Arthritis Today - Arthritis Research UK

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Arthritis Today
Summer 2010 | No 149
The magazine reporting research, treatment and education
Stem cell
therapies
Lifeline to future
sufferers?
Centering on pain
Our new national
centre
Gout
It’s no laughing matter
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Stem cell
therapies
Offering hope or
just hype?
How weighttraining can help RA P17
P12
Gout
It’s no laughing
matter
P26
NUTRITION FOR A HEALTHY LIFESPAN
Welcome to the summer edition of
Arthritis Today. There’s plenty to appeal
to people with all different types of
arthritis in this edition. One thing that
all arthritis sufferers have in common is
chronic pain, and we are all too aware
that while the hunt for a side-effectfree painkiller goes on, people with
musculoskeletal conditions are
struggling daily for effective ways to
manage and cope. On page 9 you can
read about our ambitious attempts to
try and tackle pain with the opening of
our new national pain research centre
at Nottingham. Watch this space for
reports on their progress.
It’s not for the faint-hearted! Find out
more on page 14.
Stem cell therapies to treat knee
osteoarthritis move a step closer with
an important new programme grant
awarded to a team of scientists and
clinicians in Oswestry, who plan to use
stem cells generated from cartilage to
repair osteoarthritic knees. Turn to
page 17.
Gout remains the subject of many jokes
but it really is no laughing matter for
those afflicted. On page 23 you can
read about an exciting new study we
are funding which could lead to gout
not only being treated more effectively,
but also taken more seriously.
We have been busy since re-launching
as Arthritis Research UK, which you can
Enjoy your read.
read about on page 4. Our chief
executive Dr Liam O’Toole’s new
Jane Tadman
column, Fighting Talk, begins in this
Editor, Arthritis Today
edition on the same page. We’re always
keen to encourage our researchers to
play a bigger role in the charity, so
we’re delighted that a team led by
orthopaedic surgeon and Arthritis
Research UK trustee Professor Andy
Carr are planning a fundraising assault
on the Three Peaks. You can read about
their preparation on page 7.
Exercise is known to be good for
people with arthritis to keep their
muscles strong in support of the joints,
but isn’t weight-lifting going a bit too
far? Not according to a team of
researchers in North Wales who have
found that heavy-duty weight-lifting
can dramatically improve muscle mass
in people with RA as well as increasing
their ability to carry out everyday tasks.
Meet the
expert
Our researchers
explain their
important work
P30
A growing
relationship
How the National
Gardens Scheme is
helping us
P33
Contents
Welcome
180 Glucosamine tablets
1,000mg
Ouch!
Feature highlights
Centering on Resistance
pain
training is
Our new national not futile
Only
£7.45
£21.49
The magazine reporting research, treatment and education. Published by Arthritis Research UK.
Our news and chief executive’s column 4
Researchers take up the challenge
7
Focus on Nottingham
9
Weightlifting and RA
12
Stem cell therapies for osteoarthritis 17
News
20
Research news
21
Gout 23
Questions and answers
26
New research
28
The hints box
29
Meet the expert
30
Get involved
32
Arthritis Research UK is a medical research charity
entirely supported by voluntary contributions and
legacies. For further information about the charity
and its work contact us at:
Arthritis Research UK
Copeman House, St Mary’s Court, St Mary’s Gate
Chesterfield, Derbyshire S41 7TD
Tel: 01246 558033, Fax: 01246 558007
[email protected]
www.arthritisresearchuk.org
Registered Charity England and Wales No. 207711,
Scotland No. SC041156.
Editor: Jane Tadman
Correspondence to the editor should be sent to
the address above or to
[email protected]
Designer: Jonathan Ogilvie
Advertising sales: Steven Smith
Redactive Media Group, 17 Britton Street
London EC1M 5TP
Printed by The Website, Leeds.
None of the products and services advertised
in Arthritis Today are in any way endorsed by
Arthritis Research UK.
Front cover: Orthopaedic surgeon Professor James
Richardson, part of a team running a new trial into
stem cell therapies for knee osteoarthritis.
Re-launching the
fight against
arthritis – let battle
commence!
was real approval of our changes, and
there is certainly a level of enthusiasm
that I have not seen before amongst
the research community.
“Our supporters are great and loyal,
and clearly appreciate the efforts we
are making. The energy has to be
sustained from here every day, from
today. We need to ride the wave we
have created.”
There were many positive comments
made at the launch event in London,
and inevitably, one or two
complaints from supporters who
didn’t see the need for another
name change. I hope we have
re-assured our long-time supporters
that the new name and our new
direction are in all our best interests,
and that only by raising our profile
considerably can we hope to have
the influence and raise the funds
necessary to make a real difference
to people’s lives.
We even got our name in lights in
Piccadilly Circus! Arthritis Research UK
became one of the first charities to run a
series of advertisements giving positive
messages about the new brand, shown
more than 5,000 times over two weeks,
and amounting to 50 hours of screen
time in front of tens of thousands of
visitors to the famous London landmark.
And we got it for free.
Arthritis Research UK’s free ad
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Nowhere is this clearer than in the
early results of our active listening
campaign, where the message
seems to be that we need to do a lot
more to help people who are at the
end of their tether because of
chronic pain. I sincerely believe that
the work that will be done at our
new pain centre of excellence in
Nottingham can go a long way to
addressing this need. And once the
results have been analysed
thoroughly we will decide on how
we take forward the information
gained in terms of campaigning.
Trustee Professor Kevin Davies chats
to regional fundraising manager Suzie
Ladbrooke and Professor Hill Gaston
at the launch reception
income and other forms of support from
our “old boys”.
sssssss
sss
ss
ss
Branch members Colin and Marilyn
Wood with Arthritis Research UK
Professor Yuti Chernajovsky
Since the launch event, that
momentum has been sustained with
a series of high-profile activities.
Arthritis Research UK gained a
substantial amount of publicity
from its involvement with
Major Phil Packer, the former
solidier injured in Iraq, who
chose the charity as one of 26
to benefit from his walking the
London Marathon in 26 hours
accompanied by a young
Professor Dame Carol Black, Liam O’Toole and rheumatoid arthritis sufferer Cat
Charles Maisey at the re-launch reception
Bull. (See article on page 32)
04
We also launched another exciting
scheme, the Arthritis Research UK
Alumni Network, which celebrates the
strong links that exist between the
charity and our research fellows. Over
the past 20 years more than £35m has
been given to support and encourage
the careers of research fellows, and this
scheme aims to generate vital new
ssssssss
ss
sss
ss
As you can read elsewhere on this
page, we have been very busy since
our re-launch as Arthritis Research
UK. I have been very clear that we
need to see the re-launch of the
charity as the start of something big
– not just a one-off event – and that
certainly seems to be happening.
That was the message from chief
executive Dr Liam O’Toole at a launch
reception in Whitehall in March,
attended by the great and the good
from the worlds of research, the third
sector and long-time supporters of the
charity.
Chairman of Arthritis Research UK
Trustees Charles Maisey caught the
mood when he said after the
event: “I sense that there
from Dr Liam O’Toole,
chief executive,
be analysing the results, which will form
the basis of our future campaigning
activities.
I’m delighted to have this new
column in Arthritis Today which gives
me an opportunity to talk directly to
so many of our supporters. I hope
over the next few months and years
to use it as a platform for a lively
exchange of views.
The re-launch as Arthritis Research UK is
just the start of a greater level of
activity in terms of both raising
awareness of arthritis the condition and
the charity as the pre-eminent research
organisation working in the field of
arthritis and musculoskeletal
conditions.
Pat Froomberg, MBE, whose severe
rheumatoid arthritis and numerous
joint replacements never prevented her
from raising huge sums for the charity
over many years, mingled with Dr David
Walsh, head of the new Nottingham
pain centre, and Professor Dame Carol
Black, National Director for Health and
Work, one of the speakers at the
reception.
Fighting
talk
We ran an advertising campaign in
national newspapers and magazines;
the “active listening” campaign, which
asked people with arthritis to talk about
the worst thing about the condition, and
what would make the biggest difference
to them. We were overwhelmed by the
reaction to this appeal, which generated
380 per cent more responses than
expected. An interesting early theme to
emerge is the isolation and depression
experienced by many sufferers. We will
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“I’m now in my sixth decade and
suspect I have been invited to boost
recruitment with the line: ‘look, if he
can make it anyone can!’ ”
Professor Carr tries to keep fit by cycling
to work every day and rowing on the
Thames but sometimes stops for a rest
“if the wind is too strong and stream
too fast.”
The team plans to start the ascent of
Ben Nevis early in the evening, finishing
about five hours later, have a quick bite
to eat –“probably a Pot Noodle” says Dr
Swales – and head down to the Lake
District in their minibus to start
climbing Scafell Pike by 3am. Four
hours later it will be time for another
Pot Noodle before heading off to North
Wales and up the tourist track to the
summit of Snowdon, getting back
down by 5pm for a welcome shower,
hearty dinner – and blessed sleep. “It
will be arduous – although none of the
An 11-strong team of surgeons,
ago….then one rainy day in the lab
walks are technically difficult the
rheumatologists, scientists and
I thought back to PEAC/peak, three
combination of walking and
students, all of whom have a special
peaks! And that’s where this completely sleeplessness will make it tough,”
interest in arthritis and are involved with insane idea came from.
agrees Dr Swales. “However, Andy Carr
Arthritis Research UK, are attempting
is phenomenally fit – whatever he says
“Arthritis Research UK is involved in
the Three Peaks Challenge.
to the contrary – and will set us a good
every level of patient care – whether
pace.”
The idea of scaling Britain’s three
through funding scientific research,
highest mountain peaks in just 24 hours clinical trials or offering patient
The team doesn’t have a target amount
was the idea of Arthritis Research UK
but hopes it will run into thousands of
education and support, so this is a
clinical research fellow in Oxford
chance for all of us to say ‘thank you’
pounds.
Dr Catherine Swales. Dr Swales then
and to give something back.”
Jacqui Manning, head of fundraising at
managed to recruit two leading
Arthritis Research UK said: “It’s wonderresearchers – Professor of Experimental
“It
will
be
arduous...”
ful that our researchers want to support
Rheumatology at Queen Mary
the charity in this way and give
University Costantino Pitzalis, and Head While Dr Swales, the mother of two
of the University Department of
something back. We really appreciate
young children aged five and three, is
Orthopaedics and Rheumatology at
their efforts, and wish them all the best
pounding the streets of Oxford for up
Oxford University Professor Andy Carr
of luck.”
to 40k a week in preparation, eminent
– who also happens to be an Arthritis
shoulder surgeon Professor Carr, who
To sponsor the Arthritis Research UK
Research UK trustee – and other
has successfully completed the Three
team of Darren Asquith, Elisa Astorri,
academics in their respective
Peaks Challenge before, is taking a
Michele Bombardieri, Francesco
departments.
slightly different approach.
Carlucci, Andy Carr, Elisa Corsiero,
Dr Swales explains: “I really wanted to
Mathieu Ferrari, Constantino Pitzalis,
“The first time I did the challenge was
do some fundraising for Arthritis
Gugliemo Rosignoli, and Catherine
six years ago when I scraped in under
Research UK this summer, but couldn’t
Swales go to:
decide what to do. I am involved in the the 24 hour deadline with 15 minutes to
www.justgiving.com/3peaksforarthr
spare. I vowed never to do it again but
research group PEAC – the
itisresearchuk
have been persuaded to join in and
Pathobiology of Early Arthritis Cohort–
and my colleague Michele Bombardieri support the cause of Arthritis Research Find out how they did in the October
edition of Arthritis Today.
had joked about PEAC/peak some time UK,” he says.
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Pain-relieving drugs such as
paracetamol, anti-inflammatories and
opiates all have a part to play, but none
are ideal, either lacking effectiveness or
bringing with them the risk of
unpalatable and sometimes dangerous
side-effects.
A new approach is obviously muchneeded and a team of researchers at the
new Arthritis Research UK Pain Centre in
Nottingham believe they have enough
joint expertise to make some real
progress over the next five years.
Their aims are ambitious, but the team
are confident they are achievable. Not
only do they want to develop a better
understanding of how people
experience pain, but to also use that
knowledge to fully understand the
biological basis of pain, to find out
which of the existing painkilling drugs
work the best in individual patients, and
to work towards developing completely
new drugs. And by studying the
evidence from imaging techniques such
as MRI, the team hope to find out how
an individual’s way of processing pain
signals may explain why their
experience of pain may not necessarily
match the severity of their joint damage
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Centering on pain
Pain is the number one concern for patients with arthritis, yet
there have been too few advances in how to manage it. The new
Arthritis Research UK Pain Centre at The University of Nottingham
aims to achieve a greater understanding of pain – and to come up
with more effective ways of dealing with it. Jane Tadman reports.
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Three distinct
approaches
•Investigate closely two forms of pain
mechanisms: the role of peripheral
pain (pain that comes from the nerves
in the joints) and central pain (the
The team are taking three distinct but
way that the brain responds to and
Experts from the fields of rheumatology, linked approaches to the problem, using
processes chronic pain) and try to
neuro-imaging, psychology,
osteoarthritis of the knee as their model.
produce new compounds that target
neuropharmacology, neurosciences and They plan to:
these pain pathways.
orthopaedic surgery will all play a big
•Look at pain from a social context;
•Run clinical trials aimed at testing
part in realising the ambitions of the
finding out from patients their own
existing drug therapies, and any new
centre, funded over five years by £2.5m
understanding of what pain is, and
painkillers that may be produced over
from Arthritis Research UK and a further
what they expect from treatment.
the next five years.
£3m from The University of Nottingham.
09
Professor Chapman and Dr Kelly are
interested in the mechanisms
underlying pain in the osteoarthritic
joint, and will be using models of
osteoarthritis to investigate changes
within the joint and the peripheral
nervous system, spinal cord and brain.
Joints and bones (although not
cartilage) have a high number of nerve
endings, and there is evidence that the
nerve fibres and the central nervous
system become sensitised in arthritis.
Understanding the mechanisms that
lead to this sensitisation will help the
identification of novel targets for drugs
which can block these changes and
decrease pain responses.
Case study
Krysia-Maria Rigley, who has lived with
crippling pain for the past seven years,
is hoping that the work of the new pain
research centre will make her life easier.
Diagnosed with severe osteoarthritis in
2003, every day is a struggle to carry on
a normal life.
Professor Bridget Scammell
Dorothee Auer, professor of
neuroimaging
Professor Auer aims to gain a greater
understanding of central pain and pain
relief by looking at the brain’s signature
of spontaneous pain and responses to
induced pain and acute pain relief. Using
functional magnetic resonance (fMRI),
the activation in different parts of the
brain will be compared to patients’ pain
perception and expectation. This will
allow them to disentangle the
processing of painful stimuli from
adaptive brain processes and their
influence on the effectiveness of pain
relief.
Under the microscope: Professor Vicky Chapman and Dr Sara Kelly
Centre director Dr David Walsh,
associate professor in rheumatology,
says that while the interplay of various
factors that cause pain are already
known, our understanding of how all
those factors contribute to the final
experience of pain is incomplete, which
he describes as “our great challenge.” He
adds: “Within five years we will have a
much better understanding of the
mechanisms behind pain, will have
piloted trials looking at targeting the
effectiveness of existing drugs, and
played a big part in the development of
new painkilling drugs.”
Nadina Lincoln, professor of clinical
psychology
So what will the eight leading members
of the research team be contributing to
the work of the centre?
Victoria Chapman, professor in
neuropharmacology, and Sara Kelly,
lecturer in neuroscience
10
Professor Lincoln will be running
interviews with patients with
osteoarthritis and compiling
questionnaires in order to understand
more about the psychological side of
pain. “We will be asking people about
their pain, and their experiences of
treatment. The extent to which
treatment is consistent with their beliefs
will have an effect on their response to
treatment. For example if a patient
thinks exercise is harmful to their joints,
they may not exercise, even if it is
recommended to them.”
“We all have different personalities,
different ways to respond and deal with
pain and different experiences of pain
that may need to be taken into account
for best treatment effect. Our study
approach is to investigate the
neurobiological underpinnings of such
individual pain and treatment response
characteristics. Understanding how a
person’s brain is likely to adapt to pain
stimuli will inform the development and
assessment of individual pharmacological and non pharmacological
treatment.”
Brigitte Scammell, professor of
orthopaedic science
Professor Scammell is a surgeon
specialising in lower limb surgery.
She is particularly interested in possible
sensitisation of the brain to pain caused
by arthritis, particularly as 15 per cent of
knee replacement patients still suffer
pain after surgery. With Professor Auer,
she will study fMRI images of the brains
of pre- and post-operative knee
replacement patients to see if the brain
processes pain differently before
surgery compared to after the
operation.
Dr David Walsh
A lively and outgoing professional
woman of 64, she is determined to
keep going and continue working as a
photographer, even though her joint
pain is sometimes so intense that it
regularly reduces her to tears.
“I just wish there was something that
would help with the pain more,” she
says. “I sob my heart out when the pain
gets to its height every day. Sometimes
when I get dressed I scream with the
pain because it is so excruciating. The
pain is always there even when I am
they don’t think there’s anything
sitting down, and it’s very hard to get
up in the mornings. But I have to fight.” wrong with me,” she says. “If I was a
little old lady with a stick it would be
Krysia-Maria’s knees were the first to be
different.”
affected by osteoarthritis but now
most of the joints in her body are
swollen, sore and painful. She has other
medical conditions that make it
impossible for her to take non-steroidal
anti-inflammatory painkillers, and she
has been recently prescribed morphine
patches by her doctor. She also takes
amytriptyline to help her sleep.
“For three years I battled with lack of
sleep while I was working, and was just
too tired to work, too tired to drive, or
do anything,” she explains.
Professor Weiya Zhang
Mike Doherty, professor of
rheumatology, and Weiya Zhang,
associate professor of
musculoskeletal epidemiology
Somehow, and with support of
husband Brian, Krysia-Maria, a former
hairdresser and estate agent valuer,
soldiers on with her professional and
personal life. A member of the Royal
Photographic Society, she recently had
an exhibition in her home town of
Nottingham, and does what exercise
she can; walking every day, and
cycling.
“I know there is no real answer at the
moment and that’s why I’m so glad
Although she is registered disabled,
that the pain centre in Nottingham has
she finds the lack of physical evidence
of her condition means that most
been set up,” she says. “All we can do is
people don’t know she has arthritis.
hope. I know that everyone is doing all
they can to find an answer to treating
“Although I’m in such pain it doesn’t
show. When I get on a bus people don’t pain more effectively. I hope the centre
will help others, as well as me.”
stand up to let me sit down because
response and to also find out how much
the placebo effect varies from person to
Professors Doherty and Zhang will use
person, and gather robust data on the
their extensive experience of running
common treatments which is not
clinical trials into osteoarthritis to run an currently available.” Other less
ambitious clinical trial (yet to be funded) commonly used drugs such as
which will test several existing
gabapentin, and any new compounds
treatments – paracetamol, topical
developed during the course of the
ibuprofen, codeine and corticosteroid
five-year research programme, may also
injections in people with knee
be trialled.
osteoarthritis. Explains Mike Doherty:
Meanwhile, an evidence-based
“We will give people four different
osteoarthritis research database
treatments for each in a random
sequence plus a placebo, to measure the (eBOARD) will be developed to assess
the clinical effectiveness and costeffectiveness of all available therapies in
the management of pain due to
osteoarthritis. This will ensure the
translation from research evidence to
clinical practice and the optimisation of
these therapies.
The Arthritis Research UK National Pain
Centre at The University of Nottingham
was officially opened on July 1.
11
Weight-training and arthritis
Resistance training
is far from futile
Sale
British-made Riser Recliners
New research has shown the effectiveness of weight-training in
people with rheumatoid arthritis. Jane Tadman finds out more.
An unlikely form of “treatment” that has
been shown to help people with
rheumatoid arthritis (RA) might never
match anti-TNF therapy. But for those
patients prepared to pump regular iron
in the gym, weight-lifting could make
quite a difference to their quality of life
– not to mention the quality of their
muscles and overall strength.
Although RA is primarily a disease
affecting the joints, it also severely
reduces muscle mass and strength at a
greater rate than in healthy people,
leading to more disability. And now an
Arthritis Research UK trial of RA patients
in North Wales has shown that intensive
resistance training improved their
muscle mass and ability to perform
everyday tasks.
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taking part in the twice-weekly training
sessions for 24 weeks was a very
positive experience.
Chris, aged 59, and Pat, who is 66, are
both firm believers in the benefits of
exercise, despite having severe RA. Pat
is doing well on adalimumab, and Chris,
And while sweating over bench presses, who has been on a number of different
leg extensions and abdominal crunches drugs but suffered severe side-effects,
might not be every RA patient’s idea of is now managing without medication.
therapy, for two willing volunteers,
Both thoroughly enjoyed the
friends Chris Jones and Pat Hopkins,
supervised resistance training sessions.
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Dr Andrew Lemmey and PhD student Sally Wilson put Chris Jones (centre) through her paces at Maesglas sports centre in Bangor
12
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Unfortunately neither of the women
kept up the same level of intensive
weight-training after the trial ended
although both still regularly exercise.
Says Pat: “The weight-lifting really
worked for me, and I put on a lot of
muscle and felt a lot better while I was
doing it. Supervision is very important
as you push yourself harder. We both
hate the gym if we’re not with people
who are helping and encouraging us.
The normal municipal gyms are not
very good for people who are older and
have something wrong with them –
and they’re always full of posers!”
Dr Lemmey picks up the point about
the need for supervision. “All the
“I enjoy anything that’s a bit physical,
that gets you going,” says Chris, a
former canteen lady at a local school.
“I felt that I was doing something about
my condition. The fact that we were
being supervised was very important.
You don’t want someone watching you
all the time but you need to know
you’re doing it right – we were pushed
and pushed and pushed and I couldn’t
have done that on my own.”
Dr Lemmey, in conjunction with
rheumatologists throughout the UK
(led by Professor Peter Maddison at
Bangor University) is keen to set up a
large multi-centre trial to look at the
cost effectiveness of resistance training
in RA patients, and wants to convince
the NHS that it’s worth doing.
“We’ve shown that resistance training is
very effective, but we can’t expect the
NHS to afford supervised sessions twice
a week for all patients with RA,” he says.
“Making the sessions supervised makes
it very expensive, but we are hopeful
that there is a way round it. We might
be able to combine supervised and
un-supervised sessions, and we might
need to involve a psychologist to help
people get in the loop and maintain a
routine, ie to invoke a behaviour
change that allows them to incorporate
exercise into their daily lifestyle.”
The weights the volunteers were lifting
were not for the faint-hearted, and
study leader Dr Andrew Lemmey from
the School of Sport, Health and Exercise
Sciences at Bangor University says that
the relative intensity at which they
worked was the equivalent of what an
athlete would do.
While the message to people with all
kinds of arthritis to exercise is
something that Arthritis Research UK
has long promoted, Dr Lemmey makes
it clear that general range of movement
exercises are insufficient to build
muscle, lose fat and improve physical
function in RA patients. A high intensity
exercise programme is needed.
“The amount of weight they were lifting
was substantially less than that of an
athlete because of their muscle waste,
but the effort they put into it was the
same – 80 per cent of their absolute
maximum,” he explains.
exercise sessions were supervised by a
trained physiotherapist and all our
volunteers said this was fantastic.
Motivation is the key. They knew what
they had to do and there was an
expectancy that they would do it, and
people were happy to go to the
sessions because they saw it was doing
them some good, although it required
a lot of time and effort. But to be
effective it appears that the sessions
have to be supervised.”
Chris Jones concurs: “I was pushed
more than body builders were, and if I’d
kept it up over a longer period of time I
would have ended up with really
chunky muscles.”
This reliance on a trained supervisor
leading the sessions is now making it
difficult to take the research forward,
because employing experienced
physiotherapists bumps up the cost.
14
The trial
It remains unlikely that this approach
will be either suitable or appropriate for
some people with RA. For women like
Chris and Pat, who are motivated and
describe themselves as “not sitterdowners”, however, it made a huge
difference.
Adds Chris: “I would love to do the
resistance training like I did before. It
was very intense. Quite a few people
have said to me: ‘Oh I could never do
that because I have too much pain.’ I
tell them that I have pain too! I think
some people think they should have no
pain, and they are not prepared to push
themselves...... but I absolutely loved it.”
Researchers at Bangor University and
Gwynedd Hospital recruited 28
patients with RA in order to study the
effect of high-intensity progressive
resistance training on their muscles.
Volunteers were divided into two study
groups, with 13 participants taking
part in twice-weekly resistance training
sessions for 24 weeks and the
remaining 15 patients doing a series of
home exercises. The group
represented the average RA patient;
two thirds were women, with an
average age of 56, who had had RA for
about eight years, and their disease
was under control. The drop-out rate
was very low, and the compliance rate
was above 80 per cent.
Assessments were carried out at the
beginning and end of the 24-week
study period and the findings were
published in the journal Arthritis Care
& Research.
The researchers found that people
who took part in resistance training
sessions typically benefited from an
increase in lean body mass – a person’s
body weight minus their fat – and
appendicular lean mass, which is the
mass of the muscles in the arms and legs,
and a decrease in total fat mass, which
was apparent in a reduction of fat mass in
their trunk (so reducing their risk of
diabetes and cardio-vascular disease).
Participants’ strength in terms of training
improved by 119 per cent, including a 30
per cent improvement in chair stands,
a 25 per cent rise in knee extensor
strength, a 23 per cent increase in arm
curls and a 17 per cent improvement in
walk time. In fact, function in these
patients improved to the point where it
was the equivalent to that of healthy
individuals of the same age; in other
words, RA-related disability had been
removed.
Increases in muscle volume were also
found to be associated with a rise in
muscle levels of insulin-like growth
factor 1 (IGF-1) and IGF binding protein
3, both of which promote the growth of
muscles, bone and cartilage.
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Stem cell
therapies –
offering hope
or just hype?
In the second of a three-part series looking
at developments in stem cell therapy to
treat osteoarthritis, Jane Tadman looks at
an exciting new project in Oswestry.
Surgeon Professor James Richardson
is currently little effective treatment.
“It’s great that Arthritis Research UK is
funding this work in Oswestry to take
things further. We are the first
laboratory in the UK producing
mesenchymal stem cells and
chondrocytes, so we are unique in
being able to test the effectiveness of
both types of cell therapy,” he added.
Stem cell transplantation surgery
involves two operations and a period of
at least six months’ convalescence and
rehabilitation. In the first operation, a
of a five-year £500,000 research
Cultured stem cells are not routinely
patient’s own chondrocytes or bone
programme.
used in the UK to treat the common
marrow cells are removed via keyhole
joint condition of osteoarthritis.
The hospital has been at the forefront
surgery, and grown in the laboratory for
However, this could change following a
of using a surgical technique originally three weeks. They are then renew Arthritis Research UK programme
pioneered in Sweden called autologous implanted back into the area of
grant, throwing a potential lifeline to
chondrocyte implantation (ACI) on
damaged or worn cartilage where over
millions of sufferers in the future.
patients with cartilage problems usually several months they form new
A new clinical trial proposes to test the caused by sports injuries, for many
cartilage. The Oswestry team will follow
years. They have also been using stem
effectiveness of mesenchymal stem
up the patients for a year, and will
cells (cells derived from a patient’s own cells from bone marrow to repair
measure success by looking at the
fractured bone for the past four years.
bone marrow) at repairing worn
quality of the cartilage, and the
cartilage in osteoarthritis of the knee in
patient’s ability to perform everyday
But now a team led by scientist Sally
comparison to chondrocytes (cartilage
activities.
Roberts, Professor of Orthopaedic
cells). A combination of both types of
Research, and James Richardson,
Once ethical approval is obtained,
cells will also be trialled.
Professor of Orthopaedic Surgery,
patients taking part in the trial will be
The aim is to repair damage to the joint, whose academic base is at Keele
recruited from orthopaedic
University, are confident that the
stopping osteoarthritis getting worse
departments around the UK, on the
and delaying or even avoiding the need procedure of cartilage regeneration
advice of the local specialist.
produces sufficient amounts of robust
for knee replacement surgery.
Arthritis Research UK is funding the
new cartilage cells for the technique to
Up to 70 people with established knee
study over five years and over that
be extended to patients with
osteoarthritis will take part in the
period, as well as running the clinical
osteoarthritis.
proposed trial, scheduled to start by
trial, scientists will seek a better
the end of 2010, to be run at the Robert Professor Richardson said the study
understanding of the biology of repair
offered a real chance to help
Jones and Agnes Hunt Orthopaedic
of ACI by studying biopsies of the repair
Hospital in Oswestry, Shropshire, as part osteoarthritis patients, for whom there tissue formed after surgery.
17
Case study
Patient Alan Bourne with the Oswestry team
Professor Richardson adds: “The
important thing is to run a randomised
trial. If successful, we need to find out if
it is cost-effective. If a few years can be
saved, the benefit to the patient may be
not to prevent the need for a joint
replacement, but to prevent need for a
revision of a joint replacement.”
Whatever the outcome of the trial,
use of stem cell therapies to treat
osteoarthritis is still experimental –
and routine clinical use is probably still
several years away.
“
patient, either privately or on the NHS,
outside the planned clinical trial.
In the third part of the series, the October
edition of Arthritis Today will profile the
new Arthritis Research UK tissue
engineering centre of excellence.
“
Despite her enthusiasm for the project,
Professor Roberts warns that stem cell
therapies, although promising, are not
the answer to all health problems.
“Stem cells are portrayed as ‘wonder
cells’ that can do anything, but they
can’t give you the joints of a 15-yearold,” she says. “At the moment they are
not the ‘magic bullet’ and they don’t
solve the underlying problem of
osteoarthritis, which still needs to be
addressed. They have been hyped up.
They certainly have huge potential –
we just need to learn how to harness it
properly.”
Super-fit Alan Bourne thought his
days of fell-running were over when
surgeons told him the articular
cartilage in his knee had worn away
to such an extent that knee
replacement surgery was his only
option.
However, Alan, who has numerous
contacts among doctors and
physiotherapists treating a number
of Premier League football teams,
including his GP, Dr Andrew Dent,
who works at Stoke City FC, decided
to investigate further. Three years
ago he ended up at the Robert
Jones and Agnes Hunt Orthopaedic
Hospital in Oswestry as the first
person to undergo surgery to repair
his osteoarthritic knee with a
combination of stem cells and
chondrocytes. This is the procedure
After suffering no ill-effects he started to
run again in earnest. He completed the
Grizedale Duathlon in the Lake District:
four miles of fell running, a 14-mile
mountain bike ride, followed by a further
four mile fell race. Although his knee was
a little sore afterwards, an ice pack
applied on the way home did the trick.
“Since then I’ve been running in a
The procedure involved two
operations; first to take stem cells from number of local races, and although the
knee does get a bit sore, it’s about 90 per
his pelvis which were grown in the
cent better than it was before,” says Alan.
laboratory and then implanted back
“I’m very happy with it. “I went back to
into his knee six weeks later.
hospital last year for an MRI scan and the
Progress after the operation was slow
cartilage had re-grown. The nurse told
and laborious. Although he was offered
me it was cartilage they would expect to
a full rehabilitation programme by the
see in a 30 or 40-year-old.”
Oswestry team, Alan took advantage of
Professor Richardson adds a word of
the offer of help from close friend
warning: “Mr Bourne was heading for a
David Galley, a physiotherapist with
joint replacement and so we considered
Liverpool FC, who devised a rigorous
exercise regime, starting as soon as he it reasonable to try something that was a
was off crutches six weeks after surgery. development of the work we have been
For two years he did aqua jogging and doing at Oswestry for over 12 years. In the
short-term he has a good result; I don’t
then cycling, and lots of exercises to
know how long this will last.”
strengthen his quadriceps muscles.
Then last year Alan started running
Mr Bourne’s experience is not likely to be
again, taking part in a five-mile trail
repeated as the RJAH is not planning to
race in his native north Staffordshire.
perform the procedure on any other
At the moment they [stem
cells] are not the ‘magic
bullet’.
Professor Sally Roberts
Alan Bourne, with examples of his
super-active lifestyle
now to be trialled as part of the
Arthritis Research UK programme
grant.
“I was very much a guinea pig and
was told that if the operation did not
work the first time I could have it
done again,” says Alan, who ran a
textile business in Newcastle under
Lyme until retiring in 2003. He paid
privately to have the operation and
was fully aware of the unpredictable
outcome of such surgery.
18
19
News
Research news
Slow-release NSAIDs
linked to higher risk of GI
bleeding
Scientists identify new
gene variants linked to
rheumatoid arthritis
People who take slow-release versions of
non-steroidal anti-inflammatory drugs
(NSAIDs) may be more likely to suffer
from gastrointestinal (GI) bleeding, a
study in the journal Arthritis &
Rheumatism has found.
Researchers have discovered seven
new regions of DNA that appear to
play a role in rheumatoid arthritis.
The study was conducted by an
international team of scientists,
including Professor Jane
Worthington from the Arthritis
Research UK Epidemiology Unit at
the University of Manchester.
The scientists analysed the genes of
5,539 European people with
rheumatoid arthritis, all of whom had
participated in one of six previous
studies, and a further 20,169
volunteers who did not have
rheumatoid arthritis.
A further analysis was carried out on
another 6,768 rheumatoid arthritis
patients and 8,806 disease-free
volunteers in order to confirm their
findings.
The research, which is published in
the journal Nature Genetics, allowed
the scientists to uncover ten genetic
clusters that may affect a person’s
risk of developing rheumatoid
arthritis, seven of which had not
previously been identified.
Research scientist Eli Ayumi Stahl,
from the Brigham and Women’s
Hospital in Boston, US, said: “This is
more rheumatoid arthritis risk
variants discovered in a single study
than any other study to date,
underscoring the importance of
large-scale studies and the
collaborations that enable them in
order to make progress in unravelling
common, complex diseases.
“The findings leverage us to better
understand the basic biology of
rheumatoid arthritis, with the goals
of developing new targets for
therapy and new biomarkers for
diagnosis and prognosis.”
The paper in Nature Genetics
coincides with a separate study from
Japan, which identified one of the
same genetic clusters as possibly
being involved in rheumatoid
arthritis.
20
Clinical trials of
ocrelizumab for
rheumatoid arthritis
halted
Scientists have decided to stop clinical
trials involving a drug called ocrelizumab
in patients with rheumatoid arthritis.
The drug had been the focus of four
phase-III trials as part of a development
programme by Roche and Biogen.
After analysing available data on the
effectiveness and safety of the drug,
scientists have concluded that other
available treatments provided more
favourable results.
Detailed results of the phase-III trials will
be presented at a later date and the
companies noted that the drug is still
being investigated as a possible
treatment for patients with relapsing
remitting multiple sclerosis.
The drug is designed to target B cells in
patients with autoimmune diseases, in
which the body mistakenly attacks its
own cells.
NSAIDs are designed to reduce pain and
stiffness and are commonly prescribed to
people with inflammatory forms of
arthritis.
Some NSAIDs are taken two or three
times a day, while others are slow-release
versions which only need to be taken
once a day.
However, the drugs can damage the
lining of the stomach and may cause
bleeding if taken in higher doses or over
a long period of time.
Professor Marc Feldmann, codiscoverer of anti-TNF therapy for
rheumatoid arthritis, and director of
the Arthritis Research UK Kennedy
Institute of Rheumatology, has been
knighted in the Queen’s Birthday
Honours List.
Professor Sir Marc Feldmann, working
with his colleague Professor Sir
Ravinder “Tiny” Maini, discovered that
a single protein mediator, termed
TNFα, was instrumental in driving the
disease process behind rheumatoid
arthritis.
Scientists at the Spanish Centre for
Pharmacoepidemiological Research have
conducted a review of existing research
which had looked at the risk of GI
complications for different types of
NSAIDs.
Data from a total of nine studies,
published between 2000 and 2008, were
included in the final analysis.
Researchers found that the risk of GI
bleeding varies depending on the type of
NSAID being used and the dosage.
Analysis revealed that drugs with a
slow-release formulation are associated
with a greater risk of GI bleeding or
perforation than those which release
their active ingredients more quickly.
Study leader Dr Luis Garcia Rodriguez
said: “We showed that persistent
exposure to the drug is an important
independent determinant; in fact, drugs
with a long half-life or slow-release
formulation were associated overall with
a greater risk than NSAIDs with a short
Professor Alan Silman, medical director of half-life.”
Arthritis Research UK, commented: “We
A spokesman for Arthritis Research UK
are disappointed that the ocrelizumab
commented that as with all drugs, the
clinical research programme had to be
risks and benefits of taking NSAIDs
stopped, but the potential risk of serious,
needed to be weighed very carefully.
possibly fatal, infections justified this
“For any patient who is prescribed
action. Fortunately there are a large
NSAIDs (including coxibs), doctors have
number of modern “biological” agents
that can be used for rheumatoid arthritis been advised to use the lowest effective
dose for the shortest period of time,” he
and related conditions, so this cessation
added.
should not impact on patients.”
It is supposed to interfere with the body’s
inflammation process and prevent the
series of reactions which lead to
irreversible joint damage in people
with rheumatoid arthritis and other
autoimmune diseases.
Co-discoverer of antiTNF therapy knighted
in Queen’s Birthday
Honours
Professor Sir Marc Feldmann with
Professor Sir Ravinder Maini
Leading Norwich arthritis
research study celebrates
20th anniversary
His work – from laboratory
investigations to clinical trials – has led
to major improvements in the
treatment not only of rheumatoid
arthritis, but also of other chronic
debilitating diseases such as Crohn’s
disease, ulcerative colitis and
ankylosing spondylitis. The anti-TNF
therapy that he developed with Sir
Ravinder (who was knighted in 2003)
has been effectively used in millions of
patients and has not only improved
symptoms and signs but also
dramatically reduced joint damage.
Responding to this honour, he said:
“Research success which impacts on
people takes a long time to achieve –
25 years in my case – and so long-term
funding of research is critical.
“I and the Kennedy Institute of
Rheumatology have been the
fortunate recipients of major and
generous long-term funding from
Arthritis Research UK, which
recognised this need early.
“Like many awards, one person in the
team is honoured, but the reality is that
success would not have been possible
without the skilled and dedicated work
of many others. I have been privileged
to work with many talented colleagues
over the years, and want to acknowledge and thank them for their
assistance.”
Twenty years of NOAR were celebrated
with a day of lectures from leading
academics at the Norfolk and Norwich
University Hospital in May. Speakers
included Diane Bunn, clinical manager of
NOAR; Professor David Scott, a consultant
A leading research study which has put
rheumatologist from Norfolk and
Norfolk arthritis patients firmly at the
Norwich University Hospital, and one of
centre of its activities has celebrated its
NOAR’s founders, as well as Professor
20th anniversary.
Deborah Symmons, director of the
The Norfolk Arthritis Register (NOAR) was Arthritis Research UK Epidemiology Unit
at the University of Manchester, where
set up in 1990 by Arthritis Research UK,
much of the data is analysed.
with the aim of recruiting people with
inflammatory forms of arthritis very early Mrs Bunn paid tribute to Arthritis
Research UK for its continuous funding of
in the disease process and following
them over several years to document the NOAR, to local GPs for recruiting patients,
hospital rheumatologists and
natural history of the condition. To date,
rheumatology nurses for remembering to
almost 4,000 people with inflammatory
notify NOAR of patients from their busy
arthritis have taken part.
clinics, and chiefly to the patients
As a result, researchers have made a
themselves.
number of important discoveries about
“They have contributed to the growing
why inflammatory arthritis develops;
international knowledge of inflammatory
establishing risk factors such as smoking, arthritis and can share in the satisfaction
obesity, and dietary factors such as low
that patients in the future will benefit,”
vitamin C intake or diets high in red meat. she added.
Do you have the
“S” factor?
A national public awareness campaign
has been launched to focus greater
attention on three common types of
inflammatory arthritis – rheumatoid and
psoriatic arthritis and ankylosing
spondylitis.
Posters (such as the one below) asking
patients if they have the S factor –
stiffness, swelling and squeezing–have
been designed and produced by the
Rheumatology Futures Project Group
(RFPG) and supported and endorsed by
Arthritis Research UK, the Royal College
of GPs and the Primary Care
Rheumatology Society.
The posters will be going up in GP
surgeries, local libraries and pharmacies,
and aim to encourage people who might
have the three most common symptoms,
described above, to contact their doctor
without delay.
The RFPG is a coalition of patient and
professional organisations formed in
2007 representing the entire
rheumatology community (primary care,
secondary care, consultants, GPs, nurses
and allied health professionals, patient
organisations) and the pharmaceutical
industry.
Posters are available to download from
our website homepage at www.
arthritisresearchuk.org or via email at
[email protected] or
by calling 01246 558033.
A18321 Back pain poster.qxd
14/4/10
09:20
Page 1
pinal pain & stiffness
in a young adult
Spinal pain & stiffness lasting
more than 3 months in a young
adult could be inflammatory if you
tick 4 out of 5 boxes:
It started before the age of 40
It started slowly: it did not come
on suddenly
You have noticed improvement
with exercise
There is no improvement with rest
You experience pain at night
(with improvement on getting up)
21
methotrexate, earlier. They stipulate that
PMR should be assessed by a minimum
set of screening blood tests, since
mimicking conditions such as rheumatoid
New guidelines have been produced for
arthritis can start in a similar way. Patients
GPs that will improve the treatment of
with PMR may well need a specialist
polymyalgia rheumatica, a common
Up to 40-50 per cent of GCA patients may opinion early in their disease.
inflammatory condition affecting the
The new guidelines have been welcomed
also have polymyalgic symptoms. The
muscles.
by leading PMR expert Professor Bhaskar
guidelines advise that irreversible sight
Amongst older people polymyalgia
Dasgupta, a rheumatologist at Southend
loss caused by GCA – often missed until
rheumatica (PMR) and the associated
University Hospital.
the headache around the temples
condition giant cell arteritis (GCA)
develops – can be prevented by looking
“We hope that the standards of care
account for a large percentage of
out for important early signs such as jaw
specified by the current guidelines will
rheumatologic inflammation. They are
and tongue pain. Vision loss can then be one day be embraced by NICE guidance,”
the commonest conditions for which
prevented by early diagnosis and start of he said. “The damage and impact of the
steroids are prescribed in the community, high dose steroid treatment.
conditions can only be mitigated by
and GCA is one of the common causes of
greater public and professional
The
guidelines
also
describe
measures
to
acute blindness.
awareness of these conditions; earlier
be taken to minimise side effects of
Clinicians hope that they will reduce the
recognition before disastrous vision loss
long-term steroids such as osteoporosis,
number of people – currently 20-30 per
and strokes; immediate and fast track
fragility fractures, diabetes, eye
cent – who are not diagnosed with PMR
review of such conditions in GP surgeries,
complications such as cataract, raised
and GCA until they lose vision.
clinics, A&E and acute medical units; with
blood pressure, bruising and most
systematic assessment and relevant
important
for
the
patients
–
weight
gain
The challenges addressed by the
investigations (such as blood tests,
and
moon-like
face.
It
is
very
important
guidelines, produced by the British
ultrasound, temporal artery biopsy) to
that
the
inflammation
level
is
properly
Society for Rheumatology, are early
prevent errors of diagnosis.”
assessed
so
that
the
symptoms
can
be
recognition, correct diagnosis and referral
and starting correct treatment early. Both kept in check with the minimum effective The guidelines group has worked with
dose of steroids.
PMR and GCA invariably start with what
Arthritis Research UK to develop an
are called ‘constitutional symptoms’ – low The guidelines point out the need for
information booklet on GCA and is
grade fever, weight loss, night sweats,
earlier and more correct diagnosis and
helping to revise its existing booklet on
the use of additional therapies, such as
PMR. Both will available later this year.
tiredness, poor appetite. PMR generally
starts with fairly abrupt onset of pain
mainly focussed around the shoulders
and thighs. Patients are usually very stiff,
unable to get out of bed, and have
difficulty in performing daily activities
without help.
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“Punch Cures the Gout, the Colic and the Tisic” – Gillray’s famous gout cartoon
Gout – it’s no laughing matter
Gout expert Mike Doherty has a theory up, as the world’s population ages and
about why gout is not taken as seriously gets fatter.
as it should be – both by the medical
“Another reason for the increase in
profession and the general public.
prevalence is that we are living longer
“As far back as the famous Gillray
cartoon gout has been seen as a bit of a and gout is an age-related problem,”
says Mike Doherty, Professor of
Rheumatology at The University of
Nottingham. “It’s also because there is
more osteoarthritis around, as urate
crystals tend to deposit in osteoarthritic
joints.”
Gout is in fact the commonest
inflammatory form of arthritis in the UK,
affecting 1.4 per cent of the population
(compared to rheumatoid arthritis,
which affects 0.8 per cent). Caused by a
build-up of sodium urate crystals in the
joints: usually the feet, knees, wrists,
fingers and elbows – it is, say sufferers,
the most excruciating pain that can be
experienced, on a par with childbirth.
jLkumya{amkyumyyaThY
UmjuhY{Yh^hL{
If gout can be cured,
why is it on the
increase and why are
so many people still
suffering? A new
study may shed
some light on why
gout is still about
– and how it can be
treated more
effectively. Jane
Tadman reports.
joke – the idea of a grown man crying
his eyes out because of pain in his toe,”
he says. “People can’t take it seriously.
Everyone laughs at gout. But no-one
laughs at rheumatoid arthritis.”
)520
21/<

1R
LQ8.
Gout
JEAN-LOUP CHARMET/SCIENCE PHOTO LIBRARY
New PMR and GCA
guidelines welcomed
Globally, gout is on the increase, largely
due to the accompanying rise in
so-called metabolic disorders – obesity,
high blood pressure, high cholesterol,
and type-2 diabetes, all of which are risk
factors. It’s also strongly associated with
osteoarthritis; also known to be on the Professor Mike Doherty
23
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He takes the view that specific dietary
factors are not the key risk as is
commonly supposed, citing obesity
and genetic factors as being more
important. “Two thirds of uric acid
comes from your body making uric acid
– so the bigger your body the more uric
acid you make. Only one third of uric
acid in the body comes from diet. So
although diet can have some influence
– if you have a diet that is very rich in
purines, so for example eating steaks
five days a week out of seven and
drinking large amounts of beer, I think
we need to focus more on diets that
overall increase obesity and play down
individual factors such as shellfish and
offal. People who get gout often inherit
it, or have inherited inefficient kidneys,
which means that uric acid isn’t
processed properly in the body.”
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Case study
Retired builder Bill Morris is in many
ways a “typical” gout sufferer. Now
73, his grandfather, father and
step-brother all had or have gout.
Bill developed it nearly 40 years ago
when he was working away from
home during the week on building
sites, eating daily fry-ups and
knocking back around 30 pints of
bitter a week.
“I wouldn’t wish the pain of a gout
attack on anyone: no matter where
you put your foot the pain was
always there,” says Bill, who also has
osteoarthritis and had a knee
replacement ten years ago. “The pain
was unbelievable. But now, I’m very
glad to say, it’s much more under
control.”
After his first bout he suffered two or
three attacks for years. He has been
treated by Professor Doherty at the
City Hospital in Nottingham for the
past five years, and is currently on a
daily dose of 600mg of allopurinol.
He hasn’t had a new attack for three
years, which he puts down to the
medication, but also to an
improvement in his diet which saw
him lose several stones in weight
– “the frying pan literally went out of
the window” – eating muesli for
breakfast, steak only every couple of
weeks, and 30 apples a week.
“Patients are often blamed for stopping
taking their long-term medication
because they can’t see any point or
There are two main ways to manage
benefit. But it’s all about how you give
gout – the first is to treat an acute
people the right information. I’ve never
attack, and the second is to miminise
had anyone say they didn’t want
the likelihood of further attacks by
urate-lowering drugs once I have
prescribing long-term medication to rid explained the alternative.”
the body of urate crystals in the joints
Clinical guidelines state that once
and to prevent new crystals forming.
patients have recurrent attacks of gout,
Unfortunately, many GPs concentrate
or if they already have evidence of joint
more on treating an acute attack.
damage or obvious swellings of
A glance at the UKGP Database reveals compacted crystals under the skin
(“tophi”) they should be put on longthat fewer than one in three people
term medication to dissolve away the
with gout is on long-term medication
crystals and prevent new ones forming.
– such as allopurinol – to lower the
If left untreated the acute attacks will
urate levels in their blood. Two-thirds
continue to occur, becoming more
are not. Again, in a community audit in frequent and severe. Allopurinol is the
Nottingham, fewer than one in three
usual first urate-lowering drug to use. It
people with gout was on urateshould be started at 100mg a day, then
lowering drugs, and half of these were
increased every four weeks or so,
not on high enough doses.
100mg at a time, until the patient’s
serum uric acid levels have been
“GPs focus on an acute attack and they
reduced to a low at which it is
don’t have a mental picture of what a
impossible to form urate crystal. If the
person’s joints may look like in ten
uric acid is kept at a low level, the urate
years’ time,” says Professor Doherty.
crystals will be dissolved away within
“It’s insufficiently realised that gout is a about one to two years of treatment.
chronic progressive disease that can
This is known as hitting the therapeutic
cause irreversible joint damage.
target. But most GPs start patients on a
either properly or adequately in
primary and secondary care.
25
What can be done about
this unsatisfactory state
of affairs?
Arthritis Research UK is currently
funding Professor Doherty and his team
to carry out a year-long proof-ofconcept study to treat 100 gout
patients who have previously received
less than ideal care. If 70 per cent of
them reach their therapeutic target and
their urate levels drop accordingly, the
study will proceed to a full-scale clinical
trial.
The trial, to be run by specialist gout
nurses, will aim to develop a practical
and acceptable treatment package for
gout patients in the GP surgery, where
most patients are treated. While one
group of patients receive the usual GP
Questions
and
answers
26
Mike Doherty believes that the trial to
test best practice in gout treatment
could have far reaching implications for
long-suffering gout patients.
“We need to change perceptions,
among both GPs and patients, about
gout. This study will lead to the first
randomised controlled trial that aims to
“cure” gout by applying currently
available treatments. We have effective
treatments but they’re not being used
as well as they should be,” he says.
“There’s a view that gout has been dealt
with, but as many gout sufferers will tell
you, it hasn’t. We’re not doing as well as
I am 56 and have suffered from
osteoarthritis since my 20s. One
hip was resurfaced six years ago. I keep
active by going to the gym twice
weekly but am rarely completely free of
pain in various joints. A recent tooth
abscess and two weeks of antibiotics
seemed to have the most welcome side
effect. Whilst taking the course I awoke
and remained pain free throughout the
day. Is there a link between
osteoarthritis and infection?
duct that drains the tears away.
Lubricants can also be used for the
mouth and a tablet called
pilocarpine may help both eyes and
mouth.
we should be doing as a medical
profession. Taking gout seriously would
be a good start.”
Did you know?
•
Sometimes starting allopurinol at the standard dose can spark off attacks of gout – so it’s better to start off with a lower dose
I am 55 and suffer from arthritis in
my knees and fingers.
Unfortunately I am not allowed to take
anti-inflammatory tablets as I’m taking
aspirin. I have tried all manner of
natural remedies but nothing works.
I am a piano teacher and as you can
imagine it is no fun having pain and
stiffness in my joints in my hands. Is
there anything that you could advise
for my situation?
•
Gout is the most common inflammatory form of arthritis in men, and the commonest form of inflammatory arthritis in post-
menopausal women
•
A new urate-lowering drug for gout called febuxostat is now available and is particularly suitable for people with kidney problems
Arthritis Research UK’s booklet on
gout is available on 01904 696994 or
an online version is available at
I have suffered from dry eyes for a
long time. I suffer from rheumatoid
arthritis and had a hip replacement in
2000. I have tried all the remedies the
NHS has to offer and have been on
sulfasalazine and methotrexate for
three years. Does rheumatoid arthritis
contribute to dry eyes? Can you suggest
a cure or anything to relieve the
symptoms?
Gordon Johnson, Vidlin, Shetland
Dry eyes are a recognised
feature (extra-articular
Gill Smith, West Midlands
manifestation) of rheumatoid
arthritis. The rheumatoid process
The short answer is ‘no’. In fact
can cause damage to the cells which
the only evidence of a link
between osteoarthritis and infection produce the moisture for the eyes
and mouth. This is called Sjögren’s
is that joints in which an infection
has occurred often become severely syndrome (Sjögren was the Swedish
eye physician who described a
and prematurely damaged by
condition that primarily affects the
osteoarthritis at some point after the
moisture producing cells in the eyes
infection has cleared. In your case it
and mouth – see Arthritis Research
is fascinating to hear of your
UK leaflet on this topic). At its most
improvement. I wonder if the
severe this condition can lead to
antibiotic you were taking has some damage of the surface of the eye and
other, pain relieving or antivisual impairment so it is important
inflammatory property? Could the
to seek help. Mostly, lubricant eye
improvement have resulted from all drops are used but sometimes
the additional pain-killers you were
surgical solutions are necessary –
taking for the tooth abscess?
these include putting a plug in the
I have had rheumatoid arthritis
for nearly 29 years. When I fell
pregnant, there was no sign of
rheumatoid in my body; so many
people will tell you the same, so how
come this isn’t researched? Could
something like “the pill” take
rheumatoid away?
Lynn Clark, Carlisle, Cumbria
You are right. This phenomenon
has fascinated rheumatologists
for a long time. Research has been
done but I’m afraid taking ‘the pill’ is
not the answer. In fact there are
many dramatic changes in a woman’s
body during pregnancy most of
which, unlike the bump, are not
Diana Blower, Tunbridge Wells, Kent
visible. Hormonal and immunoThere is no absolute reason not logical changes occur so that the
pregnancy can proceed to a
to use low dose aspirin and
anti-inflammatory tablets together, successful outcome. Don’t forget
that the baby is a little alien as far as
but doctors don’t like the
the mother’s body is concerned, half
combination because of the risks to
the genetic material coming from
the stomach. Some doctors might
the father. In order for the mother
argue that the anti-inflammatory
not to ‘reject’ the growing baby it
drug naproxen could be used as a
must become ‘tolerant’. I use single
substitute for aspirin. On the whole
inverted commas around both these
there has been a trend for GPs to
avoid NSAIDs altogether as they may words as they are terms used by
immunologists. The bottom line is
cause stomach ulcers and raise the
chance of a heart attack. As with any that for the baby to grow successfully the mother’s body must
drug the pros and cons have to be
undergo some immune alteration
balanced.
and this is probably why rheumatoid
arthritis improves in pregnancy.
What alternative treatments could
Modern drugs to treat rheumatoid
you take? Paracetamol at a decent
arthritis, such as methotrexate and
dose (up to eight tablets daily) may
anti-TNF drugs, also alter the
also control your symptoms well.
The evidence for glucosamine is not immune system so in a way we are
already following the body’s lead on
strong and the same applies to fish
oil, but you could try these for a trial this. Of course, after delivery all
these changes disappear so it is not
period. It is also important to keep
the muscles around the joints strong uncommon for the rheumatoid
arthritis to relapse a few weeks after
so don’t neglect those exercises,
delivery. This is always a letdown for
particularly for the knees.
• Gout affects three to four times as many men as women
AJ PHOTO/SCIENCE PHOTO LIBRARY
with Dr Philip Helliwell
care, the other will receive the nurseled care with advice on how to change
and improve their diet and lose weight.
This group will also be put on an
increasing dose of allopurinol or other
urate lowering drugs (such as a new
drug, febuxostat), as recommended by
current European and UK guidelines. In
a linked qualitative study patients will
complete questionnaires about their
medical history, treatment and quality
of life.
ALEX BARTEL/SCIENCE PHOTO LIBRARY
fixed 300mg standard dose and don’t
check their patient’s urate levels again;
so the urate levels don’t drop, the
patient notices no benefit, and stops
taking the drugs because they don’t
think they’re working.
the mother and is something we try
and prevent by re-starting treatment
after the baby is delivered. Which
drugs are safe in pregnancy and
while breast feeding is a whole topic
on its own , which I would be happy
to tackle in future answers.
I have received a leaflet advertising
the latest “natural” product for the
treatment of arthritis. It is called
JointEase Plus, and is a formulation of
various vitamins, minerals, plant
extracts and herbs. I have osteoarthritis
in both knees and hips and my GP has
given me a six-week course of an
NSAID, but she is unwilling to prescribe
it continually, and the only alternatives
she suggests are Buprenomorphine
patches, which I am not yet ready for, or
a possible hip operation which I am not
keen on at the age of 84. I am
wondering whether to rely on
paracetamol and this “natural”
treatment. My GP is sceptical. I should
be grateful for your more specialised
opinion.
Jayne K Mudd, Orpington, Kent
Jointease Plus is a mixture of
vitamins, minerals, plant
extracts and herbs. However, the
‘key’ ingredients are quoted to be
glucosamine, chondroitin and MSM.
I have commented on these
previously. They are probably
harmless and only have mild antiinflammatory benefit, if any. There is
no harm in trying them, along with
paracetamol. They will only harm
your wallet (unless you are allergic to
shellfish). In addition try to keep as
active as you can. And have a word
with your doctor about those
NSAIDs. As mentioned above the
benefits in your case may outweigh
the potential harm.
27
New research
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.”
Can vitamin D help
prevent arthritis?
Scientists 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 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.
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
28
Dr David Sansom
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.
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.
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.
Dr Tom Margham
The aim is to help address the lack of
training in managing arthritis and related “GPs are generalists and general practice
is all about effectively managing
conditions that doctors going into
general practice receive which at present common conditions, recognising the
is generally recognised to be inadequate. not-so-common ones and knowing when
to refer them on. All GPs are under
“To become a GP you don’t have to do
pressure but I strongly believe we should
any hospital or community-based
be able to manage the common
training job that specifically involves
problems that affect the patients who
looking after people with musculoskeletal conditions, yet up to a quarter of come through our doors.”
The
Hints
Box
Where do I get hold of
capsaicin gel?
In a recent article on complementary
medicines in Arthritis Today for arthritis
capsaicin gel was shown to be very
effective. I have asked at Boots and
health shops in Inverness and nobody
has heard of it, although there were a
few products which contained a small
amount of capsaicin. In these shops
they said they could try to get it for me
if I gave them a brand name, so I hope
you can help me.
Janet McKenzie, Inverness,
Inverness-shire
Editor’s Note: capsaicin cream or gel can
Suggestions on how to cope with be obtained on prescription from
an RA flare
pharmacies. Ask your GP.
In answer to Sally Brush’s question in
the Spring 2010 edition of Arthritis
Today about coping with rheumatoid
arthritis flare ups, what I do is gentle
exercise (if I can manage it) use frozen
peas to bring down swelling and
microwave “bean bags” to ease pain
(which work extremely well). I take
paracetamol and naproxen to reduce
inflammation. But sometimes, in the
end all I can do is have a good cry and
rest. I do take several supplements
every day that I believe limit my
occurrences of flare-ups and I find it is
important to keep moving if at all
possible. Hope this helps.
Microfibre and moleskins leisure
suit helps keep me warm
I have had rheumatoid arthritis since
1968 and I have tried various
treatments including acupuncture, but
nothing appeared to work and during
the past 15 years I have become less
active and found a greater need for
warm clothing and the constant need
to come indoors to find heat. My pain
has been constant and at times
unbearable. I have tried many different
types of clothing but never really found
any which have been very effective. In
2009 a friend who was developing a
leisure suit told me about his project.
He offered to make an all-in-one suit for
Lynn Belmar Little Sutton, Cheshire
me to try out. At first I was a little
After a very long time without any
apprehensive but after consideration I
flare-ups, which left me thinking I had
decided to give it a try. A suit was made
finally conquered my RA, I had one, and to my measurements and I have to say I
spent a very uncomfortable night with am glad that I took up this offer, as the
effect of the garment has been
aches all over my body. My GP put me
on 5mg of prednisolone, and the result unbelievable. I have worn this suit,
was immediate, leaving me pain-free.
When I next saw my consultant for my
regular six-monthly check-up he told
me that if I wanted to reduce the
dosage I had to do it very gradually, but
never to reduce it to below 2mg. If I was
to have another flare-up I was to return
to 5mg immediately. This happened a
few days ago, I am back on 5mg and
free of all usual symptoms. I am very
grateful for my six-monthly check-ups
(more frequent if I’m in trouble) and the
co-operation between my GP and
consultant. My RA was diagnosed when
I was 36 and I am now 90.
which has a warm filling sandwiched
between two layers of material during
the recent cold weather and the suit is
warm and comfortable. I can
recommend it to my fellow sufferers.
My wife was so impressed she bought
one for herself.
George Walling, Milnthorpe,
Cumbria
Kato Leisurewear can be contacted on
01524 761569 or
www.katoleisurewear.co.uk
Apple vinegar and honey helped
ease my friends’ joint pain
Last year I read an article in the Daily
Mail about curing arthritis. I passed this
information on to two friends who had
crippling pain in their swollen joints
and had been under the doctor for
months – but no drugs they were given
eased the pain. They took the advice
and tried apple vinegar and honey in
hot water four times a day. The arthritis
has completely left them. John is now
playing lawn bowls again: before he
could not even hold a bowling ball.
George is now able to work his garden,
and I have just received a bag of Jersey
potatoes from him. I have seen the
proof that this remedy works.
David Vautier, Beaumont St Peter,
Jersey
Views expressed in the Hints Box are those
of readers and are not necessarily the
views of Arthritis Research UK. The Hints
Box is also published online on our
website at
Mrs H Trott, Cheam, Surrey
29
Meet
the
expert
childhood arthritis. We are now
working hard to determine exactly
what role they play in the disease.
What do you hope or expect
to achieve as a result of your
Arthritis Research UK funding?
Dr Wendy Thomson
Childhood arthritis is relatively rare but
it can have a long term impact on
children and their families. We know
that some children who develop
arthritis will improve quickly with little
or no treatment whilst others will
continue to have active disease into
adulthood. We also know that
response to treatment varies between
individuals. The hope is that by
learning more about what causes
these differences in long-term
outcome and treatment response
we will be able to develop far more
individualised clinical care, thus
improving the lives of children with
arthritis and that of their families.
What does your work involve?
What do you do in a typical day?
Dr Wendy Thomson and Professor
Anne Neville explain their work in an
ongoing series of questions and
answers with Arthritis Research
UK-funded researchers.
I am what is known as a “basic scientist”, When I started out I spent most of my
time in the laboratories conducting
in other words I do mainly laboratory
experiments. Now I spend most of my
based research, although these days
time in meetings; these can either be
most of my time is spent at the
with individuals or small groups or
computer rather than actually in the
with much larger groups, often
laboratory. The main focus of my
involving collaborators from many
research is the identification of the
different research groups across the
factors (genetic and environmental)
UK. Within the meetings we may
involved in the development and
discuss research plans, the results of
outcome of childhood onset arthritis.
recent experiments or analysis or the
How long has Arthritis Research writing of papers.
UK been funding you?
Virtually my entire research career. My
first job was as an Arthritis Research UK
funded research assistant. I joined the
Arthritis Research UK Epidemiology
Unit in Manchester in 1990 and the
charity has continued to support my
research ever since.
What is your greatest research
achievement?
I am most proud of establishing the
Childhood Arthritis Prospective Study
(CAPS). CAPS was set up in 2001 to
study the short and long-term
outcomes in children presenting with
new onset arthritis. We collect data on
What’s the most important thing current and past medical history,
details of how severe the arthritis has
you have found out in the past
been, and details of the treatments
12 months? And why?
received. We have recruited over
We are still not sure what causes
1,000 children into this study (the
arthritis in children or why some
largest study of its kind in the
children do better than others in the
world) and many of them have now
long-term, but we do know that genes been followed up for over five years.
play a role. Understanding which genes This study will help to improve our
are involved will help us to predict what understanding of both the causes of
and outcome in childhood arthritis
the outcome might be allowing the
and represents a unique
clinician to provide the best care
opportunity to improve
possible for each child. Over the last
clinical care for children
12 months my group has identified
with this condition.
many new genes that are important in
30
Why did you choose to do this
work?
Shortly after joining the Arthritis
Research UK Epidemiology Unit
I became interested in arthritis in
children. I have continued to work in this
field ever since and am truly committed
to understanding the causes of juvenile
arthritis and to improving both the
short and long-term outcome for
children (and their families).
Do you ever think about how
your work can help people with
arthritis?
Every day. Whilst I am not a clinician and
so do not have direct contact with
patients on a day-to-day basis I have
worked in this field for a long time – just
looking at the answers given on
questionnaires regarding the effects of
arthritis on children and their families
provides me with tremendous insight
into the impact this condition can have.
What would you do if you
weren’t a scientist?
If I had to chose, I love to cook so maybe
I would be a chef – probably one who
experiments a lot with recipes.
About Wendy
Like many parents (my son is now 16
and has just completed his GCSEs) much
of my spare time is spent with my family.
I enjoy walking, cooking and have
recently taken up playing tennis again.
Dr Wendy Thomson is the deputy
scientific director of the Arthritis
Research UK epidemiology unit in
Manchester and a reader in complex
disease genetics
Professor Anne Neville
What does your work involve?
My work involves research into
corrosion; this is when metals degrade
in a conducting solution. Corrosion is
an important process in many industrial
sectors such as oil and gas recovery,
power generation and automotive. In
artificial hip joints there is a potential
for metal components to corrode when
the components rub and are in contact
with the synovial fluid. Our work in
Leeds focuses on trying to understand
the process and rates. This is becoming
increasingly relevant to patients as
metal-on-metal (MoM) hip joint
replacements are implanted and
concerns about metal-ion release are
being reported in the press as to
whether there are any possible
biological effects or contamination of
the body through absorption of metals
from the implant. The work involves
developing some fairly sophisticated
apparatus to enable us to measure
corrosion processes in hip simulators in
real time and also we analyse surfaces
with very high resolution microscopes
to understand what is happening on a
very small scale at the surfaces. It is
processes occurring on those surfaces
that determine the overall life of a hip
joint replacement.
How long has Arthritis Research
UK been funding you?
For the last three years.
What do you hope or expect
to achieve as a result of your
Arthritis Research UK funding?
Our recent Arthritis Research UK
funding has just ended in 2010 and we
are applying for follow-on funding to
completely understand the link
between corrosion, debris production
and ion release. We have for the first
time been able to attribute metal ion
release to different processes at the
ball/socket interface when they are in
relative motion and from the
dissolution of the tiny wear particles
that are produced. We are hoping that
through follow-on funding we can
exploit this new instrumented hip
simulator to fully understand all
corrosion processes occurring at the
ball/socket interface. We expect to be
able to suggest modifications to
material surfaces to reduce damage
and also ion release with the ultimate
goal being to increase the life and
reliability of MoM joint replacements.
What do you do in a typical day?
I manage a big research group of
around 30 people and so most of my
days are spent looking at results from
experimental studies and directing
students and post-doctoral
researchers. I spend time early in the
morning and late at night writing,
when it is quiet.
What is your greatest research
achievement?
and gas sector. A strange route. The
issues surrounding the use of MoM hip
replacements are highly relevant in the
management of arthritis and it is good
to know that the interesting
underpinning science is driving a
solution to a very important medical
issue.
Do you ever think about how
your work can help people with
arthritis?
Yes, this is what drives the work – to
provide an understanding and to
reduce the “scare stories” associated
with some types of artificial joints.
What would you do if you weren’t
a scientist?
Depends; if I was rich and didn’t need
to work I would spend my time on the
Isle of Mull taking in scenery and
walking on the beaches. If I had to have
another career I would be a social
worker.
About Anne
As above – hill walking and enjoying
the West of Scotland. I have a daughter
Rachel who is almost five and so most
of my free time is spent with her and
my husband, Mark.
Anne Neville is Professor of
Tribology and Surface at the
University of Leeds’ school of
mechanical engineering
To succeed in developing graduates
What’s the most important thing into competent and innovative
researchers. From a technical
you have found out in the past
perspective the greatest
12 months?
achievement has been to
We have found many important aspects instrument a hip simulator in
of corrosion in joint replacements; all of our lab to enable
which are very timely given the current measurements of corrosion to
debate on metal-on-metal systems. We be monitored as the movement
occurs. This is the first time this
were the first group to be able to
has been done and it has
monitor corrosion in a hip joint
significantly increased our
simulator and this has enabled us to
ability to understand
understand corrosion processes in a
corrosion processes.
way that was not possible before this
advance. We have found that contact
Why did you choose
between ball and socket can
to do this work?
significantly accelerate corrosion (called
I got into this work
biotribocorrosion) and that proteins in
through my corrosion
synovial fluid can protect the surfaces
work aligned with the oil
by forming a very thin reacted layer.
31
Fundraising
Get
involved
Marathon success
The millions of TV viewers who watched
the Virgin London Marathon couldn’t fail
to have noticed Arthritis Research UK’s
presence in this year’s event – thanks to
both the participation of Major Phil
Packer and a number of vivid orange
banners – in the new brand colour –
along the 26-mile route.
Major Packer, who suffered severe spinal
cord injuries in Iraq in 2008, walked the
marathon in 26 hours in support of 26
charities, and chose young rheumatoid
arthritis sufferer Cat Bull to walk the first
mile with him on behalf of Arthritis
Research UK.
Cat, aged 22, from Cobham in Surrey, a
third year medical student at Leeds
University, who had to have a hip
replaced two years ago, was struggling
to walk at all in the months before the
Cat Bull and Major Phil Packer at journey’s end
marathon because the condition had
affected the joints of her feet but she
£90,000 from their fantastic efforts once
was determined to not only walk the first Mum Penny, who with the rest of Cat’s
family joined a number of Arthritis
all the money is collected in.
mile but run the remaining 25 miles.
Research UK staff to cheer her on, added:
Said community and events fundraising
Despite suffering a knee injury around
“It was a fabulous experience for all of
the six-mile point, she struggled bravely us. Cat and Phil got on really well and the manager Gabby Bailey: “We would like to
on with her knee strapped up. Cat went first mile flew past. In fact they had
extend a huge ‘thank you’ to our runners
back the next day to join the 25 other
allotted 40 minutes to complete the first who completed this year’s London
young representatives from the other
mile but they walked it in 20 minutes!”
Marathon in support of Arthritis
charities to accompany Phil Packer on
Research UK, and to Major Packer for
A month after the marathon Cat went
the final 365 yards of the course and
down with a severe throat infection that choosing us to be one of the charities to
crossed the finishing line for the second laid her low in hospital, but was still
benefit from his amazing achievement.”
time – on crutches.
expecting to be well enough to
complete another challenge – getting to
A ‘fabulous experience’ the top of Mount Kilimanjaro in June.
“The charity’s post-marathon massage at She hopes to raise £2,000 for Arthritis
Research UK by the end of 2010.
the QEII Centre really helped me
afterwards, but it still took me a couple
“A huge thank you”
of days to get over it,” said Cat, whose
inspiring story appeared in a number of Cat was one of 59 runners taking part in
local papers as well as regional TV and
the London Marathon for Arthritis
Research UK and we hope to have raised
radio.
32
A growing relationship
NGS Gardens Open for
Charity (The National
Gardens Scheme) has
chosen Arthritis Research UK
as its charity of the year for
2010. Keen gardener, arthritis
sufferer and NGS trustee
John Hinde explains how
gardening gave him a new
lease of life.
John Hinde and wife Ann in their garden on the Wirral
When arthritis struck John Hinde he
found his salvation in gardening.
A 25-year-long battle with severe
reactive arthritis meant the formerly fit
squash and tennis playing runner had
to turn to the gentler but equally
satisfying pleasures of tending his half
acre garden with wife Ann.
Eight years ago the couple opened
their garden in the suburb of Gayton
on the Wirral to the paying public on
behalf of the NGS Gardens Open for
Charity for the first time. Since then
John joined the NGS as first a volunteer
and then a trustee, keen to spread the
message that gardens can provide
effective therapy for people with both
physical and mental disabilities, and
played a key role in selecting Arthritis
Research UK as one of NGS’s charities of
the year.
A former managing director of a
technical services company, now aged
66, John had always been interested in
gardening but turned to it in earnest
when the couple moved to their
present home, Maylands, with its half
acre plot, in 1998.
“Fifty years earlier it had been a
wonderful garden but it had become
very overgrown,” says John. “So we got
stuck in. For me, as someone with
arthritis, the great thing about
gardening is that you can do it at your
own pace; you can do a bit of pruning,
a bit of planting, and digging, you can
always vary your activities and if you
get tired you can sit down. So even
though I was no longer sporty I
maintained my weight and a
reasonable level of fitness.”
Earlier this year, however, John’s
arthritic hip became so painful that he
had to have it replaced. The operation
was a complete success, and although
he had to get someone in to keep the
garden up to scratch for six weeks, he
made a speedy recovery and was soon
able to pick up his fork and trowel
again. In May the garden, complete
with herbaceous border, lawns, pond
and fruit trees, was opened to the
public on behalf of NGS and attracted
nearly 400 enthusiastic visitors.
The key to a good garden is tending it
on a regular basis, doing little and
often, advises John. “I’m out there
if not every day, then every season,
I don’t stop in winter, I’m always doing
something; trimming, tidying and so
on. I never stop.
“I think gardens are terrific therapy
particularly for people with arthritis –
both doing your own garden and
visiting other people’s. It’s all about the
rhythm of the seasons, and bringing
people back to what’s important.”
Professor Alan Silman, medical director
of Arthritis Research UK adds:
“Gardening is very important to lots of
our supporters, so there’s a real synergy
between our charity and the NGS. Our
supporters can have an enjoyable day
out visiting one of the many open
gardens near to them – knowing that
we will benefit as a direct result.”
• More than 3,700 gardens are open on behalf of NGS in 2010.
• In 2009 the NGS donated £2.5m to charity
• Over 2,500 of the gardens opening for the NGS provide tea and cakes!
To find out more about NGS including
the NGS open garden nearest to where
you live go to www.ngs.org.uk Look
out for free County Booklets in tourist
offices and garden centres or buy a
copy of the NGS Yellow Book, from
www.ngs.org.uk or call 01483 211535 or
available from all good bookshops.
33
“I have to keep fighting.” Krysia-Maria
You can support Krysia-Maria today.
Krysia-Maria dreams of one day enjoying what
she does without having to block out her
chronic pain.
Her fight to make the most of life is truly
“I need to
inspirational. Krysia-Maria has learnt to
block out the pain and keep busy as a
take 23 tablets So it is for people like her and the millions
way of dealing with her severe osteoof other arthritis sufferers that we launched
to
get
through
arthritis. This determination has given
the National Pain Centre in Nottingham.
the
day.”
her the chance to follow in her father’s
You can read about the centre in the
footsteps and use her passion for
‘Focus on Nottingham’ article in this
photography. She tells Arthritis Research UK
magazine. It explains how essential the
just how photography makes her feel:
centre is for finding more ways to relieve
the unbearable pain that so many have to endure,
“The extreme throbbing in my fingers during photo shoots
day in, day out.
is so intense it makes me want
to scream. But when I see what
As you may already know, we receive NO government
I’ve captured through my lens,
funding and depend entirely on donations from people
for a few seconds the pain
like you. Without your kind donations, vital projects like
melts away and I’m happy
the centre in Nottingham wouldn’t exist.
inside and out.”
As the party started swinging, it was
clear who had taken their Jointace ...
®
If you can make a much appreciated cash donation today, by completing the
form below, you’ll be helping to take the pain away for the millions of arthritis
sufferers like Krysia-Maria.
I want to support Krysia-Maria
and other arthritis sufferers
Please fill in this form and post it to: FREEPOST SF671, Arthritis Today, Arthritis Research UK,
PO Box 177, Chesterfield S41 7BR.
Title (Mr/Mrs/Ms/Other)
Initials
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