New clinical studies to help diagnose and treat arthritis effectively

We know that people living with arthritis and related conditions urgently need better treatments and faster, more accurate diagnoses. Getting the right care at the right time can make all the difference.

That’s why we’re thrilled to be funding three exciting new clinical studies, with a total investment of £1.2 million. These cutting-edge projects aim to:

• Use genetics to better predict heart disease risk in people with rheumatic musculoskeletal diseases.
• Understand why knee osteoarthritis progresses faster in some people, helping to personalise treatment.
• Spot cardiovascular risk early in people with gout, so we can step in sooner.

Each of these studies brings us closer to more precise, proactive, and personalised care.

In this article you can find out more about these game-changing projects.

Using Genetics to improve the accuracy of predicting which patients with rheumatic musculoskeletal diseases are more likely to have cardiovascular disease. - Project by Dr John Bowes

Some people living with rheumatoid arthritis (RA) and other rheumatic musculoskeletal diseases (RMDs) such as lupus or gout are at higher risk of developing cardiovascular disease (CVD). However, existing tools that estimate CVD risk are not accurate for individuals with long-term inflammatory conditions. As a result, these patients may not receive timely preventive care, potentially leading to avoidable complications.

What is the problem?

Current CVD risk prediction models are designed for the general population and don’t perform well in people with RA, even when adjusted to include RA as a risk factor. This means that patients may be incorrectly assessed, either underestimating their actual risk leading to missed opportunities for early intervention or overestimating their actual risk leading to people being incorrectly categorised as high risk and given unnecessary treatments.

How could genetics help?

One promising solution is the use of genetic risk scores. These scores estimate a person’s inherited risk of developing a disease based on small changes in their DNA. Each genetic variant adds a small amount of risk, and when combined, they create an overall score that reflects a person’s predisposition to conditions like CVD.

In the general population, genetic risk scores have been shown to improve the accuracy of CVD prediction, especially when combined with existing tools in what’s known as an Integrated Risk Tool (IRT). Previous research by this team suggests that IRTs may also be beneficial for people living with RA.

What will the researchers do in this study?

This project aims to explore how genetic risk scores can be used to improve CVD risk prediction for people with RMDs. Specifically, the researchers will:

1. Assess whether integrated risk tools will be beneficial for all RMDs, not just RA, to ensure more people with chronic inflammatory conditions benefit from better risk assessment.
2. Examine performance across genders and ethnic backgrounds, to ensure the tools are accurate and equitable for diverse populations.
3. Develop new, tailored approaches for estimating CVD risk specifically in patients with RMDs.

How will this benefit people living with rheumatic musculoskeletal diseases?

Improved prediction of cardiovascular risk means that people with RMDs could receive earlier, more targeted care to prevent serious complications. If successful, these tools could be introduced into clinics and used in routine care to better protect the cardiovascular health of patients with inflammatory conditions.

The STEP FORWARD Study – Helping to Personalise Treatment and Prevent Progression of Knee Osteoarthritis. - Dr Fiona Watt

Knee osteoarthritis (OA) is a common condition that affects millions of people in the UK. The surprising thing is that over half of those with knee OA don’t get worse over time. But right now, we don’t have a way to test or predict who will progress.

The early stages of OA, when someone has knee pain but not much visible change on an X-ray, is the best time to step in and stop things from getting worse. Currently, clinical trials in osteoarthritis may fail to find  new treatments because they bunch everyone with osteoarthritis together, including people who don’t get worse.

While we know that factors like age, sex, and body weight can influence OA progression, they’re not enough to tell us who is personally at risk. Being able to test for the chance of getting worse through personalised tests would help target clinical trials of treatments at the people most likely to benefit. It would help people with knee osteoarthritis and their health professionals have a clearer picture about the future, allowing best treatment options to be offered early.

What does this research aim to do?

The STEP FORWARD study is looking for biological “markers” (measurable signs in the body) that can predict who is likely to have worsening knee osteoarthritis. Being able to identify these markers early could:

• Help match people to the right treatments.
• Make clinical trials more effective by including the right participants.
• Allow doctors and patients to better plan treatment and care.

How will they do this?

The researchers, based at Imperial College London, Department of Immunology and Inflammation, are especially interested in knee (synovial) fluid, which surrounds the knee joint. Because this fluid is so close to the tissues involved in OA, it can give us better information than blood tests alone. Proteins found in this fluid may be key indicators of whether someone’s OA will get worse.

They will follow people with early-stage knee OA over 2–5 years and track:

1. Changes in knee pain (especially pain that doesn’t improve).
2. Changes seen on X-rays.

They’ll study four groups of people (or ‘cohorts’):

1. People with early OA who previously had keyhole knee surgery.
2. Participants from an international study (STEpUP OA) who already had 7,000 proteins measured in their knee fluid.
3. A new group of people diagnosed with early OA.
4. People from the UK Biobank (a large research study) who are developing OA and have had proteins measured in their blood.

The team will compare protein levels in the knee fluid and blood with how people’s symptoms and X-rays change over time, to find patterns that predict who progresses in their knee osteoarthritis.

Throughout the study, people living with arthritis will help guide how the findings are used, ensuring future tests are useful in real-life clinical care.

How will this benefit patients with Knee OA?

If we can identify people who are most at risk of their Knee OA progressing, we can hopefully target treatments earlier and more effectively. It will also help researchers design better clinical trials for new drugs—by including the people who are most likely to benefit.

Improving prediction of cardiovascular diseases in people with gout to provide better access to preventative measures - by Professor Abhishek Abhishek

Gout is a common form of arthritis that affects 1 in 30 adults in the UK. It can cause episodes of severe joint pain, swelling and inability to use the joint for 1 to 2 weeks. People who live with gout are also at higher risk of heart attack, stroke, or dying due to these illnesses.

Recent research has shown that each gout flare is associated with a short-term increase in the risk of a heart attack, stroke or death due to these illnesses.

Despite this, currently, gout is not taken into consideration when assessing someone’s risk of developing heart disease or stroke.

Therefore, this research aims to identify the best method to predict the risk of heart disease and stroke in people with gout. This study will find out how well the methods currently used for assessing the risk of these illnesses perform in people with gout. Next, they will find out if their ability to assess the risk of these illnesses can be improved by also including gout and its severity as risk factors.

How do they plan to do this?

They will use anonymised information from the care of people in the NHS obtained using a database called the Clinical Practice Research Datalink (CPRD) which has data of electronic health records from over 38 million people in the UK.

They will identify people with gout registered in the CPRD and follow them up electronically to see how many people have developed heart diseases over a 10-year period after diagnosis.  They will also use currently used calculators to find out who was predicted at highest risk of heart disease or stroke and then compare it with what actually happened.

Next, they will modify the existing calculators by including whether the person has gout or not, and whether it is severe or not, to find out if such modifications improve their ability to assess the risk of heart disease and stroke in people with gout and also in the general population.

How will this benefit people living with Gout?

The findings of this study will hopefully facilitate a more accurate assessment of the risk of heart disease and stroke in people with gout and will hopefully result in earlier identification of those at a high risk of these illnesses . A better understanding of the risk of these life-threatening illnesses may lead to consideration of lifestyle modifications and treatment with medicines like statins that lower cholesterol level, thereby saving lives.

Your contribution is vital

Your donations  help us fund crucial research like this, aiming to effectively diagnose and treat arthritis.