Sufferers of rheumatoid arthritis in Britain have been warned that their access to a particularly effective class of drug will in future be limited.
Rheumatoid arthritis is an auto-immune disease which attacks the joints; it is a debilitating disease which causes pain and swelling.
The joints most commonly affected are those in the hands, wrists, knees and feet with the joints becoming stiff and hard to move, especially early in the morning; sufferers often feel tired and unwell - sometimes lumps appear under the skin near the joints called rheumatoid nodules.
Anti-TNF (anti-tumour necrosis factor alpha) therapy drugs such as adalimunab, etanercept, and infliximab, have been found to be particularly effective for severe cases as they can slow the progress of the disease and help to reduce symptoms such as joint pain, swelling, mobility and fatigue; each drug works and is administered in slightly different ways, but they are very expensive.
As the disease progresses, the muscles around the joint waste away, the cartilage in the joint and the bone underneath become eroded and eventually the whole joint is filled with fibrous scar tissue and completely freezes and other parts of the body such as the skin, eyes, lungs, heart, blood and kidneys can also be affected.
Rheumatoid arthritis affects about one per cent of the population and is more common in women; it usually appears in women between 25-45 years of age and often runs in families - it can strike suddenly, but is more likely to begin gradually - it can go into remission, never to reappear again in some cases - but as a rule it flares up repeatedly.
While there is no cure for rheumatoid arthritis the progression of the disease can be slowed and the symptoms treated with rest, 'physio' and occupational therapy, alternative treatments such as acupuncture and a variety of drugs.
Most sufferers use a range of treatments from different health professionals but now the National Institute for health and Clinical Excellence (NICE) in the UK say patients in England and Wales should only be able to try one anti-TNF drug, currently, patients can move on to a second or third anti-TNF if their first drug stops working - the new ruling could affect as many as 40,000 sufferers.
The expectation is that NICE will advise doctors that giving patients two, or even three, anti-TNFs is not cost-effective and that they should offer patients the next drug in line - rituximab - which costs about £3,000 less per year than the cheapest anti-TNF.
The problem however is that around a quarter of patients do not gain any benefit from rituximab and Arthritis charities say that cutting the anti-TNF options from three to one, means patients' treatment choices will be severely limited.
Earlier this year another arthritis drug was rejected for NHS use and advocates say thousands could be left with no effective way of managing their condition.
The National Rheumatoid Arthritis Society has warned that patients could face high levels of pain and the possibility of surgery and long term disability and says the clinical effectiveness of drugs and the views of patients and clinicians are being ignored.
Experts say rheumatoid arthritis sufferers often have to try each of the three drugs in order to find the most effective for them.