About the Project
Research project outline:
Rheumatoid arthritis (RA) is a symmetrical inflammatory arthritis, which uncontrolled can lead to significant joint damage and destruction. Recent advances in therapy with more aggressive and more effective options have significantly reduced the degree of inflammation, decreasing symptoms and reducing the need for large joint, especially knee, replacement surgery. However, RA has a predilection for small joint involvement, as well as affecting related soft tissues including tendons. Given this background it is not surprising that there is extensive hand pathology resulting in hand symptoms and loss of function at many stages of the disease course. Thus there are a large range of surgical procedures available at different stages of disease to improve hand outcomes. Indeed, many patients have multiple procedures during the course of the disease and hand surgery is the most common region for surgery in RA. Anecdotal evidence suggests a vast decrease in demand for hand surgery in patients with RA since the introduction of aggressive disease modifying therapy. Despite this, there is very little high quality evidence regarding the changing epidemiology of significant hand involvement. Surgical interventions are the major driver of health service costs for patients with RA as well as being a powerful indicator of disease damage. Thus a robust evaluation of the role of hand surgery, in a large population of real world patients is fundamental to assessing the clinical and economic benefit of recent advances in therapy. Answering these questions can be achieved by applying intensive pharmaco-epidemiological methodologies to appropriately derived routine data sources and examination of medical records. These latter require robust validation based on a detailed knowledge of hand surgery and the relevant surgical approaches.
The hypotheses to be addressed during the DPhil are:
1. Are there temporal changes, both at an individual patient level, and in terms of the overall burden to the NHS, on the incidence of hand surgical procedures in RA?
2. Is there evidence that any observed change is subject to geographical or socio-economic variation, suggesting inequality?
3. Are there variations in (2) and (3) above between countries with similar data capture?
4. Using detailed data from drug registers of patients started with biologic drugs with similar data from non-biologic treated patients, can the proportionate contribution of the therapy to changing trends from (1), (2) and (3) be quantified?
The project will use a range of advanced epidemiological, statistical, and health economics modelling methods using routine NHS data sets (including HES and CPRD) available to the supervisors, including links to datasets in Canada and Denmark as well as access to de-identified patient records.
Details of the research group:
The DPhil will be a joint activity between the Musculoskeletal Pharmaco-epidemiology group, with supervision from both Associate Prof Prieto-Alhambra and Prof Silman https://www.ndorms.ox.ac.uk/research/Musculoskeletal-Pharmacoepidemiology) and the Genetics and Epidemiology of Common Hand Disorders: Prof Furniss (https://www.ndorms.ox.ac.uk/research/Genetics-and-epidemiology-of-common-hand-conditions) groups. Both Silman and Prieto have published extensively in the field of pharmaco-epidemiology: Silman established the British Society for Rheumatology Biologics Registry and published on the methodological aspects of this approach to data capture as well as key analyses of outcome. Prieto is recognised internationally as an authority on use of routine data for pharmaco-epidemiology. Furniss is an academic hand surgeon with expertise in the use of ‘big data’
Current DPhil Students within the pharmaco-epidemiology group:3
Current DPhil Students within the hand disorder group: 2
Training:
The Botnar Research Centre plays host to the University of Oxford’s Institute of Musculoskeletal Sciences, which enables and encourages research and education into the causes of musculoskeletal disease and their treatment. Training will be provided in relevant related research methodology, including the handling and analysis of large datasets, and advanced statistical techniques. Attendance at formal training courses will be encouraged, and will include the “Real world epidemiology Oxford summer school” and the “Advanced musculoskeletal epidemiology UK-RIME summer school”. In addition, courses from the Oxford Learning Institute and the Oxford University Computer Sciences on key skills for the completion of a successful PhD thesis will be available. Additional on the job training opportunities will arise, and the supervisors will encourage the student to pursue such opportunities.
A core curriculum of lectures will be taken in the first term to provide a solid foundation in a broad range of subjects including musculoskeletal biology, inflammation, epigenetics, translational immunology and data analysis.
Students will attend weekly seminars within the department and those relevant in the wider University.
Students will be expected to present data regularly to the department, the research group and to attend external conferences to present their research globally.
How to Apply:
The department accepts applications throughout the year but it is recommended that, in the first instance, you contact the relevant supervisor(s) or the Directors of Graduate Studies who will be able to advise you of the essential requirements.
Interested applicants should have or expect to obtain a first or upper second class BSc degree or equivalent, and will also need to provide evidence of English language competence. The University requires candidates to formally apply online and for their referees to submit online references via the online application system.
The application guide and form is found online and the DPhil or MSc by research will commence in October 2017.
When completing the online application, please read the University Guide: https://www.ox.ac.uk/admissions/graduate/applying-to-oxford/application-guide?wssl=1
Contact details of the potential supervisor(s) for informal queries:
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