As usual, the Oscar presentations with their accompanying display of revealing evening dresses grabbed the headlines for a day or two. It must have evoked memories for Kathleen Turner of 1987, when she was an Oscar nominee.

Turner’s luminous career has been blighted by rheumatoid arthritis though she has rarely stopped working and is now starring as Martha in Who’s Afraid of Virginia Woolf? in the West End.

Rheumatoid arthritis was diagnosed in Turner 15 years ago before the present range of antirheumatic drugs such as the TNF-alpha inhibitors and now Mabthera (rituximab) were available. Treatment for the condition has been recently revolutionised but not before Turner had operations on her feet and knee.

She was 38 when she first experienced problems. These began in one of the classic ways for the onset of rheumatoid arthritis: pain on both sides of the body in the smaller joints of her feet and hands. The pain and joint tenderness are associated with stiffness in the morning, or after rest.

Rheumatoid arthritis is classified as an autoimmune disease. Usually it causes progressive symmetrical inflammation and damage of the joints by destroying the articular surfaces covering the bones. As in most auto-immune diseases there is often evidence of an hereditary predisposition. Infection and environmental factors are among possible triggers that start the immunological responses that cause the inflammatory symptoms.

Other cases may start suddenly and with acute symptoms. The inflammatory arthritic joint symptoms are only one aspect of the condition. Rheumatoid arthritis is a generalised disease and the joint troubles are accompanied by feelings of extreme fatigue, weakness, a loss of appetite and general malaise. The course of the disease isn’t always progressive but may be subject to remissions and flare-ups.

Turner’s case was no exception to the rule that rheumatoid arthritis is difficult to diagnose. It took a year before her condition was recognised. This is despite the comparative frequency of the disease — it affects 400,000 people in the UK at any one time. One person in 50 in the UK has symptoms of rheumatoid arthritis at some time in their life. It can start at any age but most commonly between the ages of 25 and 50. Both sexes are affected, but women three times as often as men.

Usually the disease is treated with non-steroidal anti-inflammatory agents; later, antirheumatic drugs may be necessary. Although conservative treatment for rheumatoid has a poor reputation with patients, 75 per cent of them improve within a year. The worry is about the 10 per cent of patients whose disease is severe and becomes progressive so that without effective therapy they will be disabled.

The tendency is to use the heavier treatment early: in the first instance, gold compounds, hydroxychloroquine, or sulfasalazin (better known to patients with ulcerative colitis). Penicillamine was much used, but now is less favoured. Methotrexate or azathioprine are useful steroid-sparing drugs. Steroids have a dramatic effect but it is one of suppression of symptoms rather than cure.

The first big advance for the 10 per cent of patients who defy standard treatment and in whom the symptoms are progressive was the introduction of the TNF-alpha inhibitors. Experience has defined which of the drugs will work best in a patient. Unfortunately, 30 per cent of patients whose refractory rheumatoid arthritis needed treatment with TNF inhibitors respond inadequately or are intolerant to them.

The latest discovery has been that Mabthera (rituximab), a drug manufactured by Roche that has become standard treatment for non-Hodgkin’s beta-cell lymphoma, also targets the beta cells involved in the inflammation of rheumatoid arthritis. Mabthera is given with methotrexate.

Mabthera breaks the chain reaction to the immune response that leads to joint destruction and crippling disability. It is given as single infusions two weeks apart: 22 per cent of patients in six months achieved a 50 per cent improvement, and 12 per cent a 70 per cent improvement.