Episode 56 IA Insights with Dr Rosemary Hollick

Introduction: Different types of inflammatory arthritis and the power of patient partnerships

Debbie: Hello and welcome to Inflammatory with Debbie.

Katy: And Katy

Debbie: We’re delighted to be joined today by Dr. Rosemary Hollick, who’s going to discuss different types of inflammatory arthritis, psoriatic arthritis and axial spas, but also her role in research. Dr. Rosemary leads a health services research program at the University of Aberdeen, which addresses critical real-world questions and drives meaningful improvement in healthcare and policy across a broad range of rheumatic and musculoskeletal conditions and she’s very keen on patient-centred approaches. Dr. Rosemary has won the University of Aberdeen Principles Excellence Award for research engagement in public patient community involvement and engagement. Such a mouthful, but congratulations, Rosemary.

Katy: Congratulations.

Rosemary Hollick: Thank you very much. you. Yeah, I think it’s harder to say than it was to win.

Debbie: how are you? And just give us a background about yourself.

Rosemary Hollick: Hi, thank you very much for inviting me to chat with you and I’m really pleased to be here. I’m a rheumatologist based up in the north of Scotland in Aberdeen, and we look after people in the north of Scotland and also the islands of Orkney. So, we cover a really large area. But as you said, I am a researcher and a rheumatologist. And so, I’m particularly interested in how we can better design and deliver services for people with rheumatic and musculoskeletal conditions. And what attracted me to rheumatology? Well, I did a science degree before I did medicine, so I’ve always been interested in science and rheumatology. You it’s about the understanding the immune system. So, you know, there’s a really strong underpinning science there. But I was attracted to the fact that you look after people with long term conditions, you get to know people and you look after them through those key life transitions, I’m an adult rheumatologist, so people, you know, diagnosed as children and moving into adult services, managing your rheumatic condition when you’ve got kids and maybe looking after older relatives and also into older age as well. And I really value that aspect of care and getting to know my patients.

Katy: how long have you been a rheumatologist?

Rosemary Hollick: How long have I been a rheumatologist? That’s a question. So, I graduated in 2004 and I came up to Aberdeen as a trainee in rheumatology in 2008. And I took a little bit of time to do my training because I had a couple of kids. So, I had some maternity leave and I trained part time. And in the middle of it all, complete madness, when my girls were three and one, I decided to do a to do a PhD, which…

Debbie: Life wasn’t challenging enough for you.

Rosemary Hollick: No, no, So that lengthens things a little bit further. So I completed my training in 2017. So I have been a consultant rheumatologist for almost 10 years now, actually, which makes me sound very old.

Debbie: No, not at all, no. But obviously you still enjoy it though.

Rosemary Hollick: Absolutely, absolutely. I wouldn’t want to do anything else, although there are some things when I think, my goodness, there’s just not enough hours in the day, but that’s life, isn’t it? Yeah.

Katy: Yes. Yeah.

Debbie: Yeah, yeah, very much. So just kind of what we’re going to be talking today, just a little bit in more detail and then going into the research side is we’ve had Andy on recently talking from the patient side about sciatic arthritis and it is a rarer form of inflammatory arthritis. But from your point of view, from the medical side, what are the main symptoms of sciatic arthritis?

Rosemary Hollick: Yeah, so psoriatic arthritis is a type of inflammatory arthritis and that means that the immune system is overactive and it causes inflammation in the joints and other parts of the body. So psoriatic arthritis is linked to psoriasis, which is a skin condition where you can get, red skin, silvery scales, et cetera.  Psoriatic arthritis, get skin changes, obviously, but you get pain and swelling and stiffness in and around the joints. And it affects around one in four people who already have psoriasis. So, most people with psoriasis do not have psoriatic arthritis, but people with psoriasis can obviously develop psoriatic arthritis. And sometimes people can actually develop the arthritis before they actually notice the psoriasis. And then occasionally, sometimes people can develop psoriatic arthritis not obvious skin disease. But it’s not simply just joint pain with psoriasis. It’s an inflammatory condition that can affect the joints and the tendons, the fingers and the toes and the nails. And you can also get inflammation in the spine as well with it.

Katy: Okay, well I wasn’t aware of that actually. So I’ve got rheumatoid arthritis and what’s the difference then between psoriatic arthritis and rheumatoid arthritis?

Rosemary Hollick: Yeah, so there is some overlap in that they’re both inflammatory types of arthritis and both can cause painful swelling, swollen joints and stiffness in the joints. But there are some important differences. So, one of them is the pattern of the joints that are involved. So, it’s not always the case, but generally rheumatoid arthritis tends to affect the same joints on both sides of the body.

Katy: Yeah, it’s symmetrical, isn’t it? Yeah.

Rosemary Hollicl: symmetrical, yeah, particularly the small joints of the hands and feet. Whereas psoriatic arthritis can be a bit more varied, so it can affect joints, sometimes the different joints, sometimes the more the joints at the end of the fingers, you can also affect the nails and the tendons and the places where tendons attach into the bone and of course sometimes the spine. So, it’s kind of a different pattern. And psoriatic arthritis can also be associated with other things such as uveitis, which is inflammation in the eyes or inflammatory bowel disease, as I said, or inflammation in the spine, which rheumatoid arthritis tends not to. People with rheumatoid arthritis can sometimes have antibodies in their blood, like rheumatoid factor or anti-CCP antibodies, which people with psoriatic arthritis don’t have as well.

Katy: Yep. Okay.

Rosemary Hollick: I think it’s a mixture of things that sort of bring you to the diagnosis. It’s the symptoms, it’s the pattern of involvement of joints and tendons and other parts of the body. So, you kind of need to bring these things together in order to make the diagnosis. There’s no one specific thing that will usually…

Katy: I guess everybody presents differently anyway, don’t they? The way people, we’ve talked about this before on the podcast, the way we all think or describe pain or trying to explain how your body feels can be really challenging. So for you as a rheumatologist, how do you cut through the patient’s own noise, so to speak, when they’re maybe not explaining themselves easily?

Rosemary Hollick: They do. They do. Yeah, so I remember when I was a medical student and I sat in with a neurologist and he was a very eminent neurologist and watching him speak to a patient and take a history from a patient was amazing. I remember him saying to me, just listen to the patient because the patient will tell you the answer if you listen and it can be difficult. I think and certainly you can help, guide and answer specific questions. But I think just having that space to be able to listen to what the patient’s telling you, they will usually be telling you the answer. You just you’ve just got to listen for it.

Katy: Okay, yeah, because that’s the hardest thing from the patient perspective is actually explaining what you’re going through to essentially help the rheumatologist or whoever you’re in front of understand the situation.

Rosemary Hollick: Yeah. And I think it can be difficult, particularly, you know, we all get aches and pains from time to time. if we all sit still for a long period of time, you know, if you’ve laid on the sofa all afternoon watching a film and then you get up, it’s not abnormal to feel a little bit stiff or a little bit achy or if you’ve been in bed had a long lie. But it’s recognising when that’s different.

Katy: Yes.

Rosemary Hollick: And, also with conditions like axial spondyloarthritis where you get, pain in the back and that’s inflammatory back pain, which is different from the normal aches and pains that we get, but everybody gets aches and pains in their backs from time to time. And I think it’s very easy to dismiss sometimes symptoms and think, I’ve just done something, I’ve got bad back. So, I think there’s two ways. I think there’s…one about hopefully raising awareness so that people recognise that actually this might be something I need to go and see somebody about.

Debbie: Because you mentioned axial spa and you said with psoriatic arthritis, you can get the back pain. So, what then gives you the diagnosis of axial spa?

Rosemary Hollick: Yeah, so Axia spondyloarthritis is another type of inflammatory arthritis and it mainly affects the spine and the joints between the spine and the pelvis called the sacroiliac joints. In saying that, you can also get inflammation in your other joints. And people with psoriatic arthritis can also get inflammation in the spine. So, there is a bit of an overlap and these sort of group of conditions are known as the spondyloarthropathies. but axial spondyloarthritis is largely the inflammation in the spine. But you can have what we call peripheral joint involvement as well. People who have axial spondyloarthritis can sometimes get uveitis as well, inflammation in the eyes. And you can also see what we call axial involvement in people with inflammatory bowel disease as well.

Katy: Okay. And when, if someone’s presenting themselves with back pain, how do you then differentiate and diagnose it as axial spa over, long-term back injury?

Rosemary Hollick: Yeah, and that can be really difficult. So typically, the kind of back pain that you get with axial spondyloarthritis is often worse in the morning, worse after rest, often prolonged pain and stiffness in the morning that gets better as you get going. Sometimes it can radiate into the buttock. It can wake people up at night. Whereas what we call more mechanical back pain, the sort of the usual back pain that we get if we’ve been sitting or, done something and pulled a muscle. It tends to be worse when you’re moving and better when you rest. Whereas the inflammatory back pain, a bit like inflammatory joint pain, tends to get better as you get going and it gets and it’s worse if you’re sitting for a long period of time. But you’re right, it’s often difficult to differentiate between that and run of the mill back pain. And so, it can often get missed and it can particularly get missed in women. So, when I was at medical school, I was told that, Axia spondyloarthritis was really, really uncommon in women.

Katy: Yes. Yeah.

Rosemary Hollick: And the ratio of men to women was about nine to one. And we now know that that is not true. we do see women who, the diagnosis has been missed because it’s just been dismissed as, mechanical back pain. It typically starts when you’re younger as well. So Axia spondyloarthritis symptoms tend to start when you’re younger. In women, can sometimes present a little bit differently and women can sometimes have more widespread pain. it is, think that’s the most important message for health care professionals is that, women get axial spondyloarthritis as well.

Debbie: Yes, because we did have Rachel on about, I think it about a year ago, because it’s just been the, yeah, because it was the AS day on Saturday, the 2nd of May. And she was saying it took her about 13 years to get a diagnosis. And unfortunately, that’s quite normal for women. And it’s just trying to raise the awareness that women can get back pain. So, if your back pain has been going on for so long, and obviously, as you say, it’s stiff, and it gets better with exercise that’s when you might have to go and see someone.

Rosemary Hollick: Yeah, particularly if you may have had other things like you’ve had inflammation in the eye or any involvement in your other joints as well. But the delay to diagnosis is a big thing in axial spondyloarthritis. I think largely because it does mimic back pain and almost all of us get back pain.

Debbie: It’s really interesting to highlight though the difference is between the mechanical and the AxSpa. But obviously, you treatment, you’re heavily involved in the research, which we’ll go on to in a minute as well, but treatment has changed dramatically over the last 10, 20 years. How has that been reflected in clinic life?

Rosemary Hollick : Well, when I first came to Aberdeen in 2008, and I’d previously trained in Glasgow, we had a ward of, we had a rheumatology ward here in Aberdeen. And patients who had a flare were often admitted for physiotherapy for steroids. biologics were only just coming in at that point. And the people that were getting biologics were people who had very established disease. And so, we had inpatients. It wasn’t uncommon to see people with really significant joint deformities and damage and also, you know, heart disease and strokes because they’ve had uncontrolled inflammation for many years. You know, fast forward now to 2026, we don’t have a ward anymore. We’re an outpatient specialty. We’re using biologics much earlier. We have fast track ways into our service for people who’ve got high suspicion of having inflammatory arthritis. So, we can start treatment early. We can then move quickly to biologic treatment. So, we’re preventing that damage occurring and we’re keeping people at work, we’re keeping people out doing what they absolutely doing what they should be doing. So it’s hugely changed the way our services work.

Katy: Do the pathways and guidelines differ between the different conditions? So I know for rheumatoid arthritis, for example, your DAS score has to be at a certain level to then be able to go on to the biologics. how does that work across the different inflammatory arthritis conditions?

Rosemary Hollick: Yeah, so there are different criteria with psoriatic arthritis and axial spondyloarthritis for starting biologic therapy. But there’s a similar process in that you need to meet certain criteria to get biologic treatment. But I think we are moving to using biologics much earlier than we did before.

Debbie: That’s the key, isn’t it? Because we know that these medications work. So actually, why put patients through going through other medications where we know that they probably won’t work, just to prove that they don’t work and then to get onto these biologics.

Katy: It blows my mind how it’s changed from 2008. So I was diagnosed in 2011 and even just in those three years, it must have changed a lot in terms of care because I was purely outpatient. So, I just, find it fascinating actually to understand what it was like in that, and it’s not that long ago.

Rosemary Hollick: So I remember, looking back through people’s notes and, people would write, they’ve got joint swelling. For example, rheumatoid arthritis got joint swelling, give them a bit of anti-inflammatory, see them back, and then you would wait until they developed joint damage. And then you would think about using what we call a disease modifying drug. And the ones that we had then didn’t work terribly well. But by that point, we’d kind of missed the boat because the damage has already occurred. So now, it’s much more about getting in hard and early. Biologics are great. I mean, in saying that, some people do OK with our standard treatment and that is OK. But yeah, we want to be able to have the pathways so that we can get people quickly to the right treatment.

Debbie: Yeah, because I suppose also those biologics some work for different people. So obviously for us as patients, that can be frustrating. We try a medication and it doesn’t work. And I know there is research trying to get rid of that trial and error, but do you find that frustrating as well that you’ve put a patient on this medication, know, fingers crossed it works.

Rosemary Hollick: I wish I could say this is the medication for Debbie. This is the medication for Katy which might be different than the medication for Rosemary. I wish we could. And I think one thing I have realised is, you know, none of our drugs work straight away usually. And we usually say three to four months to take effect, that is a very long time when you’re really struggling. That is a really, really long time. And there’s, I guess there’s various reasons why you would choose a particular drug. So, one is sort of thinking, well, this is the condition that they’ve got, and this is the most likely pathway to be involved. Therefore, we will target that. There is also cost as well. So, for example, the anti-TNF biologics are usually first line because they’re now off-patent, which means they’re a lot cheaper. So, there’s that aspect. There’s also, different ways of administrating them now. So, you know, some are weekly, some are fortnightly, some are monthly and, different things suit different people. So, there are some people, for example, who would prefer for various reasons and travel to have monthly injections rather than weekly. Weekly might be better, particularly if you’re a bit worried about infection and you want something that’s going to come out the system sooner. So, there’s various reasons why you might choose one or the other, but it’s about a shared decision with the patient.

Debbie That’s really good to know. But then moving now on to the research side, because obviously you’re very heavily involved in that and obviously you won a PPIE award. And actually, Katy and I were talking about this on our last podcast after coming out from the British Society for Rheumatology Conference. we saw you there as well. But it’s just trying to highlight the difference between PPIE and, getting involved in, the qualitative research side being part of a focus group.

Rosemary Hollick: Yeah.

Debbie: You are very keen on getting PPIE involved into research. How has that changed and what does that mean to you?

Rosemary Hollick: It’s changed hugely since I joined our group in 2017, our research group. There was no PPIE at all. Yes. No, it’s not. No, there wasn’t. And I got working with a colleague, Professor Louise Lowcock, who is a professor of health services research. And she’d done a lot of work on using patient experience data to inform

Debbie: Right, wow, even that’s not that long ago though, okay.

Katy: Wow.

Rosemary Hollick: how best to deliver care. one of the first research projects I did was program called Voices, which was looking at how we can design and deliver better care for people with rare rheumatic condition vasculitis. And particularly, we wanted to look at what key parts of service were needed to improve outcomes. We started off by asking people what good care looked like and what that looked and felt like in practice. And then what parts of the service you needed to deliver that. And then we could see actually if you were looked after in a service which had these things, did you have better outcomes? So it was a real eye-opener for me in terms of being able to go directly to the people who living with the condition and health care professionals looking after them and what does good care look like? What does that look and feel like in practice? And then applying additional research tools on top of that to understand that in more detail. And that has really formed the basis for all of subsequent research that we’ve done. Now every single piece of work that we do has patient involvement in it. And this is patient involvement in terms of helping us design the research questions, what matters to patients. So, really building on the work we did with Voices, our patient partners are involved in all aspects of all our studies now from helping us shape the research. Are we asking the right questions? Does this matter? Helping us design the research, helping us develop the information leaflets and also just how we go about the research and making sure that it’s acceptable and feasible for participants and also helping us analyse the results. that’s been something that has been really helpful. So, coming back to the Voices study again, our research fellow was looking at some of the data from the interviews that we’d done. And she was really struggling. She’s like, there’s something here and I’m missing it. And she showed some of the interview transcripts to some of our patient partners and they said, this is about feeling safe. And she’s like, that’s it. That’s exactly what it is. It was about being looked after in a service where you felt safe, both from a healthcare professional perspective and from a patient perspective as well. And particular areas where people felt really unsafe was in out of hours care when they might be admitted to a hospital where people didn’t necessarily know them. They knew most about their condition. What if they weren’t well enough to be able to articulate that. So, and that actually was an overarching theme that our patient partners helped us get out from the data. So that’s really important. And also, our patient partners have a really important role in helping us get the results out there and engineered that impact from the studies as well. So, it’s hugely important and it’s also not something that you can do in five seconds. It’s about it takes time. It’s about developing relationships and trust over time. And that’s a lot of hidden work that I don’t think is properly acknowledged in the system. So, know, funders, for example, they want PPI now. That’s great. But actually, there’s a lot of work.

Debbie: Yeah, it takes time. Yeah. Completely. Yeah.

Rosemary Hollick: That goes into developing and maintaining those relationships.

Debbie: Yeah, because I suppose that some researchers can still see it as just a tick box. know, PPIE, I’ve spoken to a patient, and we’ve slightly tweaked the research question. So, I’ve done that. Actually, it’s not as you say, it’s building those long-term relationships because you do need that trust in there because patients are giving you their whole story, their, intimate personal details about their life. And that needs to be given to someone that we really do trust and understand that actually that’s then going to make an impact.

Rosemary Hollick: They do, yeah.

Debbie: And that’s what we want as patients to then see that impact, not just doing research for research sake sort of thing.

Rosemary Hollick: Yeah.

Katy: Yeah. And how, and how do you go about building that trust?

Rosemary Hollick: Again, it takes time and it’s about respect. we always pay our patient partners for the time that they take in helping us with the research. And I don’t mean that in a transactional way, but I think that is respectful. You can’t just assume that someone’s going to give you the time. So, there’s about that respect. I think critically, it’s about showing people that you have taken on board what they’ve said. And this is what we’ve done as a result of it, because quite often people just take and then you’re like, okay, I have no idea what happened with that. when we have our PPI group meetings, one of the standing items on the agenda is, you said we did type thing and we always feedback in such and such came to speak to the group about their research idea or, it might be a student, for example, or a member of the group. this is what they take away from it. And this is what they’ve done as a result of it. So, it’s about recognizing that your input is making a difference and it’s about developing that relationships over time, which just takes time.

Debbie: It really does. And I just want to say thank you so much for giving up your time today. We’ve covered so much about, the difference of sciatic arthritis compared to other inflammatory arthritis and axial spa and your research as well. And actually, why PPIE is so, important and it’s not just a tick box and we need to get that mindset really changed that actually patients can bring so much more to your research. So, thank you so much, Rosemary.

Debbie: Please do follow us on social media. Continue this conversation. How have you been involved in research? How would you like to get involved in research? And obviously as our charity, we really do advocate people to be involved, but obviously in that whole PPIE work, not just the tick box. So just follow us on social media. We are on Facebook, Instagram, Blue Sky, and LinkedIn. You can sign up to our regular newsletter at inflammatoryarthritis.org. Thank you again, Rosemary. Fantastic, insightful conversation. And until next week, Katy, it’s goodbye.

Katy: Goodbye.

This episode was funded by UCB how had no involvement in the development of the content or associated materials.

Summary

In this insightful conversation, Debbie and Katy sit down with Dr Rosemary Hollick, a rheumatologist, researcher, and champion of patient‑centred care,  to explore the realities of psoriatic arthritis, axial spondyloarthritis, and the evolving landscape of treatment. Rosemary explains how symptoms present, why diagnosis can be so challenging (especially for women), and how biologics have transformed outcomes over the past two decades.

The episode also dives into Rosemary’s award‑winning work in health services research and the vital role of Patient and Public Involvement and Engagement (PPIE). She shares how involving patients from the very beginning of research leads to better questions, better care, and better impact. As she says in the transcript, “Just listen to the patient because the patient will tell you the answer.”

This is a warm, honest, and empowering discussion for anyone living with inflammatory arthritis or supporting someone who is.

Topics Covered

• Rosemary’s journey into rheumatology and research
• What psoriatic arthritis is and how it presents
• Differences between psoriatic arthritis and rheumatoid arthritis
• How axial spondyloarthritis is diagnosed
• Why women are often missed or misdiagnosed
• The difference between inflammatory and mechanical back pain
• How treatment has changed from 2008 to 2026
• The shift from inpatient wards to fast‑track outpatient care
• Early use of biologics and why it matters
• The challenge of trial‑and‑error treatment
• Shared decision‑making and tailoring biologics to lifestyle
• What meaningful PPIE looks like in practice
• How patient partners shape research questions, analysis, and impact
• The importance of trust, respect, and long‑term relationships in research
• The “you said, we did” approach to accountability

Resources & Mentions

• University of Aberdeen Health Services Research Unit
• VOICES Study — Rosemary’s early research programme exploring what “good care” looks like in vasculitis
• Spondyloarthritis Awareness (AS Day) 2 May

IAUK Resources

• IAUK website: inflammatoryarthritis.org
• IAUK newsletter sign‑up
• IAUK social channels: Facebook, Instagram, LinkedIn, BlueSky

This episode was funded by UCB how had no involvement in the development of the content or associated materials.

Disclaimer: Debbie and Katy are not medical professionals. They share personal experiences of living with IA to build connection and community. The podcast is for informational purposes only and is not intended to replace professional medical advice. We talk about our personal health journeys and the podcast is not intended to provide professional medical advice, diagnosis, or treatment. We are not medical professionals and in no way claim to be medically trained. The podcast does not take responsibility for any losses, damages, or liabilities that may arise from the use of the podcast. The podcast does not assume responsibility for the accuracy of third-party content.

For more information, head to https://inflammatoryarthritis.org/