A Canada-wide multicentre study of patients with early rheumatoid arthritis (ERA) has found an association between metabolic syndrome and rheumatoid arthritis, and that the prevalence is most common among men and postmenopausal women.

September is National Arthritis Awareness Month in Canada. With rheumatoid arthritis, the patient’s joints and organs are “attacked” by their own immune system. This is the most common type of autoimmune arthritis. Persons with the disease typically experience swollen joints, pain and stiffness, and chronic fatigue. In later stages of the disease, incessant inflammation breaks down the joint, causing permanent damage, and can impair nerves and blood vessels. It is important for patients to begin treatment as early as possible.

The Canadian Early Arthritis Cohort (CATCH) study collects data on over 3,000 patients across Canada with ERA. Patients in this cohort are defined as a person who is within one year of symptom onset.

Dr. Lillian Barra, Associate Scientist at Lawson Health Research Institute (Lawson), and Rheumatologist at St. Joseph’s Hospital London, was interested in learning about the association between ERA and other diseases and conditions that are commonly found among patients with ERA. Metabolic syndrome refers to a cluster of conditions that often occur together and increase the risk of heart disease, stroke, and type 2 diabetes. These include heart disease, high blood pressure, abnormal cholesterol, obesity and high blood sugar.

“It is interesting that we found these conditions of metabolic syndrome so early in the course of this disease. While previous researchers have demonstrated an association, it remains a question whether metabolic syndrome contributes to rheumatoid arthritis, or vice versa.” explains Dr. Barra.

“This information can help inform clinicians managing patients with rheumatoid arthritis. In the future, we hope to develop more precise guidelines around when these comorbidities should be screened for and co-managed over the course of treatment.”

Currently, if a newly diagnosed rheumatoid arthritis patient presents with severe symptoms, they are given therapies that work quickly to reduce the inflammation in addition to long-term disease modifying drugs that are the standard of care. These therapies include corticosteroids, such as prednisone, and non-steroidal anti-inflammatories (NSAIDs), such as Advil or Motrin. For the clinician, it is important to consider if the patient has any conditions of metabolic syndrome, as these fast-acting therapies are known to increase the risk of heart disease and stroke. The treatment approach may be altered if these conditions are present.

Dr. Barra plans to re-examine the CATCH data at a later time, to determine if metabolic syndrome and rheumatoid arthritis worsens or improves over time. In future research, she also hopes to discover some of the causes and mechanisms at play, to better understand why many patients with rheumatoid arthritis also have metabolic syndrome.

Canadian researchers working to improve military and Veteran health met at St. Joseph’s Health Care London’s (St. Joseph’s) Parkwood Institute on December 4, 2017 for their fifth Research Consortium meeting.

The Research Consortium group, established in 2015, is led by Lawson researcher Dr. Don Richardson, Physician Clinical Lead at St. Joseph’s Operational Stress Injury Clinic (OSI Clinic). The group meets two to three times a year to provide updates on their projects and foster collaborative research partnerships, rotating between London, Hamilton and Toronto as host sites.

“Members of the military and Veterans have unique symptoms and treatment needs so it’s important that we engage in knowledge transfer with other researchers working with the same group of patients,” says Dr. Richardson. “The Research Consortium meetings are a great way to learn about recent projects from our peers and identify new avenues for collaboration with the goal of providing the best possible treatment outcomes for our patients.”

In addition to researchers from St. Joseph’s OSI Clinic, the Research Consortium group includes representatives from Defence Research and Development Canada, the Canadian Institute for Military & Veteran Health Research, the Canadian Armed Forces, the Centre for Addiction and Mental Health, Homewood Research Institute, Western University, University of Manitoba, McMaster University, University of Toronto, Ryerson University and Queens University.

St. Joseph’s OSI Clinic provides specialized mental health services to Veterans, members of the Canadian Armed Forces, the Royal Canadian Mounted Police (RCMP) and their families who are experiencing mental health challenges as a result of service. The OSI Clinic is one of ten outpatient clinics in a national network across the country funded by Veterans Affairs Canada.

At the meeting, Dr. Richardson provided an update on recent projects at St. Joseph’s OSI Clinic, including research to enhance the understanding of moral injury.

Moral injury refers to lasting emotional distress that can occur when military men and women are exposed to events that disturb or undermine moral beliefs about how people can be expected to behave. OSI clinicians reported that exposure to these events drastically changes their patients’ views of the world; causes them to question their religion, spirituality or human nature; and often leaves them feeling disconnected from their loved ones. The researchers will now collect additional data from clinicians across the OSI national network and from the Research Consortium group. Part of their investigation will explore the relationship between different kinds of traumatic events and moral injuries, and mental well-being.

The COVID-19 pandemic is proving to be one of the most pressing health challenges of our time. With a rising number of cases and deaths worldwide, there’s a global urgency to finding a solution.

As the research institute of London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London, Lawson Health Research Institute excels in rapid response research and is uniquely positioned to tackle this problem from within hospital walls.

Our researchers belong to a health system at the forefront of the pandemic. With close proximity to patients and access to samples, they are mobilizing to address COVID-19.

“Lawson researchers include clinicians directly involved in the treatment of COVID-19 patients, as well as laboratory-based scientists and those with other expertise related to the pandemic response,” says Dr. David Hill, Scientific Director at Lawson and Integrated Vice President at LHSC and St. Joseph’s. “They are eager to contribute a solution and are combining their knowledge to address this issue from all angles.”

Already, Lawson research teams are initiating projects ranging from pre-clinical studies to clinical trials. They are planning to explore diagnosis, prevention and treatment of the disease, as well as long-term and mental health impacts. An immediate goal is to partner with other research hospitals to improve outcomes for COVID-19 patients around the world.

There are numerous COVID-19 studies underway at Lawson and many more going through the necessary approval processes. Recognizing the importance of a rapid response to this pandemic, Lawson’s Administration team is working to fast-track approval of the studies.

Lawson also offered a special internal COVID-19 funding competition to assist our researchers in their efforts. Lawson’s COVID-19 Pandemic Response Internal Research Fund supports projects that are identified as having the potential to impact the management of this pandemic and those that enhance our understanding of the pathophysiology of COVID-19. See the results of this competition and the 14 funded projects, for a total of more than $202,000 invested. 

While there is much to learn about COVID-19 and its impact on human health and our health care system, Lawson researchers are tackling the disease head-on.

How can you support COVID-19 research and clinical care?

Research at Lawson can be supported through three hospital foundations. With an outpouring of support from our community, the foundations are collecting donations to support our hospitals through this challenging time. Learn more about donating:

• St. Joseph’s Health Care Foundation – St. Joseph’s Health Crisis Fund
• London Health Sciences Foundation - COVID-19 Response Fund 
• Children’s Health Foundation - COVID-19 Response Fund

Learn more about COVID-19 research at Lawson:

• London researchers join global initiative to study loss of smell in COVID-19 patients
• Study to examine inflammatory response in patients with COVID-19
• Local COVID-19 research supported by St. Joseph's Health Crisis Fund

There are wide discrepancies in the instructions for how deep the nasopharyngeal swabs used to test for COVID-19 are to be inserted up Canadian noses, new research from Western University and Lawson Health Research Institute has found.  

As an otolaryngologist Dr. Leigh Sowerby is an expert in the anatomy of the head, neck and inside of the nose. Using that expertise, he and his colleagues examined the COVID-19 testing instructions provided by provincial and territorial authorities and found wide variations. They reported their findings in the Journal of Otolaryngology – Head & Neck Surgery. 

“As a surgeon who works inside the nose all the time, I was surprised to find that most of the instructions in Canada aren’t effective to reach the nasopharynx; they just don’t go deep enough into the nasal cavity,” said Sowerby, an associate professor at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute.

To perform a nasopharyngeal test, the swab must be inserted far enough into the nasal cavity to reach the nasopharynx, the upper part of the pharynx at the top of the throat behind the nose. Samples from the nasopharynx have been shown to be the most sensitive for COVID-19 testing, and are considered the gold standard. 

 

 

However, less than a quarter of provincial and territorial public health instructions tell practitioners to insert the swab deep enough to reach the nasopharynx, Sowerby said.

The research found that six provinces and territories, including the Northwest Territories, Nunavut, Ontario, Saskatchewan, Prince Edward Island and Alberta, recommended that the swab be inserted to a depth of four centimetres, or half the distance from nostril to ear. This depth only reaches the mid-nasal cavity, not the nasopharynx, he said. 

British Columbia and Manitoba recommended a seven-centimetre depth of insertion, which is still not enough -- only reaching the posterior nasal cavity but not the nasopharynx.

In Nova Scotia and Newfoundland, the recommended depth of insertion was two-thirds of the distance from nostril to ear, which would effectively reach the nasopharynx, as would following the instructions in New Brunswick and Yukon to insert the swab from nostril to external ear canal.

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“If we are doing what we are calling a nasopharyngeal swab, the technique for that should be standardized; there is no reason why there should be so much variability,” Sowerby said.  “The take-home message is that if we want the most accurate test results, there is room for improvement in the test instructions. Otolaryngologists have a role to play, as we can provide a great service by actively engaging with our local and regional health authorities to train on proper technique and anatomical knowledge.”