Bath time
Reproduced from Issue 104 of Arthritis Today
arc is pumping £1.75m of funding into research in the ancient
spa town of Bath. The city where rheumatic diseases have been treated
for the past 250 years is now a leading centre for arthritis research.
Back in 1738 it was known simply as the Bath Hospital. Later, because of its connection to the famous spa, it became the Royal Mineral Water Hospital. These days the Royal National Hospital for Rheumatic Diseases – still affectionately known as "the Min" – is more associated with cutting edge research for arthritic conditions than for hot springs and quackery. But it remains the biggest hospital in the country devoted to rheumatic diseases.
Both rheumatology research and patient care are headed up by David Blake, Professor of Bone and Joint Medicine in the School of Postgraduate Medicine at the University of Bath, who leads a team of largely arc-funded scientists and clinicians.
"The practice of truly inter-disciplinary medicine in a specialised centre is an expensive game, and highly specialised care delivered at the correct intervals with appropriate investigational back up can make all the difference to the rheumatic patient," explained Professor Blake.
"As we all know it is very small things that make all the difference, to enable someone to get up in the morning; to go to work and enjoy an appropriate social life. The RNHRD aspires to make that difference and provides a model of an integrated health care system.
"In Bath, as in so many places, it has been the Arthritis Research Campaign that has often helped make the small difference and in Bath its commitment over the years has been very substantial and utterly invaluable in maintaining the integrity of our hospital."
arc's integrated centre award (ICAC) enables excellent clinical facilities to be maintained, at the same time providing a fertile research base for the many investigators, clinical and scientific, working between the hospital and the university.
The main thrust of the research is to identify patients in the very early stages of disease, and predict who will develop aggressive, disabling rheumatoid arthritis. The aim is to then target more appropriate therapies, hoping to minimise disability in the future. So far more than 250 patients from centres in Bath, Winchester, Gwent and Bangor have been recruited. Dr Nick Hall in the pharmacy and pharmacology department is leading the scientific arm of the work, trying to develop lab tests which are useful predictors of outcome in individual patients.
Professor Blake's group (supported by an arc programme grant) specialises in trying to identify the complex mechanisms that sustain inflammatory problems in the joint. Studies by the group have led to a clearer understanding of the way in which a joint becomes oxygenated, and this in turn has led to the development of a series of drugs that specifically target tissues which lack an oxygen supply.
They deliver potent anti-inflammatory compounds directly to the joint, and thereby sparing other organs, which need the inflammatory process to be intact to provide our resistance to infection.
Many inflammatory processes in different organs are sustained by similar mechanisms, and the results generated by Professor Blake's group show very clearly the widespread benefits of supporting basic research with a long-term strategy.
"Ever since arc's inception, the charity has taken this view, and it is clear, not only form studies in Bath, but from elsewhere, that the rewards to the rheumatic sufferer are considerable," added Professor Blake.
Years ago, the old Mineral Water Hospital was renowned for treating ailments known as the palsies (skin conditions, rheumatic complaints) – brought on by endemic lead poisoning in the area – by immersing patients in hot spa waters. Immersion in warm water had a diuretic effect and led to the elimination of lead, helping to reduce symptoms, even though doctors did not understand how the treatment worked.
Rheumatological
researchers are still faced with a bewildering number of rheumatic diseases
which continue to respond to treatment for reasons that cannot be fully
explained. Researchers know many aspects of the process of disease, but
still lack a clear understanding of the pivotal cause. Inter-disciplinary
groups, working between the hospital and the university, are hard at work
to remedy this, and the sheer amount and breadth of the work is impressive.
arc-funded teams lead by Dr David Sansom, an arc Senior Research Fellow, are attempting to understand what turns on and turns off specific cells that drive the immune response in rheumatoid arthritis. How well these switches work, and what controls the switching mechanisms will prove vital for therapeutic manipulation.
Dr Jon Beresford, senior lecturer within the School of Pharmacy and Pharmacology, is tackling the very different disease of osteoporosis. The number of fractures due to the bone thinning condition is rising in line with the UK's ageing population, and currently costs more than £750m in treatment every year. His team is examining the very basic mechanisms that control the rate of bone turnover, and how it is removed and replaced in small packets throughout the skeleton. The reasons why bone is lost are complex, and change at different times in our adult lives.
The main objective of the work is to try and understand how the amount of bone that is replaced, as women age, is less than the amount that was originally lost. "If we can understand this, it may be possible to develop new ways of both preventing and treating the disease," explained Dr Beresford. "Much of the disability, pain and distress that besets our ageing population is caused by osteoporosis, and the problems created, both economically and socially, are massive."
In yet another strand of research, Dr Neil McHugh, a consultant in charge of the outpatients department, and who also works in the school of postgraduate medicine, is studying the genetic and environmental factors that influence autoimmunity in systemic sclerosis. Dr McHugh's team believe an environmental trigger may cause disease in people who are already genetically susceptible to scleroderma.
Not all the old theories about rheumatic disease have gone the way of purges, emetics and bleeding, and become historical footnotes.
As far back as 1754, cold and damp were considered by doctors at the Min to be the principle causes of rheumatism, both acute and chronic. The famous physician Dr Edward Jenner once wrote: "The walls are damp, the ditches smell, closed is the pink eyed pimpernel. Hark how the chairs and tables crack; old Betty's joints are on the rack."
The connection between damp weather and arthritis is still taken very seriously, and studies have shown that people with arthritis can detect a rise in humidity with a fall in barometric pressure, from unpleasant feelings in the joints.
Professor Blake is now setting up a humidity and rheumatic symptoms project to study this phenomenon using local patients with rheumatoid arthritis. It's reassuring to know that such homely theories still have a place in a centre whose reputation now rests squarely on current scientific practice rather than on past glories.
