Lupus Ontario
Working together to conquer lupus
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Lupus Ontario Working together to conquer lupus |
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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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