Following this he completed his junior medical training on the North Western medical rotation, obtained MRCP and embarked on the rheumatology training programme. Prior to commencing the North West England MRC Clinical Research Fellowship he completed 3 years of rheumatology training and a further masters degree with distinction researching genetics of psoriatic arthritis at the Arthritis Research UK epidemiology unit, University of Manchester. During his time in clinical training and research, the wide variation in patient response to medication and development of adverse events led to an interest in personalised medicine and pharmacogenetics.
Investigating Treatment Response and Adverse Events to Methotrexate in Patients with Rheumatoid Arthritis
Methotrexate is the most common treatment for rheumatoid arthritis, a condition in which severe joint inflammation and damage can occur. However, up to 40% of patients do not take their medication as recommended and response rates vary between individuals. Methotrexate is also associated with significant side effects but we cannot yet predict who will develop the side effects.
Currently, there are no tests by which to measure whether patients are taking their methotrexate as prescribed. During his PhD Dr Bluett developed such a test based on blood or urine samples.
In the body, methotrexate is broken down to other constituents which control the inflammation in RA. Dr Bluett investigated whether measuring these determined which patients are taking their medication and those who are more likely to respond to therapy or have side effects.
Finally, during the Fellowship, Dr Bluett performed genetic testing to predict the risk of a side-effect called pneumonitis, which affects a small percentage of people who take the drug. As this complication can be life-threatening, it is very important to develop ways of identifying people at risk.
Following the MRC Fellowship, Dr Bluett was successful in obtaining an NIHR Academic Clinical Lecturship in Rheumatology. During this time he will continue his clinical practice whilst investigating the clinical utility of the methotrexate test he developed during his PhD.