THE importance of STEM subjects in the modern world is no better illustrated than in the transformation of the treatment of diseases like arthritis where Scotland has become a key global player.

A revolution has occurred in the last decade in the way arthritis is treated largely as result of collaboration between different disciplines with biomedical science, technology, engineering and, increasingly, maths all playing their part. Glasgow specialists and the University of Glasgow in particular has been leading the way in this, with the university recognised as a EULAR Centre of Excellence.

A pan-European organisation, EULAR is composed of more than 40 national societies concerned with rheumatology and is the biggest trans-national organisation in the world supporting people with arthritis. Professor Iain McInnes, the Muirhead Professor of Medicine and director of the Institute of Infection, Immunity and Inflammation at the university, is one of the leading figures in global research into arthritis and takes over as president of EULAR in June next year.

“Glasgow really is adopting a position of leadership and making a mark as a pioneering university and city,” he said. “Arthritis is an area of clinical research where Scotland can be truly competitive and an area of which we are very proud. There is still much work to do in arthritis research – but researchers in Scotland are coming together seeking to make a difference for our patients.”
Inflammatory arthritis affects up to two per cent of the population.

It is a group of conditions where the immune system starts to attack the joints rather than defending people from infections like flu. 

The most common and best known form of arthritis is rheumatoid arthritis but there are other varieties such as psoriatic arthritis (PsA) where the skin is involved as well as the joints. Arthritis can affect people of all ages, including children. There is no cure.

“If these devastating conditions are left untreated they lead to disability and even an early death because not only do they attack skin and joints but they also increase the risk of heart attack, stroke and osteoporosis,” said Professor McInnes. 

“Going along with this is an increased risk of developing depression and other forms of psychological dysfunction. 

“People are fatigued all the time and struggle to function well in their daily lives. Arthritis is a substantial burden on the NHS in Scotland and in countries around the world.”

He added: “The reason this is interesting in the context of STEM is because the last two decades has seen such a transformation in the way these conditions are treated. A lot of that success has come about because we are applying molecular and cellular science to understand these diseases and, by doing so, we have been able to come up with new therapies.

“These really are transforming lives by bringing about less pain, less swelling, and less depression. These new medicines reduce the damage the disease used to do and that directly improves function. 

“When people think of arthritis they think of deformed joints but the need for surgery to correct these deformities is coming down very nicely. Overall, the appliance of modern molecular science has revolutionised the way these diseases are treated.”

In Glasgow, led by the university, there are a number of initiatives it is believed will be important in the battle against arthritis.  The first is the creation of the Arthritis Research UK Centre of Excellence which aims to speed up the progress towards finding a cure. 

The centre is led by the University of Glasgow in collaboration with the University of Birmingham and Newcastle University. The three universities provide complementary expertise to allow researchers to progress towards a cure at a faster rate than they would if they were working on their own.

Different scientific disciplines and experts are brought together through the centre including clinical rheumatologists, immunologists, experts in cardiovascular disease, experts in metabolic disease and experts in bioinformatics, which is the study of big data. 

“The centre brings together a variety of scientific disciplines and is a perfect example of the imperative need to bring together science, maths, technology and big data to focus on these huge clinical problems,” said Professor McInnes.

As part of this a Scotland-wide consortium has been established which involves a collaboration between Scottish universities, the NHS and patients. 

“We have gathered a cohort of people with new onset rheumatoid arthritis to collect samples so we can look for biomarkers,” explained Professor McInnes. “We are trying to work out which patient needs which drug and when best to give it. We are pioneering the development of precision medicine principles in trying to understand the disease better and then how best treat it.”

A new cohort of people with PsA has also now been collected so that PsA can be studied as well as rheumatoid arthritis.

“Doctors around Scotland are working together with people with PsA in the hope that we can apply precision medicine principles to this as well,” said Professor McInnes. 

“These are two areas where Scotland is trying to lead the world and are great examples of Scotland coming together to do important research with the chance to really make a difference.”

‘It’s what the 21st century is all about’

PIONEERING work in the treatment of people with one of the most devastating forms of arthritis is being carried out in Glasgow and is another example of multi-disciplinary research.

Psoriatic arthritis (PsA) does not only affect the joints but also the skin – a “double jeopardy”, according to Professor Iain McInnes, who was awarded the Sir James Black Prize Medal, one of the most prestigious awards in medicine, for his “outstanding contribution” to the field of immunology.

The Herald:

Expertise: Professor Iain McInnes is ‌‌the Director of the Institute of Infection, Immunity and Inflammation at the University of Glasgow. 

His ground-breaking research has already led to more effective therapies for the condition.

Until about five years ago, therapies developed for rheumatoid arthritis were used for people with PsA even though PsA poses challenges in its own right with the immune system attacking the skin as well as the joints.

Recently therapies specifically for PsA have been developed which have transformed treatment.

One area in which Glasgow has been especially at the forefront has been in investigating why PsA is associated with increased heart disease and diabetes. 

Glasgow rheumatologists have been collaborating with cardiac and diabetes experts to develop new ideas about the disease. “This work led at a European level to the development of guidelines with respect to cardiac risk and how people with arthritis should be treated,” explained Professor McInnes.

Multi-disciplinary research is now also being carried out on the depression commonly suffered by patients with PsA. 
Until recently it was assumed they were depressed as a result of the pain and poor quality of life caused by the disease but it is now believed that the inflammation that affects their skin and joints also affects their neural pathways.

Researchers at Glasgow are now able to examine what’s happening in patients’ brains with the state-of-the-art technology located at the Queen Elizabeth University Hospital.

The new £32m Imaging Centre houses Scotland’s only 7Tesla MRI scanner, the first of its kind to be fully integrated within a clinical site in the UK and which is driving the development of imaging technology for use in the diagnosis and treatment of disease.
Using the scanner, patients’ neural pathways can be examined to find out if the depression and fatigue suffered by patients can be better treated.

“The scanner is rather unique in the world in being next to an acute medical site and we are using it to try to understand what it is in PsA that causes people to feel depressed and tired,” explained Professor McInnes. 

“We are pretty sure it is not just because they have PsA. We believe the inflammation they are suffering is exacerbating their feelings of depression, difficulty in concentrating and tiredness. To try and understand what is happening in the brain we can examine it with our state-of-the-art medical equipment in the new Imaging Centre.

“This again in terms of STEM is an example of multidisciplinary research, as the project is being conducted by John Cavanagh, professor of psychiatry, along with academic rheumatologists Dr Neil Basu and Stefan Siebert. They are working together to use this brain imagery to understand why people feel depressed. 

“It would be an amazing thing to be able to treat depression and fatigue in addition to treating skin and joint diseases so that we can really treat the whole person. 

“In this way, we are building on 20 years of rheumatoid arthritis experience to refocus on PsA to try to make a difference.”
Professor McInnes added: “The idea that science can change lives is what this century is about.”