Arthritis scans could save money

By REBECCA WALSH health reporter

On bad days rheumatoid arthritis affects nearly every joint in Margaret Wesley's body.

Diagnosed with the disease 10 years ago, she has had all her knuckles and both wrists replaced. She is on the waiting list for more surgery, including an operation to fuse three vertebrae in her neck.

The 54-year-old, who is on an invalid's benefit, has difficulty with simple tasks such as chopping vegetables and has to use both hands to lift a litre of milk.

"I feel like a prisoner in my own body," she said.

"I've virtually lost the use of my hands until I have surgery done again. I don't have much strength in my fingers ... I liken it to soaking your bones in battery acid."

Research shows MRI (magnetic resonance imaging) scans can help predict which people are more likely to suffer severe rheumatoid arthritis from the early stages of the disease.

The findings mean doctors could channel expensive preventive drugs, not yet funded or widely available in New Zealand, towards those most needing them.

The research, led by Dr Fiona McQueen, a senior lecturer in rheumatology at Auckland University's School of Medicine, followed 31 patients with rheumatoid arthritis over six years.

It found an MRI scan of a patient's wrists taken soon after the onset of the disease predicted x-ray findings six years down the track.

Dr McQueen said the MRI showed the level of "erosion" of the joint about a year before an x-ray. It also revealed bone marrow oedema, the appearance of water in bone marrow, and synovitis, inflammation of the joints. These cannot be seen on an x-ray.

"In a perfect world, this study suggests it would be useful to get an MRI of the wrist at that early stage to help predict who is going to be the person who is going to be crippled and in a wheelchair in 10 years. These are the ones we would want to treat with the expensive drugs," Dr McQueen said.

The drugs, known as "biologics", reduce pain and inflammation, dramatically slowing the progress of the disease. The Rheumatology Association is lobbying Pharmac to pay for the drugs - which would cost about $25,000 per patient per year - for about 600 people in New Zealand with the most severe form of the disease.

Ms Wesley, a trained primary school teacher, takes a combination of drugs but said aside from the pain, remaining optimistic was one of the biggest challenges.

"These drugs do offer hope for me. I would be a good candidate," she said.

"One of the things that is not realised with this is the loss of economy. My earnings have been so small over this period I wonder how economic it is not to treat it with some of these more powerful biologic drugs."

Dr McQueen said MRI scans, which were more expensive, would need to be used in conjunction with current tests, including blood tests and x-rays.

Alasdair Finnie, chief executive of Arthritis New Zealand, one of the organisations which helped fund the research, said the work was highly regarded internationally.

Making the biologics drugs available to those who suffered severe rheumatoid arthritis would not only improve their lifestyle but in the long term dramatically save on hospital costs and enable people to continue working and contribute to the economy.

What the disease is

Rheumatoid arthritis is the most severe type of inflammatory joint disease.

It is an auto-immune disorder where the body's immune system attacks and damages joints and surrounding soft tissue.

About 1 per cent of the population have rheumatoid arthritis and in about a fifth of cases it progresses to a stage where people are severely debilitated.

Women are three times more likely to suffer from it than men.

It generally occurs in those aged 45 and over.