If they are treated early and assertively, arthritis sufferers today have a much greater chance of controlling the disease than what doctors ever thought possible, according to Mount Sinai Hospital's Dr. Edward Keystone, an internationally recognized rheumatologist. He should know, he has seen it happen. Ten years ago, when a patient with rheumatoid arthritis told him that she was going to "be cured," his skeptical response was, "If you do, I will be the first to publish your case."

Drs. Keystone and BombardierToday, Rebecca MacDonald, has totally regained her mobility and has been drug and pain free since 2001. Many patients regain quality of life with therapy but Ms. MacDonald is one of the very few patients in the world known to have gone into complete remission from severe rheumatoid arthritis. Her story offers hope to the approximately four million Canadians with arthritis.

Ms. MacDonald is bringing more than her inspiring story to other arthritis sufferers. Her generous gift established the The Rebecca MacDonald Centre for Arthritis and Autoimmune Disease at Mount Sinai Hospital.

The comprehensive Centre integrates clinical patient care with innovative, genetics-based research for rheumatic and autoimmune diseases. Located on the second floor of the Joseph and Wolf Lebovic Centre, it provides a variety of specialized clinics serving more than 15,000 patients annually. Patients receive treatment for any of the 115 forms of arthritis, including the most serious, potentially life-threatening forms of rheumatic and autoimmune diseases. The Centre has established programs specializing in the care of early arthritis biologies, scleroderma, and vasculitis to the benefit of patients in Toronto and across Canada.

Clinical Trials

The Centre is also home to one of the largest clinical trial centres in the world - a place where experimental therapies are tested - and is a mecca for post-graduate education. Many of these trials test innovative therapies for the first time in Canada, giving patients more options.

"Through these clinical trials, we are able to gain substantial insight into the disease process. We can study exactly how these new targeted therapies act on the body, which in turn heads us in the right direction to develop even more precisely targeted therapies. The Division of Advanced Therapeutics helps bring the most up-to-date treatments for patients, regardless of the severity of their arthritis," says Dr. Keystone. "It provides tremendous hope for better quality of life for patients. Considering the enormous progress of experimental therapy, this is one of the most exciting periods ever in the history of arthritis care."

In the same environment, the Centre brings together, for the first time at Mount Sinai Hospital, world-class expertise in genetics, epidemiology and clinical trials. Under the leadership of Dr. Katherine Siminovitch, a highly acclaimed genetics expert, the Centre's genetics researchers will expand their analysis of genetic information from thousands of rhematoid arthritis patients and their family members to identify the genetic factors that cause this condition.

In collaboration with Dr. Keystone and Dr. Claire Bombardier, Dr. Eleanor Fish, Head of Cellular Biology at the University Health Network, will establish genetic and proteomic (protein) profiles of each patient. These profiles will help doctors predict which patients will respond to which therapies and which patients are likely to develop side effects to medication. This will ultimately lead to 'personalized medicine' where medication is individually tailored to the genetic and protein makeup of the individual.

Patient Course of Care Database

In addition to these genetics studies, world-class epidemiologist and rheumatologist Dr. Bombardier is leading scientists in overseeing a user-friendly database in which the patients input their own therapeutic information. The database graphs and tracks patients' course of care, disease severity, functional limitations and drug responsiveness over time. It also tracks the progress of patients using experimental therapies.

Patients benefit because their doctors are able to use the databased information to pinpoint the right therapeutic treatment tailored specifically for them. Scientists also use the information gathered for important epidemiological research. One of the first projects is the Early Arthritis Program — a major first-time project that studies arthritis from the crucial point of diagnosis.

"We are taking a leadership role in developing a patient and physician-driven data collection system that is free of any bias," explains Dr. Bombardier. "We are using this common data set to determine how individuals and groups of patients fair in 'real life' as opposed to the artificial setting of a randomized trial. We are creating linkages with work under way on genetic predisposition and are identifyinig candidates for new trials."

"By integrating three diverse fields - genetics, therapeutics and outcomes research - we will create synergies and build upon each other's strengths," comments Dr. Siminovitch. "This kind of multi-disciplinary, integrated approach to looking at autoimmune diseases is unique in Canada and eventually it will help us to target the right drugs to the right people more quickly. I'm confident that our collaborations will have a major impact on the future health care of Canadians and people worldwide," asserts Dr. Keystone. "None of this would have been possible without Rebecca's vision and generosity."