Focus on Glasgow:
the Scottish dimension
Reproduced from Issue 108 of Arthritis Today
Dr Hilary Capell, Dr Iain McInnes, Professor Roger Sturrock, Dr Max Field and Dr Rajan Madhok
Despite its social problems, Glasgow's eminence as a major centre for arthritis research and care has never been higher and a major new arc grant has further strengthened its position.
EARLIER this year, Scottish TV broadcast a short charity appeal on rheumatology provision in Glasgow.
It gave viewers an insight into the work being done by the Centre for Rheumatic Diseases at the Royal Infirmary and the Royal Hospital for Sick Children at Yorkhill. It was proof, if any was needed, that Scotland's biggest city is one of the leading centres of arthritis research and patient care in the UK, but also, that the city is still strapped for cash and needs all the financial help it can get.
There's
certainly an enormous amount of activity, with the Arthritis Research
Campaign playing a major role in keeping the research pot bubbling.
Its current expenditure on rheumatology research in Glasgow stands
at more than £1.5m, with a huge range of different areas covered
by the numerous researchers, scientists and doctors on various project
grants, and the all-embracing Integrated Clinical Arthritis Centre
award (ICAC).
Particular areas of research expertise are infection and immunity – specifically septic arthritis, ankylosing spondylitis, cytokine biology, and juvenile arthritis.
The Centre for Rheumatic Diseases has expanded enormously since it was originally opened in 1965 and occupied a small hospital in Baird Street. The current head of department, then senior lecturer Roger Sturrock, and NHS consultant Hilary Capell joined in 1979 and in 1984 the centre moved into its current promises. In-patients are treated in a 28-bedded unit, with outpatients in the new Queen Elizabeth building, and research laboratories within the university's department of medicine.
Photograph: Daily Record
The centre acts as a referral centre for the West of Scotland, with 1,300 new patients and 5,000 returning patients attending the outpatient department every year. In addition, special clinics exist for second line drug monitoring, scleroderma, connective tissue disease, ankylosing spondylitis, joint injection and ultrasound imaging.
There are also increasingly strong links between the centre and the paediatric rheumatology unit at the Royal Hospital for Sick Children in Yorkhill, and Professor Sturrock runs a combined clinic for children and adolescents with Dr Krishna Goel.
ARC funding began in earnest in 1990 with the establishment of Glasgow's first professorial chair. Roger Sturrock became the McLeod/Arthritis and Rheumatism Council Chair of Rheumatology, with Dr Max Field appointed senior lecturer a year later, and Dr Rajan Madhok, one of arc's medical secretaries, became the second NHS consultant in 1995.
The award of arc's ICAC grant to Glasgow in 1997 was highly significant in helping to co-ordinate clinical and laboratory research across the city, and awards such as the arc Prize and the Intercalated BSc to promising young students has helped to raise the profile of the Infirmary's medical school.
The arrival of rising young star Dr Iain McInnes, as senior lecturer in experimental medicine and rheumatology, has had the effect, according to Professor Roger Sturrock, of acting as a bridge between laboratory and clinical research.
"Iain McInnes' appointment is very exciting; his prime remit is to tighten the links between clinical and lab work; we need someone who is rigorously trained in clinical work and in science – and there are very few of those individuals around," he said.
Dr McInnes has just set up a psoriatic arthritis clinic, and is also working with Professor Sturrock on cytokine biology, examining the role of the cytokine Il-15 and Il-18 in inflammatory joint disease. Work has shown that blocking its effect has a beneficial effect on the development of inflammatory arthritis and may lead to newer forms of treatment in the future.
Glasgow is also renowned for its work with children and young people with arthritis, and last year arc pumped in a further £350,000 to fund a new five-year post of senior lecturer in paediatric rheumatology based at Yorkhill, who will co-ordinate children's arthritis services and help to develop a network of clinics in other centres throughout Scotland, in Edinburgh, Aberdeen, Inverness and Dumfries and Galloway.
Lawrence Weaver, professor of child health at the University of Glasgow said the award would establish Glasgow as a childhood arthritis centre to rank alongside Great Ormond Street in London, Birmingham, and Newcastle.
"We're really pleased that arc has recognised the Scottish dimension in awarding this grant, which will help to fill unmet needs. We will work in partnership with colleagues at other centres, which will lead directly to improved patient care, and means that children can be treated closer to home. It also means that research collaborations between scientists in child health, genetics, nutrition and immunology will be facilitated."
Despite the high reputation of rheumatology research and clinical provision in Glasgow, the city's social problems and high levels of poverty have led to knock-on problems with patient care.
"Treatment of arthritis in Glasgow has improved immensely, partly thanks to better drugs and better targeted drugs," explained Dr Hilary Capell. She is currently working on a study into the effects of social deprivation in arthritis, which has shown that patients who are socially deprived tend to die earlier and have worse disease.
"We used to see patients coming in very late, when they were very badly disabled. Now we recognise that we cannot afford to wait and that we have to offer RA patients more intensive treatment earlier. But some patients find this hard to accept – they think they will be all right without it. So we're putting a lot or resources into education; we run a group on Saturday mornings to encourage patients to come in with their relatives of friends, to talk to nurses, physios, OTs and medical staff. Patients are still reticent about coming in, so the nurses have an open access policy and patients can come in and see they when they need to. It's very challenging work."
A shortage of rheumatologists in the west of Scotland – Ayrshire, for example, with a population of 400,000, has only half a consultant rheumatologist – means very long waiting times. Referrals of up to 26 weeks are the norm – although medics try and speed this process up for RA patients most in need of early treatment.
Dr Capell has been running clinical trials evaluating the effectiveness of second line disease-modifying drugs for the past 20 years, and has established a valuable database. She is currently using an arc project grant to carry out a trial of combination therapy of methotrexate and sulphasalazine on 60 patients.
Yet again, funding is an issue. "The advantages of these drugs is that they are affordable, unlike the new biologics," said Dr Capell. "What we try to do, given the acute funding problems throughout the country, is use drugs that are relatively cheap. We have to be pragmatic in the west of Scotland!"
