The 'CARDIOvascular-Immune-Mediated Inflammatory Diseases (CARDIO-IMID) UK Network'

Objective: To improve the outcomes of people with Immune-mediated inflammatory diseases (IMID) who are at risk of/have cardiovascular (CV; heart and vessels) involvement, by bringing together the UK's expertise in CV and IMID research, raising awareness, improving methods of diagnosis and monitoring and increasing research in the field.

Background: Over a million people in the UK are affected by IMIDs in which abnormal behaviour of the immune system causes inflammation of the joints, skin and internal organs. The most common IMID is rheumatoid arthritis, but also includes systemic lupus erythematosus and rare diseases such as systemic sclerosis. People with IMIDs are 3-4 times at higher risk of dying compared to the general population, with CV involvement one of the major causes.

Unmet needs: We do not have standard methods to diagnose CV involvement in people with IMIDs, which can delay diagnosis. We do not know how to identify and monitor patients most at risk of CV disease (CVD). Clinical trials of people with IMIDs do not evaluate for CVD, so we do not have good evidence on which treatments improve CV outcomes.

Key imaging methods that detect CVD are CV magnetic resonance imaging (CMR) and PET-CT. CMR is safe and very accurate but CMR measures have not been tailored to people with IMIDs. PET-CT is an effective tool to identify inflammation, but its access is variable. Also, it is not clear which patients with abnormalities may develop actual problems later.

Aims: We will establish a national network, the "CARDIO IMID UK Network" and have already identified 29 centres across England, Scotland, Wales and Northern Ireland. The Network will bring together CV and IMID experts and allow us to:

1. Bring together doctors and researchers from the CV and IMID fields and patient groups to improve education and training, and develop a national research strategy. This will lead to pathways of care tailored to people with IMIDs and better methods of diagnosis and treatment.

2a. Develop a database platform to securely store, manage and analyse clinical and heart investigation data from people with IMIDs and CV involvement across the centres so that we can conduct studies in the future.

3b. Establish a patient registry of existing and new people with IMIDs and CV involvement. This will be an invaluable resource to better understand the features of CV involvements across different IMIDs and inform future studies to improve diagnosis and test therapies.

3. Bring in uniform methods for CMR and PET-CT scanning and diagnosis so people with IMID across the UK are assessed in a way that is comparable across centres.

4a. Link the above registry with national initiatives such as the NIHR Bioresource for IMID that collects samples from people with different IMIDs

4b. Conduct a pilot study in which clinical, imaging and blood marker data obtained from a subgroup of patients recruited to the registry will establish capability to do this on a larger scale and inform the design to discover markers to help diagnose and develop new treatments

5.Establish collaboration with industry to enable inward investment and sustainability of the partnership beyond the duration of the grant; and the development of studies to target the unmet needs of this IMID population at risk of CVD.

We have crucial support from key partner groups including (i) existing national IMID networks which will identify patients and develop research projects (ii) the NIHR-Versus Arthritis Musculoskeletal Translational Research Collaboration, a network of academic experts in IMIDs and novel research to tailor therapies (iii) the NIHR-BHF Cardiovascular Partnership, a national collaborative of CV researchers, which has supported the convening of the CARDIO IMID UK Network community

If successful, the MRC-funded 'CARDIO-IMID UK Network' will be one of the largest national interdisciplinary initiatives that will have a major impact on people with IMIDs.