The promise of
precision medicine ´ KIEWICZ W R I T T E N B Y: V E R O N I K A I Z A B E L A B R Y S P H O T O S B Y: J O H N PA C K M A N
Less than half a century ago, a diagnosis of rheumatoid arthritis was like a premature death sentence. It meant a life of restricted movement, disfigurement, severe chronic pain and hospitalization. Back then, no one knew that it was actually an illness of the immune system — an immune system that, due to an imbalance triggered by genetics and the environment, became over-reactive and attacked itself. In the case of rheumatoid arthritis: a merciless attack on the tissues lining the joints. Gold injections, which dampened the symptoms of disease for a short period of time, were then part of the gold standard of care, though doctors did not understand why they worked, nor did the injections stop the disease’s progression for most patients. But since then, knowledge about the illness has come a long way. In the last two decades alone, an explosion of clinical trials has led to a broader array of medications that keep symptoms and disease progression at bay. Perhaps what is most exciting is the potential of some of the research taking place at Sinai Health System to not only help match the right drug to the right patient, but to someday stop the disease from ever manifesting in those who are at greatest risk.
Erinn’s journey Erinn McQueen is one of many rheumatoid arthritis patients who thrives for a period of time on a medication, but for reasons unknown, reaches a point when the same medication eventually ceases to work. A patient at Sinai for 17 years, her journey began at age 21 when she was a star player on her university’s varsity soccer team. All of a sudden, she felt chronically exhausted and in pain. After several misdiagnoses, she was finally diagnosed with rheumatoid arthritis, thanks to a test that recognized a known biomarker in her blood, which shows up in about 70 per cent of cases. As her illness progressed over the last decade and a half, she has had to change medications five times. At her worst, she was unable to brush her own hair or tie her own shoes, and she had to undergo several surgeries to remove damaged and disfigured joints, including a hip replacement in her early 30s. 12
