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Dr Arthur Pratt

Dr Arthur Pratt is a specialist registrar in rheumatology at County Durham and Darlington Foundation Trust.

What does your work involve?

I'm interested in looking for 'biomarkers' – measurable indicators of biological processes which might help predict the development of rheumatoid arthritis – in patients attending an early arthritis clinic. In so doing, biomarkers may also teach us something new about what’s going wrong with those biological processes in these individuals.

Together with my PhD supervisor, Professor John Isaacs, I set about this task by focusing on a particular type of blood cell called the CD4+ T-cell, which seems to be of crucial importance in this condition. In particular, I looked at the pattern by which genes were either 'switched on' or 'switched off' in these cells among patients attending our early arthritis clinic in Newcastle, seeking a 'gene signature' that predicted a diagnosis of rheumatoid arthritis. Having identified an interesting set of genes in this regard, I’ve become interested in the biological pathways that they seem to indicate may be disrupted in early rheumatoid arthritis and whether or not treatments that target such pathways might work better in those patients in whom the biomarker is most prominent. Patients and their doctors know that there's a bewildering array of different drugs available for the treatment of the condition these days. We hope that biomarkers will one day allow us not only to diagnose the condition sooner but also to pinpoint the particular drug that's likely to work best for a particular patient.

How long has Arthritis Research UK been funding you?

Arthritis Research UK awarded me funding for a 3-year clinical research fellowship project in 2007, and I’m pleased to report that I've recently been awarded my PhD! As a springboard to a career in rheumatology research, this fellowship has been priceless, and I'll always remain grateful to Arthritis Research UK for supporting me and my project.

What’s the most important thing you have found out in the past 12 months? Why?

There's a group of patients that we see in the early arthritis clinic who don’t yet definitely have rheumatoid arthritis but who look as though they may develop it; we know that some of them will and some of them won’t, and we give their illness the name 'undifferentiated arthritis'. As a result of the PhD project that Arthritis Research UK funded, we believe we may have identified a 'gene signature' in the blood of undifferentiated arthritis patients which may help us to predict who'll get rheumatoid arthritis.

What do you hope or expect to achieve as a result of your Arthritis Research UK funding?

My research career is at a very early stage, and, first and foremost, I'm very keen to confirm our findings, making sure that they didn't simply occur by chance. The 'vision' which arises from our work, and which I share with many others, is that one day it'll be possible to use relatively simple tests early on in the course of people’s arthritis to diagnose them more effectively and treat them and their disease in a more personalised way.

What do you do in a typical day?

Having completed my Arthritis Research UK-funded PhD, I'm now continuing my clinical training as a specialist registrar in rheumatology. Currently this involves seeing patients alongside a team of consultants and nurses at County Durham and Darlington Foundation Trust. I thoroughly enjoy my work and feel privileged to be able to spend time with, and learn from, the wonderful people of north-east England while pursuing my academic interest in early arthritis.

What's your greatest research achievement?

During my recent studies I have, with the help of many people, learned a range of new clinical, laboratory and analytical skills. It’s been a bumpy ride at times, but being awarded my PhD was a very satisfying experience.

Why did you choose to do this work?

As a trainee rheumatologist, I was struck by the challenge doctors continue to face in confidently diagnosing rheumatoid arthritis and by the variability with which different patients’ disease subsequently responds to different drugs. The opportunity to ask – and, hopefully, find answers to – important questions based on the problems we face in our clinics is what continues to draw me into clinical science.

Do you ever think about how your work can help people with arthritis?

Anyone involved with arthritis research will tell you that it’s not easy, and there are naturally times when one’s motivation wanes. At those times, thinking about the long-term goal of one’s work – which must always involve improving people’s lives – can be the only thing that keeps one going.

What would you do if you weren’t a clinician/researcher?

My first ambition (aged about 5) was to be a gardener – and these days my garden has reason to regret my subsequent career choices.

About Arthur

We have a 4-year-old son and a 2-year-old daughter, which about covers it I think!

This article first appeared in Arthritis Today Summer 2011, issue 153.

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