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On the move: science has transformed arthritis and rheumatism care – what’s next?

The 70 years since the foundation of EULAR – the European League Against Rheumatism – have witnessed major advances in how we manage arthritis and rheumatism

Seven decades ago, experts from scientific societies in Europe came together to found an association dedicated to improving the care of people with rheumatic and musculoskeletal diseases. In the years that followed, the prevalence of those conditions and how they are treated – as well as the role of EULAR itself – have changed significantly.

‘EULAR has evolved from an association of national scientific societies to a more inclusive organisation which includes patients and health professionals,’ explains Rik Lories, a professor at KU Leuven and active member of EULAR.

Focused on a diverse group of diseases that can affect the joints as well as muscles and other parts of the body, today’s experts in the field have tools their predecessors could only dream of. Patients, who may in the past have seen their quality of life profoundly limited, can now enjoy active and productive lives.

‘In rheumatology, we’ve experienced major advances since the beginning of the century thanks to the arrival of very potent medicines,’ says Prof Lories. ‘That was particularly beneficial to patients with autoimmune disease such as rheumatoid arthritis. Now we are seeing stronger focus on treating diseases like osteoarthritis as well as rare and orphan disease.’

These therapeutic advances have been translated into recommendations and guidelines, helping to raise standards of care around Europe. ‘When I graduated in 1996, outcomes for rheumatoid arthritis patients were not great,’ Prof Lories says. ‘The new tools and strategies we have now have completely changed the fate of patients. Much of the joint damage can be avoided if the condition is diagnosed and treated promptly.’

Clinical assessment by rheumatologists is still an essential part of patient care but specialists are increasingly supported by imaging techniques such as ultrasound. ‘MRI and x-ray can also be used to monitor what’s happening in the joints and are helping to deepen our understanding of the immunological processes at play,’ says Prof Lories. ‘These technologies can guide treatment; they may be used as a prognostic tool that helps rheumatologists to define treatment priorities.’

 

Caring for an ageing population

Osteoarthritis – which, unlike rheumatoid arthritis, is not a primarily inflammatory disease – is a growing concern as populations age. Wear and tear over many years can lead some patients to require joint replacement. In addition, one of the knock-on effects of the obesity epidemic is a rise in knee and hip problems as ageing joints come under extra pressure.

This combination of factors, says the Leuven-based expert, is a major challenge to the medical community and policymakers: ‘As treatments for cancer, cardiovascular diseases and other conditions get better, people are living longer but this makes the impact of musculoskeletal disease even more important. The burden of osteoarthritis on individuals is high, and the societal costs are also increasing.’

While medicines have transformed the lives of some patients with musculoskeletal diseases, the role of technology is beginning to come into sharper focus. From relatively simple technologies such as braces and walking sticks to more cutting-edge science, there remains unmet need in the treatment of many conditions. ‘There have been some trials in areas such as vagal nerve stimulation to investigate their potential for reducing disease activity, and some new systems for pain modulation,’ Prof Lories says. ‘We also see more interest in technologies for assessing gait and posture – there is plenty of scope for new technologies to improve patients’ lives.’

 

Advocacy role

In an era of growing pressure on health budgets, and with some countries seek to curb spending by rationing services, EULAR can also play a role in raising awareness of musculoskeletal diseases.

‘We work at a national and European level to bring policymakers’ attention to musculoskeletal conditions,’ says Prof Lories. ‘We want to highlight the burden of these diseases, the need for research funding, and the value of educational programmes and interventions that can have an enormous impact on the health of the population.’

EULAR has also engaged with members of the European Parliament to emphasise the benefits – to individuals, society and the economy – of keeping people at work. ‘Many of our patients are of working age and, at any age, it is very important for personal wellbeing to maintain the ability to stay active.’

Looking ahead, rheumatologists will continue to be on the frontline as health systems manage the growing numbers of people affected by musculoskeletal conditions. Europe’s demographics suggest EULAR will been kept busy for the next 70 years – and beyond.

 

ABOUT PROFESSOR RIK LORIES

Rik Lories directs the Laboratory for Tissue Homeostasis and Disease that is part of the Skeletal Biology and Engineering Research Center at KU Leuven. He is a consultant physician in the Division of Rheumatology at the University Hospitals Leuven. He is full Professor (“gewoon hoogleraar”) at KU Leuven. He obtained his medical degree summa cum laude from KU Leuven in 1996. He subsequently started specialty training in internal medicine and rheumatology. In 2003, he was certified as rheumatologist. In 2003 he also obtained a PhD in biomedical sciences at KU Leuven.

As past chair of the EULAR (European League against Rheumatism) Standing Committee on investigative rheumatology, he was member of EULAR’s executive committee and represent EULAR in the Biomed Research Alliance, a collaborative effort of different European medical scientific societies to foster research.

He has (co-)authored over 130 publications, including original research reports or reviews in Nature Medicine, Nature Communications,  Journal of Clinical Investigation, PNAS, Nature Reviews Rheumatology, Annals of the Rheumatic Diseases and Arthritis & Rheumatology.