The
Department
The aims of the Birmingham Department of Rheumatology
are:-
l) To provide a centre of excellence for rheumatological research, concentrating
on immunological aspects of the aetio-pathogenesis of the chronic inflammatory
arthritides (CIA) and related systemic connective diseases. The prime need is
to increase the understanding of disease mechanisms so as to improve therapy,
with the overall goal of eventually providing complete control or cure of the
disease.
2) To provide a Clinical Referral Centre, again with a strong academic thrust,
for the study and management of the rarer connective tissue diseases especially
vasculitis; the arthritides of childhood; and the evolution of early/acute arthritis
and of the complications of the common CIA's.
3) To teach clinical and research aspects of Rheumatology/clinical immunology
to medical and particularly postgraduate students.
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Rheumatology Department Staff
Hospitals Key -
*Dudley Hospitals
- Green = Birmingham Children's Hospital
- Blue = Selly Oak/Queen Elizabeth Hospital
- Red = City Hospital
- Pink= Sandwell General Hospital
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History of the Department
The Department of Rheumatology was founded in l98l following a £0.5M endowment
from the Arthritis Research Campaign . This money
was largely raised within the West Midlands by local ARC branches. The driving
force behind this was the statistics which showed there was less provision of
rheumatological care in the West Midlands than in an any other U.K. Health Region.
For example there was less than one consultant rheumatologist per million of the
population in the most populous health region, although the national average was
a fifth of that and the norm was l per l50,000 of the population. On the positive
side there existed within Birmingham University strong departments with relevant
research expertise, derived from the Experimental Pathology empire of John Squire.
In particular, within the Departments of Immunology and of Investigative Pathology
there were interests in autoimmunity, rheumatoid factors etc.
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Relationship to the NHS
The decision to set up a Rheumatology Department in the Medical School at Birmingham
- with ARC, University, and NHS involvement - was taken as a step to promote the
expansion of the speciality in the Midlands. A plan was worked out with considerable
care to provide an improved service at minimal cost. This was based on the concept
of concentrating the specialist care necessary for chronic disabling disease in
Sub-regional Rheumatology Centres each serving more than one District. The policy
was supported by the Regional Health Authority, but after an initial pump priming
regional funding for the necessary expansion was not found. The Birmingham Sub-regional
Rheumatology Centre was designed to cater for the rheumatological needs of a planned
population base of l.4 Million - the majority of the City of Birmingham. This
large centre had to face up to several interlocking tasks. It was essential to
provide care for the chronic incurable crippling diseases that make up a large
part of the burden of arthritis. In addition it was logical for the sole academic
unit in the Region to provide a focus of care and research for the rare acute
life threatening rheumatic syndromes and complications which few individual physicians
see enough of to gain a reasonable experience - but which are potentially treatable
in expert centres. Finally it was essential that the Academic Department developed
a strong research programme to improve basic understanding of disease mechanisms,
with the intention of improving therapy for patients in the future.
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Clinical Activities.
The Rheumatology Department started with a Professor, Secretary and Technician
provided from the endowment, together with a Senior Lecturer and Lecturer from
NHS funding. In addition to the research commitment and teaching within the University
there was a strong desire on the part of the Regional Health Authority to expand
the Rheumatological base within the region. The number of Consultants has now
tripled, with a steady increase in Rheumatological facilities across the Region.
The developments within the Department have included the appointment of a Senior
Lecturer in Paediatric Rheumatology - the first such specialist children's academic
appointment in the country which subsequently led to a Chair of Paediatric Rheumatology;
a second Clinical Lecturer; a non-Clinical Lecturer - from the new blood allocation;
and most recently the appointment of two Senior Lecturers with a strong commitment
to clinical science. In addition new NHS consultants have been appointed in Birmingham
and given Honorary Clinical Senior Lecturer status.
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Facilities.
The Rheumatology Department has its own well founded laboratories on two floors
of the Clinical Research Block. The equipment includes facilities for cell culture
and molecular biology, flow cytometry, microscopy, surface plasmon resonance (BIAcore)
and high field NMR spectroscopy. Extensive collaborations and centralised Medical
School facilities ensure easy access to further expertise and equipment. There
are now over 40 personnel in the Department involved in research. This incorporates
an important mixture of clinical and non-clinical scientists, including clinical
fellows studying for a PhD. Close integration is maintained between our clinics
and our laboratories. It is thus easy to move directly from clinic to cell culture
and molecular biology, ensuring the integration of clinical and basic science.
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New Treatments - Anti-TNF therapies
Tumour Necrosis factor has emerged as a key molecular target for the treatment
of rheumatoid arthritis. Two effective new therapies infliximab (Remicade) &
etanercept (Enbrel), the first of their kind as biological response modifiers
and disease controlling anti-rheumatic therapies, have become available this
year for the treatment of severe resistant rheumatoid arthritis.
This document provides information to justify the funding of anti -TNF therapies
in order to treat severe, resistant rheumatoid disease.
Guidelines for the use of anti-TNF have been prepared by a Working Party of
the British Society for Rheumatology. The aim of these guidelines is to ensure
that these new therapies are introduced in a systematic way, for patients with
active disease who have failed to respond to standard therapy, with careful
monitoring of the medical, social and economic impact.
A national disease registry, which will be fully audited, is proposed to monitor
potential toxicity. The financial costs of 4 options for the phased introduction
of anti-TNF therapy are provided. These are derived from accepted incidence
and prevalence data using an algorithm based upon estimated response by patients
to standard therapy for RA, prior to use of anti-TNF therapy.
Click here for more information
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Department of Rheumatology, Copyright 2001 University of Birmingham.
UK
Staff Pages created by Daniel Situnayake.