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World Arthritis Day on 12 October 2013: around 30 per cent of patients achieve remission.

(Vienna, 10th October 2013) The Medical University of Vienna has been acknowledged internationally as leading the way in arthritis research for many years, and researchers in the Clinical Department of Rheumatology at the MedUni Vienna have played a key role in the development of the latest new treatment guidelines set down by the European League Against Rheumatism (EULAR). Their leader, Josef Smolen, has been the most-cited rheumatologist in the German-speaking region for many years. In a current ranking by Thomson Reuters, which includes the citations of all researchers from all over the world and from all types of diseases, Smolen stands in an impressive 13th place as the third most-cited rheumatology expert in the world.

Smolen states: “In terms of these citation rankings, which are an extremely important indicator of scientific recognition, no other Austrian university comes close to the MedUni Vienna.”

“Our goal is always remission or at least a low level of disease activity," says Smolen in the run-up to World Arthritis Day next Saturday (12.10). The current stage of research has already put the conditions in place for this: around three to five per cent of the population has inflammatory rheumatoid arthritis (in Austria, this equates to around 250,000 to 400,000 people), of whom around 30 per cent can achieve remission – i.e. a permanent subsidence of their symptoms – after just one to two years. A further 50 per cent, says the Viennese scientist, will have a marked decrease in their disease activity. “Only the remaining 20 per cent continues to present us with treatment challenges."

20 years ago, remission in rheumatoid arthritis was a miracle
Says Smolen: “20 years ago, remission in rheumatoid arthritis was a miracle, and rheumatology outpatient clinics were full of people in wheelchairs. Nowadays, people are able to cope with the condition much more easily."

Arthritis research at the MedUni Vienna has played a huge part in this. Under Smolen’s guidance, Daniel Alehta, Kurt Redlich and Tanja Stamm (University Department of Internal Medicine III at the MedUni Vienna / Vienna General Hospital) developed European treatment and diagnostics algorithms that form the basis for the development of a treatment matrix for patients with rheumatoid arthritis. The new therapeutic algorithm for rheumatoid arthritis defines the individual stages of treatment in 14 points.

This means that action can be taken sooner than previously if a treatment fails to have any effect and a different therapeutic agent needs to be switched to. With regard to the changing of treatments: “In the past, rheumatoid arthritis patients may have changed treatment two or three times over the course of a decade, but now we rethink things after six months if there has not been any significant improvement. The diagnosis of ‘a bit better’ is no longer good enough for us these days. We want to stop the disease from progressing early on.”

Focus on clinical investigations
Other factors involved in the generally improved outlook for rheumatoid arthritis patients include: the use of biopharmaceutics, which began around 14 years ago, the excellent efficacy of the rheumatoid arthritis medication Methotrexate and the increased focus on actual disease activity, such as the number of swollen joints, or even better, on scores that have also been developed in Vienna. Says Smolen: “In rheumatoid arthritis, there are unfortunately no biomarkers in the blood or tissue which – such as in cancer treatment – would facilitate personalised therapy; we primarily have to resort to clinical investigations.”

The working group within the Clinical Department of Rheumatology at the MedUni Vienna, led by Smolen, has latterly published several papers on this subject in the highly respected journal “Annals of the Rheumatic Diseases (ARD)”:
- “Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force.” Ann Rheum Dis 2013;0:1–11. doi:10.1136/annrheumdis-2013-203419.
- “Forget personalised medicine and focus on abating disease activity.“ Ann Rheum Dis 2013;72:3–6. doi:10.1136/annrheumdis-2012-202361
“Development of patient-centred standards of care for rheumatoid arthritis in Europe: the project.  Ann Rheum Dis. 2013 Aug 6. doi: 10.1136/annrheumdis-2013-203743”
- “Treating rheumatoid arthritis to target: the patient version of the international recommendations“. Ann Rheum Dis 2011;70:891–895. doi: 10.1136/ard.2010.146662.