Wrist arthritis can cause debilitating pain, weakness and decreased range of motion. When patients are first diagnosed, the condition can often be managed with activity modification and pain medication. However, as symptoms progress, patients eventually require surgery.

Surgeons typically perform a procedure called four-corner fusion to preserve wrist motion and provide pain relief.  This surgery involves removing one of the carpal bones and fusing four of the remaining carpal bones. Although this procedure is one of the most common treatments for wrist arthritis, it is not known how the position of the fusion of the wrist bones affects range of motion and joint contact.

Lawson associate scientist Dr. Nina Suh is leading a study with the goal of improving the surgical technique for four-corner fusion to maximize wrist function and symptom relief, and delay wrist arthritis progression.

Dr. Suh and her team will use a customized active-motion wrist simulator to create different carpal bone fusion positions. They will then assess how these positions affect wrist motion and joint contact area.

“We hope this research will lead to new surgical techniques that will help us to more effectively manage wrist arthritis with four-corner fusion,” says Dr. Suh, who is also an orthopaedic surgeon at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London and an assistant professor at Western University’s Schulich School of Medicine & Dentistry. “The project will also advance our understanding of wrist biomechanics, providing a foundation for the development of enhanced patient-specific surgical tools, such as custom wrist fusion devices and implants.”

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The study is being funded through the Lawson Internal Research Fund (IRF), designed to allow scientists the opportunity to obtain start-up funds for new projects with exciting potential.

“The IRF program is valuable for scientists as external funding sources routinely require preliminary data to strengthen applications,” says Dr. Suh. “Particularly for new scientists such as myself, these grants provide seed funding that allows us to demonstrate the validity of our methodology and the clinical usefulness of our results.”

The IRF is designed to provide Lawson scientists the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

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.