• PsA
• spondyloarthropathy

Verna Wright arrived in Leeds in 1956, having qualified in Liverpool. At that time there were few ‘official’ rheumatologists as care for arthritis was delivered by general physicians or physical medicine specialists. His interest in psoriatic arthritis was kindled by the patients admitted to the regional rheumatic disease hospital in Harrogate—the Royal Bath Hospital. When he went to the USA for a spell (to follow his interest in biomechanics) he asked one of the senior nurses in Harrogate to make a list of all patients admitted with psoriasis and arthritis in his absence. On his return he had his first cohort—it was as simple as that. He was not the first to notice the characteristic features of psoriatic arthritis, there was an early description by Alibert1, and Bauer et al in the USA very carefully described the salient features in an article in 1941.2 However, Verna Wright’s contribution was to make careful clinical and radiographic observations of a large cohort of patients, an advantage of working in a regional centre where patients came from all over the North of England. Together with John Moll, he recognised that other arthritides shared common clinical features with psoriatic arthritis (radiological sacroiliitis, asymmetrical peripheral arthritis, uveitis, psoriasiform skin lesions and mucocutaneous lesions) and together they named them the spondarthritides (this is not a typo—Verna Wright told me that the editor of Medicine insisted that they add the ‘ylo’ to the descriptive term in the published article).3 It is important to remember that this work was done in parallel with work on human leucocyte antigens (HLA) which supported the clinical concept of spondyloarthropathy, as has much genetic, imaging and immunological work since that time. How pleased, and vindicated, they were on the discovery of the association of HLA-B27 with ankylosing spondylitis (AS), and subsequently other members of this group of diseases. The concept was fully evidenced in the seminal work ‘Seronegative Polyarthritis’ published in 1976, and fully illustrated by John Moll—if you find a copy of this book, treasure it.4

Verna Wright enlisted successive junior colleagues to collect and describe other cohorts of patients who he identified as belonging to the spondyloarthropathies—the arthritis of inflammatory bowel disease, AS, reactive arthritis, Behcet’s disease and Whipple’s disease (the latter two were later withdrawn from this grouping). This was an important milestone in the taxonomy of rheumatic disease—prior to this, most inflammatory, deforming arthritis had been called rheumatoid arthritis and even people with inflammatory spinal disease were labelled ‘rheumatoid spondylitis’. All this was done using careful clinical observation, deductive reasoning and plain radiography. The availability of a blood test for rheumatoid factor also helped distinguish these disorders from rheumatoid arthritis. The statistics were done ‘longhand’ in spidery handwriting—in subsequent years I found stacks of these buried in the cellar of our old research unit, along with Wright’s famous A4 notebooks.

Verna Wright continued his study of the mechanics of joints on his return to Leeds from the USA. He approached Professor Duncan Dowson in the Department of Mechanical Engineering to collaborate on two specific areas—the lubrication of joints and joint stiffness (a prominent symptom of people with arthritis). Verna Wright thought that if joint stiffness could be measured mechanically then it would provide an objective basis for new arthritis therapies that were emerging. Together with Dowson they supervised several PhD students who designed a number of different approaches to measuring joint stiffness but sadly none that fulfilled Wright’s original aspiration.

Verna Wright headed a diverse group in Leeds. There were four divisions: rheumatology, bioengineering, clinical pharmacology and rehabilitation. I was once told at a job interview that my research interests were so diverse that they would interfere with a true focus, but that did not seem to hamper Verna Wright. His achievements were in part due to a keen clinical eye and an ability to make connections. He always kept an open office, and anyone could seek his advice, including the cleaner. These encounters were never wasted—everything went into his A4 book and would sometimes come back to ‘bite’ people. He laughed at the excuses given when projects and ideas had not progressed: these were so diverse he wrote an article about them for the Christmas BMJ.5 He said the secret to success was to avoid university politics, and to make sure that there was enough infrastructure to support the team. He had a boyish sense of humour and his loud laugh could be heard throughout the building. He pioneered the ‘early morning meeting’ at 07:30 hours, which we then thought a struggle, but which is now routine.

Above all, Wright was a devout Christian. He co-founded the United Beach Mission and spent his summer holidays preaching on the beaches of the UK. He also used to preach on the steps of the Leeds Town Hall on a Tuesday lunchtime. We knew to avoid this spot in case he saw us and called us over to discuss some theological point. His department ‘worked’ and was a rewarding place to learn and study, as evidenced by the large number of people who spent time there, both from the UK and abroad. At international meetings he would sit prominently so that colleagues could consult with him. He told me he rarely went into the sessions, unless he was chairing, as the constant flow of people passing by kept him up to date. His memory survives in Leeds and his legacy is continued by a dedicated and productive team working in spondyloarthropathy.

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