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The Canadian Arthritis Research Conference:

Taking Collaborative Action

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February 25, 2020

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Fairmont Empress & Victoria Conference Centre
721 Government St
Victoria, BC
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Canadian Arthritis Research Conference

Thank you to everyone who attended the inaugural Canadian Arthritis Research Conference (CARC) in Victoria, B.C. on February 25 & 26, 2020 ahead of the 2020 CRA & AHPA Annual Scientific Meeting.  

The theme of the conference was “Taking Collaborative Action”, and so, in partnership with, the Canadian Rheumatology Association (CRA) and CIHR-IMHA, 90 researchers, clinicians and people living with arthritis from across Canada, the United States and the UK came together to explore perspectives, advance knowledge and enhance Canadian leadership in the world of arthritis and rheumatic diseases.  

The two day-conference saw three distinct sessions with national and international speakers presenting on the following themes: 

  1. Living Well: Easing Pain through Research 
  2. New Approaches to Inflammation and Tissue Repair 
  3. Getting Hooked on Big Data Science 

Each session was anchored by a consumer presentation and was followed by presentations from two trainees, and basic and clinical scientists’ presentations. Through collaborative presentations and group conversations, the presenters collectively highlighted current research and approaches to pain, inflammation and tissue repair, and the integration of open source data in clinical applications.  

The CARC Poster session had 28 researchers presenting on their current projects across Canada. You can read more about our two top poster winners and their research projects, Dr. Shabana Amanda Ali in the postdoctoral fellow category and Dale Fournier in the graduate student category, in the poster session tab below. Congratulations to both Amanda and Dale! 

We want to give a special thanks to the scientific planning committee, for all their contributions to the development of the program. This conference would not have come together without their leadership.

  • Dr. Hani El-Gabalawy: Chair of planning committee / Co-chair for Session 1 
  • Graeme Reed: Co-chair for Session 1 
  • Dr. Jeff Dixon: Co-chair for Session 2 
  • Dr. Heinrike Schmeling: Co-chair for Session 2 
  • Dr. Shabana Amanda Ali: Co-chair for Session 2 
  • Dr. Proton Rahman: Co-chair for Session 3 
  • Dr. Diane Lacaille: Co-chair for Session 3 
  • Dr. Marie Hudson: Committee Member 

Thank you to all the presenters and conference attendees for helping to make the 1st Canadian Arthritis Research Conference a great success!  

Photography of Yvonne Lee and Linda Wilhelm Photography of the CARC planning committee Photograpy du CARC poster session Photography of the CARC Delegates
Session 1 speakers Yvonne Lee and Linda Wilhelm CARC Planning Committee CARC Poster Session CARC Delegates

Full conference program [561kB]

Programs & Presenters

Living well: Easing pain through research

February 25, 3:00 pm - 6:00 pm

Twenty percent of the Canadian population suffers from some form of chronic pain. Yet despite this huge burden, existing treatment approaches remain inadequate for a substantial proportion of these patients. Although Canadian pain researchers are world leaders in understanding the fundamental biology and mechanisms of pain, translation of basic discoveries into new treatments has been slow with many impediments in the bench to bedside continuum. This session aims to provide a state-of-the-art summary of current pain research, a glimpse into patients’ experience living with chronic pain, and explore the challenges and impediments to developing better approaches to pain treatment.

  • Linda Wilhelm

    Thirty Five Years Living with Pain

    Photography of Linda WilhelmLinda Wilhelm is the President of The Canadian Arthritis Patient Alliance, a national, volunteer, patient-driven organization that has worked to improve the lives of people living with arthritis since 2002. She is co-chair of the Steering Committee for the Chronic Pain Strategy for Patient Oriented Research (SPOR) Network, as well as a member of the network’s patient advisory committee. She is also a member of The Evidence Alliance (SPOR) Network. Linda has participated in past Health Canada expert advisory panels and numerous conferences concerning treatment access and drug safety issues. She is a former member of both the Expert Advisory Committee for Vigilance of Health Products and the Drug Safety and Effectiveness Network's steering committee and a current member of The National Pain Taskforce.

    Ms. Wilhelm has been an active advocate for treatment access and quality of care for all patients both regionally and nationally for over twenty years and is a past board chair for the New Brunswick Division of the Arthritis Society. Ms. Wilhelm has been living with rheumatoid arthritis for over thirty five years, many of those years unresponsive to the medications used to treat the disease, which resulted in significant and irreversible damage to most of the joints in her body leaving her to manage chronic pain on a daily basis and throughout her recovery from fourteen major joint reconstructive surgeries.

    Ms. Wilhelm is a recipient of the Queen’s Jubilee Golden and Diamond Medals of honour and the 2015 Arthritis Alliance of Canada Qualman/Davies Patient and Consumer Leadership Award.

  • Dr. Yvonne Lee

    Beyond the VAS: Advances in Clinical Research on Pain in Individuals with Arthritis

    Photography of Dr. Yvonne LeeYvonne Lee is an Associate Professor of Medicine (Rheumatology) and Preventive Medicine at the Northwestern University Feinberg School of Medicine. She received her medical degree from the University of Michigan Medical School and a masters in medical science from Harvard Medical School. Her research focuses on the inflammatory and neural mechanisms of pain in rheumatic diseases. She was trained in quantitative sensory testing (QST) methods by Dr. Daniel Clauw at the University of Michigan Chronic Pain and Fatigue Research Center. 

    As the Director of Pain Research in the Division of Rheumatology, Immunology and Allergy at Brigham and Women’s Hospital from 2012-2017, she developed the clinical research program on pain in rheumatic diseases. Her studies have utilized multiple methods of pain assessment, including patient self-report measures, QST, and neuroimaging to assess pain among rheumatoid arthritis patients. She was the PI of an R01 grant, entitled “Central Pain Mechanisms, Pain Intensity, and Drug Response in Rheumatoid Arthritis (CPIRA)”. Through CPIRA, she recruited 296 RA patients from 5 sites around the U.S. and conducted QST before and 12-weeks after starting a disease-modifying antirheumatic drug. She is also at the forefront of research examining the role of mobile technology for the assessment of pain and other patient reported outcomes in RA. Her research group developed a smartphone app to track RA disease activity and identify RA flares. This app was well-received by patients, with an overall compliance rate exceeding 75%. In addition to her research activities, Dr. Lee also enjoys mentoring trainees, both one-on-one, as well as through Clinical and Translational Science Award-based training programs.

  • Dr. Cairistin McDougall

    Quantitative Sensory Testing Demonstrates Similar Patterns of Pain Sensitization between Rheumatoid Arthritis Patients and Their Unaffected First-Degree Relatives

    Photography of Dr. Cairistin McDougallDr. Cairistin McDougall attended medical school in her home province at the University of Saskatchewan and graduated in 2014. She went on to complete her Internal Medicine training at the University of Calgary followed by Rheumatology training at the University of Manitoba. During her residency, she began research with Dr. Hani El-Gabalawy on pain and QST after completing QST training with Dr. Yvonne Lee in Boston, MA. She completed her Rheumatology training in 2019 and has started practice back home in Regina, SK.

  • Dr. Yves De Koninck

    Basis/Translational Research Directions in Pain

    Photography of Dr. Yves De KoninckYves de Koninck studies the physiological, pharmacological and anatomical bases of the transmission of signals between neurons. He is interested in chemical mechanisms associated with the integration of sensory signals in the spinal cord, specifically those related to the transmission of pain influx.

    Dr. De Koninck has expertise in synaptic physiology, biophysics, in vivo and patch clamp electrophysiology, cellular imaging in brain slices, confocal and non-linear microscopy, optical super-resolution, fiberoptics-based applications, optogenetics, noise analysis and computational approaches.

    His group currently focuses on synaptic mechanisms implicating amino-acids creating inhibition or excitation, and neuropeptides such as endorphins.

    To study the alteration of the chemical transmission inside the central nervous system upon lesion, techniques such as patch clamp are used to detect faint synaptic events. High resolution techniques allow for studying the activity of individual receptors while maintaining the neuronal functional connections intact.

    His recent research interests include:

    • The integration of sensory signals in the spinal cord and the brain, and in particular the cellular changes associated with the development of chronic pain and other pathological conditions of the central nervous system.
    • Mathematical modeling of the functions of neurons.
    • The development of new imaging techniques to study neuronal function.   
    • Changes in synaptic physiology during aging.   

    Taken from:

  • Dr. Emerson Krock

    The passive transfer of fibromyalgia symptoms from patients to mice

    Photography of Dr. Emerson KrockEmerson Krock, PhD, is currently a post-doctoral fellow at the Karolinska Institute (KI) in Stockholm, Sweden. He completed his PhD in 2017 at McGill University with Lisbet Haglund, where he investigated mechanisms of intervertebral disc degeneration and chronic low back pain. At the KI, under the mentorship of Camilla Svensson, Emerson has examined various antibody-driven pain mechanisms in models of rheumatoid arthritis. Most recently, he has been exploring autoantibody and autoimmune mechanisms of fibromyalgia. Emerson has received post-doctoral fellowships from the International Association for the Study of Pain and the King Gustaf V's 80-year foundation to support his work.

  • Maria Hudspith, Canadian Pain Task Force

    Exploring the Intersection of Arthritis and Chronic Pain in Canada: Informing the Canadian Pain Task Force

    Photography of Maria HudspithMaria Hudspith is the inaugural Executive Director of Pain BC, a collaborative non-government organization working to improve the lives of people in pain. She brings more than two decades of experience in community engagement, organizational development, policy advocacy and systems change.

    She is the Co-Chair of the Canadian Pain Task Force which is mandated to recommend to the federal government an improved approach to pain care, education and research in Canada. 

    Maria is also a Co-Principal Investigator on the Canadian Institutes of Health Research's (CIHR) Strategy for Patient-Oriented Research Chronic Pain Network and Co-Lead of the Network's patient engagement initiatives.

New approaches to inflammation and tissue repair

February 26, 8:30 am - 11:30 am

Arthritis is a term used to describe a group of musculoskeletal diseases characterized by inflammation in the joints or other areas of the body. Inflammation is a complex biological response that can underpin the redness, swelling, stiffness and pain often seen in arthritic joints. Left unchecked, inflammation can lead to significant tissue damage, resulting in loss of function and disability. But the ways in which inflammation works in arthritis and ways to manipulate it aren’t fully clear, and ongoing research continues to shed light on these pressing questions. As well, advances in our understanding of the regenerative biology of joint tissues are leading to new strategies for promoting repair and healing. This session will highlight current and future approaches to research on inflammation and tissue repair, including innovative ways to do research and new directions for moving forward. The speakers will emphasize the integration of basic and clinical research, highlight potential opportunities for collaborative action by Canadian and international investigators, and encourage the audience to brainstorm opportunities for collaborative action.

  • Jack Hornecker

    Photography of Jack HorneckerJack Hornecker is an 18-year old student in his first year at the Alberta University of the Arts, studying Visual Communication and Design. He is a former patient of the Alberta Children's Hospital, where he participated in a clinical trial through the Rheumatology Clinic to treat a diagnosis of Systemic Juvenile Arthritis.

  • Dr. Ali Akram

    The role of TRAF1 in arthritis

    Photography of Dr. Ali AkramDr. Ali Akram got his M.Sc. and Ph.D. from the University of Toronto from the Department of Immunology and The Institute of Medical Science. During his graduate studies he worked on deciphering factors contributing to immunodominance following viral infection (i.e., Influenza and HIV-1) in relation to arthritis. He is well published in many high impact journals. Following his graduation, he went on to do a postdoctoral fellowship at the University Health Network/UC Berkeley before joining the lab of Dr. Ali Abdul Sater at York University to conduct his current research on the role of TRAF1 in relation to arthritis.

  • Dr. Cosimo De Bari

    Cell therapy strategies for cartilage defects and osteoarthritis

    Photography of Dr. Cosimo De BariProfessor Cosimo De Bari is a clinically active rheumatologist and a translational scientist with expertise in musculoskeletal regenerative medicine and arthritis pathophysiology. He has a long-standing interest and track record in the study of joint health and disease, with a focus on cell-based therapies for cartilage repair and osteoarthritis.

    Cosimo graduated in Medicine (summa cum laude) from the University of Bari (Italy), where he underwent specialist training in Rheumatology. He obtained his PhD from the University of Leuven (Belgium). In 2003 Cosimo moved to King's College London, where in 2005 he was awarded an MRC Clinician Scientist Fellowship. Since 2007 Cosimo holds a clinical chair in Translational Medicine at the University of Aberdeen.

    Cosimo is the founder and director of the Aberdeen Centre for Arthritis and Musculoskeletal Health (awarded “Centre of Excellence in Rheumatology” status by the EULAR), leads the Arthritis and Regenerative Medicine Laboratory, and is deputy director of the Tissue Engineering & Regenerative Therapies Centre Versus Arthritis.

  • Dr. Matthew Grol

    Gene Therapy Strategies for Treatment of Post-Traumatic and Genetic Forms of Osteoarthritis

    Photography of Dr. Matthew GrolDr. Grol received his Ph.D. with Dr. S. Jeffrey Dixon at the University of Western Ontario, and completed a postdoctoral fellowship in the laboratory of Dr. Brendan H. Lee at Baylor College of Medicine. He is currently an Instructor at Baylor where he studies gene therapy strategies for treatment of osteoarthritis. Dr. Grol received CIHR funding for his masters, doctoral and postdoctoral training, and is currently funded by a grant from the Bone Disease Program of Texas. His work on gene therapy for osteoarthritis has been published in Arthritis and Rheumatology and Human Gene Therapy, and one of these strategies is currently the subject of a Phase 1 clinical trial in the U.S.

  • Dr. Rae Yeung

    What's in a name? Lessons learned from childhood arthritis

    Photography of Dr. Rae YeungRae Yeung is Professor of Paediatrics, Immunology and Medical Science at the University of Toronto, and Senior Scientist in Cell Biology Research, Scientific Director - Sickkids Biobank and the Hak-Ming and Deborah Chiu Chair in Translational Paediatric Research at The Hospital For Sick Children, University of Toronto. The goal of Rae’s research is to understand the mechanisms governing autoimmunity, specifically the mechanisms involved in initiating and sustaining the immune response in childhood arthritis and rheumatic diseases. Basic science findings have been translated into clinical correlates, which in turn are leading to new therapeutic interventions to improve the outcome in affected children. Dr. Yeung is leading both national and international efforts to understand the biologic basis for heterogeneity in childhood arthritis and rheumatic diseases towards personalized treatment decisions. Rae’s research is supported by The Canadian Institutes of Health Research, Genome Canada, the Arthritis Society, Canadian Arthritis Network, Province of Ontario Ministry of Economic Development and Innovation, Arthritis and Autoimmunity Research Center, Heart and Stroke Foundation of Canada, ZonMw and Reumafonds (The Netherlands) and The Arthritis Foundation (USA).

Getting hooked on big data science

February 26, 12:10 pm - 3:10 pm

The availability of multiple sources of digital data collected as part of our daily lives, and the digitization of healthcare and research data has created an opportunity to adopt technology capable of collecting and analyzing a vast array of information to identify patterns, trends and associations leading to  actionable and effective insights in research and medicine. To improve our understanding and treatment of complex diseases, we need to integrate and systematically analyze these diverse data. This session will examine big data from two important perspectives – the integration of “multi-omics” datasets, and the leveraging of big data collected in peoples’ daily lives from other sources. Speakers will review open sources of big data and tools available for research, highlight approaches in integrative computational biology and artificial intelligence on the path to novel biomarkers and improved therapies, and provide examples of clinical applications of big data in arthritis. This discussion will be anchored within the context of citizen science and consumer engagement.

  • Cheryl Koehn

    Is Big Data a Big Deal to Patients? A Patient Perspective

    Photography of Cheryl KoehnCheryl Koehn lives with rheumatoid arthritis and over her 31 years since diagnosis has become a national patient community leader, educator, patient research partner and published author. Ms. Koehn has dedicated her life to helping others living with arthritis. She is the Founder and President of Arthritis Consumer Experts, Canada’s first national, patient-led organization that provides science-based information and education programs in both official languages to people with arthritis. She served as Co-Chair of the Summit on Standards for Arthritis Prevention and Care, was a volunteer member of the management committee of Canada’s first federally funded arthritis research institute (the Canadian Arthritis Network), was a consumer representative Board Member of the Arthritis Alliance of Canada and today serves as the patient representative on the Canadian Institutes of Health Research Standing Committee on Ethics.

    Ms. Koehn is also an active patient research partner participating in numerous current research projects in Canada and internationally:

    • ICON - Walk10Blocks (CIHR) – Lead, Knowledge User Group
    • PRECISION (CIHR) – Lead, Consumer Core
    • EQUIP-TJR (Vancouver Coastal Health Research Institute) – Co-Investigator and Organizational Partner
    • OPERAS (CIHR) – Collaborator and Organizational Partner
    • ANSWER 1 & 2 – Collaborator and Organizational Partner
    • CIHR Project Grant (evaluation of multidisciplinary rheumatology nursing care for people with complex rheumatic diseases) – Co-Investigator
    • Making it Work (CIHR) – Key consumer informant

    In her leadership role at Arthritis Consumer Experts, Ms. Koehn has led the development of numerous information and education innovations to the arthritis community, including the Arthritis ID and Arthritis ID PRO iPhone apps, Arthritis Broadcast Network blog, the annual JointHealth™ Arthritis Medications Report Card and Canada's Best Workplaces for Employees Living with Arthritis Award, among many others.

    Along with co-authors Dr. John Esdaile and Taysha Palmer, Cheryl Koehn authored Rheumatoid Arthritis: PLAN TO WIN, published by Oxford University Press.

    Ms. Koehn lives in Vancouver, British Columbia, where she enjoys ocean swimming, cycling, and walking her faithful dog, Molly.

  • Dr. Linda Li

    Photography of Dr. Linda LiDr. Linda Li is Professor and Harold Robinson/Arthritis Society Chair at the Department of Physical Therapy, University of British Columbia. She holds a Canada Research Chair in Patient-oriented Knowledge Translation. Dr. Li’s research centers on improving care for people with arthritis and empowering patient self-care. Her work focuses on integration of online, mobile, and wearable tools in health care. Example includes the use of fitness trackers and apps in patient coaching to promote physical activity. Dr. Li’s work in knowledge translation has also led to new studies on the benefits of engaging patients in the full spectrum of research process.

  • Nevena Rebic

    r/thritis: investigating patient-centred questions using data from social media sources

    Photography of Dr. Nevena RebicNevena Rebić is a 2nd year MSc graduate trainee at Arthritis Research Canada and the University of British Columbia Faculty of Pharmaceutical Sciences, where she previously completed a Bachelor of Pharmacy. In her research, she uses her clinical expertise to develop patient-centered approaches to examine how women with rheumatoid arthritis make medication decisions for family planning and pregnancy. She is also a mentor to undergraduate PharmD trainees and supervises student research projects employing data from social media sources. She is a recipient of the CIHR Drug Safety and Effectiveness Cross-Disciplinary Training.

  • Mathew Veras

    Regulators of ectopic calcification in a mouse model of DISH: A multi-omics perspective

    Photography of Dr. Mathew VerasMatthew Veras is a PhD Candidate in his final year in the Department of Physiology and Pharmacology at Western University. He is also affiliated with the Bone & Joint Institute at Western University where he has served as the Chair of the Trainee Leadership Committee. Matthew's PhD project is investigating regulators of ectopic calcification in a mouse model of Diffuse Idiopathic Skeletal Hyperostosis (DISH). This project has involved the integration of transcriptomic, proteomic, and metabolomic datasets in addition to behavioral assays of pain. To date, he has co-authored 4 publications related to intervertebral disc degeneration and DISH.

  • Dr. Igor Jurisica

    Explainable AI for data-driven medicine: From data to models and treatments

    Photography of Dr. Igor JurisicaIgor Jurisica, PhD, Dr Sc is a Senior Scientist at Krembil Research Institute, Professor at University of Toronto and Visiting Scientist at IBM CAS. He is an Adjunct Professor at Pathology and Molecular Medicine at Queen's University, an adjunct scientist at the Institute of Neuroimmunology, Slovak Academy of Sciences, and an Honorary Professor at Shanghai Jiao Tong University. Since 2015, he has also served as Chief Scientist at the Creative Destruction Lab, Rotman School of Management.

    He has published extensively on data mining, visualization and integrative computational biology, including multiple papers in Science, Nature, Nature Medicine, Nature Methods, J Clinical Oncology, J Clinical Investigations, and has over 13,876 citations since 2014, including 788 highly influential citations (SemanticScholar). He has been included in Thomson Reuters 2014, 2015 & 2016 lists of Highly Cited Researchers (, and The World's Most Influential Scientific Minds: 2015 & 2014 Reports. In 2019, he has been included in the Top 100 AI Leaders in Drug Discovery and Advanced Healthcare list (Deep Knowledge Analytics,

Dinner with industry presentations by AbbVie and Janssen

February 25, 8:00 pm – 10:00 pm

Poster Session

Top 2020 Posters

  • Top Post-Doctoral Fellow Poster - Dr. Shabana Amanda Ali

    Title: Circulating microRNA signatures identified in early versus late knee osteoarthritis

    Shabana Amanda Ali1*
    Rajiv Gandhi1
    Pratibha Potla1
    Sareh Keshavarzi1
    Osvaldo Espin-Garcia1
    Konstantin Shestopaloff1
    Chiara Pastrello1
    Dylan Bethune-Waddell1
    Starlee Lively1
    Anthony Perruccio1
    Y. Raja Rampersaud1
    Jason S. Rockel1
    Igor Jurisica1
    Tom Appleton2
    Mohit Kapoor1,3

    Keywords: osteoarthritis, microRNA, sequencing, biomarkers, early versus late stage disease

    Photography  of Dr. Shabana Amanda AliBio: Dr. Shabana Amanda Ali completed her PhD (2014) in the Institute of Medical Science at the University of Toronto with Dr. Benjamin Alman, studying the role of Hedgehog signaling and cholesterol homeostasis in osteoarthritis pathophysiology. She completed her first Postdoctoral Fellowship (2016) at the University of Western Ontario with Drs. Joy MacDermid and Marita Kloseck, exploring community-based management strategies for osteoarthritis. She completed her second Postdoctoral Fellowship (2019) in the Krembil Research Institute at the University Health Network with Drs. Mohit Kapoor and Rajiv Gandhi, identifying microRNA biomarkers for early detection of osteoarthritis. She is currently an Assistant Scientist in the Bone and Joint Center at the Henry Ford Health System, with a research program focused on understanding the early genomic changes occurring at both local and systemic levels in osteoarthritis.


    Affiliations: 1Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada; 2Western University and St. Joseph's Health Care, London, ON, Canada; 3Department of Surgery and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada


    MicroRNAs contribute to osteoarthritis (OA) pathophysiology in multiple ways, acting both locally and systemically. MicroRNAs are good candidates for biomarkers of diseases, and may be useful for categorizing OA patients. Next generation sequencing (NGS) is an advantageous approach for biomarker discovery because it offers the sensitivity and specificity to detect novel microRNAs and low abundance microRNAs that are unique to disease stages. This study uses NGS to profile signatures of circulating microRNAs in patients with early and late radiographic knee OA.


    Cohorts were carefully defined where early OA included patients with Kellgren-Lawrence grade 0 or 1 (N=41), and late OA included patients with Kellgren-Lawrence grade 3 or 4 (N=50). Demographic (e.g. age, sex, race), anthropometric (e.g. body mass index), and clinical variables (e.g. pain) were collected for all patients for use in statistical analyses. RNA containing microRNAs was isolated from plasma samples (N=91) and subjected to microRNA library preparation and NGS on the Illumina NextSeq550 platform. Data were normalized by total counts and interpreted using bioinformatics and computational biology approaches. 


    To visualize patterns in the microRNA sequencing results in an unbiased manner, principal component analysis was used. This showed a clear separation of late OA samples from early OA samples, with 58.2% of the variability explained by component 1. Among early OA patients, a greater percentage reported high pain as compared to patients with late OA (P=0.03), suggesting that our early OA cohort captured a clinically relevant population. Differential expression analysis identified 215 microRNAs, 97 of which were expressed at a higher level across 85% or more of the early OA samples as compared to the late OA samples. We also identified 4 novel microRNAs that were present in 50% or more of the early OA samples. Gene target analyses predicted 27 genes to be common targets of these early OA microRNAs, shedding light on the potential functions of the novel microRNAs. 


    Leveraging the sensitivity and specificity of NGS technology, we used carefully defined cohorts of radiographic knee OA patients to identify a panel of 101 microRNAs in early OA, which includes 4 novel microRNAs. To determine the utility of these microRNAs as biomarkers of disease, next steps include validation in a larger cohort and in a longitudinal cohort. 


  • Top Graduate Student Poster: Dale Fournier

    Title: Diffuse Idiopathic Skeletal Hyperostosis (DISH): Quantitative MicroCT and Histological Analyses in Humans 


    Dale E. Fournier, Ryan J. Beach, Patti K. Kiser, S. Jeffrey Dixon, and Cheryle A. Séguin  

    Institution affiliation: Bone and Joint Institute, University of Western Ontario, London, Canada 

    Keywords: diffuse idiopathic skeletal hyperostosis (DISH), heterotopic ossification, dystrophic calcification, microcomputed tomography, X-ray diffraction, human (cadaver), vertebral column (spine), intervertebral disc 

    Photography of Dale FournierBio: As a graduate trainee, my research and teaching interests have been linked closely with human anatomy, particularly as it relates to the spine. An unique arthritis of the spine, diffuse idiopathic skeletal hyperostosis (DISH), is poorly understood and there are no disease-modifying or symptom-reducing treatments. My M.Sc. research allowed me to investigate and characterise DISH using advanced microcomputed tomography imaging and histological techniques. My current combined M.PT./Ph.D. program allows me to translate our basic research findings into the clinical setting and to address important gaps in our understanding of DISH to improve early diagnosis, identify therapeutic targets, and better understand patient needs. 


    Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spondyloarthropathy characterised by ectopic mineral formation along the anterolateral aspect of the spine. The prevalence of DISH is estimated to be 15-25% of North Americans over 50 years and is listed by The Arthritis Society as the second most common form of arthritis. Classically, the clinical diagnosis of DISH is based on radiographic features of flowing mineral along at least four contiguous motion segments (four intervertebral discs [IVDs] and adjacent vertebra) and preserved IVD space. Importantly, these criteria limit the diagnosis of DISH to advanced cases and the etiology of DISH is unknown; underscoring the need to characterise the tissue types and cellular changes associated with ectopic mineralisation.  

    Methods: Intact spines (cervical-thoracic) were dissected from 19 embalmed cadavers (6 females and 13 males; range 65-94 years) and scanned by microCT. Images were used to diagnose DISH using the current clinical criteria and to quantify radiographic features of ectopic mineralisation. Six spines with DISH were then evaluated using histology and physical techniques. Individual motion segments (15 total) were isolated from regions of the thoracic spine. Sections were stained with haematoxylin & eosin and Masson’s trichrome for histopathological analysis. Scanning electron microscopy, energy dispersive X-ray spectroscopy, and X-ray diffraction were used to evaluate the elemental composition and mineral content of DISH.  

    Results: 53% of the cohort met the diagnostic criteria for DISH (3 females and 7 males; range 72-94 years). Histological examination revealed two distinct characteristics of ectopic mineral. First, features of mature lamellar bone were evident outside of the IVD, consistent with heterotopic ossification. Second, isolated regions of amorphous calcified material within the anterior longitudinal ligament, annulus fibrosus and/or fibrocartilage extensions of the IVD, inconsistently stained and granular in appearance, consistent with dystrophic calcification. Both calcifications and ossifications showed similar physical characteristics–a high content of calcium and phosphorus and a crystalline diffraction pattern matching hydroxyapatite. Although similar in radiographic appearance, calcifications could be differentiated by radiodensities exceeding bone using microCT. 

    Discussion: Our findings demonstrate that ectopic mineral associated with DISH is formed by both dystrophic calcification and heterotopic ossification of spinal tissues. These features are both captured by the current clinical criteria for DISH, but these distinct processes may reflect stages of disease and hence the pattern of disease progression within the spine. Ongoing studies will investigate the spatiotemporal relationship between dystrophic calcification and heterotopic ossification in the pathogenesis of DISH. 

CARC 2020 Poster Session Booklet [1MB]


The Arthritis Society, Canadian Rheumatology Association (CRA) and CIHR-IMHA would like to thank our corporate sponsors for their generous support of this program.

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