Tamil Nadu - Chennai

Immunology can help cure rheumatic disorders, say experts

CHENNAI: Immunology could lead the therapeutics of the future in the treatment of rheumatic disorders, A. V. Ramanan, consultant paediatric rheumatologist, University of Bristol, U.K., said on Sunday.

Delivering the ‘Millennium Guest Oration 2008’ organised by the Kanchi Kamakoti CHILDS Trust Hospital, he said immuno-based targeted therapies, and not the regime of immuno suppressants, would minimise the use of steroids in the treatment of disorders such as arthritis that afflicts 1 in 100 adults and 1 in 1,000 children worldwide.

Focusing on the advances and challenges in the treatment of Systemic Onset Juvenile Idiopathic Arthritis (SoJIA), Dr. Ramanan said the single spike in temperature during a day and a skin rash were important clues in the differential diagnosis of SoJIA. Protein levels in urine and sky-rocketing values for serum ferritin were also definitive indicators of the condition.

Dr. Ramanan discussed the Bristol Royal Hospital experience with Anakinra, a receptor antagonist in treatment of SoJIA, which accounted for 10-20 per cent of all cases of juvenile arthritis and two-thirds of all related deaths.

SoJIA patients put on Anakinra therapy showed dramatic improvements in their condition in two weeks. Dr. Ramanan held the receptor to be an important biological agent in taking forward the treatment philosophy of steroid sparing, or using less steroids, whose side-effects sit alongside the spectacular efficacy in alleviating the arthritic condition.

Cyclosporin and the comeback drug Thalidomide also belonged to the paediatric rheumatologists’ armoury, he said. “The future of treatment will involve improving diagnostic appropriateness and advocating immunologically targeted therapies that minimise steroids and maximise efficacy.”

Dr. Ramanan said the examination of the musculoskeletal system was as important as cardio-vascular or respiratory system evaluation. Unfortunately, the contemporary teaching of medicine failed to lay emphasis on this aspect. “We have a long way to go in understanding musculoskeletal subtleties.”

Contrary to the charges that many modern diseases and syndromes were “inventions” created to advance commercial interest, Dr. Ramanan said many of the disorders being newly diagnosed and named had always existed. The unearthing of many pre-existing disorders was largely because of the progress in medical knowledge.

Dr. Ramanan urged clinicians to constantly evaluate their diagnostic conclusions and not hesitate to cross-check with an expert in another specialisation.

His parting advice to paediatricians was: “You could justify avoiding an investigation; but resorting to an investigation and then failing to act on its findings is indefensible.”

Madras High Court Judge S. Rajeswaran called for more collaboration between the medical and legal professions. The readiness to consult another expert should be an integral part of medical ethics.

© Copyright 2000 - 2009 The Hindu