ARCHIVED - Research About – Arthritis

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $ 21.6 million in 2008-09 in arthritis-related research.

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The Facts

• Arthritis is a category of disease that includes more than 100 conditions, such as osteoarthritis, lupus, fibromyalgia, gout and scleroderma.
• Arthritis is not just a disease of the elderly. It can strike anyone at anytime, regardless of age or health. In 2000, three of every five people with arthritis were younger than 65.
• Each year, approximately 100,000 Canadians are diagnosed with arthritis. The average age of onset is between 41 and 50. About one in six Canadians aged 15 and older has some form of the disease and two thirds of those affected are women. The most common type of arthritis in Canada is osteoarthritis, affecting 1 in 10 Canadians.
• Rheumatoid arthritis is the second most common type of arthritis, affecting 1 in 100 Canadians. It is an autoimmune disorder, in which the immune system attacks healthy joints, resulting in damage to cartilage, bone, tendons and ligaments.
• Arthritis affects nearly twice as many Canadian women as men.
• Arthritis costs Canadians more than $4 billion each year in health-care expenses and lost productivity.

Source: Canadian Arthritis Network, Arthritis Facts and Figures

Finding Solutions

Using the Pill linked to lupus risk

A highly respected Quebec scientist has found that using combined oral contraceptives is associated with an increased risk of developing systemic lupus erythematosus (SLE) – especially for women just starting contraceptive use. "This risk appeared to be mostly limited to the first three months of use with first- and second-generation contraceptives containing higher doses of ethinyl estradiol," Dr. Samy Suissa and co-authors reported in Arthritis & Rheumatism in April. Dr. Suissa, a CIHR Distinguished Investigator Award winner and the Director of Clinical Epidemiology at the Royal Victoria Hospital, McGill University Health Centre, led a team that compared the health records of almost 800 SLE women with those of almost 8,000 non-SLE women. The researchers have called for further studies to identify women most susceptible to developing lupus after taking oral contraception.

Does arthritis affect auto ability?

While arthritis can cause disabilities and pain that affect driving performance, it's not known if patients pose an increased risk of motor vehicle crashes. Dr. Ann Cranney of the Ottawa Health Research Institute led a systematic review of the published literature to determine if people with arthritis are at increased risk of crashing and should be considered candidates for early driving cessation. The investigators found insufficient evidence to link arthritis to auto crashes, suggesting that it's premature for doctors to routinely request comprehensive driving evaluations for their arthritic patients. The research, however, also suggests that consideration be given to screening for the ability to perform driving-related activities such as shoulder checks. The study, currently being finalized for publication, was funded by CIHR.

Genetic path could lead to autoimmune disease treatments

Dr. Katherine Siminovitch of Toronto's Samuel Lunenfeld Research Institute has found a genetic path that could lead the way to new treatments for a currently incurable liver disease. The study, published in June in the New England Journal of Medicine, also holds promise for treating other autoimmune diseases such as rheumatoid arthritis. CIHR-funded Dr. Siminovitch and her colleagues identified three genes in one pathway that play a role in susceptibility to primary biliary cirrhosis (PBC), an autoimmune disease that attacks the liver's bile ducts. PBC patients – usually middle-aged women – often also have other autoimmune diseases, which suggests the same genetic factors are involved in several conditions. The findings are based on clinical tests of 1,000 Canadian and American PBC patients, with a control group of 1,000 people who do not have the disease.

The Researchers

Dr. Michael Buschmann – The Re-Generation Generation

The premise of the iconic 1970s TV show "The Six Million Dollar Man" was that critically injured astronaut Steve Austin could be re-built using robotic parts.

Dr. Michael Buschmann, a pioneering tissue engineer at Montreal's École Polytechnique, thinks there's an easier and cheaper way to repair damaged body parts – get our bodies to regenerate themselves.

Though his CIHR-supported cartilage regeneration research won't have anyone out-running a train, it could well make the difference as to whether thousands of Canadians walk at all.

"My desire is not just to do basic science," says Dr. Buschmann, Director of the École Polytechnique's Biomaterials and Cartilage Lab. "I want things to be applied clinically, and to do this they have to be effective and affordable."

With this goal in mind, Dr. Buschmann's lab group – his co-researcher and wife Dr. Caroline Hoemann, and collaborators Drs. Mark Hurtig and Marc McKee – have developed a unique natural product that spurs cartilage regeneration. It's currently being commercialized by Laval, Quebec-based biomedical company BioSyntech Canada Inc.

Cartilage is a dense connective tissue that forms the smooth surface at our joints, including knees and elbows. Damage your joint cartilage through repetitive wear, injury or osteoarthritis and the result is ongoing, debilitating pain. The problem is that unlike bone and skin, cartilage doesn't naturally repair itself.

Dr. Buschmann's approach builds on an existing practice used by orthopedic surgeons to stimulate cartilage renewal. In this procedure, a surgeon 'microfractures' small holes into the bone immediately below the injured cartilage. This stimulates the bone's healing response, but usually only produces a mechanically weak, cartilage-like tissue.

Dr. Buschmann's technique, developed by BioSyntech Canada Inc. as BST-CarGel, appears to stimulate the regeneration of cartilage with significantly improved durability and mechanical function than that produced by microfracture alone.

The technique uses a natural material called chitosan to further stimulate and guide the bone's regeneration powers. Mixed with a patient's own blood, chitosan creates a more stable and adherent blood clot than would otherwise occur. Put onto the microfractured bone surface, this chitosan-blood mixture fills and sticks to the cartilage lesion, where it acts as a temporary scaffold to direct the healing process.

In animal studies, the chitosan-blood mixture dramatically improved cartilage repair. The technique is now in the final stages of a Canadian-European multicentre clinical trial involving 80 patients with knee cartilage problems.

"The end goal of total regenerative medicine is many steps down the road," says Dr. Buschmann. "But with each advance we get two or three steps closer to this final goal. And for many people this can make the difference as to whether they live in pain with limited mobility, or lead active lives that are mainly pain-free."

For More Information

CIHR's Institute of Musculoskeletal Health and Arthritis (CIHR-IMHA) has identified three strategic areas as key research priorities for Canada: pain, disability and chronic disease; tissue injury, repair and replacement; and physical activity, mobility and health. Canadians cannot achieve optimum health if they are suffering from musculoskeletal illness or injury, and CIHR-IMHA is working to improve the way we diagnose and treat diseases like arthritis. To learn more about these priorities and other CIHR-IMHA activities, please visit their website.

For more information, go to ARCHIVED - Your Health Research Dollars at Work.