Summer 2019 (Volume 29, Number 2)
Distinguished Rheumatologist:
Dr. Edward Keystone
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Why did you become a rheumatologist?
What or who influenced
you along the way to do so?
Having completed a year of laboratory
research on rheumatoid arthritis
as an allergy fellow, I was asked
by Dr. Murray Urowitz, Dr. Hugh
Smythe and Dr. Metro Ogryzlo to
enter the field of rheumatology. I
couldn’t resist. Who could? Best
thing I ever did.
Why is it important to you to work
as a consultant to the pharmaceutical
and biotechnology industry
and as a member of numerous
biopharmaceutical advisory boards?
Despite the concept that industry was the “dark side,” I
came to realize that it was the pharmaceutical/biotechnology
industry that generated all of the novel therapies
that would be "game changers" in the field. I loved the idea
of being at the forefront of the new wave of therapies that
would substantially improve the lives of our patients.
You have been the recipient of numerous accolades
over your career, including being chosen an “Alumnus
of Influence” by the University College of the University
of Toronto in 2012 and “Rheumatologist of the Year” by
the Ontario Rheumatology Association in 2014. What
was your first thought when you learned you won this
CRA award?
I was gratified by the concept that my peers chose me as a leader amongst such a group of respected colleagues who
are dedicated to making a difference to our patients.
In 2003, you established The Rebecca MacDonald Centre
for Arthritis and Autoimmune Disease – a centre devoted
to research of genomics, therapeutics, and outcomes
in autoimmune inflammatory joint disease. As
Director of the Centre and head of the Advanced Therapeutics
Division, what led you to focus your research on
novel therapeutics in rheumatoid arthritis?
At the time I chose to enter the field of therapeutics, I realized
that a sea of change was coming to the field of rheumatology
with the advent of biologics. As an immunologist,
I was particularly excited by the concept
of selective targeting of the specific
inflammatory molecules driving
the disease in rheumatoid arthritis.
In concert with Dr. Katherine Siminovitch,
you are currently developing
the Centre for Excellence
in Personalized Medicine in Arthritis
and Autoimmune Disease
at Mount Sinai Hospital. What are
you hoping to see with the development
of this program and how
will it impact the rheumatology
landscape?
I believe that an understanding of
the genetic influences in our autoimmune disorders is the
only way to have a better understanding of the pathogenesis
of these conditions with a view to predicting who will
get them, what will be the outcome and, particularly, how to
select the right drug for the right person at the right time
through personalized medicine.
What major changes to the landscape of rheumatology
have you witnessed over the course of your career?
I have been extremely fortunate to witness the concept of
selective targeting of pathogenic molecules in arthritis
through biologics and new targeted small molecules in the
form of JAK inhibitors. This is the most amazing time ever in
the history of the treatment of rheumatic diseases. We have
gone from needing 40 dedicated inpatient beds for rheumatology
patients in Toronto hospitals in the 1970s to needing
only three dedicated beds in the city in 2019. That says it all.
What is the greatest professional and organizational
challenge you have faced, and how did you address/
overcome this challenge?
Raising sufficient funds to create a personalized medicine
program in our Centre of Excellence at Mount Sinai Hospital.
I addressed the challenge by not quitting, ever!
How has your work helped shape the field of rheumatology
here and elsewhere?
My work has been dedicated to enhancing the acquisition
of new and novel therapies in Canada and educating my colleagues as to how to optimize the best way to improve
outcomes.
What do you foresee as challenges to Canadian rheumatologists
in the future and what can individual rheumatologists
and the CRA do to meet these challenges?
I see a major challenge in enticing Canadian rheumatologists
into basic laboratory research in the field as a consequence
of dwindling resources from government and
elsewhere. With the advent of biosimilars, industry funding
is also being eroded for investigator-initiated studies and
observational databases.
Given your extensive work in the field of rheumatic diseases,
where do you anticipate clinical research moving
within the next decade?
Translational research from bench to bedside to understand
the fundamentals of the pathogenic process driving
the diseases, and applying them to improve the outcomes
using personalized medical approaches.
Your identical twin is also a world-renowned physician.
How has that relationship influenced your medical career?
My career was strongly influenced by my older brother
who convinced me that I could be a teacher in the field
of medicine. We succeeded in undergraduate courses by
working together and trying to compete with each other at
the highest levels. As the Gold Medalist in our U of T medical
school class, and a recipient of the Order of Canada,
my brother, Jay, set a high standard for me to live up to. In
the end we both turned out to be educators in the field of
therapeutics. How amazing and truly gratifying.
Two “Keystone Rules” are often cited when discussing
the outcomes of RA trials. How did you come up with
those? Will any therapies eventually improve on the
outcomes cited by these rules? Which ones?
I came up with the “Keystone Rules” with my interest in
therapeutics by scanning the literature on all of the new
therapies and realized that these rules applied to the responses
to all the new agents. It was truly an epiphany! The
most recently developed JAK inhibitors will improve the
outcomes set out by the Keystone Rules. I’m happy about
that!
You are known to have a great interest in animals, particularly
horses. Have you learned anything from animals
that helps in your day-to-day life in medicine?
My wife introduced me to horses while I was doing research
in London, England. We were learning to jump but I went
over the bar more than my horse, so I learned a lot about
humility. Riding was a great source of relaxation (once I
learned to ride) and a way to get into the country and away
from the madding crowd.
What do you like most about living in Ontario?
The ability to live near the city and still enjoy the beautiful
countryside.
What is your dream vacation destination?
Just living on my farm with my family and enjoying my
three dogs, two cats and one horse running around.
What book would you bring with you on a deserted
island?
I wouldn’t go to a deserted island. I am a lousy swimmer, but
I love the idea.
P.S. I never read books outside of medicine – no time!
Edward C. Keystone, MD, FRCPC
Professor of Medicine,
University of Toronto
Director,
The Rebecca MacDonald Centre for Arthritis
and Autoimmune Disease
Consultant Rheumatologist,
Mount Sinai Hospital
Toronto, Ontario
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