Dr Catherine Swales
Dr Catherine Swales is an Arthritis Research UK clinical research fellow at the Nuffield Orthopaedic Centre in Oxford.
What does your work involve?
I’m correlating what happens to patients with arthritis with what happens at a cellular and protein level in their blood, any fluid that builds up in their joints and in their joint linings. I have a special interest in the proteins that 'switch on' osteoclasts – cells designed to break down bone which go into overdrive in a lot of the inflammatory types of arthritis.
How long has Arthritis Research UK been funding you?
My fellowship in Oxford started in September 2008 and ran for three years. Bringing a clinical, patient-centred dimension to the laboratory proved very fruitful.
What’s the most important thing you've found out in the past 12 months? Why?
Although TNF (tumour necrosis factor) is very concentrated in the fluid that builds up in inflamed joints, other inflammatory proteins build up to even higher levels. This is quite a surprising finding, since it’s generally felt that TNF is the major player in joint inflammation, hence the success of the anti-TNF therapies. This result obviously opens up the possibility of blocking these other proteins alongside TNF to damp down joint disease even more successfully than is possible currently.
What do you hope or expect to achieve as a result of your Arthritis Research UK funding?
The overall aim is to clearly determine what role various inflammatory proteins play in inflammatory arthritis, both in terms of disease severity (such as fluid building up in joints or bone erosion and destruction) and in patients’ response to treatment. In addition I’m hoping to understand exactly what activates osteoclasts to erode bone so aggressively in patients with arthritis. The ultimate aim is to find new ways to stop arthritis – to identify proteins playing a major role in arthritis and to block their action. Although anti-TNF therapy has transformed rheumatoid arthritis treatment, up to one-third of patients don’t respond to it; we’re looking to see if there’s a different protein we should be blocking in these patients.
What do you do in a typical day?
There’s no such thing as a typical day, which is very energising! My time is balanced between the clinical/patient time and laboratory work. I meet patients at various stages of their disease, including those having joint replacements, and perform a thorough assessment of disease activity and the disability it causes. If the patients are having blood tests or a joint aspirated, I take a sample of the blood or fluid to the lab to study, and if they’re having a joint replaced I take a small amount of the joint lining that’s been removed. The laboratory side involves looking at expression of inflammatory proteins and cells in blood, joint fluid and lining. In addition I look at how these patients' cells mature into osteoclasts and erode bone. The great thing is that, although I'm doing research, it’s so heavily patient-focussed I don’t feel that I’ve abandoned the clinical world altogether.
What's your greatest research achievement?
Watch this space!
Why did you choose to do this work?
I wanted to do something exciting and relevant to the majority of patients that we meet in clinic or on the ward…and to try to explain why even our best treatment doesn’t work for everyone.
Do you ever think about how your work can help people with arthritis?
All the time – it’s the reason I’m doing it all and the project wouldn’t be possible without the kindness and support of our arthritis patients. It also makes the lab samples seem very precious – even though every sample is totally anonymous, I know that it came from one of our patients who, even in the midst of clinic or the ward or even the operating theatre, still had the time, energy and generosity to help others by helping research.
What would you do if you weren’t a clinician/scientist?
I never seriously considered doing anything else, but if I could choose anything in the world I’d love to be on the stage.
I have two small boys who keep me extremely busy with their hobbies – football, swings and slides, jigsaws and general mischief!
This article first appeared in Arthritis Today Winter 2009, issue 143.