Bringing research to life – an interview with Professor Frances Williams

Frances Williams stood next to a Versus Arthritis sign.

We’re committed to funding vital research projects to help to make a difference now and in the future for people living with arthritis.

For the first in our Glass Box series showcasing our research work, we chatted to Professor Frances Williams (King’s College London) to find out more about her work as a consultant rheumatologist. Frances is a specialist in genomic epidemiology - looking at genetic factors which can determine health conditions - particularly ones which cause chronic pain, such as osteoarthritis of the spine, rheumatoid arthritis and osteoporosis.

Her work has involved carrying out research to see how the bacteria which live in our gut, mouth and elsewhere on our bodies (collectively called the “microbiome”) may affect our immune system and lead to the development of certain diseases, including rheumatoid arthritis. More knowledge and learning in these areas will help to develop better treatments for arthritis and manage symptoms such as chronic pain.

Tell us more about how you got into this work and the research you’ve worked on with Versus Arthritis? 

I got my BSc in Clinical Sciences in the early 1990s and I knew then that I wanted to work in rheumatology research. I found it interesting as it covers such a breadth of topics including arthritis, osteoarthritis, gout to chronic back pain.  

I was fortunate enough to get funding from Versus Arthritis to complete my PhD and it was at this time when I decided I wanted to focus on common conditions and genetic epidemiology in particular. 

Since then I’ve been involved in a lot of research looking at back pain which has a massive impact on society from people’s ability to work to the high cost of healthcare. 

What is significant to the progress of this work is having access to big data sets, such as TwinsUK, the UK’s largest twin registry researching the genetics of aging and complex diseases. This has meant we’ve been able to take a robust look at what a difference genetics makes, what the risk factors are and how areas like stress can have an impact. 

The biopsychosocial model was first described decades ago in back pain and is a more person-centered approach looking at the condition together with psychological, social and environmental factors. A tool called the StARTback tool helps GP identify who is at greatest risk and what treatments will offer the improvements to people living with back pain from doing more exercise to changes in diet.

Can you share what you’ve learnt about arthritis and the microbiome? 

We have found that the microbiome plays an important role in health and disease, microbes outnumber our own cells and they are on us and in us. A long list of diseases including inflammatory bowel disease, diabetes and obesity, have been associated with immune system disturbance that have resulted from changes in the microbiome. Rheumatoid arthritis is also on this list.

Our research is looking at people who’ve been newly diagnosed with rheumatoid arthritis at hospitals all over the UK. We’re following them over time, focusing how the microbiome changes at 3 / 6 months intervals following treatments on certain disease-modifying drugs e.g. methotrexate. We are very interested in discovering more about the relationship of microbiomes, rheumatoid arthritis, environments and levels of genetic risk factors, which we can study in Twins who have rheumatoid, particularly if their co-twin doesn’t. We have over 20 pairs of twins with disease mismatch on our register and are always on the lookout for more. Watch this space to find out more on what we find out… 

What is a typical day is like for you? 

There is not really a typical day, if I am honest! Mostly it will be a combination of university work, looking at data, paper writing and reviewing manuscripts. I regularly meet with project colleagues to make sure all our projects are going well and recruitment to studies on track. I get involved in trouble shooting and seeing my post-doctoral students. I am lucky enough to attend conferences too and get to share our work with other researchers in the UK and across the world. To be able to work collaboratively and bring together research contributions is so important as it helps us to achieve so much more. Our recent back pain work included over 500,000 participants and over 15 different academic groups across the USA and Europe.

What are you most proud of in terms of your work with Versus Arthritis and what are you excited about for the future?

Versus Arthritis has helped me get to where I am in many ways from my PhD to the initial funding for TwinsUK, to the research I am involved in today. The work on the microbiome is a game-changer and getting the strategic award from the charity has had a considerable impact on my career. It’s now my turn to say thank you!

I think the future of good medicine is very much focused on our listening to patients better – we know they say that fatigue and having more energy would make all the difference to the quality of their daily life. Also, managing pain and sleep are big priorities for people.  The emphasis needs to be on addressing these broad constellations of symptoms which may require a different approach from the traditional ‘disease control'.

We need to keep GPs involved and updated with developments, to work hard on expanding and embedding educational programmes to enable people to feel empowered to make a difference to their own lives. For example, taking part in peer exercise workshops and coming together with others who are in a similar situation can often provide much needed local social support and a sense that people are not alone with their problems

We need to continue to learn more about the importance of diet and health, this was highlighted in a recent edition of Radio 4’s Food Programme on the food and medicine debate.

It’s an exciting time to be in rheumatology research and we are optimistic about our ongoing studies to help develop more understanding and new treatments which will change the way arthritis and MSK conditions are managed in the future.