PRECISION: Preventing Complications from Inflammatory Skin, Joint, and Bowel Conditions

In the Fall of 2012, the Gastrointestinal Society joined three other consumer/patient organizations – representing arthritis and skin diseases – along with more than 30 research scientists, to shape a research network studying the complications of inflammatory diseases, including those of the bowel (IBD). We worked with the team to set objectives informing areas of study. Funding later followed from the Canadian Institutes of Health Research and Crohn’s and Colitis Canada.

The Canadian Institutes of Health Research (CIHR) is Canada’s federal funding agency for health research. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada.

Individuals with inflammatory diseases of the skin, joint, and/or bowel are no longer dying because of the first wave of inflammation. However, they are suffering and dying prematurely from chronic low grade inflammation, not necessarily related to the primary disease, but from its complications, which are similar across the skin, joint, and bowel diseases.

At the roundtables, researchers and informed patients theorized that improving treatment of inflammatory disease could lead to reduced patient morbidity and mortality, as well as reduced health care costs. These discussions gave birth to the formation of a multi-disciplinary team and research project called PRECISION.

What sets PRECISION apart is that most previous research has treated inflammatory complications as though they were the presence of one or more diseases or disorders, in addition to a primary disease (comorbidities), rather than the direct result of chronic inflammation. PRECISION looks at complications in a new way, that is, by seeing them as rooted in inflammation. If this view is correct, then complications are potentially avoidable, and researchers can begin to design programs to reduce or eliminate their occurrences.

The PRECISION project will study about 1 million of the 5 million Canadians affected by any of the following eight chronic inflammatory diseases: psoriasis, rheumatoid arthritis, systemic autoimmune rheumatic disease, ankylosing spondylitis, gout, osteoarthritis, Crohn’s disease, and ulcerative colitis.

The aims of the project are to:

  • assess the exact role of inflammation in causing various complications
  • evaluate and prevent inflammatory complications
  • test pilot health interventions to reduce or prevent complications using pharmacists, primary care physicians, and case managers (a person who helps to identify available resources within the health care system, with the goal of enabling clients to lead a healthy life in the context of their chronic disease)
  • develop tools to improve patient self-management by monitoring physical activity through wearable digital technology, such as fitness wristbands or bracelets

Specifically, the study will attempt to uncover the following:

  • how common and how costly complications from inflammatory disease might be
  • what predicts which patients will develop a complication from these diseases
  • the effectiveness of new ways to diagnose and treat inflammatory diseases
  • why aboriginal communities have a higher chance of developing arthritis and why the disease is more severe
  • why women have a greater risk of developing chronic inflammatory conditions/diseases
  • which types of physical activity help people with inflammatory diseases

One of our first activities as a collaborator was to share a PRECISION survey to obtain perspective from those living with inflammatory disease. In a span of three weeks, 636 individuals responded. We later asked 10 individuals with IBD to complete a detailed paper survey of a more complex questionnaire, which we will launch online later in the year.

PRECISION’s lead researcher, Dr. John Esdaile, is an internationally respected rheumatologist who spearheaded the creation of Arthritis Research Canada. His areas of research include rheumatoid arthritis, osteoarthritis, and systemic lupus erythematosus.

Dr. Gilaad Kaplan oversees the gastrointestinal content. He is a gastroenterologist and epidemiologist, based in Calgary, with a clinical research interest in inflammatory bowel diseases.

First published in the Inside Tract® newsletter issue 197 – 2016