Joint work on joint pain
Dr. Robin Poole Investigates Pain Due to Arthritis
Although arthritis is a term usually associated with old age, the condition can affect all age groups. Stemming from the Greek, the word means 'joint inflammation.' When it flares up, everyday activities such as gardening, writing or climbing the stairs are difficult to endure for the arthritis sufferer.
Arthritis comes in various forms, but the most common types are osteoarthritis and rheumatoid arthritis. In osteoarthritis, the protective lining covering the articulating ends of bones in the joints, is called articular cartilage. It starts to wear away, allowing bone to rub against bone. This can causes pain as well as stiffness of the joints. Rheumatoid arthritis is an autoimmune disorder in which the body's immune system short-circuits and begins to attack the joints, causing swelling and serious discomfort again destroying the articular cartilage.
Dr. Robin Poole, director of the Joint Diseases Laboratory at the Montreal Shriners Hospital for Children and professor in the UU直播 department of surgery, researches arthritis in both children and adults. He is identifying new targets for arthritis drugs and developing technology to detect and monitor joint damage in patients and its treatment.
One particular feature of arthritis Dr. Poole has been looking at is the production of arthritis biomarkers. These are chemicals that can be detected in a patient's blood and reflect the breakdown products of deteriorating cartilage during joint destruction. These markers allow doctors to predict whether or not a patient is likely to develop some form of arthritis and can also measure the rate at which the disease is progressing.
"The biomarkers could totally replace the requirement down the road for traditional clinical trials," notes Dr. Poole, since the markers help doctors track the disease's course as well as the success of the drug therapy being tested. A traditional trial in osteoarthritis may take up to 3 years and cost $100 million US. A biomarker trial may take only a couple of months as the predictive value of the biomarker reflects outcome after a much shorter treatment period. Using these biomarkers to identify drug targets has also prompted Dr. Poole to collaborate with pharmaceutical companies in order to "take the knowledge from the bench to the bedside and develop it for the patient."
As the current scientific Director of the Canadian Arthritis Network (CAN), a National Network of Centres of Excellence comprised of over 130 arthritis researchers, Dr. Poole has managed to create a strong partnership among researchers, government and industry. He is a member of the advisory board of the Institute of Musculoskeletal Health and Arthritis (IMHA), a division of the Canadian Institutes of Health Research.
A recent conference on osteoarthritis which Dr. Poole helped to organize as Organizing Committee Chair brought together investigators, patients, trainees, allied health professionals and doctors to discuss arthritis research and explore treatment options. "Normally there's very little integration of effort. So we're trying to break the barriers down and do something different," says Dr. Poole of his efforts to create a forum for discussion and exchange. With the Arthritis Society and IMHA and CAN, Dr. Poole is working to create a National Arthritis Program in Canada which will be a world first in this field.
Dr. Poole collaborates with pain researchers such as former UU直播 Physiology and Psychiatry professor Jim Henry to study the importance of pain in joint damage. They have recently discovered that nerves servicing the joints damaged during arthritis can be separated into two categories: those that trigger signals associated with joint damage and those that send signals to reduce such damage. "We now know that the nerves are not just sensing pain, but are actually controlling processes in the joint that either promote degradation or suppress it."
As for available treatments available, some rheumatoid arthritis (RA) drugs not only help with the pain caused by inflammation, but can also push the disease into remission. Unfortunately, current treatments for osteoarthritis, while helpful in diminishing pain, do nothing to slow the disease. And because most of these drugs are so expensive, Dr. Poole notes: "There's a tremendous problem getting drugs to people, because the governments won't pay." Some of the drugs being used to control RA are looking very effective at controlling cartilage damage in OA. So there is much hope for the future treatment of OA.
Dr. Poole also points to positive advances such as his new diagnostic techniques which have allowed doctors to predict the progression of the disease. "To be able to take blood samples from a patient and be able to know what's going to happen to them 18 months down the road is amazing." And with such advances, as well as increased collaboration among governments, researchers, doctors, and patients, many more promising findings are on the horizon.
This is the seventh in a series of interviews with UU直播 pain researchers whose investigations are funded by the Canadian Institutes of Health Research. The project, carried out in cooperation with The UU直播 Office for Chemistry and Society, aims to highlight recent advances in the study of pain. Permission is granted to reprint in whole or in part.
