New Research

Published on 01 July 2010
Source: Arthritis Today

David SansomScientists in Birmingham are about to embark on the first stage of research which could see vitamin D used alongside, or even instead of, current treatments for rheumatoid arthritis.

Dr David Sansom and Dr Karim Raza in the department of immunology at the University of Birmingham believe their work exploring how the popularly-used supplement affects the immune system – and in particular whether it can prevent rheumatoid arthritis developing – holds real promise for patients.

 

The Birmingham team is the first in the world to use vitamin D – found in oily fish, and through sunlight – as a way of altering the body’s immune system in this way.

The Birmingham team, with funding of £222,000 over three years from Arthritis Research UK, now plans to perform laboratory studies to find out whether vitamin D can alter the aggressive immune response found in rheumatoid arthritis and turn it into a less harmful or even a protective one.

“We know that many people with arthritis have low levels of vitamin D and we have recently found that vitamin D can have powerful effects on the type of immune cells which may cause rheumatoid arthritis,” explained Dr Sansom. “This study will help us understand a lot more about how this happens. This is the first stage in considering whether vitamin D could be used as a treatment alongside or instead of current treatments.”

It may take between three and five years to develop the research sufficiently to permit clinical trials, and it may be necessary to combine vitamin D with other drugs to get better effects. However, as vitamin D was already in clinical use for other diseases, for example skin inflammation, this should make it easier to transfer into treating arthritis.

The Birmingham team has found that the vitamin has a powerful effect on T cells – white blood cells that play an important part in the development of rheumatoid arthritis. Their studies will aim to use vitamin D to re-programme T cells to behave in a less damaging way. “Overall, vitamin D is the most powerful regulator of T cell responses I have seen in 20 years of working in this field,” said Dr Sansom.

“We believe the time is right to explore this in more detail to generate enough strong data to allow these ideas to be tested in arthritis models, and then in patients.”

New post to boost GPs’ confidence in treating arthritis 

Arthritis Research UK has appointed its first ever specialist GP in musculoskeletal medicine, as part of its commitment to improving the care given to people with common musculoskeletal conditions in primary care.

Dr Tom Margham, a GP in Tower Hamlets in East London, has been appointed on a part-time basis to help co-ordinate the charity’s efforts to boost doctors’ confidence and ability to treat patients with common musculoskeletal conditions – such as osteoarthritis, back and neck pain, knee pain, gout, carpal tunnel syndrome and tennis elbow – which account for between one fifth and one-quarter of all GP visits.

The aim is to help address the lack of training in managing arthritis and related conditions that doctors going into general practice receive which at present is generally recognised to be inadequate.

"To become a GP you don’t have to do any hospital or community-based training job that specifically involves looking after people with musculoskeletal conditions, yet up to a quarter of people who come through the GP’s doors have one of these conditions – so you could argue there is a gap,” says Dr Margham. “A lot of GPs don’t feel confident in treating arthritis patients as a result.”

Dr Margham will work closely with researchers at the Arthritis Research UK National Primary Care Centre at Keele University, which is aiming to raise standards of treatment in primary care nationally by establishing best practice. He is currently identifying key players such as medical students, GPs, GPs with special interests, GP tutors, deans of medical schools and health professionals to strengthen existing networks of experts to become local “champions” and deliver the charity’s message. “These people are our eyes and ears on the ground, and can help us to get to those difficult-to-reach GPs, and can identify what is needed locally in terms of training.”

The charity will then develop a number of different practical, hands-on training initiatives in which GPs can learn on the job – whether it be through small, local workshops, bigger-scale national events or online learning – and to measure how effective it is in improving care and treatment.

Dr Margham adds: “We need to be better at managing musculoskeletal conditions, and the will is there to do that from GPs; we all want the best for our patients. “GPs are generalists and general practice is all about effectively managing common conditions, recognising the not-so-common ones and knowing when to refer them on. All GPs are under pressure but I strongly believe we should be able to manage the common problems that affect the patients who come through our doors.”

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