Portrait and video Annette van der Helm: "In our collaboration, 1 and 1 add up to 3"

Inflammatory joint rheumatism causes persistent pain and limitations in the daily lives of approximately 270,000 Dutch individuals. Prof. Dr. Annette van der Helm, a professor of rheumatology, aims to prevent this disease and reduce the burden it imposes. "With our approach, we can currently identify patients 6 to 12 months earlier than the standard diagnosis."

Van der Helm is a professor at Leiden University Medical Center and Erasmus Medical Center. She was recently appointed as a Medical Delta professor.

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What does the appointment as a Medical Delta professor mean to you?

"Despite my position at LUMC since 2015 and also being appointed as a professor at Erasmus MC, unlike many other Medical Delta professors, this appointment does not entail a new workplace for me. Nevertheless, this appointment holds value. It is a positive reinforcement of an ongoing effort that sometimes needs an extra push. University Medical Centers (UMCs) are individually assessed for their performance, but progress often requires collaboration. This can be challenging. In our collaboration, 1 and 1 add up to 3. It is a beautiful synergy, and it is important to convey that.

For me, fostering connections is crucial, not only within my field but especially with experts beyond my expertise. This adds a new dimension that brings me joy and satisfaction. Within Medical Delta, this is made possible."

Can you briefly describe your expertise?

"I am a rheumatologist. In our research, we focus on how to recognize inflammatory joint rheumatism as early as possible and prevent it from becoming chronic. We have established an early recognition pathway at LUMC, Erasmus MC, and surrounding hospitals. Individuals with suspicious pain symptoms are prioritized for evaluation. With our approach, we can currently identify patients 6 to 12 months earlier than the standard diagnosis.

A rheumatologist can feel joint inflammation externally. If this is not detectable, there is currently no diagnosis, and the approach is often 'call when it swells,' meaning come back when it worsens. This can lead to more complaints, loss of work, and, at that later point, processes are often irreversible. Therefore, it's crucial to work towards a rapid diagnosis."

How do you identify inflammatory joint rheumatism much earlier?

"There are several facets. To get people to the rheumatologist early, good collaboration with general practitioners is essential. That is why, since 2010, I have been running a secondary care clinic. It operates between primary and secondary care. General practitioners who suspect their patients with pain symptoms may have joint inflammation refer them to me. I then conduct a very brief five-minute examination. If there is joint inflammation, the person returns for a full consultation with priority. Such screening is rarely done elsewhere and is due to a lack of workforce.

Additionally, an MRI is helpful. Inflammation is often present for a longer time before a rheumatologist can detect it with a physical examination. MRI can make this early inflammation visible. Normally, creating an MRI scan takes time and requires contrast fluid, making it an expensive test. We have developed a short sequence that does not require contrast and works on different scanner brands. In Erasmus MC, we collaborate with Professor Edwin Oei for this.

It would be great to develop a portable MRI, for use in general practitioners' officesWe aim to work even more efficiently by combining imaging with Artificial Intelligence. We are exploring this with the group led by Professor Berend Stoel at LUMC. We are also searching for blood biomarkers relevant to developing rheumatism. Ultimately, we want to connect molecular big data analysis and MRI analysis. We are analyzing the cost-effectiveness of rapid diagnostics and treatment with Medical Delta professor Maureen Rutten at Erasmus University. Hence, multiple disciplines converge in this research. One last improvement is the MRI scanner. So far, we have used hospital MRI scanners. It would be great to develop a portable MRI, for use in general practitioners' offices. I am working on this with fellow Medical Delta professor Andrew Webb from LUMC and TU Delft. He has significant expertise in this area.

The expectation is that the shortage of healthcare personnel will only increase. It would be fantastic if, in the future, the secondary care screening I, as a rheumatologist, do could be replaced by a short scan followed by an AI-assisted response."

What does collaboration bring to your work?

"As medical centers working together, we can achieve more than individually. For example, we recently conducted a unique prevention trial successfully through collaboration. Ultimately, I am a rheumatologist, and I want to prevent rheumatism. Secondly, I want to contribute to keeping rheumatology care in the Netherlands effective and accessible, even in times of personnel shortages. This combined goal is my driving force. To achieve this, I am very pleased with this Medical Delta environment."

How do you involve practical aspects in your research?

"For me, it's straightforward. I come from a practical background and am actively involved. My research questions also stem from practical observations. I run clinics myself and witness the benefits of early treatment every day."

What is it like to start collaborating with someone from a completely different discipline?

"It is always enjoyable and inspiring. It begins with exploring and understanding each other's language. Then, you start recognizing what you can do together. This provides tremendous insights into what will be possible.

Although I had explained a lot, seeing it in person made it much clearer. Such practical experiences are helpful.Getting to know each other requires frequent meetings and discussions. Recently, someone from TU Delft came to observe my clinic. Although I had explained a lot, seeing it in person made it much clearer. Such practical experiences are helpful. Meetings and visiting each other are crucial. While online meetings via Teams are good and useful, sometimes seeing each other in person is more efficient and motivating."

What do you feel is missing within Medical Delta to achieve your goals? What call would you like to make?

"A challenging question, as I have just been appointed. The Medical Delta network communicates regularly and tries to accomplish things. I hope it works the same way in practice. That we can easily connect and exchange knowledge, making Medical Delta a platform and springboard for the broader picture. And I hope this trickles down to young researchers. We should involve young people and make interdisciplinary work easier for them."

Now that you will likely meet more scientists from other disciplines and institutes, whose work has truly surprised you and why?

"Every collaboration leads to new insights, precisely because of diverse backgrounds. It is difficult to name one person. But a good example is Prof. Dr. Hans Bloem, former head of radiology at LUMC. He laid the foundation for the 5-minute MRI we use now. He initiated the idea that it could be done. It has grown with many collaborations around it, but he planted the seed."