Interview with Dr. Iain McInnes, Glasgow, Scotland

Interview with Dr. Iain McInnes, Glasgow, Scotland

We had the privilege of meeting Dr. McInnes at the 2016 American College of Rheumatology Annual Meeting in Washington D.C., after one of his speaking sessions. We love the opportunity to highlight rheumatologists and healthcare professionals who demonstrate excellence in science and patient care, and Dr. McInnes was kind enough to agree to an interview.

Dr. McInnes is Professor of Experimental Medicine and Rheumatology, and Director of Institute (Immunology) at the University of Glasgow. He lives with his wife, two daughters, and "an irrepressible black Labrador just outside Glasgow, in the beautiful west coast of Scotland." He speaks of Glasgow as a "reborn city built on a rich heritage of heavy industry and world trade, but more recently upon academia, health care and culture. It is a vibrant and exciting place to be!" As far as pastimes go, he says, "We are close to the mountains, upon which we enjoy walking, and some of the best golf courses in the world upon which I play rather poorly. In those very occasional quiet moments, my solace is in music of many kinds, best enjoyed with family."

Drawn to the field of rheumatology by "the challenge of looking after chronic disease," Dr. McInnes began his career when there were few targeted treatments available for rheumatoid disease and a lot of unmet clinical needs. "Rheumatology from the perspective of the clinician," he says, "requires a rare combination of communication, empathy and commitment to the long term," which he found enticing, though far from easy. "I learned from wonderful mentors who demanded thoughtful, meticulous and considerate care of people with rheumatic diseases – I have never forgotten those remarkable lessons. As time has passed I am now learning most often from the people with rheumatic diseases whom I treat – they are inspiring and constant reminders of how much more we must do in the field. I care even more now than I did when I set out in the discipline." Of his patients, he says, "They humble me with their courage and continue to teach me about the disease to inform my research."

Dr. McInnes was also training as an immunologist -- someone who studies the body's own defense system -- and, he says, "It was becoming clear at that time that the immune system might play a significant role in the causes and perpetuation of many rheumatic diseases. So it has transpired, and as such in the last decade I have been able to work with superb scientists investigating the causes and consequences of rheumatoid and psoriatic arthritis. Researching the causes of rheumatic diseases is like being part of a great novel – every page that turns brings new possibilities, but often with twists and unexpected turns. Being an academic physician engaged in both clinical care and research is a privileged position indeed."

Seeing that he takes a very patient-centric approach to his work, we asked Dr. McInnes what he thought could help foster better relationships between people with rheumatoid disease (PRD) and their doctors. He offers that "we should accept that we all have different personalities and that relationships that people form with their doctors may be quite different, but still good for that individual! Speaking from my point of view as a rheumatologist – I always encourage people to tell me how they really feel rather than what they think I want to hear – good doctors should respond by seeking solutions for what really ails you. Sometimes we need to find a range of solutions but can only really appreciate this if we understand the full extent of the problems you are facing as a result of the disease."

There are a myriad of challenges facing rheumatologists today. One of the largest challenges according to Dr. McInnes, and I think we'd all agree, is that a cure to this disease continues to elude us. "I would like to believe that we will one day be able to cure some of the rheumatic diseases," says Dr. McInnes. "The current combination of amazing medical research technologies together with emerging information and digital capabilities makes this ever more possible. But still some time in the future I fear…"

One of the challenges often faced by PRD is the assumption that "rheumatoid arthritis" is simply a form of arthritis and that its effects are limited to achy joints. While acknowledging the term as descriptive of the most obvious manifestation of the disease, Dr. McInnes also says that "the phrase hides the wider implications of the disease given the higher rates of heart disease, strokes, depression and osteoporosis that we now recognize as a part of the clinical spectrum." The priority, he says, "is to constantly educate our colleagues across the health disciplines about the broad challenges posed by the disease."

Despite the challenges, Dr. McInnes sees a lot of hope for the future of fighting rheumatoid disease. "Perhaps most exciting is that we now have remarkable technologies (both laboratory and imaging) that will allow us to explore the very origins of the disease, even before it is clinically obvious to doctors or even patients. This together with the new discipline of 'systems medicine', which brings information and computational technology together with conventional biology, will allow us eventually to decipher which pathways are driving disease in individual people. This in turn may allow us to select the best medicine for a given individual person at the 'right' or 'best' time. If we could find 'at risk' people, before they even develop arthritis, we could think of preventing disease. Ultimately this will lead to designer drugs and diagnostic tests – so called personalized medicine. This is some way off, but if realized could change completely the way we think about immune diseases."

If rheumatology research is a novel, we hope that more characters along the likes of Dr. McInnes are added to the story, that as the pages continue to turn and we work together, we might come to a happy ending in this fight against rheumatoid disease.

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