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Spondyloarthritis describes a group of arthritic illnesses where there is inflammation of the joints of the lower back. Joints become painful and stiff, and inflammation ultimately fuses the spine. A better understanding of the role of various immune components might help us better prevent it and perhaps cure it.

Q: What is Spondyloarthritis and what causes it?

PB: Spondyloarthritis describes a common group of arthritic illnesses where there is inflammation of the joints of the spine; that's the spondylo. The commonest of these is called the ankylosing spondylitis. Initially you get inflammation, which is painful and stiff, but eventually the spine turns to solid bone and that's where it becomes ankylosed. This is a common group of arthritic illnesses.

Q: What is the role of the immune system in this illness?

PB: We think that the diseases are caused by an overactive immune system, so that's what causes the inflammation. But we don't know exactly the mechanism and that's something many of us would love to know.

Q: Can we prevent it or cure it?

PB: Unfortunately as things stand at the moment we can't either prevent of cure any of these Spondyloarthritic diseases. We do know some are triggered by infections so that's something we might be able to prevent. A lot of our research into trying to understand how the immune system is misfiring in these diseases, we hope, will lead us to both prevention and a cure in the long term. But we are quite a way away from that at the moment.

Q: What are the most important lines of research that have developed over the past 5 or 10 years?

PB: Actually there's been a lot of exciting research over the last 10 years. Using the human genome information and the Wellcome Trust information we've now got a great deal of knowledge about the genes that are important in predisposing to developing these diseases, because they've turned out to have a major genetic component. We now know at least 5 and maybe 10 genes that can cause the disease. The commonest is called HLA-B27, the other genes are genes involved in for example development of a particular kind of T-cells, these white blood cells, called a Th17 cell.

Q: Can you give us an example of the kind of research you are doing?

PB: The research my group is heavily involved in is really trying to understand how these genes that we know are involved, how they actually work both in healthy people and in people with arthritis. For example we can use antibodies and what is called FACS staining of individual cells to look at the blood cells of patients and compare them for example with cells from the joints. With that we have been able to show that the cells in the joints have very high levels of producing inflammatory molecules. In fact, one of them called IL17 which is unpleasant and causes some of the pain and symptoms.

Q: Why does your line of research matter? Why should we put money into it?

PB: Firstly, these are a common group of illnesses so about 1 in 200 people are sufferers. They are mostly young people: for most people the disease starts between 15 and 30. It causes a great deal of pain and disability, so for all those reasons it is important. But also our research, we hope, will tell us a lot about the immune system in other diseases and in health as well; so I think there are 2 reasons why it is an important area to understand more about.

Q: How does your research fit into translational medicine within the department?

PB: Within the Department of Medicine there's a lot of research going on into inflammation, and our research fits in very well with that. For example, we know that a number of the genes that are important in ankylosing spondylitis are also important in developing ulcerative colitis and Crohn's disease. There's a big interest in the Department of Medicine in inflammation in those diseases, so there's actually a close relationship between two groups of disease where inflammation is important.

Paul Bowness

Ankylosing spondylitis

Professor Paul Bowness works on Ankylosing Spondylitis, the commonest form of spondyloarthritis. This rheumatic disease seems to be caused by an overacting immune system. It has a major genetic component: at least 5-10 genes are known to contribute the disease, with HLA-B27 being by far the most important. Professor Bowness studies how these genes work in the immune systems of both healthy people and patients with arthritis.

This podcast presents the research done by Professor Bowness whilst working in the Nuffield Department of Medicine. Professor Paul Bowness now works at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences.

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