comparable improvement, and of the 20 patients who underwent 18 months of treatment, only two have not benefited at all.

Whether long-term remission is possible remains unclear. So far this treatment, which involved two short hospital stays for intravenous infusions (although hospitalization may not be necessary in the future), has had to be repeated annually. Yet even if that pattern of retreatment holds, the team argues, it would still be very worthwhile. If these preliminary results are repeated in the large controlled trial currently in progress, B cell depletion treatment may soon help quell even the most stubborn cases of rheumatoid arthritis.

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