I’d like you to look at your hands have
a good look at them
would you stretch them out a fist put
them together and give them a squeeze
you feel comfortable I want you to have
a think about some of the things that
you might have done this morning any
dressed making yourself some toast and
spreading a bread if you haven’t changed
the baths or getting your car keys or
locking the front door all of these
things so straightforward he probably
didn’t even think about them pretty
simple easy things to do it if you’re
someone with active rheumatoid arthritis
each one of these activities is a
massive struggle rheumatoid arthritis is
a condition with a body’s defense system
that normally fights off bugs such as
viruses baby coughs and colds it gets
confused and it starts attacking your
joints particularly the lining of your
drinks the lining of the knuckle joints
the wrist joint elbow joints in fact
almost any joint in the body can be
affected and what happens where the
body’s immune system will the defense
system fights against itself as it
causes the joint lining to swell the
fingers become stiff swollen and painful
and in addition to this you feel
absolutely exhausted because it feels
like you’ve got a really bad back or flu
all the time it doesn’t just cause
symptoms though if untreated this
condition causes permanent disability
and damage
here in this image you can see that the
person’s finger has become as we call
dislocated so it’s dropped down out of
the knuckle joint and in addition to
that the fingers have started to move
over to the side
this person will really struggle to make
a pinch grip or a fist I want you to go
back to thinking about those things that
you’ve barely thought about doing this
morning and imagine trying to do those
things without being able to make a
pinch or a fist grip pretty challenging
the good news is we have some good tools
some good med students to try and treat
this condition the thing I didn’t tell
you though is that rheumatoid arthritis
is well we have one name for it has many
different facets in different people
this means that not everyone responds in
the same way to the same medicines which
means that it’s difficult to know which
of our good medicines that we should use
first off now when we target treatments
for rheumatoid arthritis they work by
just slightly dampening down the body’s
immune system the defense system that’s
gone on an attack against itself and we
have to be careful we have to be gentle
because we don’t want to wipe out the
immune system because then a simple
corporal coddles could be fatal so we
have to be gentle and take it slow which
means that each treatment takes some
time to work it can take up to six
months to know whether or not the
treatment is going to work for someone
so if the first treatment works for you
then you can get some benefit within the
first few months but if you have to wait
and wait it’s not long before you may
well be waiting a couple of years to get
relief from your symptoms all the while
knowing that your drink’s may be
becoming damaged irreversibly as well
the other thing I need to tell you is
that our treatments don’t work in an on
off fashion so we don’t get a response
or nervous
we get a spectrum of response so if we
have a hundred patients with rheumatoid
arthritis ten of them will probably not
respond at all 50 of them will get some
response they’ll get a little better and
that the 30 will get quite a lot better
and then only at about ten we’ll get
really completely better so how do we
try and identify who’s going to respond
to these medicines first up well
researchers tend to look at population
so large groups of people with
rheumatoid arthritis you take treatments
and we try and group them together to
try and find common patterns about who
responds well and who doesn’t respond so
well and then by doing that we try and
predict who will respond well from their
treatments first of all now that all
sounds well and good but it requires
that you can tell the different groups
apart now that a large population
sometimes is easy to see the separate
group but actually what happens in the
real life is that usually there’s a
little bit of overlap and that means
there’s a bit of uncertainty about where
you should put your group in fact
there’s usually a fair bit of
uncertainty and in fact quite often a
lot of uncertainty now this is important
because where you put your groups
decides who you find within that group
and who’s within that group tells you
what predicts and being a macron to give
you an example of a sports crowd can
sometimes help
so in this crowd you can clearly see
groups of people they’re all together
it’s quite clear there are people with
red shirts people with blue shirts
people with white shirts you could you
could draw a line around those groups
you feel quite confident about where the
group starts and finishes and this is an
ideal scenario so you can then look at
those groups and say what what’s the
common amount of people with white
shirts they support one team or blue
shirt support another team what usually
happens though in research the people
like this it’s really difficult to see
groups up there are some groups within
there because they used to be up in the
stands they’ve now gone onto the pitch
and so there are groups are now but it’s
really difficult to tell exactly where
they are the other thing to be aware of
is about when you look now then if ever
any of you have ever had these when you
were younger of sort of a flip book
where you could flip through and you can
see the pattern emerge as you flip
through the pages of the flip book now
what this tells us is that when we’re
measuring how well someone does
rheumatoid arthritis continues over time
it doesn’t just stop at six months it
doesn’t stop at 12 months it’s there all
the time and it fluctuates so it gets
better and it gets worse from day to day
but when you do a research study you
need to say I’m going to look at six
months well I’m going to look at 12
months if I ask everyone at that time
how they’re doing but everyone will be
at different phases through their flip
book so they might be having a good time
going down the hill everything’s great
they might be finding it difficult going
up the hill and in fact if you ask them
a week or two later things might be
different and we don’t know whether or
not there’s a happy ending so I’m going
to show you some of the data from a
large database that we work on in the
United Kingdom and this database is
about 20,000 people with rheumatoid
arthritis who’ve been taking treatments
for their condition and it’s been going
for about 15 years and we ask people
every six months how they’re doing and
we recall back down and if we put all of
that data onto one slide we cannot see a
great deal okay whatever you put a slide
up by these people generally go well we
can see there was some vertical lines
the vertical lines of every six months
that’s because we ask people every six
months how they’re getting on some
people fill within a bit early and some
people a bit late which is why you’ve
got that spread of data and on the side
you can see it’s how bad
soit arthritis is say tens really bad
zero is no symptoms at all and on the
bottom you can see time so looking at
this apart from those vertical line it
is really difficult to see any pattern
as such and the thing is is when we look
at this sort of data we need to start
thinking about groups of people and we
can be helped in understanding this by
thinking about starlings or Birds
generally so if you look at one Starling
is a you looks very happy sitting there
but we can’t tell a lot about what’s
going on you can tell a lot about him as
an individual but not as a group as a
whole in fact if we look at a few on a
line we can still not really see much in
the way of patterns it’s not until we
grew we really zoom out we can see that
there’s a group of steins there are a
couple of hundred storming step I don’t
know if ever you’ve seen on a summer’s
evening walking home groups of birds
like this swarming around it’s
absolutely fantastic if you zoom in on
that group you don’t see the real
patterns you don’t see what’s going on
it’s not until you step back in fact
sometimes you can see that there are two
groups or is it one brief in this case
it’s two groups but if we look back at
that image again we can see that now
there probably are two groups now
overlapping so we can use our knowledge
to actually find new patterns within the
data and this means that instead of
trying to say well let’s look at things
just at six months and say how are you
doing in six months we can start saying
should we have a look at people in real
time over time and try and understand
trajectories of how people do how do
people do in the real time over the long
haul
so let’s look back the bat and slide
against ill-concealed see the slides
with the lines of the vertical lines is
not fabulously clear but if we ask the
computer to say can you split that up
into groups we see something interesting
the computer will join everyone’s data
points doctor dogs so there are people
here that will have one every one day to
point every six months or so and it
joins them together and
splits them out into some groups that it
can see and what it sees it it starts
seeing that there are patterns within
the data so previously you couldn’t see
really very much at all but now we can
see that there seems to be at the top a
group of people who have continued to
not do very well and at the bottom a
group of people that seem to do really
well this is still a really difficult
slide to see exactly what’s going on so
that’s asking to clean it up a little
bit more and we can see that there are
now four groups of people that split out
and they split out pretty early I spit
out actually you can start telling
difference at about one or two months
and what’s really exciting is that we
can now look at those different lines
and we can trace it back to the
beginning
– before anyone has taken their medicine
and we can say what’s different between
these groups what is different between
someone who’s going to go on the top
line and someone who’s going to go on
the bottom line because if you go on the
bottom line you can do really well and
that’s a good treatment for you if
you’re on the top line the treatments
not probably that great for you and we
can see that there are some common
passes people there are many different
things that we’ve seen that some of the
things that we’ve seen is people through
in whatever way it seems to not do so
well people who smoke don’t do so well
and women don’t seem to do as well
generally with treatments as you men and
we don’t know why and if you’re thinner
you also seem to do better so we’re
right at the beginning here this is one
database for one drug set but there are
many different databases out there and
we’re starting to be able to link these
together and with the computing power
that we have now we can start seeing new
patterns within those data we can start
seeing new flocks of starlings where we
previously saw one we can see two and we
can start being able to predict things
much better so that we can go from any
having ten percent or ten in a hundred
people been well to having everyone
doing well first time
your hands are the most amazing tools
that you have and it’s really important
that we stop this from happening and I
believe we can stop this and we are
seeing less of this we want to stop the
damage and disability and protect
protect our hands when we young twin
holes
[Applause]
a good look at them
would you stretch them out a fist put
them together and give them a squeeze
you feel comfortable I want you to have
a think about some of the things that
you might have done this morning any
dressed making yourself some toast and
spreading a bread if you haven’t changed
the baths or getting your car keys or
locking the front door all of these
things so straightforward he probably
didn’t even think about them pretty
simple easy things to do it if you’re
someone with active rheumatoid arthritis
each one of these activities is a
massive struggle rheumatoid arthritis is
a condition with a body’s defense system
that normally fights off bugs such as
viruses baby coughs and colds it gets
confused and it starts attacking your
joints particularly the lining of your
drinks the lining of the knuckle joints
the wrist joint elbow joints in fact
almost any joint in the body can be
affected and what happens where the
body’s immune system will the defense
system fights against itself as it
causes the joint lining to swell the
fingers become stiff swollen and painful
and in addition to this you feel
absolutely exhausted because it feels
like you’ve got a really bad back or flu
all the time it doesn’t just cause
symptoms though if untreated this
condition causes permanent disability
and damage
here in this image you can see that the
person’s finger has become as we call
dislocated so it’s dropped down out of
the knuckle joint and in addition to
that the fingers have started to move
over to the side
this person will really struggle to make
a pinch grip or a fist I want you to go
back to thinking about those things that
you’ve barely thought about doing this
morning and imagine trying to do those
things without being able to make a
pinch or a fist grip pretty challenging
the good news is we have some good tools
some good med students to try and treat
this condition the thing I didn’t tell
you though is that rheumatoid arthritis
is well we have one name for it has many
different facets in different people
this means that not everyone responds in
the same way to the same medicines which
means that it’s difficult to know which
of our good medicines that we should use
first off now when we target treatments
for rheumatoid arthritis they work by
just slightly dampening down the body’s
immune system the defense system that’s
gone on an attack against itself and we
have to be careful we have to be gentle
because we don’t want to wipe out the
immune system because then a simple
corporal coddles could be fatal so we
have to be gentle and take it slow which
means that each treatment takes some
time to work it can take up to six
months to know whether or not the
treatment is going to work for someone
so if the first treatment works for you
then you can get some benefit within the
first few months but if you have to wait
and wait it’s not long before you may
well be waiting a couple of years to get
relief from your symptoms all the while
knowing that your drink’s may be
becoming damaged irreversibly as well
the other thing I need to tell you is
that our treatments don’t work in an on
off fashion so we don’t get a response
or nervous
we get a spectrum of response so if we
have a hundred patients with rheumatoid
arthritis ten of them will probably not
respond at all 50 of them will get some
response they’ll get a little better and
that the 30 will get quite a lot better
and then only at about ten we’ll get
really completely better so how do we
try and identify who’s going to respond
to these medicines first up well
researchers tend to look at population
so large groups of people with
rheumatoid arthritis you take treatments
and we try and group them together to
try and find common patterns about who
responds well and who doesn’t respond so
well and then by doing that we try and
predict who will respond well from their
treatments first of all now that all
sounds well and good but it requires
that you can tell the different groups
apart now that a large population
sometimes is easy to see the separate
group but actually what happens in the
real life is that usually there’s a
little bit of overlap and that means
there’s a bit of uncertainty about where
you should put your group in fact
there’s usually a fair bit of
uncertainty and in fact quite often a
lot of uncertainty now this is important
because where you put your groups
decides who you find within that group
and who’s within that group tells you
what predicts and being a macron to give
you an example of a sports crowd can
sometimes help
so in this crowd you can clearly see
groups of people they’re all together
it’s quite clear there are people with
red shirts people with blue shirts
people with white shirts you could you
could draw a line around those groups
you feel quite confident about where the
group starts and finishes and this is an
ideal scenario so you can then look at
those groups and say what what’s the
common amount of people with white
shirts they support one team or blue
shirt support another team what usually
happens though in research the people
like this it’s really difficult to see
groups up there are some groups within
there because they used to be up in the
stands they’ve now gone onto the pitch
and so there are groups are now but it’s
really difficult to tell exactly where
they are the other thing to be aware of
is about when you look now then if ever
any of you have ever had these when you
were younger of sort of a flip book
where you could flip through and you can
see the pattern emerge as you flip
through the pages of the flip book now
what this tells us is that when we’re
measuring how well someone does
rheumatoid arthritis continues over time
it doesn’t just stop at six months it
doesn’t stop at 12 months it’s there all
the time and it fluctuates so it gets
better and it gets worse from day to day
but when you do a research study you
need to say I’m going to look at six
months well I’m going to look at 12
months if I ask everyone at that time
how they’re doing but everyone will be
at different phases through their flip
book so they might be having a good time
going down the hill everything’s great
they might be finding it difficult going
up the hill and in fact if you ask them
a week or two later things might be
different and we don’t know whether or
not there’s a happy ending so I’m going
to show you some of the data from a
large database that we work on in the
United Kingdom and this database is
about 20,000 people with rheumatoid
arthritis who’ve been taking treatments
for their condition and it’s been going
for about 15 years and we ask people
every six months how they’re doing and
we recall back down and if we put all of
that data onto one slide we cannot see a
great deal okay whatever you put a slide
up by these people generally go well we
can see there was some vertical lines
the vertical lines of every six months
that’s because we ask people every six
months how they’re getting on some
people fill within a bit early and some
people a bit late which is why you’ve
got that spread of data and on the side
you can see it’s how bad
soit arthritis is say tens really bad
zero is no symptoms at all and on the
bottom you can see time so looking at
this apart from those vertical line it
is really difficult to see any pattern
as such and the thing is is when we look
at this sort of data we need to start
thinking about groups of people and we
can be helped in understanding this by
thinking about starlings or Birds
generally so if you look at one Starling
is a you looks very happy sitting there
but we can’t tell a lot about what’s
going on you can tell a lot about him as
an individual but not as a group as a
whole in fact if we look at a few on a
line we can still not really see much in
the way of patterns it’s not until we
grew we really zoom out we can see that
there’s a group of steins there are a
couple of hundred storming step I don’t
know if ever you’ve seen on a summer’s
evening walking home groups of birds
like this swarming around it’s
absolutely fantastic if you zoom in on
that group you don’t see the real
patterns you don’t see what’s going on
it’s not until you step back in fact
sometimes you can see that there are two
groups or is it one brief in this case
it’s two groups but if we look back at
that image again we can see that now
there probably are two groups now
overlapping so we can use our knowledge
to actually find new patterns within the
data and this means that instead of
trying to say well let’s look at things
just at six months and say how are you
doing in six months we can start saying
should we have a look at people in real
time over time and try and understand
trajectories of how people do how do
people do in the real time over the long
haul
so let’s look back the bat and slide
against ill-concealed see the slides
with the lines of the vertical lines is
not fabulously clear but if we ask the
computer to say can you split that up
into groups we see something interesting
the computer will join everyone’s data
points doctor dogs so there are people
here that will have one every one day to
point every six months or so and it
joins them together and
splits them out into some groups that it
can see and what it sees it it starts
seeing that there are patterns within
the data so previously you couldn’t see
really very much at all but now we can
see that there seems to be at the top a
group of people who have continued to
not do very well and at the bottom a
group of people that seem to do really
well this is still a really difficult
slide to see exactly what’s going on so
that’s asking to clean it up a little
bit more and we can see that there are
now four groups of people that split out
and they split out pretty early I spit
out actually you can start telling
difference at about one or two months
and what’s really exciting is that we
can now look at those different lines
and we can trace it back to the
beginning
– before anyone has taken their medicine
and we can say what’s different between
these groups what is different between
someone who’s going to go on the top
line and someone who’s going to go on
the bottom line because if you go on the
bottom line you can do really well and
that’s a good treatment for you if
you’re on the top line the treatments
not probably that great for you and we
can see that there are some common
passes people there are many different
things that we’ve seen that some of the
things that we’ve seen is people through
in whatever way it seems to not do so
well people who smoke don’t do so well
and women don’t seem to do as well
generally with treatments as you men and
we don’t know why and if you’re thinner
you also seem to do better so we’re
right at the beginning here this is one
database for one drug set but there are
many different databases out there and
we’re starting to be able to link these
together and with the computing power
that we have now we can start seeing new
patterns within those data we can start
seeing new flocks of starlings where we
previously saw one we can see two and we
can start being able to predict things
much better so that we can go from any
having ten percent or ten in a hundred
people been well to having everyone
doing well first time
your hands are the most amazing tools
that you have and it’s really important
that we stop this from happening and I
believe we can stop this and we are
seeing less of this we want to stop the
damage and disability and protect
protect our hands when we young twin
holes
[Applause]
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