Focus on Newcastle
Reproduced from Issue 100 of Arthritis Today
The first of a series of profiles of the UK's leading rheumatology centres begins with a look at the latest academic and clinical developments on Tyneside.
Dr Helen Foster
Let's be clear about this – the city of Newcastle is more well-known for its football team and the fervour of the Toon Army than for its rheumatology services.
But while there is little chance of rheumatological matters knocking Alan Shearer and co off the front pages of the soccer-obsessed local papers, nevertheless, the city is quietly establishing itself as a future centre of excellence in terms of both patient care and scientific research.
arc is playing a major part in this, currently providing more than half a million pounds in research grant funding, and paying the salaries of 14 out of the 20 research staff at the department of rheumatology at Newcastle University.
Ever since rheumatology was first recognised as a speciality in the city more than 40 years ago, a firm scientific base has become established, and over the past five years, with the rapid progress in molecular biology, dramatic advances in therapy have started to emerge.
At the same time, the clinical services have been developed, with in and out-patient facilities set up on the same site in the musculosketal unit at the Freeman Hospital.The unit opened three years ago and incorporates rheumatology, metabolic bone disorders, and elective orthopaedics. There are five consultants rheumatologists and ten orthopaedic surgeons, including a new Professor of Orthopaedic Paediatrics, Professor Paul Gregg. Now, around 18,000 rheumatology patients and a further 18,000 orthopaedic patients are treated there each year.
But the catalyst for the current talk of the foundation of a rheumatology centre of excellence was the appointment in October 1996 of leading scientist Tim Cawston, a former arc Senior Fellow at Cambridge, as the new Professor of Rheumatology.
Professor Tim Cawston
This is the first time that a non-clinical clinical scientist has been appointed to such a post. And from the start, Prof Cawston was aware of the need to strengthen the links between university academic staff in the medical school, and the Freeman, a couple of miles away.
"The medical school here felt that the links between the Freeman and the academic department could be strengthened – it is sometimes felt that academics have their heads in the clouds and the clinicians are at the coal face – doing all the work without getting any of the kudos," he says.
"Having a non-clinician here has maybe made it easier to bridge that gap in some ways, but we have to make sure that everyone works hard at making strong collborative links. The clinical staff have been extremely good at including us in things, and fortunately we have five excellent consultants who are equally keen on seeing closer links with us."
So as well as setting up new labs, overseeing a major refurbishment programme at a cost of around £600,000, and continuing his research work, Prof Cawston has organised a series of joint meetings and social events, in the hope of improving professional relationships. Over the next two-three years, academic and clinical staff will be working on joint projects, and working on clinical trials together.
A major aim is to appoint a clincian/scientist who will work in the laboratories, and at the Freeman Hospital.
"What we want to ensure is that basic advances in our understanding of disease mechanisms are rapidly translated into improvements in patient care," adds Prof Cawston. "It's no good having a great academic centre if patients are being ignored."
Dr Helen Foster, a former holder of an arc Fellowship, and now one of the few specialists in the country to have the title consultant paediatric and adult rheumatologist, couldn't agree more.
She holds children's arthritis clinics once a week at the Royal Victoria Infirmary, and for teenagers and young adults at the Freeman, seeing youngsters from the Newcastle area and as far afield as Whitehaven, Darlington and Carlisle.
"It's no good having a great |
She is one of those doctors at the "coal face", working in what is often still regarded as a low profile speciality, in a children's outpatient department where rheumatology jostles for attention with other better-known, more life-threatening conditions. Of all the specialities, rheumatology is the only one not to have its own nurse specialist, and, initially has had difficulty in attracting young doctors.
"I'm always promoting the idea that children with arthritis need a lot of support and attention," said Dr Foster. "The vast majority of children with JCA appear well, and are not in wheelchairs. Nevertheless they can still be in a great deal of pain. Arthritis can have a huge impact on their families too – a parent may have to give up work to look after the child, so there can be financial implications too."
Youngsters with JCA need specialist attention from a multi-disciplinary team, in particular skilld physio and occupational therapy.
Dr Foster recalls one young patient she saw recently, a not untypical case."He was six, and had JCA since he was two, but had only just been referred to our team. He was unwell, and hardly able to walk, but after a month of intensive physiotherapy and aggressive treatment with steroids and methotrexate, he is walking and and is much better and happier in himself.
"But his disability could have been largely avoided by an earlier referral. GPs don't tend to see many JCA patients, and such children tend to go to paediatricians and orthopaedic surgeons. It takes a long time for them to be passed down the line to our team. I'm very keen to improve the current situation, and to improve awareness among medical colleagues that thse chikdren need to be managed in specialist centres."
It's children like that who could one day benefit from the rheumatolgy department's research work, translated into increasingly effectivement treatment. It remains to be seen whether Tim Cawston's aim of creating a centre of excellence in Newcastle will take root. But early signs indicate a strong willingness among medics and academics to make it happen.
And that can only be good news for people in the North East – whatever the fortunes of Newcastle United.
Research developments in Newcastle
Cartilage and collagenase team
Prof Cawston's field of interest is the destruction of cartilage and bone that leads to loss of joint function in both osteo and rheumatoid arthritis. He and his team have identified which enzymes (called collagenases) break down tissue in the joint and are finding different ways to stop them working.
New drugs have been developed that stop the enzyme from working, and so could ultimately stop joint damage occurring. The Newcastle team are hoping to set up clinical trials involving patients later this year.
T cell team
Dr John Goodacre, arc lecturer for the past 12 years, set up his research group in 1990 to look at what causes auto-immune rheumatic diseases such as RA and Lupus, and how the body makes an immune response against its own proteins."There is a lot of common ground between our projects, although we are coming at it from slightly different areas of expertise,"explained Dr Goodacre.
"We want to design specific ways of stopping the disease – at the moment the drugs used are non-selective, so they have some side effects. We want to make the drug treatment more specific and effective."
The goal would be to produce a kind of vaccine for people who have been proven to be susceptible to developing RA and other auto-immune rheumatic diseases.
Other studies are looking into environmental triggers of arthritic disease – such as the streptococcus bacteria which commonly causes tonsillitis – and a collaborative study with the University of Northumbria to test new materials for joint replacements.
Patient Studies Team
The patient population in the North east is very stable, which has enabled pioneering studies to be set up in families of rheumatic disease, and patients with Sjogren's Syndrome and psoriatic arthritis. Consultant rheumatologists have built up a unique data base of patients detailing treatment regimes and disease activity over a ten-year period.
In the future, one or two clinically trained researchers will be working in the medical school. Technical staff are currently carrying out a sample collection procedure at the Freeman Hospital where samples of serum and synovial fluid are collected, recorded on a data base, and stored at -80 degrees C in a freezer, provided by arc.
