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Finding the right balance for kids with rheumatic diseases: Q&A with Dr. Kelly Brown

June 23, 2016
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Dr. Kelly Brown is a scientist at BC Children’s Hospital and an Assistant Professor in the Division of Rheumatology in the Department of Pediatrics at the University of British Columbia. She recently received the Michael Smith Foundation for Health Research / Cassie and Friends Society for Children with Juvenile Arthritis and Other Rheumatic Diseases Scholar Award. Dr. Brown spoke about how her research will help clinicians improve the diagnosis and treatment of children suffering from debilitating rheumatic diseases. Among other things, her work looks for evidence to help delicately balance the need for aggressive treatment with the possibility of long-term side effects of medications on young patients.

What research are you currently working on?
Dr. Kelly Brown:
I research childhood rheumatic diseases, which have in common pain or inflammation of muscles, tissues, joints and major organs in the body. These diseases are usually treated with steroids to reduce inflammation and immunosuppressive drugs that inhibit the immune system. These drugs can be highly effective in treating rheumatic diseases, but many have potentially serious side effects, so the challenge is in choosing which drugs to use, how much to use and how long to use them.

Right now we have three research projects up and running. One is on childhood vasculitis, a sometimes life- or organ-threatening condition that causes inflammation of blood vessels in vital organs such as the kidneys, heart and brain. Another project is on uveitis, which can result in permanent blindness. The third is on autoinflammatory diseases, a diverse group of illnesses that can cause fever, pain in the joints and abdomen and other complications. For all three projects we’re looking for signs of inflammation that aren’t immediately obvious to physicians but that we can find in blood, urine, saliva, tears and other samples from patients and which could tell clinicians when to start or stop treatment.

How will your research lead to better care?
KB:
Most clinical decisions are based on things physicians can see – recognizable signs and symptoms. By looking for signs of disease that physicians can’t detect as easily, we’d be giving clinicians more specific information about a child’s disease, and potentially which drugs to use and how long to use them. My research adds experimental evidence to the current clinical evidence base. This will hopefully enable more precise clinical decisions and better outcomes for children.

Do you have an example for one of the conditions you’re looking at?
KB:
In the childhood vasculitis project, we want to discover what indications would tell us when a disease is starting to “quiet down.” We look at genetic material, blood serum and urine from the children at the time of diagnosis. Then, after the children come off an initial set of drugs, we take another sample, and again at a point when the child is on little or no medication. We compare the samples to see which markers are present at different stages of the disease. When a disease seems to be inactive, physicians might take patients off treatment. However, if the immune system is not truly at rest, tapering treatment will inadvertently cause a flare up. By comparing samples throughout the disease’s progression, we hope to lessen this risk by determining with greater certainty when there is or is not inflammation.

How did you become interested in rheumatology?
KB:
I was doing postdoctoral research in Sweden and by chance, there was a large group of children with autoinflammatory diseases in the western part of the country where I was living and working. A physician I knew came to me and the rest of the lab asking for our help, so I began studying these autoinflammatory diseases and then other rheumatic diseases. I not only became fascinated by these diseases from a scientific perspective, I realized there were significant gaps in understanding that impeded clinical care and that could be addressed through an integrated clinical and basic science research program.

What drew you to working at BC Children's Hospital?
KB:
When I was a postdoctoral researcher at UBC, I was fortunate to spend some time at BC Children’s Hospital and had excellent mentors: once you start working with people here you never really lose the connection. I worked with Dr. David Speert, Dr. Stuart Turvey, and Dr. Rusung Tan, and they showed me the role research plays in care. As someone who isn’t a clinician, I started to appreciate the challenges doctors face when they’re treating people. I had great experiences at BC Children's Hospital, so naturally I wanted to come back.

What do you like to do outside of work?
KB:
I have a young son and as a family we do a lot of outdoor activities together like hiking, bike-riding and skiing. Even with two knee reconstructions – you’d think I’d learnt my lesson – I still play competitive soccer, although at a much slower pace. If I had more time in the day, I’d read more novels, play more outdoors, take more photographs, learn how to care for my garden, and probably get on my family’s nerves trying to systematically inventory and organize every item in our house.

Dr. Brown's research is made possible by the support of BC Children's Hospital Foundation.