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For more information, go to www.arthritisresearchuk.org

Focus on Aberdeen: Casting a wide net

Published on 05 January 2012
Source: Arthritis Today

Professor Gary MacFarlane with Dr Gareth Jones and Professor David Reid

With funding of £4.5m from Arthritis Research UK, research into musculoskeletal conditions at Aberdeen University is as broad as it’s long, covering inflammatory arthritis, osteoarthritis, bone diseases and chronic pain. Jane Tadman talks to its leading lights.

There’s been a long tradition at Aberdeen University of carrying out musculoskeletal research that successfully combines not just basic science and clinical research, but also encompasses a number of different conditions affecting bones, muscles and joints.

Unlike, for example, Birmingham University, the subject of the last Focus feature in Arthritis Today which concentrates on specifically targeting rheumatoid arthritis, researchers in Aberdeen cast their net wider. As a result they recently won plaudits from the European League against Rheumatism (EULAR) which awarded its musculoskeletal research collaboration centre of excellence in rheumatology status in recognition of the international quality, not to say breadth, of its research output.

Arthritis Research UK has played and continues to play a big part in the university s impressive track record. The charity recently hosted a well- attended open evening for its leading researchers to explain to the Aberdeen public exactly what they do. And in September, Aberdeen s role as one of the four sites making up the Arthritis Research UK Tissue Engineering Centre made the headlines in the Scottish media, when local footballing legend Willie Miller joined researchers to promote the launch of the centre and to highlight the need for new ways of treating osteoarthritis from his own experience.

Gary Macfarlane, professor of epidemiology since 2005, says that although the musculoskeletal research collaboration is a ‘virtual structure’ with its members based in different departments across the campus, there is plenty of collaboration where it matters – in terms of actual research. “By combining basic molecular and cell biological research with patient studies we’re aiming to develop new or better ways of diagnosing and treating musculoskeletal disorders,” he explains.

Professor Macfarlane’s own area of interest is chronic pain. For the past three years he has been co-leading a major Arthritis Research UK clinical trial testing the effectiveness of delivering cognitive behavioural therapy over the telephone to people with chronic widespread pain (including fibromyalgia) compared to gym-based exercise. Both types of ‘treatment’ were found to be effective. (A more detailed report on the outcome of this trial will follow in the next edition of Arthritis Today.)

Professor Macfarlane and his colleague Dr Gareth Jones are authors of Arthritis Research UK’s very popular Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia report. This publication is currently being revised and updated, and a second publication,
Complementary therapies for the treatment of rheumatoid arthritis, osteoarthritis and back pain is due for completion around Easter time.

Professor Macfarlane chairs the working group that looks at each medicine or therapy and scores the products or therapies between one and five for effectiveness, and red, amber or green for safety, based on the evidence provided by randomised controlled trials.

“People are really interested in this area, and lots of people took the opportunity to write to me when the first report was published,” he says, professing to find the process of evaluation “challenging and fun”.

“I think what came out of the report was that very few therapies work for everyone and for many of these therapies there is just so little available evidence. But a lot of them are very expensive, so we’re trying to provide some evidence so that the public can make informed choices.”

Traditional medicine may have something to learn from complementary therapy practitioners, in the way that patients are dealt with, he believes. “A trial of homeopathy, for example, tells you that homeopathy works, but it doesn’t tell you whether it’s the whole consultation – and the fact that the practitioner is very interested in you – that works rather than just the homeopathy medicine. If it’s the consultation rather than the homeopathy maybe we should try and deliver traditional medicine in the same way, and tap into that large non-specific effect.”

Colleague Dr Jones, a senior lecturer in epidemiology, is running another charity-funded clinical trial of 500 people suffering from lower arm pain, which is common and costly to treat. He is heading a £640,000 study which is investigating whether patients with arm pain do best when offered advice to keep active, or whether it’s better for them to rest while waiting for physiotherapy to start. The trial will also test whether ‘fast-track’ physiotherapy results in a long-term reduction in their lower arm pain compared to physiotherapy given at the time usually provided by the NHS – rarely quicker than six to eight weeks.

If the team find that physiotherapy given early is effective, this would lend support to the government’s drive to reduce waiting lists.

It would be impossible to write a Focus feature without reference to Professor David Reid. For many years the Aberdeen-born professor has been the lynchpin between basic science and clinical research at the university and is renowned internationally as an authority in bone diseases. Although these days he is very much the elder statesman and has more or less moved upstairs into a top management role – he is now research and development director of NHS Grampian, head of the school of medicine and dentistry, holds just one clinic a week, and has largely put aside his research interests – he still heads up the Arthritis Research UK clinical studies group in metabolic bone diseases and chairs the board of trustees for the National Osteoporosis Society. He has collaborated with pharmaceutical companies on a number of clinical trials of new drugs for bone conditions and has been heavily involved in the National Institute of Health and Clinical Excellence (NICE) and other guidelines for the management of osteoporosis.

So Professor Reid knows what he is talking about when he says of Arthritis Research UK’s continued funding of research in his native city: “Our very active musculoskeletal group would not have been as active as it is without our Arthritis Research UK funding. It’s a huge investment, and of huge value.”

Professor Macfarlane echoes that sentiment. “In our pain research, about a third comes from the research councils such as the MRC, another third from the pharmaceutical industry and a third from charities, the biggest of which by far is Arthritis Research UK.

“Musculoskeletal researchers in Europe and outside Europe are envious of this source of support. It allows us to do studies that we would not otherwise be able to do. There is absolutely no doubt that in terms of epidemiological trials that the UK is leading the way, largely because of funding from the charity.”

AT A GLANCE: BASIC SCIENCE IN ABERDEEN

Dr Keith Thompson with Dr Julie Crockett and Dr Fraser Coxon

OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS


Professor Cosimo de Bari, who heads up the Aberdeen arm of the Arthritis Research UK Tissue Engineering Centre, also holds two other charity-funded grants, investigating the role of stem cells in both rheumatoid and osteoarthritis. Professor de Bari is testing the theory that rheumatoid arthritis is sustained and perpetuated by diseased stem cells in the joint that give rise to abnormal tissue, which causes loss of bone and cartilage. The second grant hopes to understand how stem cells may be stimulated to migrate from the bone marrow and the other tissues in the joint to repair damaged cartilage.


OSTEOPOROSIS

Bone is a dynamic tissue, made and maintained by various cell types. Many of the diseases of bone such as osteoporosis and Paget’s disease are brought about by an imbalance in the activity and function of these key cells. Basic investigations are ongoing into bone cell biology and signalling.

Dr Julie Crockett is aiming to identify genetic factors in molecules that are critical in bone cell function to predict individuals who have low bone density.

Professor Mike Rogers’ £780,000 programme grant to study and identify molecular switches in bone cells, with the aim of understanding what certain proteins do in the skeleton, is coming to an end. New ways of treating of preventing bone disease may result.

Dr Fraser Coxon is studying the role of a protein which is an essential component of the process involved in the breakdown of bone. His project is investigating how osteoclasts – cells that break down bone – work to identify new ways to inhibit these cells to reduce bone degradation.

Dr Keith Thompson has a career development fellowship to investigate the interactions between the immune system and bone-destroying cells in rheumatoid arthritis.

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