Ulcerative Colitis

Methotrexate or azathioprine are useful steroid-sparing drugs.

Steroids have a dramatic effect but it is one of suppression of symptoms rather than cure.

The first big advance for the 10 per cent of patients who defy standard treatment and in whom the symptoms are progressive was the introduction of the TNF-alpha inhibitors.

Experience has defined which of the drugs will work best in a patient.

Unfortunately, 30 per cent of patients whose refractory rheumatoid arthritis needed treatment with TNF inhibitors respond inadequately or are intolerant to them.

The latest discovery has been that Mabthera (rituximab), a drug manufactured by Roche that has become standard treatment for non-Hodgkin’s beta-cell lymphoma, also targets the beta cells involved in the inflammation of rheumatoid arthritis.

Mabthera is given with methotrexate.

Mabthera breaks the chain reaction to the immune response that leads to joint destruction and crippling disability.

It is given as single infusions two weeks apart: 22 per cent of patients in six months achieved a 50 per cent improvement, and 12 per cent a 70 per cent improvement.

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