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Rheumatology Group
Summary

Arthritis is a leading cause of joint deformity and disability that affects up to 15% of the population, 2% suffering from inflammatory forms such as rheumatoid arthritis and psoriatic arthritis. Arthritis is the most common cause of pain in our society especially in the elderly, a section of the population expanding rapidly in the next decade. Arthritis reduces mobility and therefore increases social isolation, furthermore it is associated with significant co-morbidities including psoriasis, diabetes and obesity also increasing in prevalence. Over the years major advances in the understanding of the pathogenesis of rheumatoid arthritis at a cellular level have been made. This has seen the advent of the biologic therapies including anti-cytokine agents such as anti-TNF-alpha therapy. However, these novel treatments are expensive, placing further strain on an already over-stretched health budget, are partially effective with efficacy in 30% of patients and may be associated with serious and unacceptably high rates of adverse effects such as tuberculosis and other opportunistic infections. The costs of arthritis to both the individual and society are high, both direct and indirect. These include the economic and social costs, drugs, hospitalisations, lost workdays and the costs to family and carers too. The cost to patients is very high in terms of reduced quality of life. Therefore new treatment strategies are required to improve outcome in unresponsive patients and reduce toxicity. Development of more targeted and effective therapies for the treatment of arthritis will have considerable benefit for the individual in terms of quality of life and for society as a whole in terms of economic and social benefits.

The Rheumatology Research group has a primary clinical focus on early, inflammatory arthritis and a scientific focus on mechanisms of angiogenesis, inflammation, Giant Cell Arteritis, Metabolic Turnover and joint damage. The main aim of the group is to:
 

(i) identify biomarkers that may (a) predict disease outcome, (b) disease response and (c) remission,

(ii) using novel models of arthritis, in vitro, ex vivo and in vivo, to identify mechanisms involved in the pathogenic process of inflammatory arthritis, with particular emphasis on (a) angiogenesis, (b) hypoxi- induced mitochondrial pathways, (c) novel mediators/cytokines involved in cartilage destruction,

(iii) pre-clinical proof of concept studies in collaboration with industry partners, using novel ex-vivo synovial explants model  and transcriptomics to identify potential new therapeutic targets,

(iv) develop new imagining techniques. The importance of PET/CT imaging to health care and research is increasingly recognized. Acquisition and visualisation MRI protocols have been successfully standardised. We are developing innovative software in collaboration with the radiological group in UCD to analyse hybrid PET/CT images fused with MRI to quantify metabolic activity and blood flow for direct comparison to clinical status, tpO2 and molecular outputs in arthritis patients.