(MBRC) Studying pathophysiology and measurement of raynaud’s phenomenon using mobile phone technology in an ambulatory setting

Raynaud’s phenomenon (RP, episodic colour changes of the extremities on cold exposure) is a major cause of pain and morbidity, especially in patients with systemic sclerosis (SSc) spectrum disorders who may progress to finger ulcers and gangrene. Development of effective treatments requires better understanding of pathophysiology and better outcome measures (the lack of reliable outcome measures is a major contributor to the dearth of clinical trials).

At the University of Manchester and at Salford Royal Hospital (a tertiary referral centre for patients with RP and SSc) we have a major interest in developing and applying non-invasive imaging techniques to better understand pathophysiology of RP and to develop badly needed, reliable outcome measures for use in clinical trials. This clinical fellowship builds upon our previous and ongoing studies and will provide exciting opportunities to take state-of-the art methodologies ’to the patient’ in his/her everyday environment (which is where attacks of RP occur) in order to further our understanding of disease process and measurement. Specifically, the work will be informed by current projects examining mobile phone technology to document attacks of RP, and automating analysis of low magnification capillaroscopy images.

There will be three parts to the fellowship:
1. Developing ’at home’ nailfold capillaroscopy, to study structural microvascular change in patients with SSc over time, initially in a pilot feasibility study and then (if the pilot is successful) in a longer term study.
2. Studying relationships between finger colour and temperature (never previously explored, but providing a ’next step’ in our understanding of different forms of RP), using mobile phone photography and infra-red thermography contemporaneously. Patients with both primary and SSc-related RP will participate.
3. Developing a mobile phone ’app’ as an outcome measure/biomarker for RP, incorporating symptoms, colour changes, and temperature (and possibly capillaroscopy). This work will pave the way for treatment studies including industry collaborations.

The clinical fellow will have the opportunities afforded by working within an internationally recognised multidisciplinary group of clinicians and scientists researching RP and SSc (with a focus on the associated digital vascular disease). S/he will gain research skills/knowledge in the following: study design and set-up, co-ordination of studies in patients with chronic disease, several different non-invasive imaging techniques, mobile phone technology, data management, analysis of data including statistical analysis, interpretation and write-up of results, and presenting at national and international meetings, including to patient organisations.