Understanding palindromic rheumatism: defining the impact, identifying the phenotype and establishing research priorities

Description

Aims: Palindromic rheumatism (PR) is a poorly understood condition which results in sporadic joint pain which eventually resolves. The aim of this work is to (i) understand the impact and progression of symptoms from the patient perspective; (ii) to identify key features which may predict the diagnosis and progression of PR; and (iii) to develop strategic priorities for research into PR.

Method

This application is a collaborative, tripartite approach to understanding the drivers of palindromic rheumatism and to build capacity for future research. First, we will explore PR from a patient perspective: in Birmingham, we will conduct qualitative interviews with patients to determine the symptom profile and impact of PR, including issues around uncertain diagnosis and unnecessary treatment. We will identify candidate biomarkers in order to establish predictors for accurate and efficient diagnosis of treatment. Using existing databases in Leeds, we will identify patients with PR and explore candidate biomarkers including serological, imaging (ultrasound and MRI) and immunological assessment. Finally, we will establish a PR Research Network, bringing together four key early inflammatory research centres (Leeds, Birmingham, Newcastle and Glasgow), patient partners (Leeds Musculoskeletal Biomedical Research Unit PPI Group, Birmingham Rheumatology Research Patient Partnership and the Palindromic Rheumatism Facebook Group) and Arthritis Research UK to develop a national collaborative research group who will prioritise research questions and develop a capacity building strategy specifically for PR.

Background

PR is a form of arthritis that results in intermittent joint pain and swelling: the symptoms often come in cycles, often moving from one joint to another. While the symptoms may then resolve without the need for long term treatment, a small proportion of patients later develop rheumatoid arthritis. Given the nature of the symptoms, there are frequently delays in diagnosis and inconsistencies with treatments. Even though PR has been long identified as a problematic condition, very little research has been undertaken into this area. A better understanding of palindromic rheumatism would facilitate prediction, and therefore appropriate management. This, together with an improved understanding of the disease process could help to inform future development of novel therapies, with the conversion of clinical arthritis to self-limiting disease as occurs in palindromic rheumatism a major ambition of therapy.

People

Professor Anne-Maree Keenan, School of Healthcare, University of Leeds, NIHR Leeds

Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Primary Investigator:  Professor Paul Emery, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Professor Maya Buch, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Dr Jackie Nam, Consultant Rheumatologist, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Dr Rebecca Stack, University of Birmingham

Professor Karim Raza, University of Birmingham

Dr Laura Hunt, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Co-Applicant: Dr Ai Lyn Tan, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust

Funding body: Arthritis Research UK: £94,220

Contact: Anne-Maree Keenan