The British Society for Rheumatology Annual Conference 2023: Research Round-Up

In April, SRUK attended the British Society for Rheumatology Annual Conference in Manchester. We joined over 2,300 attendees including leading doctors, nurses, and healthcare professionals. The conference was a fantastic opportunity to raise awareness of Scleroderma and Raynaud’s and the work of the charity. We listened to talks from experts and researchers whose work has been supported by SRUK in the past, and learned of the latest developments aiming to improve our understanding and open new avenues of care.

Understanding the link between systemic sclerosis and cancer

Dr John Pauling from the University of Bristol showcased a project co-funded by SRUK in 2016 in partnership with the Bath Institute for Rheumatic Diseases. The study aimed to investigate the relationship between systemic sclerosis and cancer, another leading cause of death within the scleroderma community.

By analysing anonymised healthcare data held within the Clinical Practice Research Datalink, which holds data on 60 million UK patients, the study found a 32-41% increased risk of cancer in people with systemic sclerosis, who are also twice as likely to die within six months of a cancer diagnosis. Mucocutaneous cancers, as well as breast and lung cancer, were most common.

Crucially, the study identified several high-risk groups who could be candidates for targeted pre-screening. These included people aged 50-65 and those testing positive for certain autoantibodies. Dr Pauling described the potential to pre-screen these groups for cancers, especially by imaging the chest for signs of breast and lung cancer. The work could pave the way for earlier detection of cancer in SSc, which could greatly improve individual outcomes.

Could capillaries be the key to understanding scleroderma?

Professor Francesco Del Galdo from the University of Leeds often works closely with SRUK. He presented the latest research relating to nailfold capillaroscopy for the early diagnosis of scleroderma, and explored how broader investigation of the capillary network is being used to better understand what causes the condition.

Nailfold capillaroscopy is a non-invasive imaging technique that assesses the capillaries in the nailfold area. Professor Del Galdo discussed the diagnostic value of this in early stage scleroderma, explaining that several studies have demonstrated that finding no abnormalities on a nailfold capillaroscopy is a strong indicator that someone will not progress from Raynaud’s to SSc.

He then talked about his current investigation around whether damage to the capillary network may be a cause, rather than an effect, of scleroderma. Capillary network alterations throughout the body are a hallmark of SSc, and could be a cause of early physical changes as the condition develops. This ongoing study offers the potential to learn more about what drives the development of scleroderma – a crucial gap in our current understanding.

Precision medicine: improving treatment outcomes in SSc-associated lung disease (SSc-ILD)

The conference also hosted a session on the management of lung and heart disease in SSc. The first talk was given by Dr Voon Ong from the Royal Free Hospital and supervisor of Dr Nina Goldman, whose PhD research (co-funded by SRUK in partnership with the Medical Research Council), is investigating the role of B-cells in SSc-ILD.

Dr Ong discussed the evidence for the effectiveness two drugs – tocilizumab and rituximab. Focusing on the results of some recent clinical trials and the findings from a study at the Royal Free, he outlined the effects of these drugs on lung function, and highlighted that the data shows both treatments can be effective in patients with lung involvement.

The team also wanted to understand whether some patients will respond better to one drug or the other. They looked at how people respond to these treatments based on their auto-antibody profile, and found that those testing positive for the ATA auto-antoantibody were more likely to improve when given toculizumab.

Cardiac involvement in systemic sclerosis

This was followed by a talk from Professor Maya Buch of the University of Manchester. SRUK have previously supported their research relating to heart involvement in SSc.

Professor Buch’s talk focussed on recent work by an international consortium of doctors, researchers, and organisations to improve understanding and management of cardiac involvement in scleroderma. She described how they developed a consensus definition of SSc-related heart involvement, to assist with diagnosis and detection, monitoring, risk stratification, and treatment.

Professor Buch also shared the consortium’s guidance relating to the screening, diagnosis, and follow-up for people with cardiac involvement. This aims to ensure individuals at high-risk are identified and effectively treated, and could lead to improvements in the detection and management of heart involvement in SSc.

The session was concluded by Dr Daniel Knight from the Royal Free, who detailed the use of cardiac MRI in assessing heart involvement. This can provide key information about the size and function of the heart, as well as the presence of disease. A study carried out at the Royal Free used cardiac MRI and machine-learning to analyse 260 patients with SSc and assess their prognosis. It showed that features captured by the MRI, (such as cardiac size and function), were prognostically important and related to poorer survival outcomes. This technique could provide useful insight into cardiac health and help identify people needing treatment.

Combating the causes of inflammation and fibrosis

A team from the University of Leeds working alongside Professor Del Galdo have identified a potential biomarker and therapeutic target for treating systemic sclerosis, particularly in people with lung involvement.

They found that high levels of a protein called CCL24, which regulates inflammation and fibrosis, are present in the blood of 25% of SSc patients. Their research using blood samples showed that patients with high circulating levels of CCL24 in their blood were more likely to experience complications such as digital ulcers, calcinosis, and crucially, interstitial lung disease. This means that higher levels of CCL24 may mean a higher chance of disease progression and even mortality (particularly as a result of lung disease).

These findings suggest that CCL24 could be a therapeutic target to prevent some of these complications. The team are working with an industrial partner who have developed an antibody capable of neutralising CCL24 that could soon be assessed in clinical trials.

Looking beyond medications – The anti-inflammatory effects of exercise

The conference also hosted a series of talks on alternative, non-pharmacological approaches to managing rheumatic conditions that can be used alongside medical treatments.

Professor George Metsios from the University of Wolverhampton presented on the antiinflammatory effects of exercise. He outlined the potential benefits of aerobic and strength training over time for individuals with rheumatic and musculoskeletal diseases, using the recommended physical activity guidelines published by EULAR in 2018.

He noted that aerobic exercise performed three-to-five times a week for 20-45 minutes, at 60-85% of an individual’s maximum heart rate could potentially reduce fat mass (a factor linked to inflammation) and cardiovascular disease risk, while increasing cardio-respiratory fitness, even within just three months. Exercise can also improve quality of life and functional ability in the longer-term, when exercise load increases progressively over time to avoid injury.

Highlighting the lack of studies around the effect of exercise in rheumatic and musculoskeletal disease, Professor Metsios stressed the need for further research. We hope that this could ultimately lead to the development of exercise guidelines and prescribable training protocols to improve health and quality of life.