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Thanks to a very effective collaboration with the GPs, the Early arthitis clinic, set up
in 2000 by Dr Karim Raza, usually sees the patients within a few weeks after their first
symptoms. — This gives us the possibility to gain knowledge of the early and very specific
mechanisms of the disease and perhaps find the answer to why 50 percent of such
early patients never actually develop RA, says Professor Chris Buckley. Professor
Buckley is a member of the AutoCure management group, and head of a group
of 25 people, a dynamic mix of basic researchers and clinicians. Four out of the six teams in the Birmingham RRG are part of the AutoCure project.

— I am a big fan of this modern way to do research. By combining skills and collaborating with other research groups you have a much better chance of getting good results. Even with some healthy competition between the AutoCure groups it’s a win- win situation. The partnership with AutoCure has facilitated our work in Birmingham, not least by funding one of
our excellent technicians, and new funding for a much needed research nurse. We
also collaborate closely with our partners in Amsterdam, Leiden, Switzerland, Sweden
and Austria. So far six of the lab staff have visited colleagues at the AMC in Amsterdam
and one in Zurich, says Professor Buckley, who is a perfect example of translational
research himself, having a dual role as clinician and research scientist. A significant part of the research in our group is based on two fundamental questions ”Why does RA persist and why does it have a predilection for the synovium?

— We know that more than half of our patients with early symptoms like stiffness and pain in the joints will get better without any treatment after six months. But the other half WILL develop RA or some other inflammatory disease. We want to find out why. Our best bet is that it is the stromal cells, the soil in which the white blood cells grow, which seems to
be abnormal, says Professor Buckley. Thanks to a seminal study on a cohort of patients with early disease the RRG team discovered that patients with a certain cytokine-profile are much more likely to develop RA than others. — This has only been known for about five years but now we are exploring whether patients with this particular cytokine-pattern should be treated with an aggressive therapy right from the start, says Professor Buckley and refers to Dr Karim Raza who is leading this part of the work.

— The key is to catch and identify
patients by taking blood and tissue-samples at a very early stage of the disease.
Thanks to the extensive network that we have built with a wide range of primary
care physicians, people are sent to our clinic as soon as they present to primary
care with RA-symptoms. —This makes it possible for us to do unique follow-ups, comparing those who develop RA and those who get well. Because we have samples from the onset
of the disease we have a unique chance to study and gain knowledge of the underlying
mechanisms in the inflammatory process.