Arthritis Newsletters April 2019

NEW APPOINTMENTS

 

Program Medical Director for Altum Health

Dr. Rajiv Gandhi has been appointed as the inaugural Program Medical Director for Altum Health. Dr. Gandhi is an Associate Professor of Surgery at the University of Toronto, and an Orthopedic Surgeon specializing in hip and knee reconstruction at Toronto Western Hospital. He is also a Clinician Investigator at Krembil Research Institute. Dr. Gandhi obtained his MD from McMaster University in 2001, completed his residency training in orthopedic surgery at McMaster University and an Arthroplasty Fellowship at the University of Toronto. He also holds a Master of Science in Clinical Epidemiology from Harvard School of Public Health.

New Members of the Hand Program

Dr. Ryan Paul attended medical school at the University of Western Ontario and orthopaedic surgery residency at the University of Alberta. He then completed a clinical fellowship in hand and upper extremity surgery at the Roth McFarlane Hand and Upper Limb Centre in London, Ontario, and a sports/soft tissue reconstruction fellowship with the University of Toronto Orthopaedic Sports Medicine program. He is currently pursuing a Master’s degree through the Institute of Medical Science with a focus on complex shoulder reconstruction.

 

 

Dr. Andrea Chan is a fellowship-trained orthopedic surgeon with a clinical interest in pediatric, adolescent and adult hand and wrist surgery. Dr. Chan completed her orthopedic residency training at the University of Toronto in 2017, followed by a 1-year adult upper extremity and hand fellowship at the Roth McFarlane Hand and Upper Limb Centre in London, Ontario. Most recently, she completed a 6-month pediatric hand and upper extremity fellowship at the Cincinnati Children’s Hospital in Cincinnati, Ohio. She has a research interest in wrist biomechanics and the integration of advanced bioimaging in the post-traumatic prognostication of wrist cartilage health.

AWARDS & RECONGITIONS

Double Recognition

Dr. Igor Jurisica, a Senior Scientist at Krembil Research Institute, has been granted the scientific rank of 'Doctor of Medical Sciences' from the Scientific Council of the Slovak Academy of Sciences. In addition, Dr. Jurisica was included on a list of the world's Top 100 Artificial Intelligence (AI) Leaders in Drug Discovery and Advanced Healthcare. The list, released by Deep Knowledge Analytics, recognizes leaders who have contributed towards data-driven transformation of the pharmaceutical and healthcare industries, and is based on the cumulative impact the individual has made in this field.

 

 

Lifetime Achievement Award – Global Impact

Dr. Murray Urowitz was awarded the Dean’s Alumni Lifetime Achievement Award. This award recognized Dr. Urowitz's global impact in changing lupus diagnosis and management as well as establishing the University of Toronto Lupus Clinic and Lupus Databank Research Program in 1970 — now recognized as one of the world’s premier clinical and research centers for lupus. Dr. Urowitz has also helped create the University of Toronto Centre for Prognosis Studies in Rheumatic Diseases, as well as the Systemic Lupus International Collaborating Clinics. Dr. Urowitz is a Rheumatologist at Toronto Western Hospital and a clinician investigator at the Krembil Research Institute.

Teaching Recognition

Dr. Lori Albert was recently recognized in the top 10% of teachers in the undergraduate medical education program at the University of Toronto. Dr. Albert is a Rheumatologist at Toronto Western Hospital, University Health Network. She completed her undergraduate and postgraduate medical training at the University of Toronto. Dr. Albert has a particular interest in undergraduate education and has been involved in resident education both locally and at the national level.

 

 

AHPA Carolyn Thomas Award

Laura Passalent is an Advanced Practice Physiotherapist at Toronto Western Hospital. Laura recently received the Arthritis Health Professions Association (AHPA) Carolyn Thomas Award which recognized the best scientific abstract submitted by an AHPA member, at the Annual General Meeting in Montreal on March 1, 2019. This was for the study her team conducted regarding “Closing the Gap Between Symptom Onset and Diagnosis in Axial Spondyloarthritis”.

Women in Science

Dr. Sowmya Viswanathan, an Affiliate Scientist at the Krembil Research Institute, was recently featured in an article in CIHR which marked the 2019 International Day of Women and Girls in Science. CIHR aimed to celebrate the diverse experiences of female researchers across the country by asking them about their love of research, their mentors, and their thoughts on making sure that women have the opportunity to choose science and stay in it.

 

 

Krembil 2018 Fall Fellowship Competition

Dr. Anusha Ratneswaran was one of three applicants to be awarded the Krembil 2018 Fall Postdoctoral & Clinical Fellowship. Dr. Ratneswaran is a postdoctoral fellow co-supervised by Dr. Mohit Kapoor and Dr. Heather Baltzer. She joins the Arthritis Program after having completed her PhD at Western University, a Postdoctoral Fellowship at Western University and a Postdoctoral Fellowship at Dalhousie University.

Arthritis Alliance of Canada Research Award Winner

Eight awards were given out by the Arthritis Alliance of Canada to recognize contributions to arthritis research in Canada. Dr. S. Amanda Ali was awarded the Arthritis Alliance of Canada Post-Doctoral Fellow Award. Dr. Ali completed her PhD in Medical Science at the University of Toronto, followed by her first Postdoctoral Fellowship at Western University in London, Ontario. She is currently pursuing a second Postdoctoral Fellowship with Dr. Mohit Kapoor and Dr. Rajiv Gandhi.

 

Canadian Rheumatology Association

The Canadian Rheumatology Association Annual Scientific Meeting took place in Montreal, Feb. 27 - Mar. 2, 2019 and included two awards for trainees in the Arthritis Program. Dr. Remy Pollock, a postdoctoral fellow at Dr. Dafna Gladman's laboratory, was the recipient of Best Basic Science Abstract by a Trainee. Dr. Carolina Muñoz-Grajales, a Rheumatologist and a PhD candidate at Dr. Joan Wither's laboratory, was the recipient of Best Abstract by a Post-Graduate Research Trainee.

Natural Sciences & Engineering Research Council Awards

Kevin Robb and Lucy Luo were the recipients of the Canada Graduate Scholarships-Doctoral Program Award and the Canada Graduate Scholarships-Master's Award, respectively. Kevin Robb is a second year PhD student under the co-supervision of Dr. Sowmya Viswanathan and Dr. Rajiv Gandhi. Lucy Luo is a first year Master's student under the supervision of Dr. Sowmya Viswanathan.

Pitch Perfect Competition

On April 9, 2019, 13 trainees from the Krembil Research Institute presented a 3-min elevator pitch to a panel of UHN Public Affairs judges. Two of the three winners are trainees from the Arthritis Program, Dr. Akihiro Nakamura and Zoya Qaiyum. Dr. Akihiro Nakamura is a clinical fellow in the Rheumatology Division and a first year PhD student in Dr. Nigil Haroon's lab. Zoya Qaiyum is a research associate in Dr. Robert Inman's lab.

RESEARCH DAYS

QMSKI 2019: 22nd International Workshop

The 22nd International Workshop on Quantitative Musculoskeletal Imaging (QMSKI) is the premier international meeting for musculoskeletal imaging research. The event took place in the heart of the Canadian Rocky Mountains at Lake Louise from February 24 to March 1, 2019. The workshop included international leaders in the field and was co-organized by Dr. Angela Cheung, Director of Osteoporosis Program.

NOTABLE PUBLICATIONS

Cause for Concern

A recent publication in Arthritis Care & Research explored the effect of opioid use and other factors—such as body mass index, age, level of education and health status—on the outcomes of patients with end-stage osteoarthritis having surgery. The study revealed that a large proportion of osteoarthritis patients—up to one third—are using opioids. Furthermore, opioid use was higher in younger individuals (those under 65 years of age) and those experiencing symptoms of depression. “Our findings provide compelling evidence that more rigorous guidelines, and effective and timely alternatives are needed to protect individuals with osteoarthritis from the potential harms of opioid use. Also, given that recent studies have linked opioid use to worse surgical outcomes, carefully considering patient factors, such as age and mental health, could help to counteract these effects and improve the lives of those with osteoarthritis” says Dr. Raja Rampersaud.

Differentiating Psoriatic Arthritis from Osteoarthritis

It is often difficult to distinguish Psoriatic Arthritis (PsA) from Osteoarthritis (OA), the most common form of arthritis, because both forms of arthritis affect similar joints (knees, hips, finger joints, etc.), have common features on x-rays, and have no reliable blood tests. Therefore, a recent publication in Annals of the Rheumatic Diseases by Rheumatologists and Orthopaedic Surgeons in the Arthritis Program aimed to identify proteins in the blood that differentiate PsA from OA. Through a series of analyses of blood samples, a panel of four markers (cartilage oligomeric matrix protein, resistin, monocyte chemoattractant protein 1 and nerve growth factor) strongly differentiated PsA from OA. Further follow up studies will be conducted to confirm these findings and develop a diagnostic test for PsA.

Disease Course Patterns in Systemic Lupus Erythematosus

Disease activity in systemic lupus erythematosus (SLE) follows three different courses: long quiescent, relapsing remitting and persistently active, but the patterns of disease course since diagnosis remain unknown. A recent publication in Lupus, led by Dr. Urowitz over a period of 10 years, aimed to assess the prevalence and characteristics of disease course. Relapsing-remitting course manifested in approximately 70% of SLE patients, whereas prolonged remission and persistently active courses each manifested in 10% of SLE patients. Further, early response to treatment was associated with a less severe course and better prognosis.

Mesenchymal Stromal Cells Clinical Trial in Osteoarthritis

Dr. Sowyma Viswanathan, Dr. Jas Chahal and other members of the Arthritis Program at UHN recently published the results of the first-in-Canada autologous bone marrow mesenchymal stromal cells (MSCs) trial on 12 mid- to late-stage knee osteoarthritis patients. This clinical trial demonstrated safety and feasibility of dosing MSCs, as well as significant clinical and statistical improvements in patient-reported outcomes. Furthermore, there were decreased levels of pro-inflammatory monocytes/macrophages and inflammatory cytokines post-MSC treatment. MSC donor heterogeneity was a significant factor. The authors were able to curate a panel of anti-inflammatory genes that was highly correlated with patient outcomes, which suggests that these panel of genes may be used to predict MSC clinical potency.

Opioids and Pain

The effects of opioids on chronic pain are uncertain, whereas the harms found to be associated with prescription opioids include diversion, addiction, overdose, and death. In this meta-analysis of RCTs of patients with chronic non-cancer pain published in JAMA, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with non-opioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

Patient Outcomes in Osteoarthritis

A recent publication in Arthritis Research & Therapy by the Viswanathan Laboratory investigated the role of immune cells, particularly monocytes/macrophages in OA pathology. Monocytes/macrophages were the most abundant immune cells in the synovial fluid of OA patients. Moreover, a specific subset of these monocytes/macrophages correlated with patient reported outcomes including joint stiffness, joint function and quality of life, even when adjusted for age, gender and body mass index. These monocytes/macrophages may have a role in potential adaptive immune responses. This was the first clinical cohort study to associate specific subtypes of monocytes/macrophages with patient reported outcomes.

Putting Labels on Protein Behaviour

A recent publication in Nucleic Acids Research by the Jurisica Lab reported a substantial expansion of a database started in 2005. The database now includes protein interactions for 18 species, providing tissue specificity of the interactions, the diseases they are associated with, and whether they might respond to a known drug. For human, the database covers 969,843 interactions across 19,250 proteins, and annotates them with 133 tissues (including detailed joint-related tissues and 38 brain structures from Allen Brain Atlas), 91 disease conditions (including neurodegenerative diseases), drug targets (including enzymes, ion channels, receptors, and transporters), and many other contexts.

The Course of Back Pain in Canadians

A recent publication in Arthritis Care & Research aimed to identify and describe back pain (BP) trajectory groups and to compare indicators of health status, medication, and healthcare use by these groups. The authors found that almost one-in-five people with BP experience a persistent trajectory with associated increased pain, disability, and healthcare use. Further research is needed to determine whether the identified groups represent different diagnoses, which may provide insights to the selection of stratified treatments and aid designing early prevention and management strategies in the population.​​