Research over the past several decades has provided valuable advances and insight into arthritis. However, over the past few years, the research world has evolved into a dramatically different paradigm. The new strategic direction for research is intended to harmonize The Society’s program with international trends in health research and continue to position The Society as a leader in the field.

The two main thrusts of the strategic direction for research are:

1. A move towards a more integrated research plan — where researchers work in collaboration, across disciplines, institutions and geography.
   
2. Improved delineation between the two basic elements of the national research program — clinical training and research.

On June 18, 2004 The Arthritis Society’s National Board of Directors adopted the concept of a new strategic direction for research. Although the implementation plan for the new strategic direction is still in development, the National Board did agree that the clinical manpower portion of the research program should be re-assigned to the Medical Advisory Committee (MAC). The Scientific Advisory Committee (SAC) will continue to oversee research.

Arthritis Society donors, partners and stakeholders are encouraged to forward this announcement to their colleagues, read the report prepared by The Society’s Scientific Advisory Committee (SAC) and provide comments.

An electronic version of the SAC report is available on The Arthritis Society’s Web site at www.arthritis.ca/research. Hard copies can be ordered through Vicky Henderson at vhenderson@arthritis.ca or by calling 416.979.3353 ext. 353. Comments on the report should be sent to the attention of Bonnie Thorn at bthorn@arthritis.ca or The Arthritis Society, National Office, 393 University Ave., Suite 1700, Toronto, Ontario M5G 1E6. The deadline for submissions is September 15, 2004.
 

"These new findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, M.D., Director, National Center for Complementary and Alternative Medicine (NCCAM). "The data not only assists us in understanding who is using CAM, what is being used, and why, but also in studying relationships between CAM use and other health characteristics, such chronic health conditions, insurance coverage, and health behaviors."

The survey, administered to over 31,000 representative U.S. adults, was conducted as part of the Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey (NHIS). Developed by NCCAM and the CDC's National Center for Health Statistics (NCHS), the survey included questions on 27 types of CAM therapies commonly used in the United States. These included 10 types of provider-based therapies, such as acupuncture and chiropractic, and 17 other therapies that do not require a provider, such as natural products (herbs or botanical products), special diets, and megavitamin therapy.

According to a NCCAM release, although there have been many surveys of CAM use to date, the various surveys included fewer choices of CAM therapies. In addition, they often surveyed smaller population samples primarily relying on telephone or mail surveys versus in-person interviews used for this survey. Thus, the results from the CAM portion of the NHIS provide the most comprehensive and reliable data to date describing CAM use by the U.S. adult population.

Overall, the survey revealed that CAM use was greater among a variety of population groups, including women; people with higher education; those who had been hospitalized within the past year; and former smokers, compared to current smokers or those who had never smoked. In addition, this was the first survey to yield substantial information on CAM use by minorities. For example, it found that African American adults were more likely than white or Asian adults to use CAM when megavitamin therapy and prayer were included in the definition of CAM.

"We're continuously expanding the health information we collect in this country, including information on the actions people take in dealing with their own health situations," said NCHS Director Edward J. Sondik, Ph.D. "Over the years we've concentrated on traditional medical treatment, but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands."

CAM approaches were most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were:

• Prayer for own health, 43 percent
• Prayer by others for the respondent's health, 24 percent
• Natural products (such as herbs, other botanicals, and enzymes), 19 percent
• Deep breathing exercises, 12 percent
• Participation in prayer group for own health, 10 percent
• Meditation, 8 percent
• Chiropractic care, 8 percent
• Yoga, 5 percent
• Massage, 5 percent
• Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4 percent.

In addition to gathering data on the use of CAM practices, the survey also sought information about why people use CAM. Key findings indicate that:

• 55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments;
• 50 percent thought CAM would be interesting to try;
• 26 percent used CAM because a conventional medical professional suggested they try it; and
• 13 percent used CAM because they felt that conventional medicine was too expensive.

Interestingly, the survey also found that about 28 percent of adults used CAM because they believed conventional medical treatments would not help them with their health problem; this is in contrast to previous findings that CAM users are not, in general, dissatisfied with conventional medicine. 

"There will be over 5,000 presentations including diverse topics such as, asthma, stem cell and bone marrow transplantation, vaccines, arthritis and new therapies for HIV," says Dr. Emil Skamene, Congress President. "The caliber of the presentations is outstanding and the number of delegates indicative of the high interest in this important area of science. The link between science and better treatments for many chronic diseases has been achieved by the integration of the ICI and FOCIS programmes - a historical first for these two organizations. This will prove to be an extremely exciting and informative conference."

"This meeting is the world's largest and most prestigious gathering of immunologists," says Dr. Marianna Newkirk, Congress Scientific Program Chair. "It is the first time these two groups of basic and clinical immunologists will meet in Montreal. The city has done an excellent job of accommodating the needs of this conference - a task only a few cities in Canada can accomplish. We are confident the delegates will have a successful and enjoyable time in Montreal."

The congress will also organize a university-industry marketplace, where the transfer of new technologies in immunology from labs to biotech, and pharma spin-offs will be emphasized. Here the newest inventions from all over the world will be offered for commercialization to Quebec and Canadian venture capital and biotechnology groups. The meeting will offer demonstrations and tutorials of new concepts, equipment and products, and educational clinical immunology symposia of the highest scientific content, supported by the world's leading immunology companies.

The ICI-FOCIS 2004 conference will be held at the Palais des congrès de Montréal from July 18 to July 23. Press conferences will be held Monday through Friday.

The ICI-FOCIS 2004 conference is presented by the National Research Council Canada (NRC), in conjunction with the Canadian Society for Immunology and the International Union of Immunological Societies. The overall motto of the Congress is "through science of immunology to improvement of health and to creation of new wealth in the knowledge-based economy". Conference organizers include Dr. Emil Skamene, Scientific Director. Research Institute of the McGill University Health Centre, Dr. Marianna Newkirk, Researcher, McGill University Health Centre, Dr. Phil Gold, Executive Director, Clinical Research Centre, McGill University Health Centre, Dr. Pierre Talbot, Director INRS- Institute Armand-Frappier, and Dr. Marika Sarfati, Researcher, Centre hospitalier de l'Université de Montréal.

Conference presentations will include the following topics:

• Stem cell and bone marrow transplantation 
• Emerging diseases-SARS, influenza 
• Vaccine development 
• Infectious diseases of the 21st century 
• Immune deficiency diseases 
• HIV therapies 
• Tumour biology 
• The genetics of immunological disease 
• Cell roles in immunology 
• Allergies 
• Asthma 
• Autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, and diabetes

The first recipient of the two-year fellowship is Allen Lehman, a Ph.D. candidate in Educational Studies at UBC and an ARC researcher. His research will identify the types of support that people with rheumatoid arthritis (RA) feel they want and need and assess how that support is associated with their overall health.

"The support that people with a chronic illness such as rheumatoid arthritis receive from family members is crucial to improving their well-being and helping them better manage their disease," said Lehman. "Most people with arthritis feel that members of their family don't know enough about their disease, don't understand what they are going through and therefore can't adequately provide the kind of support they need."

According to an ARC release, family members are the primary providers of support for people with RA, and Lehman hopes that his research will provide a model to more effectively identify the needs of people with arthritis and other chronic diseases and develop strategies to address them.

"The burden of arthritis both on people with the disease and on the economy is tremendous, and as a leader in arthritis care in Canada we are committed to supporting research that will improve our understanding and treatment of the disease," said Theresa Firestone, Vice-President, Government and Public Affairs at Pfizer Canada. "We are thrilled to be partnering with ARC to support such exciting, Canadian-based research."

"In diseases like arthritis there is a great need to develop strategies that will help people better cope with their illness. Doing this will contribute to a much better quality of life for them," said Dr. John Esdaile, Scientific Director of ARC and Professor and Head, Division of Rheumatology, Department of Medicine at UBC.

The Arthritis Research Centre of Canada (ARC) was created in 2000 by the Board of The Arthritis Society, BC and Yukon Division. In April 2002 ARC became an independent organization that continues to work closely with The Arthritis Society for the benefit of all people with arthritis. 

"Other immune system proteins are potential targets for new autoimmune disease treatments, but they all affect large portions of the immune system, making weakened immune function a potential side effect of any new drug. Targeting SAP for treatment may avoid that risk." Scientists have used several animal models to study the immunological underpinnings of human lupus.
 
In one of these models, exposing mice to a hydrocarbon oil known as pristane causes mice to develop a condition with many similarities to human lupus, including kidney disease and arthritis. But in the new study, available in the July 15 issue of the Journal of Experimental Medicine, a genetically modified line of mice continued to be fit even after pristane exposure. Created by National Institutes of Health researcher and coauthor Pamela L. Schwartzberg, the mice lack the SAP gene.
 
"The mice appear to be generally healthy," Peng says. "They have none of the lupus-like symptoms of the control group, and their immune systems generally respond to vaccinations like those of normal mice."
 
SAP, also known to scientists as SH2D1A, affects the activity of a number of surface molecules on immune system cells known as lymphocytes. Earlier research had shown that higher levels of SAP were present in animals with autoimmune conditions than in normal animals. Instead of disabling whole groups of immune system cells, SAP's removal seems to disrupt communication between two different types of immune cells, T and B cells. Scientists have long known that T cells help B cells produce antibodies meticulously customized to destroy the last scattered remnants of a persistent invader. But they've had a hard time determining the details of how those interactions take place.
 
"We know a lot of molecules that are important to the activation of T and B cells, but we have never understood what was important for their interaction," Peng says. "SAP may give us an important first insight into how these interactions occur."  

• Move towards a more integrated research plan — where researchers work in collaboration, across disciplines, institutions and geography.
• Improve delineation between the two basic elements of the national research program — clinical training and research.

Although the implementation plan for the new strategy is still in development, the National Board did agree that the clinical manpower portion of the research program should be re-assigned to the Medical Advisory Committee (MAC). The Scientific Advisory Committee (SAC) will continue to oversee research.
 
John Fleming, the CEO of The Arthritis Society, added: “The new strategy will harmonize The Society’s program with international trends in health research. As in the case of the Frontiers conference, this involves bringing together scientists, clinicians, allied health professionals and consumers.”
 
Throughout the summer and early fall, members of the Scientific Advisory Committee, in collaboration with the Medical Advisory Committee, will be working on the development of a more defined structure for Arthritis Society Centres of Research Excellence as well as an implementation plan. Once this work has been completed, input will be sought from The Arthritis Society’s partners and stakeholders including members of the scientific and medical communities. This consultation process is expected to begin in August and continue through to the end of September.

Click here for the complete release. 

In the Duke study, the researchers fed guinea pigs -- which develop knee osteoarthritis in a manner remarkably similar to humans -- low, medium and high doses of vitamin C during an eight-month period. The researchers found that high-dose guinea pigs developed more cartilage damage and had more bony spurs form in their knee joints than did the medium- and low-dose groups. The researchers' examination of the spurs revealed a possible cause for the link between vitamin C and osteoarthritis. They discovered a protein in the spurs that leads to spur formation and can be activated by vitamin C.

Because this study indicates potential drawbacks to long-term use of high-dose vitamin C supplements, adults should not supplement their dietary vitamin C levels above the recommended dietary allowance (RDA), Kraus said. The RDA for men is 90 milligrams per day and the RDA for women is 75 milligrams per day. A diet that includes five servings of fruits and vegetables a day supplies about 200 milligrams per day of vitamin C.

"It's possible that brief exposure to high levels of vitamin C offers antioxidant effects with a minimum of side effects, while prolonged exposure results in deleterious effects," Kraus said. A randomized, controlled clinical trial in humans would be required to definitely resolve the issue of vitamin C dosing, she said.

The antioxidant properties of vitamin C were posed as one explanation for the earlier positive results, because oxygen radicals can degrade collagen and proteoglycan, a connective tissue protein. The vitamin has also been shown to help collagen synthesis and stimulate production of key components of collagen. The Duke researchers did find an association between higher levels of vitamin C and increasing collagen in knee cartilage. However, there was also a strong correlation between vitamin C dose and the severity of disease, including the number and size of osteophytes, or bony spurs at the knee joint.

The researchers found an important protein in bone growth called active transforming growth factor beta almost exclusively in the osteophytes. The protein is known to cause joint degeneration and spur formation, and vitamin C can convert this protein from an inactive to an active state, Kraus said. This conversion means that vitamin C's ability to enhance collagen synthesis and activate transforming growth factor beta might be the reason guinea pigs fed high doses of vitamin C developed more osteoarthritis, she said.

The study was published in the June 2004 issue of Arthritis & Rheumatism. The research was sponsored by the U.S. National Institutes of Health and Arthritis Foundation. 

Results from a drug trial, led by UCL Professor Jonathan Edwards, Professor of Connective Tissue Medicine, were published in the New England Journal of Medicine. The report explored the possibility of using a one-off drug treatment to banish the symptoms of rheumatoid arthritis form the body for months or years, with the ultimate aim of permanent relief, rather than relying on continuous drug therapy.  Of 161 patients involved in the study, 43% of those receiving a short course of B cell targeted therapy based on the drug rituximab found arthritic symptoms such as joint pain, swelling and stiffness were reduced by more than half as measured six months later, compared with 13% in the control group who took conventional drugs only.  The study was designed to assess improvement over six months but it was found that in many cases improvement was maintained for at least a year, confirming pilot studies at UCL suggesting an average benefit lasting over a year and sometimes as long as three years.

According to the university, previous laboratory research at UCL had led Professor Edwards and colleague Dr Jo Cambridge to suggest that antibodies directed against the body's own proteins might not only cause inflammation in rheumatoid arthritis but might also create a vicious cycle driving the disease on. Antibodies are made by B-cells and the idea was put forward that removing B-cells might cause the cycle, and the disease, to collapse. Experience at UCL indicates that permanent relief from a single course of treatment is not yet possible. However, the fact that improvement can last for a period of years suggests that the approach is on the right track. Moreover, studies from UCL and elsewhere in other autoimmune diseases such as lupus are producing similar results.

"This study provides clear evidence for the importance of B-cells in rheumatoid arthritis, heralding a major shift in our understanding of the disease," says Professor Edwards. "The cycle underlying autoimmune diseases such as rheumatoid arthritis may be similar to a bug in a computer that makes it loop and crash. B-cell targeted therapy is like rebooting the computer of your immune system to sidestep the bug. As is often the case, if you have not removed the bug completely the computer system may crash again. This seems to be where we are at present, possibly because the current treatment does not remove more than 80 to 90 per cent of B-cells, where the ideal treatment would knock out 100 per cent of cells."

"The challenge is to break the cycle once and for all. Many different B-cell targeted drugs are now in development and I am optimistic that long term benefit from a single treatment is achievable," adds Professor Edwards. "People with arthritis desperately want to be free of painful, sleepless nights and fatigue and stiffness in the day. They also want to be free from the burden of long term drug treatment. This is what we should be aiming for."

A university release explains that around a billion B-cells, or lymphocytes, are created every day by the body's immune system. B-cells generate antibodies to help fight infections. Each B-cell makes a different antibody by shuffling its antibody genes. B-cells that by chance make antibodies to the body's own proteins normally disappear. However, very rarely it seems that they can set up the vicious cycle that allows them to grow and produce damaging effects, known as autoimmunity. Current B-cell targeted therapy works by knocking out 'bad' B-cells, but also knocks out useful B-cells for a period of months. The effect on 'bad' antibodies is greater than on useful antibodies but after repeated treatments levels of useful antibodies may be reduced. This suppression of the useful side of the immune system, with a risk of infections, is a common problem with treatments for autoimmune disease. For this reason, the university explains, further studies are needed to ensure the treatment is as safe as possible. It is also an incentive to develop B cell targeted therapy either to remove only disease-related B-cells or to ensure that treatment is powerful enough to avoid the need for repeated courses. 

Researchers at the U.S. Department of Health and Human Services' National Institutes of Health (NIH) have launched a five-year study to see whether a therapy using transplantation of hematopoietic stem cells (blood stem cells found in bone marrow) can produce long-term remission for patients with severe, treatment-resistant lupus. The study will include a basic research component to examine the roles of B and T cells, white blood cells in the immune system, in triggering lupus symptoms.

In this pilot study, 14 patients from ages 15 to 40 will receive stem cell transplantation therapy, during which their stem cells will be removed from their bone marrow. These cells, which will become different kinds of blood and immune system cells in the body, will then be harvested and cleaned. After the patient's bone marrow is treated with immunosuppressant drugs to destroy the disease-causing immune cells, the stem cells will be returned to the bone marrow. The stem cells will then repopulate the marrow and body to establish a more properly functioning immune system.

The initial treatment requires several outpatient visits followed by a two-week hospital stay. Patients then have monthly medical visits for six months, quarterly visits for two years, and annual visits for the remainder of the study. Following therapy, researchers will assess whether this treatment produces sustained, relapse-free disease remission for 24 months.

"Many patients with severe forms of lupus have limited treatment options that may offer only temporary relief of symptoms and no disease regression. For these patients, stem cell transplantation therapy may offer hope for a normal functioning immune system," said Dr. Stephen I. Katz, director of NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

According to NIAMS, severe forms of lupus can devastate patients, causing pain, fatigue, depression, and in some cases, premature death. Patients who enter this study must have been treated, to no avail, with high doses of immunosuppressant drugs, which decrease immune function. Researchers believe that by combining immunosuppressant treatment with stem cell transplantation, they can create a new immune system that doesn't attack the body's healthy cells.

In addition to the clinical study, researchers will look at how B and T cells function in the immune systems of lupus patients. Previous studies have shown that the dysfunctioning T cells, which normally regulate the immune response, coupled with overactive B cells, which target both foreign and healthy cells, are responsible for the destructive autoimmune process that takes place in lupus. Researchers will compare the activity of B and T cells extracted from patients before stem cell transplant therapy with those that repopulate in the "new" immune system after therapy. They will be looking for cell properties that may contribute to the faulty immune response found in lupus. B cell studies will be conducted by scientists at NIAMS, while T cell studies will be conducted by scientists at National Cancer Institute.

Researchers at the National Institute of Neurological Disorders and Stroke and the National Institute of Diabetes and Digestive and Kidney Diseases will join this collaborative effort, investigating the central nervous system and kidney involvement, respectively, of lupus patients. "This study is an example of what can be accomplished when scientists from various disciplines combine resources and experience to create better outcomes for patients," said Dr. Katz.

Minister of State for Public Health Dr. Carolyn Bennett announced details of the new Public Health Agency of Canada. The Agency will have two main pillars, Winnipeg and Ottawa, and will work with a network of specialized centres across the country.
 
Minister Bennett also announced the appointment of Dr. Frank Plummer as the Acting Chief Public Health Officer (CPHO) until a permanent CPHO is found. In this capacity, Dr. Plummer will act as a special advisor to Minister Bennett. As well, Dr. Plummer will retain his responsibilities as the scientific director of the National Microbiology Laboratory and Director General of Health Canada's Centre for Infectious Disease Prevention and Control. The CPHO will be primarily located in Winnipeg, with offices in Ottawa, and will have responsibilities for the three key functions of the Agency: infectious diseases, emergency preparedness and chronic diseases.
 
"This national and coordinated approach will help improve the health of Canadians by dealing with the epidemics of chronic disease as well as ensuring we are ready in the event another serious infectious disease hits our shores," said Minister Bennett.
 
"The health of Canadians is the top priority of this government. The shock of SARS demonstrated vividly our vulnerability to infectious diseases and the rising trends of chronic illnesses such as diabetes, cardiovascular disease and cancer that threaten the health of Canadians and the long-term viability of our health care system," said the Honourable Pierre Pettigrew, Minister of Health.
 
The Agency's Winnipeg pillar, home of Canada's only Level 4 microbiology lab for human health, will be coordinating the Agency's infectious disease functions, including epidemiology, and will have a critical function, nationally and internationally, in the event of an infectious disease outbreak. The Agency's Ottawa offices will be responsible for working closely with other departments, including Public Safety and Emergency Preparedness Canada, on emergency planning, preparedness and response to national public health emergencies. Ottawa will also coordinate efforts to reduce chronic diseases and injuries.
 
In addition, Minister Bennett announced the creation of six National Collaborating Centres for Public Health to enhance Canada's response to infectious and chronic diseases. The Government of Canada is making an initial investment of $15 million dollars over two years to establish the six National Collaborating Centres.
 
These centres will be established in various parts of the country, each having a very specific public health focus:

• Atlantic Canada - Determinants of Health: to study how social factors affect health \
• Quebec - Public Policy and Risk Assessment: to study the impact of public policy on Canadians' health and well-being
• Ontario - Infrastructure, Info-Structure and New Tools Development: to study how public health information can best be gathered and utilized to minimize health risks
• Prairies - Infectious Diseases: to study the present and future risks of emerging and re-emerging diseases
• British Columbia - Environmental Health: to study the effects of the environment on human health
• Given the significant and persistent health disparities that exist for Canada's Aboriginal Peoples, a National Collaborating Centre for Aboriginal Health is being established to study the health factors affecting the health status of Aboriginal Canadians in urban, rural and remote communities.