as Chair of Rheumatology at UWA in June I have divided these into three main

Transcription

1 Professor Johannes Nossent Chair of Rheumatology & Musculoskeletal Medicine Head, Rheumatology Dept. - Sir Charles Gairdner Hospital Friday, 22 April 2016 To: Mr R Forlano, CEO Faculty of Medicine, Dentistry and Health Sciences School of Medicine & Pharmacology QEII Medical Centre Unit (M503) The University of Western Australia 35 Stirling Highway CRAWLEY WA 6009 T F E Johannes.nossent@uwa.edu.au 2 nd Floor, Harry Perkins Institute of Medical Research QQ Block, QEII Medical Centre, 6 Verdun Street NEDLANDS WA 6009 WA-AOF Dear Ric, Please find enclosed an overview of activities undertaken since my appointment as Chair of Rheumatology at UWA in June I have divided these into three main categories which are detailed on following pages. While the educational activities seem to already have gotten a solid footing, the processes for the development of the main service activities (nurse and physiotherapy support in community setting) as well the major research activities (WARDER and PERTH Lupus Registry) have taken a longer time to fully develop, but these are expected to come to fruition in the next months. I would like to take this opportunity to thank the Foundation for the ongoing support, which is being recognised at every public and scientific presentation as well as acknowledged in peer reviewed publications in scientific journals. With kind regards, Professor Johannes Nossent Chair of Rheumatology & Musculoskeletal Medicine The University of Western Australia

2 Educational activities 1. MD curriculum at UWA June-Dec 2014: Participation in UWA working group for MD student program development, resulting in the incorporation of a one week Rheumatology teaching block in the second year of MD program (IMP-1). Jan-June 2015: Development of onsite as well online content for MD Rheumatology block teaching and coordination of this teaching program across the three main hospital sites. July current: Served as unit coordinator for Rheumatology program in IMP-1 with for administrative responsibility (resolving logistical problems, complaints etc.) while directly involved in clinical teaching of 4-6 student at SCGH on weekly basis and developing material for written and practical examinations 2. WA Arthritis Foundation (2014-current) a. Provision of research updates on current topics for Arthritis Today magazine b. Speaker during CME course for GP s c. Background medical information for the WA-AOF donor letter program d. Contributed a chapter on immunological background for RA in Rheumatoid Arthritis to Education & Self-Management Program Reference Book (copyright WA-AOF) e. Establishing WA AOF subcommittee for WA Rheumatology Research Interest Group f. Member of Arthritis Australia Grants Assessment Committee (2015-current) 3. RACP program for Advanced Trainees in Rheumatology in WA a. Supervision for AT in Rheumatology at SCGH b. Member of AT selection committee in WA c Rheumatology Grand round presentations at SCGH 2014 and Medical advisor for /speaker at WA Lupus Group meeting 5. ARA-WA ASM presentation on B cell depletion in lupus nephritis 6. BUPA seminar presentation on ANCA- associated vasculitis in Oct 2014 Service provision activities current: clinical service provision for out- and inpatients at SCGH current: Member of the WA Health Musculoskeletal Network for the development of strategies for Service improvements in WA regarding MSK health current: Implementation of dedicated Connective Tissue Disease Clinic at SCGH current: SHRAC application to implement Rheumatology Nursing service including nurse led clinics at SCGH - ongoing Application to WA Health BEHIP to implement Rheumatology nurse service in Community- ongoing 2015-current: Pilot program for introduction of Advanced Scope Physiotherapy service at Rheumatology outpatient department at SCGH 2014-current: Chairman of Board at Lupus Group WA

3 Member of WA Health Advisory Committee on antirheumatic drug register in WA Research activities WARDER Prof Nossent is Chief investigator for a project on the epidemiological characteristic of rheumatic disease in WA (WARDER). Project protocol designed and approval sought and obtained to receive state wide linked data set for analysis of outcomes for inflammatory joint diseases in WA over period This large data set contains de-identified information on hospital admission rates and causes, cancer and mortality data as well as emergency room usage for approx people with a defined forms of rheumatic disease. By comparing these outcomes with a similar sized age and gender matched control group, this dataset will inform us on rheumatic disease prevalence and severity and help define the weak points in medical care for a wide range of rheumatic disease patients in WA. Status: the WA Data Linkage Branch is in final phase of data extraction and linkage with expected delivery in middle of WARDER has received AUD in funding support from Arthritis Australia Perth Lupus registry Prof Nossent is founder and chairman of the Systemic Lupus Erythematosus Working Party (a collaboration between QEII campus based rheumatologists, clinical and basic immunologists and renal physicians) in order to increase research activity into this disease and coordinate local service to SLE patients. THE SLE Working party together with the IT department at Faculty of Medicine UWA has designed on online database registry (Perth Lupus Registry) to capture all relevant clinical data on SLE patients who have consented to have their disease data registered in an anonymous fashion. This registry has received approval by the NHMS Ethics Committee and will allow the detailed study of disease course, predictors of complications and the collection of biological material to perform translational research into underlying genetic and pathophysiological mechanisms of SLE. Status: The online database has gone live in April 2016 and will be gradually populated with data from up to 250 patients. Already collected samples will allow biomarker studies to be performed in period with additional studies projected such as the contribution of genetic changes in the complement system (ongoing collaboration with A Prof Daniella Ulgiati at School of Pathology, UWA) current Busselton Health Study Prof Nossent initiated a collaboration with Prof Matthew Knuiman at the School of Population Health to investigate the role of rheumatic disease markers as a predictor of cardiovascular disease in the Busselton Health Study. The two markers studied were

4 1. Uric acid (UA) levels, which are a marker for gout development. The results indicated a significant impact of increased uric acid on the risk of future heart disease and stroke, especially in patient who had already developed gout. Status: The data analysis has been finalised and the results are being presented in abstract form at the 2016 annual ARA (Darwin) and EULAR (London) meetings while a full manuscript is currently under peer-review for publication 2. Rheumatoid factor (RF), which is an unspecific marker of rheumatic and other inflammatory diseases. The results indicate the widespread presence of RF in the population and confirm its poor diagnostic value for rheumatic disease. Furthermore, RF was found not to be a useful predictor of heart disease, unless patients reported a diagnosis of Rheumatoid arthritis. Status: The data analysis has been finalised and the results are being presented in abstract form at the 2016 annual ARA (Darwin) and APLAR (Shanghai) meetings while a draft version of the full manuscript for peer reviewed publication is currently being revised by the authors 2015 current Takaysahu s arteritis in WA Prof Nossent initiated an investigation with dr K Makin while she was training at SCGH into the presence and outcome of Takaysahu s arteritis in WA. This rare form of blood vessel inflammation affects young women in particular and can lead to severe disability and premature death unless diagnosed early. The results confirm the severity of TA with a 30% mortality rate, mainly related to delayed recognition. Status: The data analysis has been finalised and the results were presented in abstract form at the 2015 annual ACR meeting in the USA and APLAR meetings while a draft version of the full manuscript for peer reviewed publication is currently being finalised Biopsy proven Lupus nephritis Prof Nossent initiated a collobarative investigation with drs B Wong, D Wong and A Chakera to evaluate the frequency, severity and outcome of renal disease in patients with SLE at SCGH over the period Status: The data collection is halfway and initial results are expected by the end of 2016 for presentation in abstract form at the 2017 annual ARA and EULAR meeting in the USA Ankylosing spondylitis In collaboration with Assoc. prof Gunnstein Bakland at the University of Northern Norway, Prof Nossent investigation the influence of variations in the ERAP1 gene on the disease course of patients with Ankylosing Spondylitis. A certain combination of genes that reduces the function of the ERAP1 protein was found protective for the development of uveitis (eye inflammation). This suggest that interrupting the function of ERAP1 is a potential pathway for the treatment of AS. Status: The data analysis has been finalised and the results have been presented in abstract form at the 2015 annual ARA (Adelaide) and EULAR (Rome) meetings while a full manuscript for peer reviewed publication is recently been published in the Scandinavian Journal of Rheumatology.

5 Von Willebrand Factor in SLE In collaboration with Assoc. prof Gro Eilertsen at the University of Northern Norway, Prof Nossent investigation the cause and consequences of elevated levels of Von Willebrand Factor (a clotting factor) in SLE patients. The study demonstrated that VWF in SLE does nor promote clotting, but is a marker of severity of inflammation and does require a specific treatment to prevent clotting. Status: The data analysis has been finalised and the results will be presented in abstract form at the 2016 annual ARA (Darwin) and EULAR (London) meetings while a full manuscript for peer reviewed publication has recently been submitted to Lupus Science current Role of IL-17 in SLE Prof Nossent supervised bioscience honours student Sheynae Griffiths in this collaborative project with Assoc. prof Gro Eilertsen at the University of Northern Norway to determine the role of IL-17 (a inflammation promoting cell signalling molecule) in SLE patients. The study demonstrated that IL-17 was not a marker of disease activity o severity in SLE, but closely related with a number of other cytokines except IL-6. Status: The data analysis has been finalised and the results will be presented in abstract form at the 2016 annual ARA (Darwin) and APLAR (Shanghai ) meetings while a full manuscript for peer reviewed publication is nearing completion.