Sinai Health

Changing care for rheumatoid arthritis When Rebecca MacDonald was diagnosed with rheumatold arthritis (RA) in 1998, she told her rheumatologist at Mount Sinai Hospital, Dr. Edward Keystone, that she would beat the disease. True to her word, she went into complete remission, regaining her mobility and staying drug- and pain-free since 2001. While achieving remission from RA is quite rare, Rebecca vowed to do everything she could to help others with RA achieve the best possible outcomes. As a result of her vision and commitment, the Rebecca MacDonald Centre for Arthritis and Autoimmune Disease at Mount Sinai Hospital was born. With approximately 14,000 patient visits every year, the Centre has been leading with way in the development of groundbreaking treatments and a personalized approach to the disease. A personalized approach Clinician-researchers like Dr. Kathy Siminovitch, Sherman Family Chair in Genomic Medicine, will be using personalized medicine strategies to tailor treatment to each individual RA patient. Together with her colleagues, Dr. Siminovitch is creating and analyzing large databases of patients' genetic and clinical information to identify genes that increase risk and influence the outcomes of RA. Patients' risk factors for the disease can then be identified based on their unique genetic makeup, allowing for customized treatment. Early detection Preventing RA is getting closer to reality with the opening of the pre-rheumatoid arthritis clinic, under the leadership of Dr. Edward Keystone, Director of the Rebecca MacDonald Centre. Using a simple blood test, the clinic will test patients to determine their risk for developing RA. High-risk patients could be eligible for a treatment that may prevent this debilitating disease before it starts. Treatment and research optimization Dr. Claire Bombardier is leading the Ontario Best Practice Research Initiative, which includes a user-friendly database where patients input their own therapeutic information. This serves many important purposes: it allows physicians to track a patient's course of care, disease severity and drug responsiveness; it helps patients take an active role in their own care and receive treatment tailored specifically to their needs; and, it allows scientists to use the data for important epidemiological research. Timely Intervention The period of time between symptom onset and therapeutic intervention is critical in RA. If a patient can be quickly diagnosed and treated, they have a much greater chance of avoiding the rapid joint destruction and disability that can be associated with the disease. The Early Arthritis Program, under the direction of Dr. Vivian Bykerk at the Rebecca MacDonald Centre, allows patients who are at risk of developing RA to receive treatment in a timely fashion. This kind of multi-disciplinary, integrated approach to autoimmune diseases like RA is unique in Canada and eventually will help us target the right drugs to the right people at the right time. I'm confident that our collaboration will have a major impact on the future health care of Canadians and people worldwide. None of this would have been possible without Rebecca's vision and generosity. — D r . Ed w a r d K e y st o n e 4 t h e b e st m e d i c i n e m att e r s

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