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Rheumatology Research Group awarded five year EULAR Centre of Excellence Status

Written by Louise Stanley on . Posted in Inflammation and chronic disease.

The Rheumatology Research Group (RRG) at BHP founder-member the University of Birmingham has been awarded five-year EULAR Centre of Excellence status for the second time in a row.

EULAR (European League Against Rheumatism) represents people with arthritis/rheumatism as well as health professionals in rheumatology and scientific societies across Europe.

The application reflects extensive collaboration across rheumatology departments at the University of Birmingham, Sandwell and West Birmingham NHS Trust and fellow BHP member University Hospitals Birmingham NHS Foundation Trust. The RRG was first awarded Centre of Excellence status in 2016.

Professor Karim Raza, RRG lead said, “The whole of the Birmingham Rheumatology Research Group is immensely proud that our EULAR Centre of Excellence has been renewed. This award is testament to the outstanding research carried out in Birmingham in the fields of rheumatoid arthritis, systemic lupus erythematosus and Sjögren’s syndrome with research programmes spanning the full spectrum from discovery science to experimental medicine to applied health research. Collaboration with other EULAR centres of excellence in the UK and across mainland Europe has been critical to our ability to deliver high quality Rheumatology research and we look forward to continuing and expanding those collaborations.”

The Centre of Excellence status will be valid until June 2026.

New study aims to improve healthcare for pregnant women with multiple health conditions

Written by Louise Stanley on . Posted in Health inequalities, Inflammation and chronic disease, Maternal health, Mental health.

BHP founder-member the University of Birmingham is leading a new three-year UK-wide study aimed at improving healthcare and outcomes for pregnant women who have two or more active long-term health conditions.

Currently, one in five pregnant women in the UK have two or more active long-term health conditions. These can be both physical conditions (like diabetes or raised blood pressure), and mental health conditions (such as depression or anxiety). Often women also have to take several medications to manage their different health needs.

The new study, called Multimorbidity and Pregnancy: Determinants, Clusters, Consequences and Trajectories (MuM-PreDiCT), aims to use data-driven research to characterise and understand what makes having two or more long-term conditions more likely for pregnant women and the consequences for mother and child; and to predict and prevent adverse outcomes.

MuM-PreDiCT will be divided into five research work packages:

      1. Examining how health conditions accumulate over time and identifying what makes a woman more at risk of developing two or more long-term health conditions before pregnancy.
      2. Exploring women’s experiences of care during pregnancy, birth and after birth, working together with families and health professionals to establish how care could be improved.
      3. Deeper delve into how having two or more long-term health conditions may affect pregnant women and their children by identifying outcomes that women, health professionals and researchers feel should be reported in research; examining how often women experience pregnancy complications; and exploring how frequently women and their children develop additional long-term ill health
      4. Investigating how taking combinations of medication may affect pregnant women with two or more long-term health conditions and their babies.
      5. Building a prediction model to help identify how likely a previously healthy pregnant woman will develop multiple long-term conditions after pregnancy.

Professor Krish Nirantharakumar, of the University of Birmingham’s Institute of Applied Health Research and Principal Investigator of MuM-PreDiCT, said: “Having two or more health conditions is becoming more common in pregnant women as women are increasingly older when they start having a family and as obesity and mental health conditions are on the rise in general.

“However, we don’t really understand what the consequences are of multiple health conditions or medications for mothers and babies.

“This can make pregnancy, healthcare and managing medications more complicated. Without deeper understanding of the problem, women with several long-term health conditions may not have the best and safest experience of care before, during and after pregnancy because services have not been designed with their health needs in mind.”

Dr Beck Taylor, Clinical Senior Lecturer at the University of Birmingham and Co-Investigator of MuM-PreDiCT, said: “Our research will provide valuable information to help women and clinicians make informed decisions and identify points for prevention and intervention. We will also explore the experiences of maternity care for women with two or more long-term conditions and work with families and health and social care professionals to produce recommendations on how to plan and design services that meet the needs of women and their families before, during and after pregnancy.”

MuM-PreDiCT is being funded via the £20M UK Research and Innovation’s (UKRI) Strategic Priorities Fund (SPF) initiative ‘Tackling multi-morbidity at scale: Understanding disease clusters, determinants & biological pathways’. SPF is delivered by the Medical Research Council and National Institute for Health Research in partnership with the Economic and Social Research Council, and in collaboration with the Engineering and Physical Sciences Research Council. It is jointly funded by UKRI and the Department of Health and Social Care, through the NIHR.

MuM-PreDiCT is being led by the University of Birmingham in collaboration with the University of Aberdeen, University of St Andrews, Swansea University, Queen’s University of Belfast, University of Ulster, The University of Manchester, Keele University, University Hospitals Bristol & Weston NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, and Guy’s & St Thomas’ NHS Foundation Trust.

Siang Ing Lee, Academic Clinical Fellow at the University of Birmingham and MuM-PreDiCT, added: “We would like to extend our heartfelt gratitude to our amazing patient and public involvement (PPI) advisory group and PPI co-investigators who will play an integral part in MuM-PreDiCT.”

a mother and daughter select healthy foods from a selection of fruits and grains

Increased risk of chronic kidney disease in people with ‘healthy’ obesity

Written by Louise Stanley on . Posted in Inflammation and chronic disease.

People with ‘healthy’ obesity have a 66% increased risk of chronic kidney disease compared to metabolically healthy individuals with normal weight, finds a new study led by the University of Birmingham.

Those that are metabolically healthy (do not suffer with metabolic conditions such as hypertension, diabetes, high cholesterol or cardiovascular disease) and are overweight but do not have obesity are at a 30% risk of chronic kidney disease compared to healthy people with normal weight, the study found.

The research also found that the increased risk was greater in those aged under 65, while also the more the number of the metabolic complications a person has the higher risk of chronic kidney disease even in the normal weight range.

The research, published in the American Journal of Kidney Disease, was carried out in collaboration with University Hospitals Birmingham NHS Foundation Trust and the University of Warwick.

The retrospective population-based cohort study examined the GP records of around 4.5 million individuals from the UK and tracked their health over an average of almost five-and-a-half-years. Of the 4.5 million individuals, 1,040,921 (23.4%) and 588,909 (13.2%) were metabolically healthy overweight and metabolically healthy obese, respectively.

Chronic kidney disease has a major impact on global health and cost the UK National Health Service £1.45 billion in 2009-2010. In 2017, 697.5 million people in the world had the disease, and it accounted for 1.2 million deaths. The prevalence of chronic kidney disease increased by almost 30% between 1990 and 2017, while the number of deaths caused by the condition rose by 41.5% in the same period. Similarly, the prevalence of obesity is also on the rise, tripling between 1975 and 2016.

First author Dr Jingya Wang, Research Fellow at the University of Birmingham, said: “Our results demonstrate that individuals with metabolically healthy obesity might have a higher risk of developing chronic kidney disease compared with normal weight individuals, especially those younger than 65 years.

“Looking to the future, a clinical trial of a weight loss intervention could be considered in these individuals to help us establish whether this can reduce their high risk of chronic kidney disease.”

Dr Abd Tahrani, Senior Lecturer in Metabolic Endocrinology and Obesity Medicine at the University of Birmingham, says: “It is likely that weight loss in people with metabolically healthy obesity is likely to reduce their risk of chronic kidney disease as it will also reduce their risk of future type 2 diabetes, and hypertension, both of which can worsen kidney function and result in chronic kidney disease, however this needs to be examined in future trials.

“In addition, we know from previous trials that weight loss in individuals with normal weight can reverse non-alcoholic fatty liver disease for example, hence weight loss could offer an important strategy to prevent obesity complications in this population.”

Dr Krish Nirantharakumar, also of the University of Birmingham, said: “Furthermore, our results suggest that individuals with normal weight who have metabolic abnormalities are also at a higher risk of chronic kidney disease and as such might benefit from meticulous metabolic control to reduce the risk of developing the condition.

“Ultimately, chronic kidney disease is largely preventable, and therefore, it is important to identify and treat the underlying modifiable causes and risk factors.”

This new study follows previous research led by the University of Birmingham and published in 2017 in the Journal of the American College of Cardiology which showed that individuals living with obesity who are metabolically healthy have an increased risk of cardiovascular disease events compared to those who are normal weight without metabolic abnormalities.

Neil Thomas, Professor in Epidemiology and Research Methods at the University of Birmingham, adds: “This new study and our previously published study together demonstrate that individuals who are metabolically healthy can develop organ damage over time.

“Therefore, metabolically healthy obesity should not be considered ‘benign’ or harmless and addressing obesity in metabolically health people might reduce organ damage including chronic kidney disease.”

Weight loss surgery significantly reduces brain pressure in patients with IIH

Written by Louise Stanley on . Posted in Clinical trials, Inflammation and chronic disease.

Weight loss surgery is more effective than dieting to reduce brain pressure that can cause blindness in patients with a neurological condition, finds a study led by Birmingham Health Partners founder-members the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust (UHB).

Idiopathic Intracranial Hypertension (IIH) is a debilitating condition that raises pressure in the brain and can lead to chronic headaches and even permanent sight loss. The illness, which often leaves patients with a reduced quality of life, predominately affects women aged 25 to 36 and weight gain is a major risk factor of developing IIH and relapses of the disease.

Weight loss has been shown to be an effective treatment, with a reduction in body weight of between three to 15% inducing disease remission. However, maintaining weight loss is notoriously difficult, as most patients regain weight over a two to five year period.

In the first clinical trial of its kind, the research team set out to analyse whether bariatric surgery or a 12-month community weight management intervention (delivered through WW) would be the most effective for reducing brain pressure in women with IIH.

The trial, supported by the National Institute for Health Research (NIHR), involved 66 women with IIH with an average age of 32 years and a body mass index (BMI) of 35 or more. Half underwent bariatric surgery, while the other half took part in WW. Brain pressure was measured by lumbar puncture at the start and after 12 and 24 months.

The results, published today in JAMA Neurology, showed that bariatric surgery was significantly more effective than community weight management, with those having had surgery seeing an average intracranial pressure reduction of 25% after 12 months.

The results also showed that the surgery group lost on average 23Kg, as compared to losing 2kg in the WW group at 12 months. This difference was greater at 24 months with 24% more weight lost in the surgery group as compared to WW. This was because the bariatric surgery group continued to lose more weight over time (28Kg from the start of the study to 2 years), whilst the community weight management group had regained weight lost and, on average, were only 1kg lighter than at the start of the study.

Senior author Alex Sinclair, Professor of Neurology at the University of Birmingham and Neurology lead of the Idiopathic Intracranial Hypertension Service at UHB, said: “A link between weight and IIH has long been observed but, until now, there has been no robust evidence that weight loss can reduce brain pressure.

“We have shown that weight loss achieved through bariatric surgery is significantly more therapeutic than community weight loss management interventions both in the short and longer term to treat IIH brain pressure.

“Whilst we recognise that bariatric surgery may not be an appropriate approach for all patients with IIH and increased weight, it is important to now have the evidence that a surgical approach can lead to significant sustained disease remission.”

First author Dr Susan Mollan, Director of Ophthalmic Research at UHB, added: “We hope that as a consequence of this research, current NHS and NICE guidance can change to include bariatric surgery as a treatment for women with IIH and a BMI greater than 35 when appropriate and in line with the patient’s best interests and wishes.

“Weight stigma is a major barrier to patient care in IIH. We also hope this research will prompt discussion and education around weight management to ensure this sensitive topic is approached with care and dignity.”

Co-author James Mitchell, Lecturer in Neurology at the University of Birmingham, added: “Weight regain is often driven by biology rather than willpower, and obesity is a chronic relapsing disease that requires lifelong treatment. Therefore, it’s essential that patients are given appropriate support to achieve weight loss and further work is done to ensure they have good access to weight management services.”

Trial aims to prevent blindness in patients with neurological condition IIH

Written by Louise Stanley on . Posted in Clinical trials, Inflammation and chronic disease.

A new clinical trial being led by two Birmingham Health Partners founder-members aims to identify the best surgical treatment option to prevent blindness in patients with a neurological condition.

Funded by almost £1.5 million from the National Institute for Health Research (NIHR), it is hoped the research will lead to changes in healthcare policy for the treatment of patients with Idiopathic intracranial hypertension (IIH).

Thus far, there is no known cause for the neurological condition, which increases intracranial pressure around the brain without the presence of tumour or disease. Common symptoms of IIH include debilitating headaches, visual loss, pulsatile tinnitus, and back and neck pain. If left untreated, the disorder can lead to blindness.

The condition is managed with weight loss and medication, however, in severe cases that present as an emergency with decreasing vision, surgery is needed to prevent blindness.

Currently two different types of surgeries – dural venous sinus stenting (stenting) and cerebrospinal fluid (CSF) shunting – are used to prevent blindness, however there have been no clinical trials to determine which is the best operation. The team will carry out a clinical trial involving up to 138 IIH patients with rapid vision deterioration to establish which of the surgical procedures is the best at saving vision; the safest with least complications; and the most cost effective.

The research, which has been developed in consultation with patient charity IIH UK, will be carried out by a team of BHP experts at the University of Birmingham, University Hospitals Birmingham (UHB), and at sites around the UK.

Alexandra Sinclair, Professor of Neurology at the University of Birmingham, Honorary Consultant Neurologist at UHB and Chief Investigator of the new research project, explained: “CFS shunting involves implanting a thin tube known as a shunt in the brain, which allows the excess cerebrospinal fluid flow to another part of the body, thus rapidly reducing brain pressure.

“However, within the first year of surgery many tubes become blocked or infected and stop working. This, and other complications, have a significant impact on patients’ lives and have important cost implications for the NHS.

“More recently, stenting has been used, which involves placing a small stent across a narrowing of certain blood vessels in the brain, which can improve blood flow and lower brain pressure.”

Philip White, Professor of Interventional and Diagnostic Neuroradiology at the University of Newcastle and Co-Investigator, added: “So far, studies have not provided high quality evidence to show that this procedure can prevent blindness when vision is rapidly declining. Additionally, we need to confirm procedural durability compared with the surgery, which may need to be repeated and establish its safety is at least comparable.”

Miss Susan Mollan, Director of Ophthalmic Research at UHB and Co-Investigator, added: “We hope that the results of our study will provide evidence that will influence NHS policy and will lead to improved care for IIH patients, ensuring they receive the best possible treatment to prevent them from losing their eyesight.”

Amanda Denton, IIH UK Trustee and Research Representative, said: “IIH UK is delighted that this important trial is being carried out. Identifying the best types of intervention is one of our members’ top ten research priorities. Many of our members have shunts and stents to prevent them losing their sight and research to find the most effective method with the least complications is vital to improve their quality of life.”

The trial, will see participants being allocated to CSF shunting or stenting, which will be decided at random by a computer. The main outcome of the trial to be evaluated will be preservation of vision. A number of key additional outcomes, including treatment-related complications, headache and patient reported quality of life, will also be assessed.

Dr Ben Wakerley, Consultant Neurologist at UHB and Co-Investigator, comments: “The impact of these interventions on headache and quality of life have been highlighted to be of key importance by patients.”

An economic evaluation will be performed, led by Professor Emma Frew, University of Birmingham Co-Investigator, to estimate the cost-effectiveness of shunting versus stenting. Participants will be asked to attend routine hospital check-up visits over a year. Their health would then be monitored through linked NHS database records for longer-term follow up at two years.

£1.1m funding to improve uptake of at-home dialysis

Written by Louise Stanley on . Posted in Inflammation and chronic disease.

A new study being carried out in collaboration with BHP founder-member the University of Birmingham could save the NHS up to £45m over three years by increasing the number of dialysis patients whose treatment takes place at home.

Funded by the National Institute for Health Research (NIHR), the study will focus on the reasons why home therapies are not used more equally and fairly by kidney centres across the country, as well as designing and testing possible solutions to improve the uptake of home therapies.

Called Inter-CEPt (“Intervening to eliminate the centre-effect variation in home dialysis use”), the research builds on previous collaborations and is a multi-disciplinary project integrating ethnographic and statistical expertise from Keele University, health policy researchers from the University of Birmingham and health economists from the University of Sheffield.

Around 30,000 kidney failure patients in the UK currently manage their condition with dialysis, either at home or by travelling to their local dialysis unit as an out-patient, where it is provided by healthcare staff.

Although national guidelines encourage the use of home dialysis, the uptake is limited and varies greatly by treatment centre. Some centres offer home treatments more than others, with provision varying between 2-28% of patients requiring kidney replacement therapy.

Having dialysis at home is associated with improved clinical outcomes, treatment satisfaction and patient autonomy. It has also been safer for patients during the Covid-19 pandemic.

Recent research by the Renal Registry has also found that certain groups in society were less likely to have home therapy, with patients from Black, Asian and Minority Ethnic (BAME) groups, and those from poorer or more disadvantaged backgrounds being particularly affected.

This research aims to change the uptake and availability of home dialysis treatments, by using a five-stage approach to assess the main factors affecting home dialysis availability, which will allow the researchers to develop a practical and feasible approach for dialysis centres to make these treatments more accessible.

The research team includes BHP’s Dr Iestyn Williams and Dr Kerry Allen, of the University of Birmingham’s College of Social Sciences, and Dr Sarah Damery, Institute of Applied Health Research, University of Birmingham.

Dr Williams, Reader in Health Policy and Management at the University of Birmingham, said: “It is really important that the most effective treatments are accessed by everyone, including marginalised and disadvantaged groups.  This study will be crucial in helping us to understand how this can be achieved.”

Professor Simon Davies, of Keele University’s School of Medicine said: “We will use in-depth knowledge of what constitutes a strong and equitable home therapies programme to inform a wider survey of dialysis unit practices linked to patient outcomes.

“This will allow us to develop a bundle of interventions designed to support inclusion of those patients into home therapies who may not currently benefit from this treatment option.”

Professor Lisa Dikomitis, also of Keele University, added: “I am delighted to be part of this timely and important study, which is underpinned by a robust patient and public involvement and engagement strategy.

“Ethnographic and qualitative data will provide us with a better understanding of why certain groups in our society are less likely to have home therapy and how we can improve the uptake of such therapies.”

Dr James Fotheringham, of the University of Sheffield, who leading the health economics research for the study, said: “The internationally renowned expertise in health economics which the School of Health and Related Research brings to this project, ensures that the costs and benefits of these important treatments are fully understood so they can inform policy and clinical practice.”