Lupus Ontario

Lupus Research - See Lupus Clinics in Ontario Listing

In Hamilton, Ontario Canada

HAMILTON HEALTH SCIENCES, MCMASTER DIVISION
1200 Main St W., McMaster University, Room 3V46
Hamilton, Ontario, L8N 3Z5
Ph: 905-521-2100 ext 76714 Fax: 905-521-4971

Clinic Facts
Originated in 1975
Location: 3V2 Clinic at McMaster Division of the Hamilton Health Sciences Corporation
Clinic time: Mondays & Thursdays, 9 :00 a.m.- 12 :00 p.m.
Clinic Reception Phone: (905) 521-2100, Ext. 76704
Attendance last year: 899 (832 follow-up/67 new)
Referral sources: Hamilton, Toronto, Northern Ontario and the Greater Niagara Region and occasionally the United States and Europe.

Clinic Staff
Clinic Director and Chief attending physician - Dr. Judah Denburg
Other attending physicians - Drs. Susan Waserman and Paul Keith
Clinic Nurse - Marie Kancer
Receptionist - Kelly Massi
Clinic Research Co-ordinator - Katheryne Stewart (905) 525-9140, Ext. 22939
Regular Clinic Consultants - Dr. Donald Rosenthal - Dermatology
Dr. Susan Denburg - Neuropsychology
Dr. I. Siotis - Psychiatry
Drs. E. K. M. Smith and N. Wright - Nephrology
Drs. R. Lo and W. Oczkowski - Neurology
Drs. J. Ginsberg and P. Brill-Edwards - Thromboembolism
Residents/Trainees in the subspecialties of Immunology/Allergy, Rheumatology, Dermatology and Internal Medicine

CURRENT RESEARCH STUDIES

The role of Lymphocytotoxic and Phospholipid Antibodies in the Development of Clinical and Subclinical Nervous System Lupus: A Longitudinal Study

Previously funded by: The Arthritis Society
An important feature of neuropsychiatric SLE (NP-SLE), even in the absence of overt manifestations such as seizures and psychosis, is the presence of cognitive abnormalities. The latter appear to be related to the presence of antibodies directed against specific lymphocyte antigens as well as phospholipids, but whether these actually cause subclinical NP-SLE is the major question to be answered by this study. All previously assessed SLE patients, regardless of their original NP status, are being approached to return for reassessment of their cognitive/emotional status, disease activity and antibody status.
UPDATE as of June 14, 1999: Currently unfunded, follow-up data continues to be collected.


Neuropsychological and Serological Predictors of Neuropsychiatric Problems in Systemic Lupus Erythematosus

Funded by: Ontario Mental Health Foundation (OMHF)
This is a follow-up study of those patients who have never had any major neuropsychiatric involvement in the course of their disease. Patient reassessment will take place every two to three years through the use of both questionnaires and cognitive reevaluation. Patients who have had a CNS event since their last test date will be compared to those whose CNS status is unchanged. This comparison will identify cognitive and immunological factor(s) that may be predictive of the development of major CNS events in SLE and hopefully will provide valuable insight into patient management.
UPDATE as of June 14, 1999: Data collection completed.
Lupus as a model of immune-mediated depression

Funded by: Medical Research Council
(MRC) from July 1999 - July 2002.
Depression is the most frequent psychiatric presentation in lupus (SLE). There is, however, little agreement as to whether depression represents a primary manifestation of nervous system involvement in this disease. In a pilot study, psychiatric symptoms and cognitive (thinking) function in depressed SLE patients was compared with a group of non-depressed SLE patients and psychiatric patients who were depressed but did not have SLE. There was no difference between the two depressed groups in mood-related symptoms, suggesting that the clinical presentation of depression in the two groups may be indistinguishable. In contrast, while verbal productivity was reduced in both depressed groups, the depressed SLE patients tended to perform more poorly than both of the other groups on tasks involving sustained mental effort, verbal and nonverbal learning and visuospatial planning. These preliminary findings point to the potential importance of cognitive variables in studying the basis for depression in SLE. Due to the small sample size to date, we propose to continue to gather data for this study. SLE patients will be screened for depression, and those who are suspected of being clinically depressed will be further interviewed to confirm a diagnosis. The same three groups of patients as in the pilot study, as well as depressed and non-depressed rheumatoid arthritis control groups, will then undergo assessments of cognitive functioning, mood and disease activity. Further study of this frequent manifestation of SLE could provide physicians with information that is critical to the understanding and management of the depressed SLE patient.
UPDATE as of June 14, 1999: The name of the study changed, and there is a slight change in focus. More to come on this one.
Warfarin prophylaxis in SLE patients with antiphospholipid antibodies

Funded by: Medical Research Council
(MRC) from July 1998- July 2001.
Approximately 1/3 of patients with SLE will have antiphospholipid antibodies (APLA) and the presence of APLA is associated with thromboembolic complications. Seventy-five percent of patients with SLE and APLA have thromboembolic events and these events can be serious complications especially when they occur in the central nervous system. Anticoagulant therapy with warfarin has been highly effective in the prevention of thromboembolic events in other clinical conditions and could potentially reduce events in patients with SLE and APLA. However, warfarin can have serious side effects such as bleeding. Therefore, prior to recommending prophylactic anticoagulation in these patients, the safety and efficacy needs to be determined in clinical trials.
UPDATE as of June 14, 1999: Study to get underway this summer.

Warfarin prophylaxis of recurrent thrombosis in patients with antiphospholipid antibodies

Funded by: Medical Research Council
Many people with clotting complications such as strokes, heart attacks and blood clots in the legs and lungs are found to have a condition in which certain antibodies (antiphospholipid antibodies [APLA]) interfere with normal blood coagulation. Current clinical practice is to use high doses of blood thinning medications (warfarin) to prevent recurrence. This practice is, however, associated with substantial bleeding risk and is based on poor quality studies. Therefore, before this treatment is generally recommended, an assessment of its efficacy and safety is required.UPDATE as of June 14, 1999: Study On-going

A study in which patients with these antibodies and a previous episode of stroke, heart attack and/or blood clot in the legs or lungs will receive one of two intensities of warfarin for two years. It is expected that patients who receive the high-intensity warfarin will have fewer blood clots. This study will provide the first carefully controlled data on the effectiveness of warfarin for the prevention of recurrent blood clots in patients with APLA.

Animal Model of CNS Lupus

Funded by: Medical Research Council and the Canadian Psychiatric Research Foundation
A growing area of investigation, from which important insights regarding CNS lupus are certain to emerge, is the development of an animal model of CNS lupus in collaboration with colleagues in the Department of Biomedical Sciences (neuroscientists Drs. B. Sakic and H. Szechtman). While not strictly related to the Lupus Clinic, this focus has broadened the group and made lupus a source of interest to the basic scientific community at McMaster and in the community.
The development of an autoimmune condition in lupus-prone mice has been associated with major changes in behaviour. These include increased anxiety, symptoms of depression and impaired learning and memory. Our current and future research in this area focuses on gaining further understanding and treatment of factors in the brain which have been associated with these changes.

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