The moment Dr. Alan Rosenberg learned that children could develop arthritis is seared into his memory. It was 1970, and an adult rheumatologist introduced the then-second-year medical student to a 16-year-old girl living with arthritis. The meeting altered the trajectory of Dr. Rosenberg's career.
"I shook her hand and was startled by her contorted fingers and rigid wrist," Dr. Rosenberg recalls. "At the time there were no pediatric rheumatologists in our community and, I learned, none in Canada and few in the world. It seemed to me then that this child deserved more from our profession than it was prepared to provide."
Now a pediatric rheumatologist, arthritis researcher and Distinguished Professor at the University of Saskatchewan, Dr. Rosenberg decided to help provide the care and research that was lacking more than five decades ago. It was a choice that has led to a lengthy list of accomplishments, including the Saskatchewan Order of Merit in 2022. Dr. Rosenberg has steadily received support from Arthritis Society Canada, and has once again secured a grant to do research that could profoundly impact the care of children affected by arthritis.
Drilling down to disease development
In November 2023, Dr. Rosenberg received an Ignite Innovation Grant from Arthritis Society Canada to explore the role of certain proteins in the development of arthritis. Some forms of childhood arthritis are believed to be autoimmune diseases, whereby one's immune system produces proteins called antibodies that mistakenly attack healthy tissues. These antibodies target parts of the cell nucleus, but it is not known which parts are implicated. If Dr. Rosenberg's team can pinpoint the targets, then diagnostic accuracy can be improved, and more personalized treatments and care plans can be created.
Dr. Rosenberg says, "An ideal outcome is that we would identify the targets, which could lead to potential point-of-care testing. Think of it as a rapid test that could be done at the bedside in the clinic. The doctor could say, 'This patient has this antibody and therefore needs this medication and care plan.'"
There's an added benefit to the work that could dig deeper into the origins of arthritis. Currently, why the antibodies in question launch an attack is a mystery. Dr. Rosenberg's team intends to uncover the reason. They will look at databases to determine, for example, if certain infectious agents share the same molecular structure as the proteins targeted by antibodies in children living with arthritis. This could offer clues into the cause of the disease. If the researchers can understand what precipitates the attack, then perhaps they can intervene to prevent it.
Dr. Rosenberg notes that Arthritis Society Canada's two-year Ignite Innovation Grant is essential. His team has leveraged it to secure additional support for the project.
A meaningful partnership
In 1979, Arthritis Society Canada funded Dr. Rosenberg with a fellowship during his training. Two years later, the organization provided the first grant to the University of Saskatchewan's Pediatric Rheumatology Research and Innovation Laboratory. Since then, a plaque acknowledging support from Arthritis Society Canada has been displayed in the Laboratory as a symbol of a strong bond.
"There's no question — I wouldn't be doing what I'm doing without the support of Arthritis Society Canada. Arthritis Society Canada has been instrumental in allowing us to sustain what is one of the longest, if not the longest, continuously-functioning pediatric rheumatology research labs in the world. That speaks to the support we've received. It also speaks to how old I am," Dr. Rosenberg says with a laugh.
Research wasn't initially on Dr. Rosenberg's radar. Patient care is what sparked his interest, but a new picture of his future was painted early in his career.
"It became apparent to me that I would not be comfortable sitting with children and families day after day, month after month, year after year, saying, 'Yes, your joints are swollen, but we don't know why. We have treatments that I think will work, but we're not sure,'" he says. "Despite progressive advances, much work remains. We don't know the cause of the disease. Treatments are getting better, but are still not as safe or effective as we desire, and we have almost no insight into cure and prevention."
Understanding the origins of childhood arthritis is the key to preventing it, and is what drives Dr. Rosenberg. When asked how he spends his spare time, he shares that he enjoys acreage living and gardening under the expert guidance of his wife. It doesn't take him long, however, to redirect the discussion back to his research.
"It's the children and their families who inspire my work," he says. "They sustain my desire and commitment to keep this going, and I think we, as a dedicated international pediatric rheumatology community, are finally on the cusp of making discoveries that will really transform the way we understand and prevent this disease."