I would first like to thank BRITSpA for awarding me this fellowship, the sponsors for funding, Karly for her help, and Helena and the Leeds spondyloarthritis team for hosting me.

My overall aim for the fellowship had been to 1) learn from the SpA service at Leeds to help inform and improve services at Liverpool and 2) to create research collaborations with the Leeds research team.

Given the proximity of Leeds and Liverpool, we agreed that the optimal use of this Fellowship would be to visit on several occasions so that administrative and other details relating to potential projects can be done in between visits.

For the first aim, I made an initial three-day visit to the Leeds SpA service on the 23-25 October 2019.  I attended the research clinic for SpaRRO (SpondyloArthropathy Register for Research and Observation).  Patients who consented were followed up at a higher frequency than routine practice. They also underwent longer and more thorough assessments – collecting outcome measures that would not otherwise be part of routine care (e.g., nail score). The data was then entered onto a dedicated database which will undergo further verification at a later date.  My experience prior to seeing this clinic had been to fit research into already busy NHS clinics; e.g., consenting inbetween patients and collating data after clinic. This limits both the amount of data that can be collected, and benefits that patients may get as a direct result of talking part.  It opened my eyes to how clinical observational studies can be conducted in a structure similar to clinical trials.

I was also able to attend the routine SpA clinic, where junior doctors first have a detailed consultation with the patient, discuss it with the consultant, who then sees the patient together with them.  This is unlike the training that I’ve received – giving more time dedicated to training. There are definitely lessons to be learnt from clinical training delivery for my home Trust, which I will feedback to our training representative.

Opportunistically, I was also able to attend the preceptorship that was running that week. The lectures reinforced evidence-based good care delivery to SpA patients but also aspects of basic science and related specialties (e.g., dermatology).

Through the three days I discussed potential research projects and collaborations with Helena and her team for aim 2. We provisionally arrived at the following:

1) Combining observational data from Leeds and Liverpool to examine clinical differences between axial SpA with psoriasis and axial PsA.

2) Combining observational data from Leeds and Liverpool, and possible other centres, to compare effectiveness of biologic therapy in axSpA, specifically IL17A inhibition vs TNFi after initial TNFi failure.

Sizheng Steven Zhao