A joint approach to eliminating pain

With 4.5 million Canadians affected by arthritis, it has become one of our most costly chronic conditions. Every year, more than $21 billion is spent combatting the disease, but there are still no approved drugs to stop it from progressing.

The Arthritis Program at the Toronto Western Hospital has world-leading researchers and clinicians investigating ways to diagnose arthritis early, develop new treatments, and create personalized treatment plans for patients. Among the team are Dr. Mohit Kapoor, Senior Scientist, Buchan Arthritis Research Centre in the Krembil Research Institute; and Research Director, the Arthritis Research Group and Dr. Raja Rampersaud, Scientist, Buchan Arthritis Research Centre in the Krembil Research Institute; Orthopaedic Spine Surgeon; and Co-Director, Arthritis Centre for Health Transformation.

Drs. Rampersaud and Kapoor are collaborating in their efforts to advance research and treatment to help people suffering from arthritis right now, and in the future.

Molecular basis of arthritis

A major focus of  Dr. Kapoor’s research has been on diagnosing arthritis earlier. With  Dr. Rampersaud and Dr. Akhiro Nakamura, he studied studied tissue biopsies of 55 patients with varying stages of oseteoarthritis. Within these samples, they looked at 2,100 microRNAs, which are small molecules that control 60 per cent of our genes. They discovered  two specific microRNAs – called biomarkers – that contribute directly to cartilage destruction and increased inflammation. These biomarkers also depleted collagen, the most important component in cartilage. These biomarkers will help track osteoarthritis and improve the way we monitor response to treatment. They will also use this knowledge to develop a drug that blocks the molecules causing cartilage destruction.

The next steps for Dr. Kapoor will be to launch the next phase of the trial which will involve more than 250 patients. He is also developing two new tools: one to detect osteoarthritis biomarkers in patients’ blood, and another to block the microRNAs that contribute to osteoarthritis. These tools will make it easier for doctors to diagnose osteoarthritis in its earlier stages, and limit irreparable damage to patients’cartilage. Biomarkers could also help doctors prescribe more effective treatment plans by  recommending surgery sooner rather than later.

Fast-track to arthritis care

Dr. Rampersaud started the Inter-Professional Spine Assessment and Education Clinics (ISAEC) with three goals in mind: to improve the way we assess serious pain, to create tailored treatment plans for each patient and to fast-track referrals to specialists. Essentially, he wants to eliminate the shotgun approach to treating joint pain.

He leading a program to train advanced practice clinicians (physiotherapists and chiropractors) to work with nurse practitioners, family doctors and specialists to provide integrated and timely assessment, education and treatment plans for patients with low back pain and related symptoms. Before this initiative, it could take 6 to 12 months before a patient saw a spinal surgeon, only to be told surgery is not the answer. But through ISAEC, patients are  assessed and educated more thoroughly, and only those who would benefit from seeing a specialist like me receive an appointment.

The response to the project has been promising. More than 95 per cent of patients have reported that they understood their condition much better after meeting with one of our advanced practice clinicians. And after surveying primary care providers who are part of the ISAEC network, Dr. Rampersaud found their confidence in assessing their patients with lower back pain had improved significantly. They have also seen a 33 per cent reduction in unnecessary spine MRIs.

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