Every year, about 9,000 people over the age of 50 are diagnosed with muscular rheumatism. Traditional treatment with the anti-inflammatory drug prednisone causes quite a few side effects, which is why research is being done into a better drug. And there has now been a breakthrough in this. Doctor Ted van Essen explains.
Just like ‘normal’ rheumatism, muscular rheumatism is a so-called autoimmune disease. This means that the immune system turns against its own body and causes inflammation in certain places. In muscular rheumatism, the inflammation is not so much in the joints, as in normal rheumatism, but in the tendons, bursae and tendon attachments around those joints. As a result, people experience severe pain in their muscles. The muscles of the neck, shoulders, hips and buttocks are stiff and painful, especially in the morning when you get up but also at night.
The pain is almost always symmetrical. That means it is on both sides of the body. The pain gets worse with movement. This makes washing, dressing, getting up from bed or a chair very difficult. Other complaints include: feeling generally unwell, losing weight and having a mild fever. It mainly occurs in people over 50, and two-thirds of patients are women. It is not that easy to determine whether someone really has muscular rheumatism, because these complaints also occur with other conditions, but blood tests can reveal this. In quite a few cases, the condition eventually resolves or disappears. But that can take 2 to 3 years and sometimes even longer. And there can also be flare-ups again.
Prednisone suppresses inflammation, causing symptoms to disappear quickly. A good and effective medicine against muscular rheumatism, but it is also a strong medicine. Because it suppresses the immune system, which is disrupted in an autoimmune disease such as muscular rheumatism, you as a user also run the risk of contracting other infections. Prednisone also has side effects such as osteoporosis, increased risk of diabetes, insomnia, weight gain, stomach complaints, etc. To counteract these risks, additional medications are often prescribed.
So in addition to a pill containing prednisone every day, people often have to take much more. If the symptoms have disappeared due to the prednisone, you must first continue to take the prednisone, otherwise the muscle rheumatism may return. Over time, the medication will then be gradually reduced. But that remains difficult, because it is all very precise. The blood must be checked regularly to see if the inflammation is decreasing and the amount of prednisone is also important. It is a constant weighing of the complaints of the muscular rheumatism against the complaints of the side effects. “It’s about 2 to 3 years later and when you think you’ve gotten rid of it completely, unfortunately it can just flare up again,” says Dr. Ted.
New drug against muscular rheumatism: rituximab
But there is hope on the horizon. The Sint Maartenskliniek in Nijmegen specializes in disorders of the musculoskeletal system and therefore also in rheumatology. The clinic wanted to know whether there was a drug other than prednisone that could help against muscular rheumatism. They conducted research into the drug rituximab, which is also used for other rheumatic diseases. No real evidence has ever been provided for its effect on muscular rheumatism and this is necessary to be able to prescribe such a drug. Research is therefore required and that costs money. “The Sint Maartenskliniek has now done that and the results have been hopeful. Rituximab has fewer side effects than prednisone and is very effective against the complaints caused by muscular rheumatism. The difference between the two medications is that prednisone must be taken daily as a tablet and rituximab is given once as an infusion. The people who received rituximab in the study were much less dependent on prednisone after 1 year. Half of the people who received rituximab even stopped taking prednisone completely after 1 year. In the group without rituximab, 80 percent of the people still needed prednisone after one year.”
More research needed
“This first study was conducted among a small group of people, but is so promising that a much larger study is now underway into rituximab as a replacement for prednisone. Several rheumatism centers and hospitals (Rijnstate, Gelre hospitals, Radboudumc, ZGT Almelo and UMCGroningen) are now also participating,” says doctor Ted.
The Sint Maartenskliniek encourages people with muscular rheumatism to participate in this study. Whether you have just been diagnosed or are suffering from a flare-up due to tapering off prednisone, the Sint Maartenskliniek and the other participating hospitals encourage you to register. This helps to confirm the findings as quickly as possible and make rituximab available to all people with muscular rheumatism. More information about the study and how you can register for the study can be found here website of the Sint Maartensklink.
Doctor Ted van Essen discusses this, and other topics, in Time for MAX on Tuesday, September 26, 2023.
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