Full Text: CRA Meeting Introduction

The 11th Annual Winter Workshop and Meeting of The Canadian Rheumatology Association (CRA) was held at the Fairmont Chateau Lake Louise, Lake Louise, Alberta, Canada, February 25-28, 2004.

The program consisted of presentations covering original research, symposia, the Dunlop-Dottridge lecture, workshops, the Royal College Debate, and a special spotlight on Canadian excellence in rheumatology by the CRA Distinguished Rheumatologist, Distinguished Investigator, and Young Investigator (Figure 1).

The meeting opened with the National Journal Club coverage of Antirheumatic Drugs in Pregnancy, Biochemical Markers in Arthritis, Role of Statins in Rheumatology, and Hypertension in Arthritis.

President Arthur Bookman introduced the podium presentations by Fellows, followed by the 2004 Dunlop-Dottridge Lecture on New Insights into the Pathogenesis and Treatment of Osteoarthritis, by Dr. David Felson of Boston, Massachusetts.

This year's Royal College Debate, "Be it resolved that data from clinical trials are believable," was moderated by Dr. John Esdaile of Vancouver, British Columbia, who gave revealing background information about each of the eminent speakers. Dr. Dianne Mosher, Halifax, Nova Scotia, and her colleague Dr. Janet Pope, London, Ontario, favored the motion. Both defended the view that well conducted clinical trials were believable because they set a scientific standard for demonstrating effective clinical use of new medications. For example, studies such as the Women's Health Initiative drew new attention to potential side effects from an old treatment regimen of hormone replacement therapy. The resolution was opposed, first by Dr. Alice Klinkhoff, Vancouver, BC, who countered that despite favorable results of clinical trials physicians should "beware" of possible side effects not seen in selected study patients who are not representative of the general public for whom the drug was intended. Dr. Claire Bombardier of Toronto also sounded a cautionary note that, generally speaking, clinical trials may not report a "real-world experience" because the results of a clinical trial could prove less effective in the general population. Moreover, the consequences of negative trials are rarely published. The side effects of newer agents in real life may also be greater than seen in trials. Further, the new emphasis on direct-to-consumer advertising may distort the true value of any new agent. Dr. Bombardier's closing challenge: that consent forms for patients enrolled in clinical trials could better disclose the foregoing factors.

The meeting also provided an occasion for presentation of a number of awards. The Ian Watson Lupus Canada Award went to Sindu Johnson, University of Toronto. Dr. Johnson described ethnic variation and its relationship to the presence of renal and central nervous system (CNS) lupus, with overall end-organ damage and mortality. Among the 1017 study patients, including 853 Caucasians, 88 African Canadians, and 76 Chinese, who were followed for up to 32 years, there was no significant difference in organ damage, CNS damage, or mortality among the 3 ethnic groups. The exception was that African Canadians showed a higher prevalence of renal damage.

Other honors included the CRA Award for Basic Science and Overall Merit, awarded to Dr. Yan Liu of the University of Toronto. Dr. Liu examined the question of whether prophylactic surgical fusions should be offered to patients with rheumatoid arthritis (RA) and cervical instability before development of neurological symptoms. The results of this decision analysis indicated that prophylactic surgery was a reasonable management option for patients with cervical instability from RA. The P.S. Rosen Award went to Dr. LeeAnne Luft from the University of Calgary. Dr. Luft outlined identification of autoantigen GW182 showing novel cytoplasmic structures referred to as GW bodies. This autoantigen represents a new category of ribonucleoprotein autoantigen that can be classified as messenger RNA ribonucleoprotein (mRNP) complexes.

Dr. Robert Inman, of the University of Toronto, a preeminent basic and clinical spondyloarthritis researcher, received the Distinguished Investigator Award. The Distinguished Rheumatologist Award went Dr. Watson Buchanan of McMaster University, Hamilton, described as a facilitator, role model, academic, mentor, ambassador, and physician without parallel. Drs. Inman and Buchanan addressed the association dinner with insightful and amusing comments.

Pediatric researcher and clinician Dr. Rae Yeung of the Hospital for Sick Children, Toronto, whose research has centered on studying the pathogenesis of Kawasaki disease, received the Young Investigator Award.

The greater than ever attendance at the meeting confirmed the ongoing enthusiasm and interest of rheumatologists and Fellows from all parts of Canada. Their contributions are well reflected in the abstracts of the meeting, which we are pleased to publish in this issue.

Clockwise from top left: CRA President Arthur Bookman and Distinguished Rheumatologist awardee W. Watson Buchanan. Murray Urowitz and Dunlop-Dottridge lecturer David Felson. Rob Inman and Rae Yeung, recipients of the Distinguished Investigator and Young Investigator awards. Chair of the CRA Scientific Committee Walter Maksymowych.