Here are some of our current active research projects:
Juvenile Idiopathic Arthritis (JIA) Studies
The CAPRI JIA Registry
The Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) network includes all pediatric rheumatology centres in Canada that care for children with JIA. The CAPRI-JIA National Registry enrolls all children and teens diagnosed with JIA in Canada at CAPRI centres. Information is collected from children and parents, and pediatric rheumatologists at each visit, helping to learn how JIA affects the lives of children and teens, study treatment effectiveness and frequency of side effects from treatments, and understand long term disease outcomes. The CAPRI Registry is an ideal platform to facilitate other research projects; for example there is a trial of using anti-nausea medication for children with JIA prescribed methotrexate (OPT-JIA Trial), and information is collected through the CAPRI Registry. Dr. Guzman is the CAPRI JIA Registry lead, and the Registry is held in Vancouver.
The Ondansetron Premedication Trial in Juvenile Idiopathic Arthritis- OPT-JIA Trial
Far too many kids and families live in dread over the weekly nausea and vomiting that can be caused by methotrexate in up to 30% of patients. Methotrexate is a medicine that can be very effective in controlling active arthritis in children with JIA. This registry-based pragmatic randomized controlled trial is testing if routine premedication with the anti-emetic drug Ondansetron, reduces nausea and vomiting and increases the proportion of children able to continue methotrexate. By preventing nausea before it starts, we hope to give kids and families a better quality of life and see a more cost-effective use of medication.
Treating children with arthritis according to their individual probability of outcomes and response to treatments – The PERSON-JIA Trial (Personalized estimates of response and severity outcomes)
The PERSON-JIA Trial is a clinical trial testing the use of Shared Decision Making (SDM) with families to help with the decision making of treatment choices for children with arthritis. Our Canada-wide research team have developed a simple way to enter information into a doctor’s smartphone or computer, at the time of a child’s diagnosis of JIA, that can produce a short report that accurately tells the family and doctor important information that can help in making evidence-based treatment decisions. We want to test whether using the report at the time of a child’s diagnosis can result in improved outcomes of JIA over the short term, and patient and family satisfaction. In this Canada-wide study, pediatric rheumatologists will either be using the PERSON tools, or using their usual standard care. Families will be followed as usual in the clinic, with information collected into the CAPRI JIA registry to study how well they do in the first year after diagnosis.
UCAN CAN-DU: Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases
Juvenile idiopathic arthritis (JIA) is a group of diseases that can decrease quality of life and lead to lifelong chronic disease for pediatric patients. Providing timely and effective treatments is crucial to improve short and long term health outcomes for children. Biologic therapies are common treatments which may come with undesired side-effects and are often prescribed without a treatment end-date. In collaboration with researchers in Canada and the Netherlands, UCAN CAN-DU is studying how to improve treatment gaps and disease activity outcomes. Researchers are working to develop a system to predict a child’s arthritis disease course, a clinical tool to predict response to therapy and to identify the risk of relapse after continuing therapy. If a patient agrees to enroll in UCAN CAN-DU, they will be asked to provide medical history, complete questionnaires about the impact of JIA on their family and provide two blood samples for biomarker testing.
Vasculitis Studies
PedVas: The Pediatric Vasculitis Initiative
The PedVas study is an international study, headed by Dr. David Cabral, based at BC Children’s Hospital and includes collaborators in Canada, US, and various countries across the globe. The project is funded by the Canadian Institutes of Health Research (CIHR). This study is examining childhood chronic vasculitis, a set of rare inflammatory diseases affecting blood vessels in body organs such as the kidneys, lungs and brain. Through the PedVas study Dr. Cabral and his colleagues are learning more about pediatric vasculitis to improve the diagnosis and treatment of vasculitis in children and adolescents. You can read more about PedVas on the clinicaltrials.gov website.
Autoinflammatory Disease Studies
CAN-Fever Registry
Auto-inflammatory diseases are rare conditions, where inflammation occurs either in episodes or chronically, and can affect many areas of the body. Many of these disorders begin in early childhood, and some are associated with immune gene mutations. The purpose of this BC-based registry is to collect information about auto-inflammatory diseases in kids in order to better understand the cause of disease, impact on children and families, and outcomes, and to be able to study medication effectiveness. All children with auto-inflammatory diseases seen in the Systemic Auto-Inflammatory Diseases Clinic in the Division of Rheumatology are eligible to enroll in this registry. The CAN-Fever Registry is a platform for development of a variety of additional studies in auto-inflammation. This registry has already provided information leading to a publication on the diversity of ethnicity in children with SAIDs in BC, and a publication on multiple gene mutations in a case study of SAID. Further links to translational research are being developed.
Development and validation of classification criteria for chronic nonbacterial osteomyelitis in children using a data-driven approach
Chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), is an auto inflammatory bone disease of unknown cause. Making the diagnosis of CRMO can be challenging, because doctors need to consider other conditions such as infection or tumor; this often requires biopsy of the bone. This international study is developing valid classification criteria for CNO through a data-driven statistical approach, by collecting a large number of CNO cases as well as cases that are similar to CNO. The result will ensure children with CNO/CRMO get faster diagnosis and help to avoid bone biopsies if possible. Our team has contributed CRMO case information to this study and are part of the research team.