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Irish research was a key focus of this year’s ISR Autumn meeting, with a significant number of oral basic science and clinical presentations from local researchers who had submitted their projects to the ISR for consideration for the research prizes.
One of those to present was Best Scientific Presentation prize-winner Dr Charlene Foley, National Centre for Paediatric Rheumatology, Dublin, who outlined her project on the comparison of B- and T-cell subsets, cytokine expression and synovial pathology in Down’s arthritis (DA) and juvenile idiopathic arthritis (JIA).
Dr Foley explained how a pathological feature of Down syndrome (DS) is dysregulation of the immune system, which almost certainly contributes to the observed high incidence of autoimmune diseases in this cohort: Previous work by her group suggests that the prevalence of DA is 18-to-21 fold greater than JIA.
Children with DA often follow an erosive, polyarticular course of disease, with small joint involvement observed in a significantly greater proportion of children than expected in a typical JIA cohort, Dr Foley noted. The DA clinical phenotype may be distinct from JIA, however little is known about the differences in synovial pathology or immunological regulation. No studies to date have examined these entities in DA, thus Dr Foley and colleagues examined B-cell subsets and T-cell cytokine profiles; and characterised and compared the synovial membrane immunohistochemistry in children with DA and JIA.
The study found that there are significant differences in B-cell populations, T-cell cytokine production and immunohistochemical features of synovial tissue in children with DA and JIA but more work is required to verify these results.
Dr Foley highlighted the need for awareness of the risk of DA in children with DS, as they are often diagnosed very late, by which time they have suffered irreversible joint damage.
“So in summary, DA does appear to be a distinct clinical phenotype with an increased risk compared to JIA. The majority of children present with a polyarticular rheumatoid factor-negative arthritis with predominance in the small joints of the hands and wrists… DA and JIA represent distinct conditions with different clinical features, immunology and synovial histology.”
The meeting also heard from the five inaugural (2017) winners of the new ISR research funding initiative, the Rheumatology Patient Initiative Fund (RPIF).
The initiative is intended for innovative researchers undertaking a body of research in rheumatology in Ireland that will directly impact on patient care and quality of life.
One of the RPIF 2017 winners was Prof Gerry Wilson, Consultant Rheumatologist in the Mater Misericordiae University Hospital and Professor of Rheumatology at UCD, who gave an update on the work of the Irish Arthritis Research Coalition (ARC). The ARC was established in 2016, and he highlighted how clinicians can help classify and stratify subtypes of diseases and identify patient cohorts to improve research quality and impact in Irish rheumatology. He briefly outlined the impressive research outputs already underway through ARC, including a number of projects in paediatric rheumatology, and a planned one on rheumatoid arthritis, with the primary aim of the ARC biobank to recruit patients with common rheumatic diseases, and obtain biosamples that will underpin clinical research. A secondary aim is to increase national involvement in clinical trials of novel therapeutic agents.
“The aim of ARC is really to undertake good clinical translational research, which we have seen in the great presentations here, highlighting the importance of having well-characterised clinical cohorts for undertaking patient-centred research,” Prof Wilson commented.