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Immunology

Immunology

We have made a difference in so many lives with new therapies that have changed the way diseases are treated.

Dan Baker, M.D.

VICE PRESIDENT, IMMUNOLOGY DISEASE AREA STRONGHOLD LEADER,
JANSSEN RESEARCH & DEVELOPMENT

INTRODUCTION

We have a rich history in the development of medicines to combat immunological disorders. Immunology is the branch of science that focuses on research into the immune system. We continue to augment our expertise through expansion of our pipeline of innovative products for the treatment of complex immunological diseases such as rheumatoid arthritis, ulcerative colitis and psoriasis.

Our focus areas in immunology include:

Rheumatology

- Rheumatoid arthritis (RA)

- Ankylosing spondylitis (AS)

- Psoriatic arthritis (PsA)

 

Gastroenterology

- Crohn’s disease (CD)

- Ulcerative colitis (UC)

 

Dermatology

- Psoriasis

 

Helpful links:

- The South African Gastroenterology Society www.sages.co.za

- The South African Rheumatology Association www.saraa.co.za

Transparency

 

Rheumatology
Rheumatoid arthritis (RA)

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a type of arthritis where the body’s immune system ‘attacks’ the joints. RA causes swelling of the protective lining (synovium) that covers the inside of the joints, resulting in pain and stiffness of the joints.

What causes Rheumatoid arthritis?

The cause of RA is not known but many possible risk factors for RA have been identified. It is thought that multiple factors interact in people with a genetic predisposition to cause RA. In addition to genetic factors, environmental, hormonal, infectious and other factors are likely to contribute to RA.

How common is Rheumatoid arthritis?

RA is the most common type of inflammatory arthritis and affects around 23 Million people worldwide. The disease is three times more common in women than men. Women usually develop the disease between the ages of 30 and 60, while in men, it occurs more commonly over the age of 45.

What are the symptoms of Rheumatoid arthritis?

The inflammation of RA causes pain, swelling and stiffness in the joints. Symptoms usually start in the hands and feet, but RA can affect any joint. Usually the inflammation is symmetric, with the same joint on both sides of the body being affected, for example, both wrists. The inflamed joints are usually most painful and stiff just after waking, with stiffness lasting for an hour or more.

Affected joints are often tender, warm and enlarged because of swelling and can quickly become deformed. Joints may freeze in one position so that they cannot bend or open fully which leads to a limited range of motion. People with RA may have mild disease with occasional flare-ups and long periods of remission when the disease is inactive, or they may have a steadily progressive disease with an increasing number of joints becoming affected over time. The course of RA is unpredictable. The disorder progresses most rapidly in the first few years. For this reason, once a diagnosis of RA is made by the doctor, it is important to start treatment straight away. Early treatment can help prevent a lot of the damage that RA can do to the body.

 
Ankylosing spondylitis (AS)

What is Ankylosing spondylitis?

Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes pain in the back, the neck and sometimes the hips. ‘Ankylosing’ means fusing together and refers to the loss of

flexibility of the back and the neck that can result from the inflammation. ‘Spondylitis’ means inflammation of the vertebrae (spine).

What causes Ankylosing spondylitis?

The cause of AS is not known, but the disease tends to run in families, suggesting that genetics play a role. A person’s risk of developing AS increases if a first-degree relative (parent, sibling or child) has AS.

How common is Ankylosing spondylitis?

AS is a disease that affects young people, most commonly between 20 and 30 years of age and is 3 times more common in men than women. Because there is a strong genetic tendency in AS, it is between 10 and 20 times more common among 1st degree relatives of AS patients than in the general population.

What are the symptoms of Ankylosing spondylitis?

Spinal pain, almost always in the lower back, is usually the first and most common symptom.

Back pain with AS generally:

  • Begins in early adulthood (before 45 years of age).
  • Has a gradual onset – rather than a sudden onset after an injury.
  • Lasts longer than three months.
  • Is worse after rest and improves with activity.
  • Can cause buttock pain that alternates between left and right side.

The flexibility of the back may be reduced. For example, putting on socks and shoes may become difficult due to a limited ability to bend forward. Other symptoms may include joint pain in other joints such as the hips or shoulders, difficulty in sleeping caused by back or joint pain, feeling tired or unwell, mild fever and weight loss. Some people also have recurring attacks of mild eye inflammation called uveitis.

 
Psoriatic arthritis (PsA)

What is Psoriatic arthritis?

Psoriatic arthritis (PsA) is a type of arthritis that causes joint pain, swelling and stiffness in people who have Psoriasis of the skin or nails. It occurs in up to 40 % of people with Psoriasis, a skin condition that causes patches of thick, inflamed skin that are often covered with silvery scales.

What causes Psoriatic arthritis?

The cause of PsA is unknown, but it is thought that genetics and environmental factors play a role. People with a certain gene (HLA-B27) and those with affected family members are at a higher risk of PsA. Exposure to certain infections caused by bacteria and viruses may also contribute to the development of PsA.

How common is Psoriatic arthritis?

PsA usually appears in people between the ages of 30 to 50, but can begin as early as childhood. Men and women are equally at risk. Children with PsA are also at risk to develop uveitis (inflammation of the middle layer of the eye). Approximately 15 % of people with psoriasis develop PsA. At times, the arthritis can appear before the skin disorder.

What are the symptoms of Psoriatic arthritis?

Symptoms of PsA include pain and tenderness in the joints.  Inflammation often affects joints closest to the tips of the fingers and toes, although other joints such as the hips, knees and spine can also be affected.

In addition to joint pain and stiffness, PsA may also cause swelling in the areas where tendons attach to bones, a condition called enthesitis. Almost half of people with PsA also experience dactylitis, which causes the entire finger or toe to swell. Dactylitis is associated with progressive joint damage.

Gastroenterology
Crohn’s disease (CD)

What is Crohn’s disease?

Crohn’s disease is a disease that causes inflammation, or swelling, and irritation of any part of the digestive tract – also called the gastrointestinal (GI) tract. The part most commonly affected is the end part of the small intestine called the ileum.

What causes Crohn’s disease?

The cause of Crohn’s disease is unknown, but it is believed to be a result of an abnormal reaction by the body’s immune system. Normally, the immune system protects people from infection by identifying and destroying bacteria, viruses, or other potentially harmful foreign substances. In Crohn’s disease, the immune system attacks bacteria, foods, and other substances that are actually harmless or beneficial. During this process, white blood cells accumulate in the lining of the intestines, producing chronic inflammation, which leads to ulcers, or sores, and injury to the intestines. High levels of a protein produced by the immune system, called tumour necrosis factor (TNF), are present in people with Crohn’s disease.

Inflammation seen in the GI tract of people with Crohn’s disease involves several factors, like:

  • inherited genes
  • the person’s immune system
  • the environment

How common is Crohn’s disease?

Both men and women are affected by Crohn’s disease equally. People with Crohn’s disease may have a biological relative—most often a brother or sister with some form of IBD. Crohn’s disease occurs in people of all ages, but it most commonly starts in people between the ages of 13 and 30. Men and women who smoke are more likely than non-smokers to develop Crohn’s disease. People of Jewish heritage have an increased risk of developing Crohn’s disease.

What are the symptoms of Crohn’s disease?

The most common symptoms of Crohn’s disease are:

  • Abdominal pain, often in the lower right area
  • Diarrhoea
  • Rectal bleeding
  • Fatigue
  • Weight loss
  • Fever
  • Mouth ulcer
  • Nausea
  • Vomiting

Bleeding may be serious and persistent, leading to anaemia - a condition in which red blood cells are fewer or smaller than normal, which means less oxygen is carried to the body’s cells.

 
Ulcerative colitis (UC)

What is Ulcerative colitis?

Ulcerative colitis (UC) is a chronic disease that causes inflammation and sores, called ulcers, in the inner lining of the large intestine, which includes the colon and the rectum – the end part of the colon.

What causes Ulcerative colitis?

The cause of UC is unknown. What is known is that people with UC have abnormalities of the immune system which protects people from infection by identifying and destroying bacteria, viruses and other potentially harmful foreign substances. With UC, the body’s immune system is believed to react abnormally to bacteria in the digestive tract. UC is not caused by emotional distress, but the stress of living with UC may contribute to a worsening of symptoms. In addition, while sensitivity to certain foods and food products does not cause UC, it may trigger symptoms in some people.

How common is Ulcerative colitis?

While UC can occur in people of any age, it usually develops between the ages of 15 and 30 and less frequently between the ages of 60 and 80. The disease affects men and woman equally. People with a family member or first-degree relative with an Inflammatory Bowel Disease (IBD) are at higher risk for developing UC, as are Caucasians and people of Jewish descent.

What are the symptoms of Ulcerative colitis?

The most common symptoms of UC are abdominal discomfort and blood or pus in diarrhoea.

Other symptoms include:

  • Anaemia
  • Fatigue
  • Fever
  • Nausea
  • Weight loss
  • Loss of appetite
  • Rectal bleeding
  • Loss of bodily fluids and nutrients
  • Skin lesions
  • Growth failure in children
 
Dermatology
Psoriasis

What is Psoriasis?

Psoriasis is a common skin condition and, is very simply, a speeding up of the usual replacement processes of the skin. Normally skin cells take about 21 – 28 days to replace themselves; in Psoriasis this process is greatly accelerated, and skin cells can be replaced in just a few days.

What causes Psoriasis?

Traditionally, Psoriasis was thought to be a condition of the upper-most layer of the skin (the epidermis), but research has found that the changes in the skin begin in the immune system when certain immune cells (T cells) are triggered and become overactive. The cause of these triggers is unknown. The T cells then produce inflammatory chemicals that act as if to fight an infection or heal a wound which leads to rapid growth of skin cells causing psoriatic plaques to form.

How common is Psoriasis?

Psoriasis can affect anyone, ranging in age from childhood, all the way through to the elderly. There are, however, two ‘peaks’: from late teens to young adulthood, and between the ages of 50 – 60. Men and women get Psoriasis at about the same rate and in many cases; there is a family history of Psoriasis.

What are the symptoms of Psoriasis?

Most Psoriasis causes plaques. These plaques are raised thick and red patches of skin, covered with silvery white scales. The silvery white scales are the accumulation of the skin cells waiting to be shed, and the redness is due to the increase in blood vessels required to support the increase in cell production. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. They can also show up in other places such as fingernails, toenails, genitals, and inside the mouth.

Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:

  • Red patches of skin covered with silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning and soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

 

 
Transparency

Bloem Arthritis NPC

Bloem Arthritis NPC is a non-profit organization aiming to create awareness around arthritis, auto-immune diseases and the medication that is involved in treating these conditions.

“By creating awareness amongst the population living with arthritis, we want to enable people to help themselves by knowing what is available in terms of medication and have greater support from their families and friends and the medical persons involved. The end goal is to have an impact on their quality of life, their future and to establish a well-supported network amongst these living with arthritis.”

Project description: Patient education and support program

Contract signed: 10 May 2017

City of organization: Bloemfontein, South Africa

Web address of organization: N/A

Contribution made by Janssen:  R14 622.50