Dr Kulveer Mankia

Profile

I qualified in medicine from Oxford (Magdalen College) with first class honours and undertook general medical training at the Oxford University Hospitals where I was a NIHR academic clinical fellow. Basic science research in molecular imaging of early inflammation was carried out as part of this fellowship. I was also awarded a Postgraduate Diploma in Health Research from the University of Oxford. After specialty training in rheumatology at the Nuffield Orthopaedic Centre, Oxford, I was awarded the Doris Overend Throup Scholarship for research into rheumatoid arthritis, which brought me to Leeds to undertake research on preclinical rheumatoid arthritis. My doctoral research was focused on characterising individuals at risk of developing RA. This included investigating periodontal disease and periodontopathic bacteria as risk factors for RA, and imaging studies on palindromic rheumatism patients. I oversee the Leeds CCP and palindromic rheumatism cohorts and two proof-of-concept industry-partnered clinical trials which are in progress. I continued my research on preclinical RA and RA prevention as NIHR academic clinical lecturer and was appointed Clinical Associate Professor and Honorary Consultant Rheumatologist in 2019.

Research interests

My research is focused on preclinical RA and RA prevention. Within this area I have a number of current interests and collaborations:

Periodontal disease and periodontopathic bacteria in individuals at risk of RA

I am interested in whether periodontal inflammation may trigger RA-related autoimmunity in at risk individuals. I collaborate with Leeds Dental Institute (Prof Val Clerehugh, Dr Aru Tugnait, Dr Alastair Speirs, Dr Stefan Serben) and oral microbiology (Prof Deirdre Devine, Dr Thuy Do, Dr Josie Meade) as part of the multidisciplinary RA-perio group. We have performed comprehensive periodontal assessments and subgingival plaque sampling in anti-CCP positive at-risk individuals and identified an increased prevalence of periodontal disease and periodontopathic bacteria in this individuals compared with controls. I am collaborating with Prof Kim Midwood (Kennedy Institute, Oxford University) on a mechanistic study using mass spectrometry to better understand citrullination at the oral mucosa.

Mucosal autoimmunity and novel biomarkers

I am investigating the localised autoimmune response at the oral and lung mucosa in individuals at-risk of rheumatoid arthritis. I have detected IgA anti-CCP antibodies in the saliva of at-risk individuals and am now investigating whether these same individuals also have sputum autoantibodies.

Palindromic rheumatism

I have recruited a regional inception cohort of palindromic rheumatism (PR) patients (~100 recruited). I have investigated the imaging phenotype of palindromic rheumatism and shown that this is distinct from rheumatoid arthritis on ultrasound and MRI. This has implications for refining the diagnosis and management of PR. I am currently working with Dr Frederique Ponchel and Dr Sinisa Savic to better understand the genotype and gene expression signature of PR and its relationship with RA. An interventional study (clinical trial with a IL-1 inhibitor) is also in progress. 

Imaging

I am interested in the use of high resolution imaging (ultrasound and MRI) in indivduals at-risk of RA. These techniques help us understand disease pathogenesis and are also valuable prognostic biomarkers. I have recently shown that extracapsular inflammation of the interossoeus hand tendons is prevalent in at-risk individuals without clinical synovitis, suggesting RA inflammation may intially present outside the joint capsule.

Qualifications

• BMBCh
• MA (Oxon)
• DM
• MRCP
• PGDip Health Res

Professional memberships

• MRCP
• BSR
• MPS

Student education

I teach undergraduate medical students on the rheumatology curriculum. I am member of the question writing group for MRCP rheumatology (part 2).

Research groups and institutes

• Leeds Institute of Rheumatic and Musculoskeletal Medicine
• Inflammatory Musculoskeletal
• Biomedical Imaging Science