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infection and inflammation


Name: Dr Karen Walker-Bone BM, FRCP, PhD

Academic position: Senior Lecturer (Honorary Consultant) in Rheumatology and Clinical Academic Sub-Dean, BSMS

Research: The epidemiology of rheumatic diseases

Contact details:

Euan Keat Education Centre
Princess Royal Hospital
Lewes Road
Haywards Heath
RH16 4EX

Tel: +44 (0) 1444 448746

Fax:+44 (0) 1444 441536


E-mail:

Biography:

  • 1991, qualified BM Southampton University Medical School
  • 1999-2002, Arthritis Research Campaign Clinical Research Fellow
  • 2002, qualified PhD ‘Prevalence and risk factors for musculoskeletal disorders of the neck and upper limbs’, MRC Environmental Epidemiology Unit, Southampton University Medical School
  • CCST Rheumatology, 2002
  • 2002-2003, Senior Research Fellow, MRC Environmental Epidemiology Unit, Southampton
  • 2002-3, Research Fellow, Wessex Deanery, Winchester
  • 2003, Senior Lecturer in Rheumatology, Sub-Dean Brighton and Sussex Medical School

Teaching and training focus:

I have always had a keen interest in undergraduate and postgraduate education. In Southampton, I taught on undergraduate and postgraduate courses and participated in programmes of teaching for the British Society of Rheumatology Core Course, MRCP, Allied Heath Professionals.

To further my interest and knowledge in postgraduate education, I worked as a Research Fellow for the Wessex Deanery. Here I worked on the RITA process, devising and completing an extensive survey of practice and acting as an adviser in cases with failing trainees. I participated as a facilitator in Appraisal and Assessment workshops.

In BSMS, I was responsible for devising, planning and introducing Module 201 (Clinical Practice) in year 2 the first time that this was run (I day per week all year). I then devised Module 404 (Individual Research Project) and continue to act as module leader. I continue to teach regularly on Module 201 and in the musculoskeletal module, year 4. As a Sub-Dean, I have been part of the team devising and introducing the year 5 teaching programme and participate in this weekly.

I continue to pursue my interest in postgraduate Rheumatology training, having sat on the KSS/South Thames STC in Rheumatology since 2000 and am currently Programme Director for Rheumatology (KSS) and act as representative for Rheumatology to the KSS Deanery.

I am currently supervising an MPhil and two PhD students.

 

Research focus:

  • Rheumatic and bone manifestations of HIV infection

In collaboration with the consultants in HIV/GUM, I have initiated a clinic devoted to musculoskeletal problems among patients with prevalent HIV infection. This clinic has now assessed almost 200 patients, representing the largest case series in the UK. Funded by NHS R&D, we have recently surveyed all 1200 HIV subjects with prevalent HIV infection for evidence of musculoskeletal pain, fractures, skin rashes and other clinical manifestations of rheumatic diseases. Funded by BHIVA, Martin Fisher, Yvonne Gilleece and I are about to commence a study of bone density among a subset of HIV positive homosexual men.

  • Epidemiology of neck and upper limb disorders and pain

I have continued to maintain an interest in this field:

(a) My MPhil student, Miss Karen Denyer, has surveyed complementary and orthodox therapists to measure the extent to which these approaches to neck/upper limb pain are integrated

(b) We have surveyed 2000 residents of Sussex, representing two different socioeconomic profiles about the prevalence and risk factors for neck/upper limb pain, their beliefs about the pain, psychosocial factors and expected outcomes and a follow-up study is planned

(c) I maintain a collaboration with the MRC Epidemiology Centre in Southampton and we are actively engaged in surveying prevalence of regional and widespread pain among adults aged 65-75 years in Hertfordshire (Dr Elaine Dennison)

  • Management of glucocorticoid-induced osteoporosis

My PhD student, Mr John Keegan, is evaluating the beliefs, knowledge and understanding of all secondary care doctors in a large NHS trust about the guidelines for the prevention of GIOP and is comparing these findings with those of a separate study of 400 patients taking glucocorticoids.

  • Epidemiology of patients receiving coronary artery stents in Lille, France, as compared with Brighton, UK

I have actively assisted in the development of a collaboration between clinical cardiology in Brighton (Dr Adam de Belder and Dr David Hildick-Smith) and biomaterial scientists (Prof Sergey Mikhalvsky, Dr Lyuba Mikhalovska) working on stent materials at the University of Brighton. We have obtained funding from the Brighton Heart Support Trust in order to undertake a five-year study of outcomes following coronary artery stents in France and UK. We have a Clinical Research fellow, Dr Peter Haworth, who will undertake his PhD in this field.

 

Current research:

My research field is epidemiology (the study of how various factors determine the frequency and distribution of diseases within humans), a powerful scientific technique that provides new information on the causes and nature of diseases. To date, the focus of my research has been in soft tissue rheumatic disorders of the neck and upper limb and osteoporosis.

Whilst an ARC Clinical Research Fellow in the MRC Environmental Epidemiology unit in Southampton, my colleagues and I evaluated the distribution and determinants of neck and upper limb disorders in the general population. We developed and tested a new examination protocol for the assessment of patients with upper limb symptoms and we showed that around 30-40% of working-aged adults report neck/upper limb pain at any one time and that pain is associated with considerable disability and time lost from work. Key associated factors included workplace mechanical factors and psychological stress. In collaboration with my colleagues in Southampton, we are now seeking funding in order to undertake a randomised controlled trial of interventions among such patients as they present in primary care.

Our research also suggested that only around 25-30% of adults with pain had seen their GP in the preceding 1-year. To date, it is unknown whether patients who do not consult their GP are consulting complementary and alternative practitioners instead, or are managing their own symptoms. Furthermore, increasingly, patients with such symptoms are referred to secondary care, but the pathways of patients through the healthcare system are ill-defined and appear to even be somewhat random. This has led to a PhD studentship, funded by the NHS R&D, with Miss Karen Denyer, aiming to survey adults who have and have not consulted recently in order to understand what are the determinants of healthcare use among these patients, the expectations of such patients and how much these expectations are fulfilled.

The use of corticosteroids is widespread in the UK, with an estimated prevalence of 1%, rising to 3% among those aged > 70 years. Many studies have confirmed that osteoporosis is a major side-effect of this treatment and that it may be prevented by the appropriate introduction of drugs e.g. bisphosphonates but audits of clinical practice frequently show sub-optimal management of patients. The Headley Trust have granted funding for another PhD studentship aiming to explore the detection, diagnosis and management of steroid-induced osteoporosis among patients attending hospital, aiming to develop new strategies to improve the compliance of patients.

More than 20 years after the first cases of the acquired immunodeficiency syndrome (AIDS) were recognised, human immunodeficiency virus (HIV) infection has spread to the level of a global pandemic and has become our modern-day plague. Since the first description of AIDS in 1981 and the identification of HIV in 1984, direct or indirect involvement of nearly every organ system has been reported. The first report of the occurrence of reactive arthritis (Reiter's syndrome) in HIV-infected individuals was followed by descriptions of a diversity of rheumatological manifestations including arthralgia, myalgia and myositis, various forms of arthritis, vasculitis, a Sjogren's syndrome-like disorder known as the diffuse infiltrative lymphocytosis syndrome (DILS), and osteonecrosis. In Brighton, around 1050 adults have known HIV infection and this cohort has been well-characterised. These patients provide an opportunity to explore the epidemiology of rheumatic diseases among HIV positive patients and this has been the subject of a recent major grant proposal.

Key/recent publications:

Jenkins EA, Walker-Bone K, Wood A, McCrae FC, Cooper C, Cawley MID. The prevention of corticosteroid induced bone loss with intermittent cyclical etidronate. Scand J Rheumatol 1999; 28:152-156.

Palmer K, Walker-Bone K, Linaker C, Reading I, Kellingray S, Coggon D, Cooper C. The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb. Ann Rheum Dis 2000; 59:5-11.

Walker-Bone K, Javaid K, Arden N, Cooper C. The medical management of osteoarthritis. BMJ 2000; 321:936-40.

Adachi JD, Roux C, Pitt PI, Cooper C, Moniz C, Dequeker J, Ionnadis G, Cawley M, Jenkins EA, Walker-Bone KE, Pack S, Stephenson GF, Laan RF, Brown J, Geusens P. A pooled data analysis on the use of intermittent cyclical etidronate therapy for prevention and treatment of corticosteroid induced bone loss. J Rheumatol 2000;27:2424-31.

Palmer K, Walker-Bone K, Griffin MJ, Syddall H, Pannett B, Coggon D, Cooper C (2000). Prevalence and occupational associations of neck pain in the British population. Scand J Work Environ Health 2001; 27:49-56.

Palmer K, Cooper C, Walker-Bone K, Syddall H, Coggon D. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Occup Med 2001; 51:392-5.

Godfrey K, Walker-Bone K, Robinson S, Taylor P, Shore S, Wheeler T, Cooper C. Neonatal bone mass: influence of parental birthweight and maternal smoking, body composition and activity during pregnancy. J Bone Miner Res. 2001; 16:1694-1703.

Cooper C, Javaid MK, Taylor P, Walker-Bone K, Dennison E, Arden N. The fetal origins of osteoporotic fracture. Calcif Tissue Int 2002; 70: 391-4.

Walker-Bone K, Byng T, Shipp A, Linaker C, Reading I, Coggon D, Palmer K, Cooper C. Reliability of the Southampton examination schedule for the diagnosis of upper limb disorders. Ann Rheum Dis, 2002; 61: 1103-6.

Mitchell S, Reading I, Walker-Bone K, Palmer K, Cooper C, Coggon D. Pain tolerance in upper limb disorders. Occup Environ Med 2003; 60:217-21.

Reading I, Walker-Bone K, Palmer KT, Cooper C, Coggon D. Anatomic distribution of sensory symptoms in the hand and their relation to neck pain, psychosocial variables and occupational activities. Am J Epidemiol 2003; 157:524-30.

Walker-Bone K, Palmer KT, Reading I, Cooper C. Criteria for assessing pain and non-articular soft tissue rheumatic disorders of the neck and upper limb. Seminars Arthritis Rheum 2003; 33: 168-184.

Walker-Bone K, Palmer KT, Reading I, Cooper C. Soft tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors. Semin Arthritis Rheum 2003; 33: 185-203.

Walker-Bone K, Reading I, Coggon D, Palmer K, Cooper C. The diagnosis of soft tissue upper limb disorders. J Orthop Med 2003; 25:97-106.

Mehta G, Taylor P, Petley G, Dennison E, Cooper C, Walker-Bone K. Bone mineral status in immigrant Indo-Asian women. Q J M 2004; 97:95-99.

Walker-Bone K, Reading I, Coggon D, Cooper C, Palmer K. The anatomical pattern and determinants of pain in the neck and upper limbs: an epidemiologic study. Pain 2004; 109:45-51.

Walker-Bone K, Palmer K, Reading I, Coggon D, Cooper C. Prevalence and impact of soft tissue musculoskeletal disorders of the neck and upper limb in the general population. Arthritis Rheum 2004; 51:642-51.

Walker-Bone K, Wood A, Hull RG, Ledingham JM, McCrae FC, Shaban MR, Thomas AL, Mackay KR. The prevention and treatment of corticosteroid-induced osteoporosis in clinical practice. Clin Med 2004; 4:431-6.

Walker-Bone K, Cooper C. Hard work never hurt anyone – or did it? A review of occupational associations between soft tissue musculoskeletal disorders of the neck and upper limb. Ann Rheum Dis 2005; 64:1112-7.

Reading I, Walker-Bone K, Palmer K, Cooper C, Coggon D. Utility of restricted neck movement as a diagnostic criterion in case definition for neck disorders.Scand J Work, Environ Health 2005; 31: 387-93.

Walker-Bone K, Reading I, Cooper C, Coggon D, Palmer K. Risk factors for specific upper limb disorders as compared with non-specific upper limb pain. Occup Med (Lond) 2006; 56:243-50.

Ye S, Patodi N, Walker-Bone K, Reading I, Cooper C, Dennison E. Variation in the matrix metalloproteinase-3, -7, -12, and 13- genes is associated with functional status in rheumatoid arthritis. Int J Immunogenetics 2007; 34(2):81-5.

Walker-Bone K, Farrow S. Rheumatoid Arthritis. Clinical Evidence 2007: In Press.

Wall E, Walker-Bone K. Use of bisphosphonates and dual-energy X-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in Rheumatology. QJM 2007: In press.

Research funding:
  • Risk factors for musculoskeletal disorders of the upper limb and neck Arthritis Research Campaign Clinical Research Fellowship, 1999: £125,000
  • Pre-conceptual maternal body build, maternal nutrition during pregnancy and neonatal bone mass (with Professor C. Cooper)
  • National Osteoporosis Society Project Grant, 2000: £10,000
  • Healthcare utilisations among patients with musculoskeletal pain in the neck, shoulder and upper arm NHS R&D PhD studentship, Jan 2004: £25,000
  • The detection, diagnosis, treatment and monitoring of corticosteroid induced osteoporosis The Headley Trust PhD studentship, June 2004: £65,000
  • An epidemiological survey of the rheumatological manifestations of HIV infection NHS R&D, Jun 2005: £29,850
  • Evaluation of the role of anti-cyclic citrullinated (anti-CCP) antibodies in the diagnosis and management of rheumatoid arthritis NHS R&D, Jun 2005: £2050
  • Epidemiology, risk factors and new technology in coronary stenting INTERREG III, July 2005: £653,776
  • The epidemiology of coronary artery stenting in Brighton, UK as compared with Lille, France, Brighton Heart Support Trust, August 2007: £90,000
  • Evaluating the use of peripheral DEXA scans in the detection of osteoporosis in a population of HIV-infected men British HIV Associations, October 2007: £10,000

 

Prizes:

  • ARC prize for best presentation of ARC funded work: BSR XVIIIth Annual General Meeting, Apr. 2000
  • BSR Travelling Fellowship: Manchester, Oct. 2000
  • SouthWest, South Wales and Wessex Rheumatology Club prize for best oral presentation of research, Oct. 2000
  • Sir Dorabji Tata Trust Award: First World Congress: Fetal origins of adult disease, India Feb. 2001
  • BSR Young Investigator Award: BSR XIXth Annual General Meeting, Apr. 2001
  • Pfizer Academic Travel Award 2001-2: Travel bursary – American College of Rheumatology 65th Annual Scientific Meeting, San Francisco, Nov. 2001
  • NOS Young Investigator Award: 8th Bath Conference on Osteoporosis, Dec. 2001
  • National Institute for Farm Safety Research Award National Symposium on Agricultural Health & Safety, June 2004, Colorado, USA.

External referee:

Grant-awarding bodies

  • Arthritis Research Campaign, Chesterfield, UK
  • Thrasher Research Fund, USA
  • The Guys’ and St Thomas’ Charity, London, UK

Journals

  • The Lancet
  • Annals of the Rheumatic Diseases
  • Quarterly Journal of Medicine
  • American Journal of Public Health
  • Journal of Public Health Medicine
  • International Journal of Behavioural Medicine
  • Applied Ergonomics
  • Scandinavian Journal of Work, Environment and Health
  • Rheumatology
  • American Journal of Epidemiology
  • Journal of Paediatric Research
  • Acta Neurologica Scandinavica
  • Expert review of Pharmacoeconomics and Outcomes Research
  • Journal of Orthopaedic Medicine
  • Journal of Rheumatology
  • BioMed Central Public Health
  • Osteoporosis International
  • Nature Clinical Practice Rheumatology

Advisory activities:

  • Health Technology Assessment Group: 'Effectiveness and Cost Effectiveness of Diagnostic Tests for the Assessment of Shoulder Pain', 2002
  • Department of Occupational Health, Unilever PLC, London: External assessor in cases of appeal against ill health retirement, 2002
  • Industrial Injuries Advisory Council: Invited expert witness in review of prescribed upper limb disorders, June 2004
  • Royal College of Physicians Guidelines Development Group: Management of upper limb disorders, Oct 2007 ff