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This month’s focus on our eLearning platform is rheumatoid arthritis (RA). We speak to Prof John Isaacs from Newcastle University, who talks to us about his career, how RA research is leading the way for other conditions, and how it will be possible to predict who develops RA in the future.

You have a number of professional roles; can you tell us more?

My primary role is Professor of Clinical Rheumatology at Newcastle University. Around 15 months ago, I also took on the role of Associate Medical Director for Research at Newcastle Hospitals. I oversee the entire research portfolio from a strategic point of view to embed research into everyday care. As well as being a consultant rheumatologist, I’m also the Director of Therapeutics North East.

My role involves bringing together the best knowledge throughout the region and encouraging collaboration with other academics and industry. I’m Deputy Director of the Newcastle Biomedical Research Centre and my other significant role is my Director of Research post at Newcastle Health Innovation Partners. My task there is to ensure that research is accelerated into adoption. I have lots of different roles, but they are very much interlinked.

Why did you choose rheumatology?

I initially trained to be a renal doctor and did my PhD in the field of immunology, focusing on manipulating the immune system to help transplants succeed. I saw some powerful work where monoclonal antibodies could switch off rejection and avoid the need for immune suppression.

I was interested in applying this philosophy to more common diseases. At the time, RA had nothing going for it in terms of treatments. I decided to experiment with these therapies in a common disease to see if we could transform management. I gave a TED talk a couple of years ago and you can hear more about my career and the patient who changed my life.

Why is RA so important?

RA is a relatively common condition where we can learn about principles of immunosuppression. Increasingly, we now recognise that a whole host of conditions have fundamental roots in inflammation, such as inflammatory bowel disease and psoriasis. Most inflammatory diseases have common roots in genetics and environment and the approaches taken will cross-fertilise from one to another. Rheumatology is leading the way and these other areas are learning from what we do.

What does the future look like for RA?

There’s still a long way to go, but there’s a bright future. Therapies have been important but what’s dramatically changed the course of RA treatment is early arthritis clinics. We’re treating the condition much earlier and changing outcomes. We can, to a certain extent, recognise patients who are going to develop RA. The tools aren’t perfect, but we’re increasingly confident that it should be possible to intervene and maybe prevent people getting rheumatoid altogether.

What advice would you give to people thinking about a career in research?

Follow your curiosity and enthusiasm. Some people think that research is intellectually difficult, and it doesn’t need to be. Personally, I think it’s important to be involved in research because it broadens your horizons and brings variety to the job. You’ll be successful if you can follow your instincts and are prepared to dedicate the time.

How has COVID-19 affected your research?

We had to pause a lot of our research. But we’ve found solutions, such as students' work being extended, and I hope in the long term there won’t be any major fallout.

In terms of COVID-19 research it’s been fantastic. I took over as Director of Research in January 2020 and couldn’t have predicted what was going to happen.

We may have had to pause our usual research, but we ramped up all the COVID research. We recruited more than four thousand patients to vaccine research alone in Newcastle. COVID has shown us that research is important, it can happen quickly if the will is there, and it can make a huge difference.

How has your clinical work changed?

It’s obviously been a difficult time for everyone, but some positives have come out of it. We’ve been using telephone clinics and while they don’t replace face-to-face, there can be some advantages. My patients come from all around the North East and for much of my career I’ve wondered why stable patients have had to travel hundreds of miles to see me. Examination is incredibly important, but I increasingly recognise that if you have a good history and know your patients, then you only need to examine when necessary.

If during a telephone consultation the patient has said something or I’ve picked something up, then I’ll bring them in for a face-to-face. But for stable patients, it makes sense to do remote consultations. One of the other good things that has come out of COVID-19 is the need to look at how we deliver care. There’s no perfect solution, but I think a mixture of face to face and remote consultation is going to be the way of the future. Healthcare delivery is an important area of research and COVID-19 has brought that into focus.

Many thanks to Prof Isaacs for sharing his RA expertise. Improve your knowledge on the condition and boost your CPD by visiting our eLearning platform. This month you can benefit from a wealth of resources including a webinar and podcast talking about RA treatment decisions, suggested journal reading to keep you up to date, and an eLearning case to test your knowledge.

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