Protecting research time for arthritis

WHEN IT comes to providing services for people with arthritis, Ireland finds itself sorely lacking, according to the patient charity Arthritis Ireland.

Even though about 714,000 people in Ireland suffer from the condition – including young adults and children – medical graduates here get little exposure to arthritis and other rheumatic diseases during their training.

And at a time when science is closing in on cures for some forms of arthritis, the specialist rheumatologists in Ireland treating people who have painful and debilitating conditions find their clinical workload leaves little time to carry out research that could help improve those patients’ lives.

That’s why Arthritis Ireland is gearing up to fund three new professorships in Irish universities that will boost education about rheumatology and provide protected time to build up research teams to find better treatments, and possibly even cures.

“For the first time in my lifetime as a rheumatologist, the ‘c’ word is being talked about – the cure,” says Prof Oliver FitzGerald, Arthritis Ireland’s chairman and a consultant rheumatologist at St Vincent’s University Hospital in Dublin.

“There is some emerging evidence that if you can treat patients with very early in the course of the disease and suppress it such that the patient’s inflammation disappears, you may be able to stop the medication and the patient may be disease-free and free of all treatment.

“Drug-free remission is close to cure. How long it lasts, I don’t know, but papers are starting to trickle out now that are suggesting it may be around the corner.”

And getting closer to that goal requires research that bridges basic science and the clinical treatment of patients, according to FitzGerald.

“Research is not a luxury, it’s an essential part of moving forward,” he says. “We are never going to be able to treat patients better than we do at the moment unless we understand why they develop the disease and how best they can be treated.”

Yet while FitzGerald has the title professor, he and his colleagues in clinical rheumatology have no protected time for carrying out research and need to carve out time elsewhere. “It’s very difficult to do good quality research and to compete at the highest level for funding if you are also doing a full-time clinical job. All the research is being done after hours, at night time, weekends,” he says.

“You can do some research, but you can’t really achieve all you might achieve if you are operating at the coalface of clinics and also looking after – as most of us do – general medical patients coming in through the accident and emergency department.”

FitzGerald hopes the three new professorial chairs being founded in Irish medical schools by Arthritis Ireland will help address that problem by protecting research time.

It’s a model that has been shown to work, he explains. One of the biggest recent breakthroughs in arthritis treatment came through charity-funded professorships in Britain. It supported research that identified the protein TNF as an important driver of inflammation in diseases like rheumatoid arthritis, and led to the development of drugs to block TNF’s action.

” are very expensive and they need to be carefully watched, there are problems that can occur, but if used properly in the clinical setting it can give patients a new lease of life,” says FitzGerald. “I have seen people who were wheelchair-bound who were up and working again. It is the development that has made most change to people’s lives in the last 10 or 15 years.”

FitzGerald’s own research on a type of arthritis linked to the autoimmune condition psoriasis is discovering genetic differences between the patients who get only the skin symptoms and the 15 per cent who go on to develop joint problems too.

“The whole idea is to be able to identify the patients with skin disease who need to be watched more carefully for the development of arthritis over time,” he says. “It would be very helpful to know how we can predict who is going to get joint disease.”

As well as boosting research, the new professors – who will be recruited over coming months – and their teams will anchor rheumatology in the universities and improve the standard of education about musculo-skeletal disease, adds FitzGerald.

“Whats perhaps not appreciated is how little exposure medical students get to rheumatic diseases, he says. They come out qualified and have seen very few patients with connective tissue disease, and yet they will be the people who are assessing patients.”

Five out of the State’s six medical schools have submitted proposals for the Arthritis Ireland scheme, which will cost about €7 million over five years for the three medical schools selected. After that, each host university takes over, according to John Church of Arthritis Ireland.

So far, the money is being built up by Arthritis Ireland and Atlantic Philanthropies, and the organisation is in discussion with the Health Service Executive to fund the professors’ clinical sessions.

Church hopes the initiative will attract more bright medical graduates into the field and build up the discipline here – with currently only one specialist rheumatologist per 400,000 heads of population, Ireland falls well short of the World Health Organisation’s recommendation of one per 80,000.

Ultimately, the patients should benefit from the arrangement, says Church.

But excellence is the goal and the positions will be filled only if the right people can take them, says Church.

“We are not looking just to fill posts and get lost within a university. We want rheumatology to sit up there with all the other disease areas and to be recognised.

“And we are prepared to walk away from it if we can’t find the right candidates.”

For more information on arthritis see arthritisireland.ie