Competition Results

Project Title: Towards the Discovery of Predictive Biomarkers for Outcomes in Lupus Nephritis

Project Summary: 

Biomarkers for outcomes in lupus nephritis 

Many people living with lupus nephritis, a kidney disease that commonly develops in people with lupus, do not respond well to existing treatments. Additionally, it is often a challenge for physicians to predict treatment response. Through testing kidney biopsies from people living with lupus nephritis, researchers found a type of gene that could predict poor treatment responses but, unfortunately, the technique used to measure the genes is impractical for clinical use due to cost, time, and the need for fresh tissue sampling. To improve this testing, Dr. Whittall-Garcia and team developed a technique to measure levels of a similarly predictive protein in blood samples. The team will now further adapt this technique to measure these proteins in kidney biopsies to assess their levels during kidney flares and better determine their ability to predict treatment response. If successful, this test could enhance early identification of patients with a high probability of poor outcomes and help them to receive more aggressive treatment sooner in the disease course.  

Project Title: CLIMB: Complement activation Levels and Interferon activity as novel Myositis Biomarkers

Annual Commitment: 

Year 1: $125,000
Year 2: $125,000
Year 3: $125,000

Project Summary: 

Using artificial intelligence to design new blood tests for autoimmune muscle diseases

Autoantibodies are immune system proteins that attack the body’s own tissues. These autoantibodies often interact with other proteins in the blood of people with autoimmune inflammatory myopathies (AIM), and blood tests that look for these proteins could help diagnose and monitor the disease. Dr. May Choi and her team are examining combinations of blood proteins that could be used to diagnose AIM and indicate its severity. The team will first examine blood samples of people with AIM to determine whether certain blood proteins provide information about the subtype or severity of the disease. They will then use machine learning approaches to determine the best combinations of blood proteins to diagnose and monitor AIM. The results could help in developing a blood test that would guide treatment decisions and improve outcomes for people with the disease. 

Project Title: Shoulder osteoarthritis phenotyping: Towards improved understanding, diagnosis, and therapeutic management of post-traumatic and end-stage OA

Annual Commitment: 

Year 1: $125,000
Year 2: $125,000
Year 3: $125,000

Project Summary: 

Improving early detection and treatment of shoulder osteoarthritis

Researchers do not understand shoulder osteoarthritis as well as other forms of osteoarthritis, which makes early detection and treatment difficult. New imaging technologies that allow researchers to study the whole shoulder joint and its movement can provide more information about how the disease begins and progresses. Dr. Nikolas Knowles and his research team are using these innovative technologies to analyze shoulder tissue structure and movement in people at various stages of shoulder osteoarthritis, from those at high-risk to those with end-stage disease who need a joint replacement. These images will help researchers understand how shoulder joint structure and function change as the disease progresses, which will help to improve diagnosis and treatment, and may lead to strategies that prevent or slow the disease.

Project Title: Psilocybin as a novel therapy for treatment-resistant chronic osteoarthritis pain 

Annual Commitment: 

Year 1: $49,313
Year 2: $49,313

Project Summary: 

Using psilocybin to treat hip and knee osteoarthritis pain

Many people with knee and hip osteoarthritis pain do not find relief from the current pain management options. Early research suggests that the psychedelic drug psilocybin, a hallucinogen found in some types of mushrooms, has potential to treat some types of pain, but it has not been tested for treating chronic osteoarthritis pain. Dr. Anthony Adili and his team will conduct a small clinical trial testing whether psilocybin given at doses too low to be hallucinogenic can relieve pain in people with hip and knee osteoarthritis who have not had success with other pain management options. The trial will help determine the safety and effectiveness of psilocybin for pain management and the best dose to treat chronic pain. The study will help inform a larger trial of psilocybin for chronic pain and could ultimately provide a new treatment option.

Project Title: Combining Transcranial direct current stimulation and yoga for improved pain management for knee osteoarthritis: A pilot and feasibility trial 

Annual Commitment: 

Year 1: $50,000
Year 2: $49,900

Project Summary: 

Combining non-invasive brain stimulation and yoga to treat knee osteoarthritis pain

Knee osteoarthritis can be very painful and currently does not have effective treatment. Since the nervous system has an important role in how people experience pain, Dr. Lisa Carlesso and her team are looking for ways to target the changes in the nervous system that cause chronic knee osteoarthritis pain. They have created a unique therapy that combines non-invasive brain stimulation and yoga to target both the brain and the nerves throughout the body and help restore the nervous system’s functions. Dr. Carlesso’s team will use this small study to collect the first data about whether this treatment is effective and what participants think about it, which will help inform future larger trials. If this combination of treatment is effective, it has the potential to reduce pain and pain-related symptoms and may change osteoarthritis pain management. 

Project Title: Targeting affective/motivational and cognitive components of arthritis pain to improve the quality of life: A preclinical study 

Annual Commitment: 

Year 1: $50,000
Year 2: $50,000

Project Summary:

Targeting unpleasant aspect of pain 

Pain has a sensory component, which is the location and intensity of the pain, as well as an affective component, which is how unpleasant the pain feels. Currently, arthritis drugs only target the sensory component of pain. In this project, Dr. Louis Gendron and his team propose to target the affective component of pain as a new approach to pain management. They will study the delta opioid receptor, a protein found on nervous system cells. They will examine whether stimulating this receptor in the amygdala, a part of the brain that processes the affective component of pain, blocks the unpleasantness of the pain sensation. If successful, the research could contribute to the development of new pain-relieving strategies that would prevent people with arthritis from feeling pain as bothersome, providing relief, and improving quality of life.

Project Title: Developing an artificial intelligence-based online tool for automatic joint detection and scoring of radiographic joint damage among patients with rheumatoid arthritis using continual learning 

Annual Commitment: 

Year 1: $50,000
Year 2: $50,000

Project Summary: 

Using machine learning for evaluating disease progression in rheumatoid arthritis

Doctors often use x-rays of joints to monitor joint damage in people with rheumatoid arthritis. To help clinicians assess joint damage in x-rays more efficiently, Dr. Pingzhao Hu and his team have developed a computer-assisted tool that can identify joint damage in x-rays and uses machine learning to improve its accuracy as it gains experience. The team will continue to refine the tool to improve its accuracy, and they will then develop a web-based platform for clinicians to upload x-rays and securely receive reports of the joint damage. Such a tool would be particularly useful in rural or remote regions that have limited access to clinicians with expertise in assessing x-rays for joint damage. This tool will help clinicians efficiently and effectively monitor changes in joint damage over time and inform treatment decisions for people with rheumatoid arthritis. 

Project Title: Personalizing care in dermatomyositis: A pilot study for longitudinal home monitoring of disease activity using patient-reported outcomes and fingerstick blood sampling 

Annual Commitment: 

Year 1: $49,316
Year 2: $48,205

Project Summary: 

Using an at-home disease monitoring strategy for dermatomyositis

People with dermatomyositis experience inflammation in their muscles, skin, and joints. Some people with dermatomyositis experience flares, during which their symptoms worsen, followed by more inactive periods. A protein called interferon, which is found in the muscle and skin of people with dermatomyositis, may be able to predict a flare, if it can be easily monitored. Dr. Valérie Leclair and her team are investigating whether information that can be collected at home, specifically interferon levels in blood samples, can predict dermatomyositis flares. They will collect health data from people with dermatomyositis through wearable fitness trackers and use fingerstick blood sampling to examine their interferon levels to determine if interferon levels correlate with and predict flares. Using this innovative approach, the researchers hope to develop a reliable technique to predict clinical flares using data collected at home so that clinicians can be more proactive in managing dermatomyositis.

Project Title: Cone-beam computed tomography as a novel imaging approach to diagnosis and treatment monitoring in rheumatoid arthritis 

Annual Commitment: 

Year 1: $50,000
Year 2: $49,989

Project Summary: 

 

Cone-beam computed tomography to diagnose and monitor rheumatoid arthritis 

One of the ways that clinicians detect and measure bone damage in people with rheumatoid arthritis is through computed tomography (CT), which provides high-quality, 3D images of bones and joints. However, reading these scans is time-consuming for clinicians. To help doctors diagnose rheumatoid arthritis sooner, Dr. Sarah Manske and her team are developing a computer program that automatically scans images from cone-beam computed tomography, a low-radiation form of CT scan, to detect bone damage. Using images from people with rheumatoid arthritis, the team will teach the computer program to detect bone damage, examine how effective the program is at detecting damage, and determine if it can measure changes in the size of damaged areas over time. This technology could improve how bone damage is detected and measured so that doctors can start treatment sooner and monitor whether treatments are working. 

Project Title: Targeting autoimmune B cells via metabolic vulnerabilities

Annual Commitment: 

Year 1: $50,000
Year 2: $50,000

Project Summary: 

Understanding how sugar fuels autoimmune disease

In people with rheumatoid arthritis, some types of immune system B cells produce antibodies that attack the body and cause damaging inflammation. Dr. Aaron Marshall and his team are examining whether disease-causing B cells in rheumatoid arthritis break down and use sugars differently from other B cells. The team will study blood from people with rheumatoid arthritis, specifically looking at B cells and enzymes that help break down sugar and compare them to the blood of people without rheumatoid arthritis. This will help determine whether the changes in enzymes contribute to B cells producing damaging antibodies and how this might happen. The results could identify specific enzymes that contribute to rheumatoid arthritis, which may lead to new treatments that slow or prevent B cells from producing harmful antibodies and causing disease.

Project Title: Discovering the targets for antinuclear antibodies in Juvenile Idiopathic Arthritis:  Towards precision diagnosis to improve care 

Annual Commitment: 

Year 1: $50,000
Year 2: $50,000

Project Summary: 

Discovering antibody targets in cells of children with arthritis

Certain types of childhood arthritis are thought to be autoimmune diseases, in which the body’s immune system produces proteins called antibodies that attack healthy tissues. In many cases, the antibodies target parts of the cell nucleus, but researchers don’t know exactly which parts. Dr. Rosenberg and his team aim to uncover which proteins in the cell nucleus are being targeted by antibodies in childhood arthritis. They will examine how antibodies respond to and interact with different proteins in the cell nucleus. They will also look for genetic changes that lead to overproduction of any proteins in the nucleus. Discovering the proteins that are under attack in the cells of children with arthritis will help explain how the disease develops and may lead to new treatments to prevent these immune system attacks.

Project Title: Blockers of acid-sensing ion channels as novel analgesics for the treatment of arthritis pain 

Annual Commitment: 

Year 1: $50,000
Year 2: $50,000

Project Summary: 

Targeting tissue acidification to relieve arthritis pain 

Inflammation in arthritis causes cells to release molecules that make tissues more acidic, contributing to the joint pain that people with arthritis experience. Dr. Philippe Séguéla and his team are studying a group of cell surface proteins called acid-sensing ion channels, which are found in pain-generating nerves around joints and bones. They are also studying whether targeting these channels would be an effective form of arthritis treatment. In earlier research, they identified molecules that could block the acid-sensing ion channel, and they are now testing whether these molecules are effective pain relievers for inflammatory arthritis. They also plan to identify the gene that produces the main acid-sensing ion channel to better understand the channels. This research has potential to lead to the development of new drugs that block the acid-sensing ion channel and acidification process and improve treatment for inflammatory arthritis pain.

Project Title: A Scleroderma patient-centered intervention network project to understand resilience and its influence on mental health in people with systemic sclerosis: A qualitative study using a dyadic interview approach

Annual Commitment: 

Year 1: $49,729
Year 2: $50,000

Project Summary: 

Understanding resilience and mental health in people with systemic sclerosis

Systemic scleroderma is an autoimmune disease that causes pain and inflammation throughout the body, resulting in negative physical and mental health outcomes, but developing resilience can help protect mental health through challenging circumstances. Dr. Amanda Wurz and her team want to understand resilience among people with scleroderma to inform programs that help others with scleroderma to develop and enhance resilience. In this unique study, the research team will interview people living with scleroderma and their caregivers to understand their experiences with resilience, understand how resilience affects their physical and mental health, and identify coping strategies. They also aim to identify essential information to include in future supportive care programs to help people with scleroderma build resilience. This research will capture the nuanced experiences and perspectives of people with scleroderma and provide insights to inform supportive care programs to improve their mental health.

Project title: Regenerative approaches to treat disc degeneration and back pain

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Potential new treatments for low back pain

Intervertebral disc degeneration (breakdown of the cushion-like disks between the spine’s vertebrae) is one of the major causes of back pain. Older disc cells can accumulate in the intervertebral discs and cause inflammation, which may contribute to progression of disc degeneration. A class of drugs called senolytics could remove these older cells, but researchers do not yet know whether they are effective in preventing or delaying disc degeneration and back pain. Under the supervision of Dr. Lisbet Haglund, Saber Ghazizadeh Darband will evaluate whether two senolytic drugs (o-Vanillin and RG-7112) are able to prevent or delay disc degeneration and reduce pain in a preclinical animal model. The researchers will test the senolytic drugs on their own and in combination to determine their efficacy and safety. Through this research, they hope to identify therapeutics that prevent or delay intervertebral disc degeneration and back pain.

Project title: Novel treatments for inflammatory arthritis 

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Toward new treatments for rheumatoid arthritis

Immune cells release signalling molecules known as cytokines, which are important in the immune response to infection or injury. However, unregulated cytokines can also cause excessive inflammation that damages cells and tissues, as seen in rheumatoid arthritis. Under the supervision of Dr. Hugh Kim, Zhexuan (Steven) Jiang will use cells and mouse models to study cytokines that come from platelets in the blood and examine their role in rheumatoid arthritis. The research team will also examine whether shutting down platelet-derived cytokines reduces tissue damage in rheumatoid arthritis. Understanding whether the release of these cytokines can be controlled to treat this disease could eventually lead to new therapies to improve clinical outcomes.

Project title: CD40 homodimer formation and its role in systemic lupus erythematosus 

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Understanding the biology of systemic lupus

In the autoimmune condition systemic lupus erythematosus (SLE), the body’s immune system attacks its own cells, which can impact many organs including the joints. An immune system protein called CD40 is involved in the development of SLE and could be targeted by therapies, but researchers first need a better understanding of its role in the disease. Under the supervision of Dr. Walid Mourad, Joseph Khoury will study immune cells and animal models in the lab to evaluate how CD40 works. The researchers will examine normal and genetically modified CD40 molecules to better understand how CD40 affects immune responses and cellular processes that contribute to SLE development. With this understanding, the researchers aim to identify targets for new treatments that will improve survival, reduce health complications, and improve quality of life for people with this debilitating disease.

Project title: Development and testing of a remotely delivered, technology-enabled, Joint Protection Program for people living with Hand Osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

A video-based joint protection program for hand osteoarthritis

Joint protection programs for hand osteoarthritis are self-management strategies that can help reduce pain and delay disease progression, but current programs are outdated and often inaccessible. Under the supervision of Dr. Joy MacDermid and Dr. Pavlos Bobos, Dimitra Pouliopoulou will develop and test a video-based joint protection program that teaches people with hand osteoarthritis ways to reduce the “load” they put on their joints. The research team will incorporate research evidence and clinical best practices and will work closely with people living with the disease and clinicians to ensure the program meets diverse needs and goals. They will then compare the effectiveness of the new program to current practices to inform a larger clinical trial. This approach will lead to an innovative, evidence-informed, accessible joint protection program that will help people with hand arthritis manage their symptoms, maintain hand function, and improve quality of life. 

Project title: Anti-inflammatory gene therapy strategies to promote joint repair in a preclinical model of post-traumatic osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Anti-inflammatory gene therapy for osteoarthritis

Because inflammation in the joints of people with osteoarthritis contributes to joint destruction and pain, proteins that block inflammation could be used as therapeutics. However, early research of two such proteins in lab models showed that they were not effective for very long. Under the supervision of Dr. Matthew Grol and Dr. Frank Beier, Sepideh Taghizadeh aims to develop a gene therapy that enables joint cells to produce two anti-inflammatory proteins that target critical drivers of inflammation in osteoarthritis. They will deliver the therapy to a mouse model to examine whether it is effective in slowing osteoarthritis and blocking pain. This work may form the foundation for developing a gene therapy strategy that slows osteoarthritis progression after a single injection.

Project title: Moving towards the personalization of treatment choices in rheumatoid arthritis: Combining clinical modelling strategies to personalize risk estimates

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Personalizing treatment choices in rheumatoid arthritis

Rheumatoid arthritis has many available treatment options, but finding the best treatment for each patient is challenging. Clinicians need a model that uses data from multiple sources to predict how individual patients will respond to a treatment. Under the supervision of Dr. Glen Hazlewood, Jocelyn Thomas aims to develop a risk prediction tool that can be used in rheumatology clinics. The research team will use evidence from randomized controlled trials of the effectiveness of available drugs for rheumatoid arthritis along with observational data to develop a tool that can give personalized predictions of the effectiveness of each treatment. This project could lead to rheumatology care becoming more personalized so that patients and their physicians can identify the ideal treatment sooner.

Project title: Investigating immune endophenotypes using single-cell RNA sequencing on patients with rheumatoid arthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

A tool to guide personalized medicine for rheumatoid arthritis

While treatments are available for rheumatoid arthritis, they don’t work for everyone and doctors need a better way to predict which will be effective for individual patients. Under the supervision of Dr. Hugues Allard-Chamard and Dr. Michelle Scott, Jean Vencic plans to identify biomarkers of rheumatoid arthritis and develop a new computational tool to predict a patient’s response to treatment based on the changes found in their own immune system. The research team will collect blood samples and clinical information from patients over time and study the behaviour of individual cells, then use an artificial intelligence approach called machine learning to develop the tool. This tool will help healthcare providers tailor treatments for each person, with the goal of improving outcomes and quality of life.

Project title: Dysregulation of the RNF146 E3 ubiquitin ligase is associated with development of inflammatory arthritis through its substrate the adapter protein 3BP2

Annual commitment (plus 50/50 match):

Year 1: $25,000
Year 2: $25,000
Year 3: $25,000

Project summary:

Cell signalling as a treatment target in rheumatoid arthritis

A newly discovered cell signalling pathway that controls inflammation and bone formation/destruction may also be important in the development of rheumatoid arthritis. Under the supervision of Dr. Robert Rottapel, Dr. Yosuke Asano will examine the relationship between this pathway, inflammatory arthritis, and the bone, as well as whether a specific enzyme can suppress this pathway. The research team will examine cellular composition and inflammation in joint tissue to evaluate the severity of arthritis in animal models and analyze cell signalling pathways. Through this project, the researchers will learn more about the role of the signalling pathway and whether it is important in rheumatoid arthritis development, which may provide the data needed to develop new therapies.

Project title: Granzyme B as a potential therapeutic target for rheumatoid arthritis

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary:

A potential new target for rheumatoid arthritis treatment

A protein called Granzyme B, which breaks down proteins in inflamed tissues, is found at high levels in the blood and joints of people with rheumatoid arthritis, especially in severe disease. Under the supervision of Dr. David Granville, Dr. Alexandre Aubert will investigate the role of Granzyme B in rheumatoid arthritis using experimental models and samples of blood and joint fluids from patients. They will also investigate whether a new drug that inhibits Granzyme B alleviates rheumatoid arthritis. The researchers expect that this study will identify how Granzyme B actively degrades proteins and worsens disease and that the Granzyme B-inhibiting drug will alleviate joint inflammation and symptoms of rheumatoid arthritis. The results could help inform the development of new therapies for rheumatoid arthritis.

Project title: Exploring PlGF expression and signalling pathways: Towards novel targeted therapy for fibrosis in scleroderma

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary:

Fighting fibrosis in scleroderma

Scleroderma is a rare chronic autoimmune disease characterized by excessive fibrosis – a process that leads to scarring and organ dysfunction, which can impact the joints and many other tissues. Under the supervision of Dr. Véronique Moulin, Dr. Elodie Mareux aims to explore the role of a protein called placenta growth factor (PlGF) in fibrosis development. The research team will investigate genetic expression and protein levels of PlGF in human fibrotic tissues and cells and examine the PlGF signalling pathway in healthy and fibrotic cells. The study will provide insights into how fibrosis forms and the role of PlGF in scleroderma progression. It may also identify new targets for therapies in scleroderma and other fibrosis-associated diseases to prevent irreversible fibrosis and potentially life-threatening complications and improve people’s quality of life. 

Project title: Exploring the Lived Experiences of Sexual and Gender Minority Populations Living with Arthritis: A Patient Engagement Centered Approach

Annual commitment (plus 50/50 match):

Year 1: $25,000
Year 2: $25,000
Year 3: $25,000

Project summary:

Making arthritis research more inclusive of sexual and gender diversity

People from 2SLGBTQIA+ communities are often not included in arthritis research, resulting in a large gap in providing the best care for these individuals. Under the supervision of Dr. Linda Li, Dr. Codie Primeau aims to learn more about the pain experiences of people with arthritis who identify as being sexual or gender minorities to find ways to improve their health and healthcare. The research team will engage with participants to better understand diverse perspectives with pain and generate further research questions. By learning from the perspectives of people with lived experiences and building partnerships with communities, they hope to uncover important information to explore in future research to better support the health needs and improve outcomes of these communities.

Project title: Inflammation and activity-induced pain in knee osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $25,000
Year 2: $25,000
Year 3: $25,000

Project summary:

The immune system, exercise, and osteoarthritis pain

Immune cell changes may contribute to activity-induced joint pain and sensitivity in osteoarthritis, but exercise can also reduce arthritis pain. Under the supervision of Dr. Tom Appleton and Dr. Trevor Birmingham, Dr. Brent Wakefield aims to understand how immune cells contribute to activity-induced osteoarthritis pain. The research team will collect tissue samples from participants’ knees and use cutting-edge molecular techniques to analyze immune cells and how they differ between people with and without activity-induced pain. They will also investigate the effects of exercise on immune cells in the knee joints of people who experience activity-induced pain. This research will improve the understanding of the immunological mechanisms that contribute to activity-induced pain in osteoarthritis and could uncover potential targets for drug development.

Project title: Understanding how health factors, job context, sex and gender affect workplace accommodation among men and women with arthritis: The scleroderma model

Annual commitment (co-funded by CIHR-IMHA):
Year 1: $150,000
Year 2: $150,000
Year 3: $150,000

Project summary:

Scleroderma and support at work: How and when it is needed

New treatments have improved the lives of people with arthritis. Many wish to maintain their ability to work. How you function at work is not entirely explained by your age or disease symptoms. It is also related to other personal factors, work context, and workplace practices that may support work performance or impede it. Using scleroderma – an inflammatory disease that can cause arthritis and disability – as a model, Dr. Sindhu Johnson will study how health factors, job context, sex, and gender affect accommodations made in the workplace for men and women with this condition. Insights from this research will inform workplace policies and practices and support the development of targeted workplace supports to help people with scleroderma contribute productively to the workforce.

Project title: Advancing self-management supports, new models of care, and health professions education to improve access to evidence-based care for people with osteoarthritis and arthritis pain

Annual commitment (co-funded by CIHR-IMHA):
Year 1: $150,000
Year 2: $150,000
Year 3: $150,000

Project summary:

Improving access to evidence-based care for osteoarthritis and arthritis pain

Osteoarthritis and arthritis pain are leading contributors to disability worldwide. Treatments such as personalized exercise and self-management programs can improve function, but they are often hard to access. Dr. Jordan Miller will explore ways to make accessing evidence-based care for osteoarthritis and arthritis pain easier. First, he will adapt an effective in-person self-management program to an online format and prepare to evaluate it. Second, he will study the impact of a team-based care model putting physiotherapists in family doctors’ offices and making the physiotherapist the first person a patient sees when booking an appointment for knee or hip pain. Third, he will reach agreement amongst physiotherapy pain educators across Canada on what skills, knowledge, values and attitudes physiotherapists need to help people living with pain. Together, these studies are expected to provide evidence on ways to make it easier for people with arthritis across Canada to access evidence-based care.

Project title: Thrombelastography-defined duration of hypercoagulability following elective total hip and total knee arthroplasty

Annual commitment (co-funded by CIHR-IMHA):
Year 1: $150,000
Year 2: $150,000
Year 3: $150,000

Project summary:

Evaluating individual blood clotting risk after hip or knee replacement surgery

A simple blood test can be used to analyze how someone forms and breaks down blood clots, as an indicator of which patients may be at increased risk for life-threatening blood clots after hip and knee replacement surgery. Dr. Prism Schneider will measure blood clotting changes in people before surgery, 24 hours after surgery, and at routine follow-up visits until three months after surgery. Ultrasound imaging of the legs two weeks after surgery will also be used to look for blood clots. This research will be used to personalize risk assessments and improve preventive treatment to help reduce painful and life-threatening blood clots after joint replacement surgery.

Project title: Imaging approaches to understand the role of patient biological factors in outcomes following total joint replacement

Annual commitment (co-funded by CIHR-IMHA):
Year 1: $150,000
Year 2: $150,000
Year 3: $150,000

Project summary:

Understanding why artificial joints fail to perform as expected

Total hip and knee replacements are the mainstay treatment for advanced osteoarthritis. Unfortunately, about a third of patients may experience complications or dissatisfaction with the outcome of the procedure, and about 10% must undergo repeat surgeries to replace failed joint implants. Dr. Matthew Teeter’s mission is to enhance patient mobility and quality of life after joint replacement through the development and application of imaging and digital technologies. Specifically, he will combine medical imaging and biological research approaches to find out how gut bacteria affect the integration between bone and artificial implants, if ongoing joint inflammation after knee replacement causes pain and dissatisfaction, and if he can see implant component damage after hip replacement associated with immune cell reactions in joint tissue. Understanding risk factors and evaluating new treatments for these issues will help patients receive more personalized treatments that avoid complications and the need for repeat surgeries.

Project title: New dietary and exercise intervention strategies to prevent the effect of obesity and associated osteoarthritis in the knee

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500

Project summary:

Preventing osteoarthritis through diet and exercise

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. Obesity is an important risk factor for developing osteoarthritis, but the best way to prevent obesity-induced arthritis is not known. Under the supervision of Dr. Walter Herzog, Nada Abughazaleh will use an animal model to see whether exercise and dietary fibre supplementation can prevent or slow obesity-induced osteoarthritis in the knees and identify the best time window to intervene. This preclinical evidence may then be used to inform clinical trials of a similar approach in humans.

Project title: Novel osteoarthritic joint-on-a-chip (JOC) systems for modelling interactions between joint resident cells and infiltrating immune effectors

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

A new model of knee osteoarthritis to support drug discovery

There is currently no cure for osteoarthritis. Potential treatments are initially tested in the lab using animal or cell models that are often poor predictors of how human joints respond, resulting in drugs that have failed in clinical trials. Under the supervision of Dr. Sowmya Viswanathan and Dr. Edmond Young, Lauren Bahn is developing a more complex “joint-on-a-chip” experimental model, which will include cartilage and non-cartilage tissues, blood vessels, and immune cells – all of which are important in osteoarthritis but have not yet been combined in existing models. The realistic joint model will be a powerful tool for the study of osteoarthritis and the testing of new treatments.

Project title: Gut inflammation in spondyloarthritis: Which immune cells are driving the process?

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Understanding gut inflammation in spondyloarthritis

Spondyloarthritis is a chronic inflammatory disease that primarily affects the bones and joints. It is also often accompanied by inflammatory conditions that affect other organs, such as inflammatory bowel disease. Under the supervision of Dr. Nigil Haroon, Shaghayegh Foroozan Boroojeni will study gut inflammation in a mouse model of spondyloarthritis, as well as the role of a protein called MIF that has been identified as a potential drug target in spondyloarthritis. Understanding gut inflammation associated with spondyloarthritis may help researchers better understand how the diseases work and guide the development of better therapies.

Project title: Examining Mig6/EGFR signalling in osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Mig6: A potential key to osteoarthritis

Osteoarthritis is the most common form of arthritis, leading to joint pain and disability, and lacks effective treatments. A protein called Mig6 has been identified as a potential novel therapeutic target. Under the supervision of Dr. Frank Beier, Ermina Hadzic will characterize the role that Mig6 plays in osteoarthritis and how it works. Experiments will use cells from people with osteoarthritis as well as genetically modified mouse models to assess how Mig6 functions in both healthy and arthritic joints. If successful, this will lay the groundwork needed to develop and test new osteoarthritis treatments.

Project title: The effect of 30 minutes of continuous walking on biomechanical and neuromuscular inter-limb asymmetries in individuals with unilateral knee osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500

Project summary:

“Will I get osteoarthritis in my other knee too?”: Impact of extended walking

Physical activity is recommended to help relieve the pain and other symptoms of knee osteoarthritis. Under the supervision of Dr. Rebecca Moyer, Carson Halliwell is studying how the knees and supporting muscles work during extended walking using 3D motion capture analysis, focusing on what happens in the non-arthritic knee of people with painful osteoarthritis in only one knee. This will help reveal how to predict a person’s risk of developing osteoarthritis in their second knee and inform tailored rehabilitation approaches to protect the joints and prevent further damage.

Project title:  Advanced MR imaging to identify causes of early hip osteoarthritis after Legg-Calvé-Perthes disease

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Hip shape and cartilage damage in teens and young adults – a path to early osteoarthritis

Legg-Calvé-Perthes disease (LCPD) is a rare condition in children that can cause a permanent change in the shape of the hip. This is linked to cartilage damage and early osteoarthritis, but it is unclear exactly how. Under the supervision of Dr. David Wilson and Dr. Kishore Mulpuri, Luke Johnson will use advanced MRI scanning in a group of teenagers and young adults who had LCPD as children, to pinpoint how the disease changed their hip shape and whether cartilage damage is occurring even in young patients. This will help us understand how LCPD leads to early osteoarthritis, and possible approaches to prevent it.

Project title: Investigating brain contributions to chronic pain in knee osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $11,958

Project summary:

“It’s all in your head”: The role of the brain in knee osteoarthritis pain

Some patients who undergo total knee replacement surgery to treat painful knee osteoarthritis continue to experience unexplainable knee pain. Changes in the brain may drive this persistent pain. Under the supervision of Dr. Ashley Harris and Dr. Sarah Manske, Samantha Leech will use brain imaging to measure brain chemicals associated with pain in people with painful knee osteoarthritis, and sensory testing to identify people who feel pain more strongly. This research could help doctors develop more personalized osteoarthritis treatment options that target the brain – not just the joint.

Project title: Exploring and validating pain phenotypes in early knee osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Explaining pain in people with early knee osteoarthritis

Pain is the primary reason why people with knee osteoarthritis seek medical care, but current treatment
options fall short. Pain is complex, personal, and challenging to measure in a meaningful way. Under the supervision of Dr. Lisa Carlesso, Raghava Neelapala will examine two existing databases of information from people with early knee osteoarthritis to compare different data profiles linked with pain and which way of grouping the data best explains knee pain and its worsening. These pain profiles could help improve personalized pain treatment for people with early osteoarthritis.

Project title: Immune profiling regulatory T cells in spondyloarthritis: Suppressive or pathogenic?

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Regulatory immune cells in spondyloarthritis: Have the good guys gone bad?

Axial spondyloarthritis is a chronic and painful form of inflammatory arthritis that primarily affects the spine. Although medications can provide temporary pain relief, the condition has no cure. Under the supervision of Dr. Robert Inman, Addison Pacheco is studying how cells that regulate the immune system work in joint inflammation. He will find molecular signatures from these regulatory immune cells to help explain why they fail to block inflammation in axial spondyloarthritis. This might eventually lead to new discoveries of biologic therapies to improve disease management and quality of life.

Project title: Using wearables inertial sensors and gait biomechanics to support patient triaging and surgical outcomes in knee osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Wearable sensors to support personalized treatment for osteoarthritis

Wait times for joint replacement surgeries for advanced osteoarthritis have required triaging that results in some patients not receiving optimal care. Small wearable sensors may help in this triaging process by collecting data on how people with osteoarthritis move in daily life. Under the supervision of Dr. Dylan Kobsar, Matthew Ruder will develop wearable sensor technology that will identify walking patterns of people with osteoarthritis who will respond best to joint replacement surgery. This research could help ensure that people with advanced osteoarthritis receive timely and effective care.

Project title: Understanding clinical outcomes in osteoarthritis research: Patient preferences, clinical relevance of treatment effects and suitability of outcomes

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500

Project summary:

Patient-centric health outcomes in osteoarthritis clinical research

Osteoarthritis is an irreversible joint disease and a leading cause of disability worldwide. Understanding which treatments best balance benefits and potential harms relies on high-quality clinical trials measuring meaningful health outcomes. Under the supervision of Dr. Peter Jüni and Dr. Bruno da Costa, Pakeezah Saadat will survey people with osteoarthritis to see which health outcomes they consider most worrisome and will evaluate available research evidence on thresholds of pain and other outcomes that patients consider meaningful. This will inform patient-centric clinical trial designs and guidelines.

Project title: The role of TRABID in inflammation and bone formation in ankylosing spondylitis

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500
Year 3: $17,500

Project summary:

Exploring a potential new therapeutic target in ankylosing spondylitis

Ankylosing spondylitis is a chronic and debilitating form of arthritis that involves inflammation and abnormal bone formation in the spine and other joints. Available treatments help with inflammation but do not address bone formation. Under the supervision of Dr. Nigil Haroon, Archita Srinath will study a molecule called TRABID that may be a promising new therapeutic target in this disease, blocking it in immune cells from patients and mouse models of the disease. If successful, a TRABID-blocking drug could be developed to control both bone formation and inflammation as an innovative therapy.

Project title: The role of subchondral bone in SLAC Progression following scapholunate instability: Utility of quantitative CT (QCT)

Annual commitment (plus 50/50 match):

Year 1: $17,500
Year 2: $17,500

Project summary:

Early changes in the injured wrist at risk of osteoarthritis

Ligament tears in the wrist can lead to lasting pain and disability are most common among young working males. If left untreated, they often lead to osteoarthritis. Under the supervision of Dr. Emily Lalone and Dr. David Walton, Lauren Straatman will use advanced imaging techniques to detect bone changes at the time of wrist injury and years later to help understand the underlying causes of wrist arthritis and chronic pain. This research could help inform how to prevent osteoarthritis following ligament injuries in the wrist, by detecting early changes to the joint following injury.

Project title: A pilot study examining the relationship between cognitive dysfunction and cognitive fatigue in SLE using structural and functional MRIs of the brain and focusing on the underlying mechanisms

Annual commitment (plus 50/50 match):

Year 1: $20,000

Project summary:

Differences in how the brain works for people with lupus: “Brain fog”

People with lupus, an autoimmune disease associated with arthritis, often complain of “brain fog” – a feeling of mental fatigue that can lead to problems with thinking. Their brains may have to work harder during these tasks. Under the supervision of Dr. Zahi Touma, Dr. Michelle Barraclough will use brain imaging to study how the brain works when people with lupus perform tasks that test their memory and attention, including when they are fatigued. This research will help inform future clinical trials of personalized therapies to help improve cognitive problems in people living with lupus.

Project title: Characterization of novel glyco-immune ligands as regulators of inflammatory arthritis

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary:

Cellular sugars and rheumatoid arthritis

All cells in our body are coated with different types of sugar molecules. Cells in our immune system can “taste” these sugars. Cellular sugars are notoriously complex, making it difficult to predict exactly how specific types of sugar molecules will affect our immune system in health and disease. Under the supervision of Dr. Simon Wisnovsky, Dr. John Daly will use innovative cellular genetics techniques to study how a protein involved in rheumatoid arthritis interacts with specific sugars. These insights may help guide the discovery of new drugs to help restore proper immune function in inflammatory diseases.

Project title: BLR-200, a novel peptide therapy: An improved strategy to treat scleroderma

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary:

Testing a novel therapy for scleroderma

Scleroderma is an incurable form of inflammatory arthritis with limited treatment options that can cause scar-like tissue to build up in the skin and sometimes other organs (fibrosis). A novel peptide-based therapeutic called BLR-200 has shown preliminary promise in the lab. Under the supervision of Dr. Andrew Leask, Dr. John Nguyen will study whether BLR-200 can block or reverse experimental
skin fibrosis in a mouse model and how it works. If successful, this will lay the groundwork for clinical trials of a potentially life-changing new treatment.

Project title: TRAF1 a novel therapeutic target for the treatment of psoriatic arthritis

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000

Project summary:

A new therapeutic target in psoriatic arthritis

Psoriatic arthritis is a form of inflammatory arthritis with limited treatment options. Accumulation of immune cells, such as T cells, in the joints results in pain and joint damage. A protein called TRAF1 is essential for the function of T cells in inflammation. Under the supervision of Dr. Vinod Chandran and Dr. Ali Abdul-Sater, Dr. Navita Sharma will study TRAF1 in immune cells from the blood and joint fluid of people with psoriatic arthritis as well as in mouse models of the disease to see if lowering its levels can reverse or prevent psoriatic arthritis. This may eventually lead to new TRAF1-blocking treatments.

Project title: The role of exosomes in ankylosing spondylitis pathogenesis

Annual commitment (plus 50/50 match):

Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary:

Learning more about what causes ankylosing spondylitis

Ankylosing spondylitis is a type of painful inflammatory arthritis that mainly affects the spine and often starts in young people. Its causes are not fully understood, and current treatments are limited. Under the supervision of Dr. Robert Inman, Dr. Fataneh Tavasolian is studying the role of tiny particles that carry molecular messages between cells (exosomes) in regulating immune cells in this disease. This will reveal more about what causes ankylosing spondylitis, potentially informing improved diagnosis and treatment. 

Project title: Comparing treatment effects of education and exercise and surgery: A matched observational study of Canadians with knee or hip osteoarthritis

Annual commitment (plus 50/50 match):

Year 1: $25,000
Year 2: $25,000

Project summary:

Comparing education and exercise versus surgery for Canadians with osteoarthritis

Wait times for joint replacement surgeries for osteoarthritis are a major problem across Canada. Education and exercise programs are a potential alternative approach to disease management. However, no data comparing these programs to surgery are available. Under the supervision of Dr. Anthony Perruccio and Dr. Michael Zywiel, Dr. James Young will examine data from many patients who either participated in an exercise and education program or underwent joint replacement surgery to find subgroups of patients who may benefit more from one treatment than the other. This will directly inform care decisions for Canadians with osteoarthritis.

Project title: Tumour necrosis factor inhibitors as a risk factor for serious infections in pregnant women with chronic inflammatory diseases and their offspring: a population-based cohort study

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: “Will my medication harm my pregnancy? My baby?”: Questions in inflammatory arthritis

Chronic inflammatory diseases like inflammatory arthritis (IA) predominantly affect women during their childbearing years. It’s also common for IA to flare during pregnancy, necessitating the use of biologics like TNF inhibitors (TNFi) to manage the disease. TNFi medications can increase the risk of serious infections in non-pregnant people due to their effects on the immune system, but the risks in pregnancy (and risks passed on to newborns) are unknown. Under the supervision of Dr. Évelyne Vinet, Leah Flatman will assess an extensive database of health records to answer this question. This will provide essential data to help inform best practice guidelines for counselling patients and balancing the risks and benefits of TNFi medications during pregnancy.

Project title: Understanding the mechanisms of knee pain: A population-based longitudinal study of postmenopausal women

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500

Project summary: Do hormones impact bone health and pain in women’s knees?

Knee osteoarthritis (OA) is one of the most commonly diagnosed diseases among postmenopausal women and is a leading cause of long-term pain. But how knee OA and knee pain develops in postmenopausal women remains unknown, including the potential role of hormones and abnormal bone density. Under the Supervision of Dr. Jennifer Brooks and Dr. Andy Kin On Wong, Emily Ha is exploring the relationships between estrogen levels, knee bone mineral density, and knee pain in 20,000 postmenopausal women with and without knee OA. Findings could inform tailored treatment strategies for postmenopausal women to improve and maintain knee bone and joint health.

Project title: Investigating the role of anabolic steroids on the intervertebral disc

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: The role of testosterone in treating back pain

Back pain is a common cause of disability worldwide. Though the causes of back pain are complex, it is often associated with intervertebral disc (IVD) degeneration and osteoarthritis (OA) in the spine. Despite its impact on quality of life, there are no disease-modifying treatments for IVD degeneration. Interestingly, injection of testosterone and growth hormone into the IVD may decrease back pain, but the biology behind this is unknown. Under the supervision of Dr. Cheryle Séguin and Dr. Andrew Leung, Jeffrey Hutchinson is characterizing the biological effects of these two hormones on the IVD in cell and animal lab models. This research will help to identify the role of steroids and growth hormones in IVD biology, and may determine their potential as novel therapeutics for IVD degeneration

Project title: The Stop OsteoARthitis (SOAR) proof-of-concept delayed control randomized trial: Can we mitigate a key risk factor for osteoarthritis following sport-related knee trauma?

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: SOARing above osteoarthritis after a sports-related knee injury 

There is no cure for OA. To reduce the burden of pain and life disruptions caused by OA across Canada and beyond, we need to prevent it. People who have injured their knee participating in sports have a higher risk of developing OA at a young age. Under the supervision of Dr. Jackie Whittaker, Justin Losciale will test whether a new physiotherapist-guided virtual exercise program called Stop OsteoARthritis (SOAR) can improve knee strength and reduce knee pain in adolescents and young adults following a sports-related knee injury in a clinical trial. The program encourages the development of long-term self-management skills and provides an effective way for injured people to take control of their knee health – and potentially prevent OA.

Project title: Development of a nanoplatform for ETA and BKB1 peptide antagonists dedicated to the long-term treatment of osteoarthritis.

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Using nanotechnology for a new osteoarthritis treatment

Developing effective new drugs for both pain management and joint preservation in osteoarthritis (OA) is a huge challenge. Because joint cartilage is a connective tissue that lacks blood vessels, it’s difficult to get drugs to where they need to work. Under the supervision of Dr. Florina Moldovan and Dr. V. Gaëlle Roullin, Seng Manivong is working on developing a novel drug treatment and new delivery system for the treatment of arthritic joints based on the incorporation of targeted drugs into an injectable “nanogel” that will more easily permeate cartilage. This research will use preclinical lab models to begin to test the treatment’s safety and effectiveness, positioning it for future clinical testing and development if successful.

Project title: Longitudinal study of bone and cartilage changes following acute ACL injury

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Imaging the earliest post-injury changes in the knee on the path to osteoarthritis

Currently, osteoarthritis (OA) is detected only after irreversible damage has occurred in the joint. The causes of OA are not well understood, but prior studies have shown that people who injure the anterior cruciate ligament (ACL) in the knee are more likely to develop knee OA. Under the supervision of Dr. Steven Boyd, Nathan Neeteson will study young, otherwise healthy men and women who have recently injured their ACL, using state-of-the-art medical imaging technologies to assess how the bone and cartilage in an injured knee evolve in the first three years following injury. This research will help determine how an ACL injury changes the bone and cartilage of the knee over time and how to detect these changes early. This could ultimately help researchers and doctors identify targeted treatment and prevention options for post-injury knee OA.

Project title: Total Joint Arthroplasty: tools for evidence-informed decision-making to improve appropriateness

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500

Project summary: Focusing on the patient when deciding on joint replacement surgery

Most hip and knee replacements are performed to manage osteoarthritis. Almost half of adults having a hip or knee replacement may not actually be suitable candidates, and up to 30% are not satisfied after surgery. Healthcare professionals often assess suitability, but little is known about how they can best support their patients’ role in decision-making to manage expectations and improve satisfaction. Under the supervision of Dr. Dawn Stacey and Dr. Stéphane Poitras, Lissa Pacheco-Brousseau is exploring what impacts the use of a patient-centred approach that focuses on patient priorities and informed preferences when assessing if adults are suitable for joint replacement. The success of such an approach could help healthcare professionals direct patients to appropriate resources, meaningfully involve patients in the decision-making process, and ultimately decrease surgery waiting lists.

Project title: Utilizing single nuclei RNA sequencing to identify distinct cell subsets and mechanisms in the synovium of early and late stage radiographic knee osteoarthritis

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Unravelling the cellular complexity of osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, causing pain and reducing quality of life. However, treatments are lacking due to the complexity of the disease and our incomplete understanding of how it develops. Many tissues contribute to OA, including the synovium (the tissue that surrounds the joint). Under the supervision of Dr. Mohit Kapoor, Kabriya Thavaratnam is using a state-of-the-art technology called single nuclei RNA sequencing (snRNAseq) to investigate unique clusters of cells in synovium samples from people with early and late stage knee OA. Lab models will be used to study how the cells drive OA progression. This is one of the first studies looking at unique, rare cell populations in the synovium by snRNAseq and has the potential to inform the development of new targeted therapies to alter the course of this complex disease.

Project title: Assessing equity considerations in the care of patients with inflammatory arthritis (ACCESS)

Annual Commitments (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Differences in health for patients with inflammatory arthritis: Are they preventable?

People with inflammatory arthritis (IA) are often required to get lifelong treatment and access care regularly. We know these people can have different health outcomes, and that many of these differences are preventable. To solve this issue, we need to understand what risk factors exist for IA patients when accessing care. Under the supervision of Dr. Mary De Vera and Dr. Mark Harrison, Megan Thomas is examining health records for patients with IA in British Columbia to identify links between access to care and patient factors (e.g., income, sex, age, location, immigrant status). By understanding the risk factors for challenges accessing IA care, the researchers hope to inform strategies to improve this access and ultimately improve patient outcomes.

Project title: Team-based primary care for the management of chronic low back pain

Annual Commitments (plus 50/50 match):
Year 1: $9,500

Project summary: Teaming up to manage chronic low back pain

Chronic low back pain (low back pain that lasts more than three months) is common in people with arthritis, particularly those living with ankylosing spondylitis, psoriatic arthritis, and sometimes osteoarthritis. It contributes to disability, decreased quality of life, and emotional distress. Under the supervision of Dr. Jordan Miller, Kyle Vader is exploring the experiences of people with chronic lower back pain and healthcare providers with a team-based approach to primary care led by a physiotherapist. This research will inform future work to improve how primary care is delivered for people with arthritis and the management of chronic low back pain.

Project title: From stem cells to to mature immune cells: Passing on defects in rheumatoid arthritis

Annual Commitments (plus 50/50 match):
Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary: Early immune stem cells carry and transfer defects as they develop into mature immune cells that cause rheumatoid arthritis 

Rheumatoid arthritis (RA) is an autoimmune disease where the body's tissues are mistakenly attacked by their own immune cells. RA causes chronic inflammation in the joints and can damage other organs to diminish people’s quality of life and shorten their lifespan. Even with anti-inflammatory treatments, some people with RA do not improve. Understanding how inflammation works in RA is therefore essential to develop new therapeutic approaches. Under the supervision of Dr. David Langlais, Dr. Mathieu Mancini is studying how genetic and molecular defects might be passed on to immune cells as they develop from stem cells, and how these precursor cells are rewired and dysfunctional in people with RA. Identifying and understanding these defects could explain how defective immune cells trigger chronic inflammation in RA and how we might be able to stop it therapeutically.

Project title: Early joint degeneration: A mechanistic model of the interaction between knee morphology,
physiology and load

Annual Commitments (plus 50/50 match):
Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary: Evaluating risk of early osteoarthritis

Knee osteoarthritis (OA) is the most common form of arthritis and is related to increasing pain and disability. Although many treatments (such as surgery) address these problems, they are most often implemented only after the disease has created irreversible joint damage. There is little understanding about early OA and how to prevent disease worsening. Under the supervision of Dr. Monica Maly, Dr. Kendal Marriott is developing a new approach to identifying early OA by exploring the experiences of people with emerging knee pain, early changes in knee bone shape, knee movements during walking, inflammation, and other factors, to create a comprehensive early OA risk profile. This risk profile could help clinicians identify people at risk of knee OA who could benefit from early implementation of treatment to prevent or slow disease onset and progression.

Project title: Improving our understanding of pain mechanisms in people with knee osteoarthritis

Annual commitment:
Year 1: $124,989
Year 2: $124,950
Year 3: $125,000

Project summary: What causes pain to worsen for people with knee osteoarthritis?

One of the most common and disabling health issues is the pain and limitations caused by osteoarthritis (OA). The knee is a joint that is commonly affected by OA. Identifying the various causes of OA pain is a significant challenge. Dr. Lisa Carlesso will use existing databases of people with knee OA to compare and confirm what causes the pain and identify which patients will get worse. Dr. Carlesso will also study a yoga-based program to determine whether it is better than traditional exercise and education for relieving pain. The results of these studies have the potential to improve pain management and quality of life for people with knee OA.

Project title:  Elucidating the role of tryptase proteolytic processing of lubricin in osteoarthritis 

Annual commitment: 
Year 1: $125,000 
Year 2: $125,000 
Year 3: $125,000 

Project summary: Comprehensive solutions to address complex problems: Increasing joint lubrication and patient comfort by reducing cartilage degeneration in osteoarthritis 

It is estimated that up to 5 million Canadians may have osteoarthritis (OA). There is no cure for OA, highlighting an urgent need to better understand the disease and develop new treatments. Current approaches to treat OA focus on a trial-and-error approach, leading to delays in pain control, acceleration of joint and cartilage damage, and disability. Although the development of OA can be associated with previous joint injury, the causes of OA are complex. Dr. Antoine Dufour will investigate how the activation of certain substances that cause persistent pain and swelling can also promote loss of joint lubrication and cartilage destruction. He will explore a new way to increase joint lubrication by decreasing cartilage destruction for people with OA. 

Project title: A complex transition: Examining the impact of rheumatic disease on the multifaceted experience of entering adulthood

Annual commitment:
Year 1: $124,910
Year 2: $123,247
Year 3: $124,982

Project summary: Exploring health, social and career challenges for young adults with rheumatic disease

Entering adulthood can be challenging for young people, and their experiences during this phase can shape their future. But what about young people entering adulthood with a rheumatic disease? How does having a chronic disease affect access to healthcare, the ability to graduate from school and enter the workforce, move away from home, and socialize? Dr. Arif Jetha will answer these questions through a review of current research, focus groups, and a survey of young people with and without rheumatic disease. Findings will highlight the unique challenges confronting young people with rheumatic disease and create opportunities for tailored strategies that promote health, quality of life and employment.

Project title: Joints and sex – Re-envisioning osteoarthritis

Annual commitment:
Year 1: $124,998
Year 2: $124,999
Year 3: $125,000

Project summary: Rethinking how we view osteoarthritis - multiple joints and sex

Osteoarthritis (OA) is a major cause of pain and disability and effective treatment remains a big challenge. Even though many people with OA have multiple joints affected, most research and care focuses only on specific joints. As well, males and females with OA pain are treated similarly. Dr. Anthony Perruccio’s work shows that specific inflammatory markers in the blood relate to the number of joints involved in the disease – however in one way for females and another way for males. This has important implications as the treatment of OA pain may need to be tailored by sex, and whether single or multiple joints are affected. In this study, Dr. Perruccio will investigate whether the patterns of inflammatory markers in joints is important, and if there are important sex differences that could lead to improvements in how OA pain is treated.

Project title:  Adapting REhabilitation Delivery for Maximum Impact at Home (ReDI@Home) 

Annual commitment: 
Year 1: $100,000 
Year 2: $140,000 
Year 3: $120,000 

Project summary: ReDI@Home - Taking care of your arthritis at home 

People who live in rural areas and have hip or knee pain can find it challenging to access rehabilitation services in their community. Living with joint pain can lead to difficulty performing activities of daily living and being physically active which in turn can reduce enjoyment of life or cause other health conditions. Dr. Lauren Beaupre will use new smart phone technology that allows physiotherapists in urban centres to treat rural residents in their own homes. Over eight weeks, therapists will meet virtually with patients and see how well they move. They will give patients exercises to do at home each week and watch to make sure they do them correctly. Patients can also talk to the therapists to discuss pain management and how to remain active. If this new technology is successful, other patients who may not be able to access appropriate healthcare in their community will receive effective virtual care at home. 

Project title:  Understanding the role of Lipocalin Prostaglandin D Synthase in osteoarthritis 

Annual commitment: 
Year 1: $100,000 
Year 2: $140,000 
Year 3: $120,000 

Project summary: L-PGDS: A new therapeutic target in osteoarthritis 

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability in Canada. It has a significant impact on quality of life and places a tremendous burden on the healthcare system. Since there is no cure for OA, there is a need to better understand how it progresses to develop more effective treatments. Dr. Hassan Fahmi will study the molecular mechanisms underlying the development of OA. Previous studies suggest that an enzyme, lipocalin-type prostaglandin D synthase (L-PGDS), may have protective properties against OA. Dr. Fahmi will study L-PGDS and its role in OA which may lead to better treatments and quality of life for people with OA. 

Project title: Targeted knee osteoarthritis care for adults with severe obesity: The Prevention Of MusclE Loss in Osteoarthritis (P.O.M.E.L.O.) feasibility and pilot randomized trial

Annual commitment:
Year 1: $100,000
Year 2: $140,000
Year 3: $120,000

Project summary: Developing personalized care for advanced knee arthritis in adults with obesity

The best way to treat advanced knee osteoarthritis (OA) in Canadians with obesity is unknown. These patients are less likely to be referred for surgical arthritis treatment due to a higher risk of infection after surgery. They are often told to lose weight even though it is uncertain if weight loss is beneficial for advanced arthritis. Further, weight loss could increase the risk for muscle loss and development of sarcopenic obesity (a condition of low muscle and low strength that negatively impacts mobility and quality of life). There may be better approaches to manage advanced knee OA for these patients. Dr. Carla Prado will determine if a program tailored to meet the needs of Canadians with obesity and knee OA is feasible to patients and improves their muscle mass and physical function. This work will support the future development of more effective non-surgical treatment approaches for this underserved patient group.

Project title: Senolytic drugs to treat back pain from spine OA

Annual commitment:
Year 1: $100,000
Year 2: $140,000
Year 3: $120,000

Project summary: Disease modifying drugs for spine osteoarthritis

World-wide, low back pain due to osteoarthritis (OA) of the spine is the single largest cause of years lived with disability. Current treatments like physiotherapy or medication may reduce pain and slow degeneration of the intervertebral discs in the spine but do not stop the progression of the disease. Senolytic therapy destroys senescent (or arrested) cells that cause inflammation in old tissues, leading to rejuvenation and slower progression of many age-related conditions. Dr. Lisbet Haglund will study two promising senolytic therapies, a natural compound, o-Vanillin, and an approved drug, RG-7112. This study may lead to the first disease modifying drugs for low back pain resulting from OA of the spine.

Project title: Rheumatoid arthritis in Canadian primary care settings: epidemiology, management of care and patient experience

Annual commitment:
Year 1: $99,974
Year 2: $139,938
Year 3: $119,740

Project summary: Rheumatoid arthritis in Canadian primary care settings

Family physicians play a key role in the management of rheumatoid arthritis (RA). They are often the patient’s first contact with the healthcare system. The management of RA across many provinces is not known. Using data from a Canadian national surveillance network that collects information from family physicians in the community, Dr. Allyson Jones will look at the number of people who are seen by family physicians for RA and the type of treatment they receive, both before they are diagnosed with RA and afterward. Dr. Jones will interview people with RA to understand their perspectives on managing RA and navigating the healthcare system. She will also interview family physicians and rheumatologists to learn about their experiences of diagnosing and supporting patients with RA The short-term impact will be a national description of healthcare provided by physicians. The long-term impact will identify any gaps in primary care and provide direction to address these gaps.

Project title: The effectiveness of medial pivot knee arthroplasty implants at improving gait and clinical outcomes in patients with knee osteoarthritis: A randomized controlled trial

Annual commitment:
Year 1: $98,723
Year 2: $135,248
Year 3: $120,000

Project summary: How different knee replacement designs influence knee movement during walking

Over 67,000 knee replacements are performed annually in Canada for knee arthritis and 20% of patients remain unsatisfied after surgery. New implants have been designed, called medial pivot implants, which claim to more closely mimic normal knee movements. There has been limited testing of these implants, so their effectiveness and safety are not clear. Dr. Shawn Robbins will compare knee movement before and after surgery for walking and stair climbing, pain, and physical function between patients who had medial pivot or traditional knee replacement implants. A better understanding of the most effective knee implants will help to maximize patient outcomes, minimize negative side effects, and decrease demands on the healthcare system.

Project title: PERSON-JIA: The Personalized Estimates of Response and Severity Outcomes in newly-diagnosed Juvenile Idiopathic Arthritis trial

Annual commitment:
Year 1: $100,000
Year 2: $129,932
Year 3: $112,680

Project summary: A truly personalized approach to treatment decisions for children with arthritis

When arthritis strikes a child, families face tough questions. Will their child suffer? Will they outgrow arthritis? Will they respond to treatment? Will there be side effects? The answers to these questions are crucial to choosing the best treatment for their child. Using information provided by thousands of families, Dr. Lori Tucker has developed a way of providing answers to these questions that are specific for the child and accessible on the doctor’s smartphone. The answers are generated automatically based on the child’s circumstances using “personalized prediction algorithms” and presented in an app. In this study, Dr. Tucker will test whether doctors who use the app to guide discussions with family on treatment choices for childhood arthritis, see better treatment response than doctors who do not. This work may result in better disease control, greater family engagement and satisfaction with care, and better-tailored treatment.

Project title:  Modeling cognitive impairment in patients with systemic lupus erythematosus: Clinical phenotyping, predictive trajectory, and associated risk factors 

Annual commitment: 
Year 1: $100,000 
Year 2: $139,932 
Year 3: $119,987 

Project summary: Modeling differences in cognitive impairment in lupus  

Up to 33-43 per cent of people with systemic lupus erythematosus (SLE) experience cognitive impairment (CI). CI includes a decline in memory, thinking speed, attention, and planning, and reduces quality of life. There is a need to identify clinical subtypes of CI in SLE and in those patients at high risk of developing impairment. Dr. Zahi Touma will determine subtypes of CI by using new data analysis techniques. Identifying patients with a high-risk of CI and those who are likely to have severe impairment over time will enhance the management of the disease and slow its progression.  

Project title: Identifying epidemiological, metabolomic, and genetic factors associated with non-responders to total joint replacement surgery in primary osteoarthritis patients

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Identifying factors to predict total joint replacement surgery success

Osteoarthritis (OA) is the most common type of arthritis, affecting more Canadians than all other forms of arthritis combined. Total joint replacement (TJR) is considered the most effective treatment for end-stage OA. However, as many as one third of patients see little to no improvement in pain and/or function after surgery. Identifying factors to predict which patients will have minimal response is imperative to save both patients and the healthcare system the stress of unsuccessful surgery. Under the supervision of Drs. Guangju Zhai and Edward Randell, Christie Costello will work to determine factors that are associated with non-responders to TJR from patient history, blood plasma biomarkers, genetic information, and markers of OA inflammation. The results of the study will raise awareness of who is a non-responder to TJR and offer insights to improve outcomes for both the surgery and quality of life of OA and TJR patients.

Project title: Investigation of the impact of secreted phospholipase A2-IIA on the intestinal microbiota during arthritis

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Bacteria in the intestine affect the development of rheumatoid arthritis

Every human shares its body with trillions of bacteria. While microbes in the intestines, which include bacteria, are widely known for their role in the digestive process, they also have a role in the regulation of the immune system. Alterations in the normal population of intestinal microbes have been observed in patients with autoimmune diseases, including rheumatoid arthritis (RA). Under the supervision of Dr. Eric Boilard, Etienne Doré is working to identify why these alterations occur and their contribution to the development of RA. A better understanding of the roles played by intestinal bacteria in this disease could help explain how arthritis develops and lead to the discovery of new therapeutic targets for the treatment of patients suffering from RA.

Project title: Investigating the role of CD22 in germinal centre B cell responses and autoimmune arthritis

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500

Project summary: Understanding the role of the CD22 protein in autoimmune arthritis development

It is estimated that over 1 million Canadians have inflammatory arthritis (IA). Most forms of IA are also autoimmune diseases, where the immune system – the body’s defense system against infections and other invaders – mistakenly starts to attack the body’s own healthy tissues. Unfortunately, there is no cure for this type of arthritis and medications for symptoms are not always effective. Understanding how IA develops is crucial for developing better therapies. Jhon Enterina, under the supervision of Dr. Matthew Macauley, is focusing on how specialized type of cells called germinal centre (GC) B-cells are formed. In patients with IA, GC B-cells are present in inflamed joints, producing molecules, called autoantibodies, that attack cells in the joints. The researchers have found that a protein called CD22 is required for antibody production and deleting it on B-cells delays arthritis development in mice. Jhon Enterina’s research aims to create new insights in GC B-cell biology and identify new targets for the treatment of IA.

Project title: The role of FcyRIIA in neuropsychiatric lupus erythematosus

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: From head to toe, the hidden side of how systemic lupus erythematosus affects the brain

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which the body’s immune system attacks and causes inflammation in its own tissues. People with SLE more frequently experience depression and anxiety, which can be due not only to chronic pain and psychological distress, but to the inflammation itself. Studies have shown that >90% of lupus patients have mood disorders, cognitive impairment (e.g. memory loss), migraines, and even psychosis. Under the supervision of Dr. Eric Boilard, Audrée Laroche will use a new mouse model and state-of-the-art microscopes to visualize cells in the brains of living mice who have lupus. They will also look at fluid from the brains of people with SLE to determine whether they contain molecules capable of causing inflammation. This research will lead to a better understanding of how neurologic and psychiatric symptoms develop in SLE, and how rheumatic disease affect the brain more broadly.

Project title: Monitoring and improving physical activity participation in pediatric rheumatic disease 

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500
Year 3: $10,500

Project summary: Staying active with childhood arthritis

Children with arthritis are often less physically active than their healthy peers due to decreased physical functioning, fatigue, and pain. This perpetuates a cycle of deconditioning, limiting participation in activities. Under the supervision of Dr. Brian Feldman, Yvonne Lee will investigate ways to help children break out of this cycle. She plans to research methods to improve physical activity tolerance and regular activity through oral supplements, use of activity trackers, and physical activity counseling. If proven to be effective, these tools may become standard practices for managing childhood arthritis.

Project title: Evaluating senolytics as a treatment option in SPARC-null mice

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500

Project summary: Assessing potential new treatments for lower back pain

Intervertebral disc degeneration, the breakdown of the discs that separate the vertebrae or bones of the spine, is a major cause of back pain, and up to 85% of working people experience low backpain during their lifetime. Current treatments alleviate symptoms but not the progression of the disease, there is a great need for novel disease modifying drugs. Recently, Dr. Lisbet Haglund and her team demonstrated the beneficial effects of two types of senolytic therapies: natural compounds, curcumin and o-Vanillin, and an approved drug, RG-7112, to reduce disc degeneration and back pain. Senolytic therapy destroys senescent cells that create inflammation in old tissues, leading to rejuvenation and slower progression of many age-related conditions. Under the supervision of Dr. Haglund, Matthew Mannarino, is studying two of these senolytic therapies, RG-7112 and o-Vanillin. This project aims to develop new treatments to prevent disc degeneration and decrease back pain.

Project title: Investigating the serological changes that accompany the onset of symptoms in anti-nuclear antibody associated systemic autoimmune rheumatic diseases

Annual commitment (plus 50/50 match):
Year 1: $10,500
Year 2: $10,500

Project summary: Looking for blood changes to predict development of lupus and other systemic autoimmune rheumatic diseases

Systemic autoimmune rheumatic diseases (SARD), like lupus, are serious diseases that affect not only the joints but also many other organs, such as the kidneys, skin, and brain. Many people with these conditions already have permanent organ damage when they are diagnosed and unfortunately, there is no cure. Antinuclear antibodies (ANA) are proteins produced by the immune system that are a hallmark of SARD patients but are also found in healthy people who will never develop SARD. Currently, there is no test that differentiates healthy people with ANA from those who will become sick. Under the supervision of Dr. Joan Wither, Carolina Munoz-Grajales is searching for differences in ANA between people with and without symptoms, and for the alterations in the immune system that ultimately cause SARD. Discovering a blood test that helps to identify patients who are at high risk of developing SARD could lead to earlier treatment before organ damage occurs. 

Project title: Targeting PRohibitins for Early DetectIon and Cure of osteoarthiTis: "The PREDICT Study"

Annual commitment (plus 50/50 match):
Year1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary: New path to PREDICT osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, affecting nearly five million Canadians (one in six), which is more than all other forms of arthritis combined. OA is a progressive disease of the joints that leads to breakdown of joint cartilage and the underlying bone. The diagnosis is made based on symptoms and physical examination. Currently, it is not possible to determine which patients have a greater risk of rapid progression of OA, but a better understanding of the role of biomarkers may close the gap between diagnosis and reaching an untreatable stage. Under the supervision of Dr. Alain Moreau, Dr. Abdellatif Abouelseoud will work to develop a test to assess the risk of early OA progression by identifying biomarkers in the plasma of joint blood proteins and measuring changes in their levels. Development of such a test may lead to better management of symptoms and less disability for people with OA.  

Project title: Cognitive dysfunction and cognitive fatigue in SLE: A pilot study examining the underlying mechanisms with structural and functional MRIs of the brain

Annual commitment (plus 50/50 match):
Year 1: $20,000

Project summary: Brain fog in systemic lupus erythematosus may be the result of an overworking brain

People with systemic lupus erythematosus (SLE) commonly struggle with “brain fog”, a feeling of mental fatigue that can lead to problems with cognitive functions like memory and attention. The brains of those with SLE must work harder during cognitive tasks, in part leading to fatigue and memory issues. These challenges significantly affect quality of life and to date there are few treatment options available. Under the supervision of Dr Zahi Touma, Dr. Michelle Barraclough will use functional Magnetic Resonance Imaging (fMRI), a brain imaging tool, to collect more information about how the brain works when people with SLE do tasks that test their memory and attention and how fatigued they get during these tasks. Information from this study will help to develop personalised clinical trials to improve cognitive problems in people with SLE. 

Project title: Role of platelets in the recruitment of neutrophils in inflamed joints in rheumatoid arthritis

Annual commitment (plus 50/50 match):
Year 1: $20,000
Year 2: $20,000
Year 3: $20,000

Project summary: Role of platelets in the recruitment of white blood cells in joints in rheumatoid arthritis

Platelets are blood cells that help the body form clots to stop bleeding. Dr. Eric Boilard’s research has previously shown that platelets are also involved in arthritis. The team found that white blood cells, called neutrophils, can increase pain by leaving blood vessels and invading the joints. Platelets may reduce pain by limiting neutrophil recruitment to the joints. Under the supervision of Dr. Boilard, Dr. Marie Bellio will analyze interactions between platelets and neutrophils and then block these interactions to quantify pain in mice. This study may identify how to change the interactions between neutrophils and platelets to reduce pain, leading to the development of a new therapy for pain management in rheumatoid arthritis.

Project title: Intra-articular therapies for knee osteoarthritis: network meta-analysis and bayesian design for a randomized controlled trial

Annual commitment (plus 50/50 match):
Year 1: $25,000
Year 2: $25,000

Project summary: Comparing intra-articular therapies for knee osteoarthritis

Effective pain relief and maintenance of physical function are the primary objectives of medical treatment for osteoarthritis (OA). However, existing treatments can fall short of meeting these objectives or have safety issues. To address this, and under the supervision of Dr. Peter Juni and Dr. Bruno da Costa, Pavlos Bobos will combine evidence from well-designed studies available in the scientific literature using network meta-analysis (NMA). This work will help to determine which intra-articular therapies in knee OA appear to have the greatest impact in a single analysis. The research team will then use data from the NMA to design a new trial to determine the true effectiveness and safety of intra-articular therapies for knee OA. Identifying the therapies that are most effective will help to personalize treatment for people with knee OA. 

Project title: Epigenomic predictors of psoriatic arthritis in patients with psoriasis

Annual commitment (plus 50/50 match):
Year 1: $20,000
Year 2: $20,000

Project summary: Predictors of psoriatic arthritis

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that often appears in people with a skin disease called psoriasis. Early diagnosis and treatment are important to reduce joint damage, however, many individuals with PsA remain undiagnosed because currently there is not a test to predict which people with psoriasis will develop PsA and which will not. Under the supervision of Dr. Dafna Gladman, Dr. Omar Cruz Correa will study how epigenetics, mechanisms that switch genes on and off, influence PsA risk and progression. The differences in these mechanisms may be used to predict which patients will develop PsA. This would allow patients at higher risk to be monitored more closely, and therapy to be personalized, preventing further joint damage and disability.

Project title: The impact of antimalarial drugs in arthritis patients exposed to SARS-CoV-2 – the CoVIRAL project

Annual commitment:
Year 1: $100,000
Year 2: $100,000
Year 3: $100,000

Project summary: What is the impact of antimalarial drugs in people with arthritis exposed to COVID-19?

People with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have a compromised immune system but it is not known if they are at increased risk of COVID-19. Dr. Paul Fortin is studying people with RA and SLE to determine if those who are taking the antimalarial drugs, chloroquine or hydroxychloroquine, for their arthritis symptoms, are affected differently by COVID-19 than those who are not taking the drugs. The study will also examine the psychosocial impact of a serious infection in people with arthritis. The current COVID-19 pandemic offers a unique opportunity to enhance the understanding of how people with autoimmune inflammatory diseases like RA and SLE respond to infection.