Spotlight on science
Reproduced from Issue 116 of Arthritis Today
arc Clinical Research Fellow Karen Walker-Bone and Professor Mike Salmon explain their work, in the first of an ongoing series of questions and answers sessions with arc-funded researchers.
What
does your work involve?
Supervised by Professor Cyrus Cooper, my research field is epidemiology (the study of how various factors determine the frequency and distribution of diseases within humans), a powerful scientific technique that provides new information on the causes and nature of diseases. Our research focuses on soft tissue rheumatic disorders of the neck and upper limb. These are common conditions, such as 'frozen shoulder', 'tennis elbow' a 'stiff neck' and 'carpal tunnel syndrome'. Although common, there has been little research into these conditions and we do not know the best ways to diagnose, manage and prevent them.
How long has arc been funding you?
I started my arc Clinical Research Fellowship in 1999. Awarded annually, these fellowships provide an opportunity for clinicians to pursue research. Fellowships are highly prized and very competitive, granted only after a peer-reviewed grant application and interview. I was delighted to be a recipient.
What is your most important discovery in the past 12 months?
More than 40% of working-aged adults reported neck or arm pain. Pain was more common among women and with advancing years. Hand osteoarthritis affected 2% of men and 5% of women. Frozen shoulder and shoulder tendinitis affected up to 5% of our population and tennis elbow almost 1%. More worrying, over half of those with pain were having difficulty sleeping, getting dressed or driving a car. These findings are important, since they quantify the extent of soft tissue rheumatism in the working population.
What do you hope and expect to achieve from your arc funding?
This work has provided an accurate picture of the impact of these
conditions, in particular the burden of 'non-specific upper limb
pain'. Our subsequent aim is to apply for additional arc support,
in the form of a Senior Research Fellowship, aiming to explore the
mechanisms underlying musculoskeletal pain.
What do you do in a typical day?
My days are extremely varied - there are few 'typical days'. Now that the project fieldwork is complete, my activities include seeing patients in the rheumatology clinic, attending postgraduate training and meeting with the research team. The remainder of my time is spent writing up our findings as posters, lectures and papers, and my PhD thesis.
What is your greatest research achievement?
Young Investigator Award at this year's British Society of Rheumatology AGM for my work on upper limb disorders.
Why did you choose this work?
My first experience of rheumatology as a junior doctor in Portsmouth showed me that this was a unique specialty, in which long-term caring relationships between doctors and patients are supported by cutting-edge science. This was the career for me.
Do you ever think about how your work can help people with arthritis?
A considerable advantage of epidemiological research is that it
focuses on individuals. I have myself examined at least 400 symptomatic
people, seeing the impact of pain on their function and quality
of life. In addition, three close members of my family have serious
rheumatic diseases – I am always thinking about how our work might
help.
What would I do if you weren't a doctor?
I honestly do not know – I wanted to be a doctor since the age of three and it is impossible to imagine a more stimulating, rewarding and all-round satisfying career than the one that I find myself in.
Tell us more about you
Outside of medicine, I used to play county tennis and I still 'bash a ball' regularly. My husband and I own a tandem and the two of us (plus our 3-year old son) are often to be seen enjoying the West Sussex countryside (he can't tell whether or not I'm pedalling when I'm on the back). Sometime in the future, we hope to do a charity ride from Lands End to John O'Groats… (but not just yet...)
Karen Walker Bone is an arc Clinical Fellow at the University of Southampton.
Professor
Salmon, what does your work involve?
Most of us develop some form of joint inflammation at times, usually associated with infection. When the infection goes away, so does the arthritis. The weird thing about rheumatoid arthritis is that it doesn't get better. Over the last ten years we have shown that a major reason for this is that the joint lays down a thickened lining layer consisting of a type of cell called the fibroblast. These actively prevent the inflammatory cells escaping from the joint or dying, both of which are crucial steps in resolving inflammation. These processes are actually important for allowing the immune system to develop memory for infections, so that we don't get them again. The problem is that they shouldn't happen in the joint. Most of our research now focuses on exactly how these processes have transferred to the joints and what exactly we can do about it.
How long has arc been funding you?
Oh God…………… Twenty-two years.
What is your most important in the past 12 months? And why?
We have identified a new type of memory T lymphocyte in a population of cells that were thought to be completely naïve, ( ie. have never encountered antigen – a molecule that elicits an immune response in the body – before). This has helped us to understand the behaviour of these cell populations considerably better and is of great importance for the study of many different diseases.
What do you hope or expect to achieve as a result of your arc funding?
We hope to be able to explain the reason for the persistence of rheumatoid arthritis and propose ways to prevent it.
What do you do in a typical day?
There really is no such thing as a typical day. The main things that I do involve design of projects, design and interpretation of experiments, research supervision, tinkering with machines, reviewing submitted publication manuscripts and grants, sitting on arc and British Society for Rheumatology committees, writing papers and grants, teaching etc etc. Hopefully some days I even get the chance to read the literature and sit with my feet on the desk staring into space.
The feet on the desk thing, or maybe having a cup of coffee with colleagues, is when the real work of science is done: putting various ideas together to create new lines for research or a new perspective. Science is very much a creative process. For fairly obvious reasons, when we get too busy, scientists become much less creative. Most of our best ideas tend to come while we are at home doing something domestic because that is when you have time to think. To be at all successful, you have to live, breath, eat and sleep science.
What is your greatest research achievement?
Nice simple question, but unfortunately there isn't a nice simple answer. Perhaps my greatest research achievement, shared by all other practising group leaders, is to still be in business after twenty-odd years. OK, to be serious, probably our early work on the nature of T lymphocyte differentiation and memory would be considered the most influential. Or possibly our basic research into apoptosis, or the discovery that inflammatory cells in joints are blocked from dying, leading to the persistence of diseases such as RA. Another twenty years should give us a better perspective on what is "important".
Why did you choose to do this work?
Because we wanted to understand why rheumatoid arthritis doesn't get better. And because it is interesting and fun.
Do you ever think about how your work can help people with arthritis?
The whole point of our work is to help people with arthritis... and those who are going to get it, but don't know it yet.
What would you do if you weren't a scientist?
Write children's books and play far too much guitar.
Please tell us something about you.
In my odd bits of spare time I read a lot, anything from Caesar's expeditions in Gaul through to Terry Pratchett's Discworld novels. My main relaxation is the guitar though. I produced a CD last year to raise funds for arc (http://www.mp3.com/MikeSalmon). So far we have donated about £800; pretty small fry compared with many of our arc fundraisers, but we do try. My wife (Caroline Gordon) is a Senior Lecturer in rheumatology and expert on SLE. She's also a very good ice-dancer actually. My daughter Emily is a very talented painter.
