Research background

My background reflects a rigorous training in Clinical Medicine (BMBCh, FRCP and CCST in Rheumatology) and Science (BA in Physiological Sciences (Immunology, Cell Biology and Pharmacology) and PhD in Rheumatology). I undertook my general professional training in Oxford and Nottingham (1993-1996) where interaction with Prof John Savill focused my interest in pathogenic mechanisms of inflammatory disease. In 1997, I was appointed to the West Midlands Rheumatology Specialist Registrar Rotation and in 2000, was awarded an arc Clinical Training Fellowship under the supervision of Prof Mike Salmon to study mechanisms driving the establishment of persistent synovial infiltrates in early inflammatory arthritis and predictors of outcome. During this time I established the Birmingham Early Arthritis Cohort, which I continue to run with my colleague Dr Andrew Filer and which forms the basis for much of my own research and the research of the wider Birmingham Rheumatology Research Group. This cohort has provided the clinical substrate underpinning numerous awards to our group, for example the Arthritis Research UK Experimental Arthritis Treatment Centre and the Arthritis Research UK Centre of Excellence in the Pathogenesis of Rheumatoid Arthritis awards.

Current research interests

My research continues to focus on rheumatoid arthritis, the most common of the chronic inflammatory joint diseases. Within this disease area, my research addresses pathogenic mechanisms, biomarker development and strategies to enhance clinical outcomes for patients with a new onset of disease. Specifically I am interested in:

1. Mechanisms driving the molecular basis for the switch to disease persistence and the timing of this switch in early arthritis. Ongoing work with my colleague Dr Andrew Filer, using ultrasound guided approaches to biopsy synovium from the earliest inflamed joints, is addressing disease mechanisms with a focus on the role of leukocytes and stromal cells in the early rheumatoid lesion. Within the MRC Centre for Immune Regulation, I am currently a Principal Investigator for the theme “Lymphoid cell/stromal cell interactions”.
2. Predictors of outcome in patients with early inflammatory arthritis. Working with patients in the Birmingham Early Arthritis Cohort, I have contributed to the development of internationally validated predictive algorithms and work actively on the development of better approaches to outcome prediction using a range of techniques including clinical assessment, imaging modalities and tissue / fluid based biomarkers.
3. Novel anti-inflammatory mechanisms that may be useful in the control of persistent inflammation, including vitamin D and endogenously generated glucocorticoids.
4. Management pathways for patients with early rheumatoid arthritis, in particular the development of strategies to facilitate rapid patient assessment.