East Anglian success
Reproduced from Issue 103 of Arthritis Today
Professor David Scott
Norwich may not traditionally be thought of as a centre for research into the rheumatic diseases – but arc is currently pumping around £1.5m into helping the region maintain its unique position.
These are exciting times for research into rheumatic disease in East Anglia. Over the past few years a number of key people and disciplines have converged in Norwich from other leading centres, and the result has been a flowering of clinical and scientific research, with major implications for the treatment and care for people with arthritis.
While Professor David Scott and the rheumatology team at the Norfolk and Norwich Hospital win plaudits and prizes for the standard of their clinical care, the nearby arc Norfolk Arthritis Register (NOAR) provides an invaluable epidemiological service to researchers working on inflammatory arthritis. Since 1989 NOAR has produced important information on the influence of age, sex, geography, diet, lifestyle and genetic factors on the development of arthritis.
The third major part of the research equation is contained within the University of East Anglia, where most of arc funding is concentrated. In fact arc currently funds nine people in the labs of the UEA's School of Biological Sciences, where arc Senior Fellow Professor Gill Murphy and arc Post Doctoral Research Fellow Dr Ian Clark – both fairly recently arrived from Cambridge – are heading up a long term study into the enzymes which destroy cartilage. (See separate panel below.)
Ian Clark, a former Copeman Fellow who has worked in the US and at Addenbrookes on the same subject, believes that UEA has become a major player in terms of rheumatological research. "Lots of good people have come together here, and there are so many different strands of research going on," he explains. "There are also important collaborative links with the Norfolk and Norwich."
There's plenty going on. In the UEA School of Health, Nicola Cooper, an arc-funded PhD student is writing a thesis on the financial cost of arthritis to the patient. She aims to provide a picture of the economic impact of rheumatoid arthritis from early onset of disease in three groups of patients being tracked by NOAR.
In another study, arc lecturer Maria Koutantji is looking at the psychological aspects of early arthritis, comparing the problems and coping strategies of these patients with those who have established disease.
In many ways Professor David Scott is the lynch pin who draws together all the various clinical research strands. As well as a hard-working rheumatologist (described recently by colleagues as "a workaholic and enthusiastic beyond all reasonable expectations"), he's also involved in numerous research projects including the epidemiology and treatment of vasculitis, and teaches at UEA – he's just finished an MSc module in rheumatology aimed at people likephysiotherapists, GPs and other health care professionals.
Last year the rheumatology department at the N and N won the Searle Rheumatology Team of the Year Award for its innovative clinical practice and overall performance. The award was much deserved, particularly as the department had only very recently moved from a different site in a dedicated hospital 14 miles north of Norwich.
Because of the ensuing reduction of in-patient rheumatology beds, there was a real need to develop a new rheumatology day unit to make sure patients didn't lose out on vital care.
Rheumatology unit at the Norfolk and Norwich Hospital
At the same time, the department's three rheumatology nurse practitioners began holding regular clinics at nine doctors' surgeries in the Norfolk area. David Scott says with a population of 500,000 spread over a large area – covered by just three rheumatologists – the extended role of nurse practitioners helps the system cope, and works very well.
He also highlights the effectiveness of the hospital's multi-disciplinary approach to arthritis patients. This is perhaps best illustrated by the early arthritis clinic, set up last year by the third rheumatologist Dr Karl Gaffney (another former arc Fellow, incidentally), conducted by a clinician, nurse practitioner, OT and physio.
The clinic's purpose is to establish a "fast track" referral service aiming to provide early diagnosis, starting a programme of second line drugs, and comprehensive education.
David Scott, like Ian Clark and other clinical and scientific researchers, is eagerly looking forward to the N and N's planned move from the centre of Norwich to a site adjacent to the UEA on the outskirts of the city, due for completion by 2002.
"The move can only strengthen the already considerable links between the two," says Ian Clark. "It will enable us to continue our ground-breaking research efforts, and to put Norwich well and truly on the map as a centre of excellence in this area."
Enzyme JigsawsGill Murphy and Ian Clark are interested in matrix metalloproteinases (MMPs), enzymes which destroy cartilage in the joint. "These can be viewed as biological scissors which chop up the components making up the cartilage," explains Ian Clark. "The body also produces a group of inhibitors of the MMPs. These are called TIMPs, and can be viewed as stopping the scissors from closing. The TIMPs block the action of the MMPs and prevent the tissues from being degraded. Normally, there is a balance between the MMPs and TIMPs so that tissues remain intact. "In diseases such as arthritis, this balance no longer holds, the MMPs take the upper hand, and the joint is destroyed." Researchers are investigating the role of MMPs and TIMPs in health and disease; how the body normally switches on the production of TIMPs in disease; the way in which the TIMPs block the action of MMPs in order to allow the design of new drugs which will do the same. In fact, the first drugs which block MMP action are currently being clinically tested – with sponsorship from a drugs company – and Norwich is one of the centres chosen for the trials. Patients at the N and N are now being recruited. "Around the world – in the US, Europe, Japan and Australia – there are teams working on this research line, all trying to piece together the jigsaw," adds Ian Clark. "The ultimate aim is to look for new drug targets, and stop the progression of the disease." |
