Summer 2022 (Volume 32, Number 2)
The CRA's 2022 Distinguished
Rheumatologist:
Dr. Lori Tucker
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Why did you become a rheumatologist? What or
who influenced you along the way to do so?
I think I might have been destined to be a rheumatologist,
actually! Prior to attending medical
school, I spent a year in a wonderful immunology
lab, run by Dr. Matthew Scharff at Albert Einstein
College of Medicine, where I learned about monoclonal
antibodies, cellular immunology, and
was fortunate to be part of a fantastic model of
translational research. After medical school, when
I started my pediatric training in Boston, the new
Department Head was Dr. Jane Schaller, a true
pioneer in pediatric rheumatology. This was the
first time I even learned that pediatric rheumatology
could be a career choice, and I found myself
drawn to the combination of complex diagnostics, immunology, and
chronic disease management. I also really loved the team aspect of
care; I love working with nursing, physiotherapy, occupational therapy,
social work all together. It was the perfect fit for me.
You are clinical professor in pediatrics and Division Head of
Pediatric Rheumatology at the University of British Columbia
and BC Children’s Hospital, as well as Clinical Investigator at the
BC Children’s Hospital Research Institute. In addition to this,
you’re one of the founding members and Past-President of the
Canadian Alliance of Pediatric Rheumatology Investigators, the
Canadian national network for pediatric rheumatology research.
a) From where did your passion for pediatric rheumatology stem?
My passion for pediatric rheumatology comes from the children and
their families. I have always loved the “solving the puzzle” aspect
of pediatric rheumatology diagnostics and using my knowledge to
help families understand what is wrong with their child and how to
make it better. I feel it is a privilege to help children with rheumatic
diseases grow and develop to their best capacity, and I love the long-term
care aspect of what we do. I also love working as part of a team
— most of the best clinical care and research have resulted from the
amazing teams I have been privileged to work with.
b) Can you tell us more about CAPRI? What led to its founding
and how has it impacted Canadian rheumatology?
The pediatric rheumatology community in Canada has always
been a close, collegial, and friendly group. When I moved to Canada,
I felt so welcomed here. In 2011, we all came together at a
seminal meeting in Vancouver, led by Ciaran Duffy, and agreed
that we should do collaborative Canadian pediatric rheumatology
research as a group. From that meeting, CAPRI — the Canadian
Alliance of Pediatric Rheumatology Investigators — was born. As
a fully volunteer group, inclusive of all pediatric rheumatologists
and those engaged in significant pediatric rheumatology research
in Canada, we have been incredibly successful in obtaining grant
funding and completing a series of national projects. I would say
the largest impact we have had is in demonstrating our ability to
do multicentre projects in a collaborative way. We have capitalized
on some of our members’ tremendous talents
in epidemiology, bench science, and clinical
science, in an environment where everyone’s
contributions are valued. I am personally excited
to see a younger generation of Canadian pediatric
rheumatologists coming together in CAPRI
to work in this same way, and I can say, we’re in
good hands with this new generation!
You have co-led the two largest multicentre
longitudinal research studies on juvenile
idiopathic arthritis (JIA) in Canada over
the past 15 years, ReACCh-Out, and LEAP
(short for Linking Exercise, Physical Activity,
and Pathophysiology in Canadian Children
with Juvenile Idiopathic Arthritis) and were
instrumental in the development of the national longitudinal
CAPRI JIA Registry. You have also established a clinical program
in auto-inflammatory diseases at BC Children’s Hospital serving
the province of BC, which incorporates translational research in
every clinical encounter.
a) Can you tell us more about your research work and how it has
shaped the pediatric rheumatology landscape?
I have been incredibly fortunate to be part of a national group of
pediatric rheumatology investigators who have worked incredibly
well together to study children with JIA in Canada. The dream,
when we first applied for funding for the ReACCh-Out research
team project, was to establish a longitudinal registry to collect detailed
information about children diagnosed with JIA from every
corner of Canada — and we have been successful in doing this.
This initial project set the stage for future work, and our group developed
methods of multicentre data collection and sample collection
that have been used in subsequent important projects. Our
ReACCH-Out results have shown that with current treatments, the
majority of children in Canada newly diagnosed with JIA have well-controlled
disease within six months, and we have been able to
understand predictors of severe disease, trajectories of pain and
quality of life, and factors associated with risks of flares. Through
work done with children with JIA and parents, we have identified
outcomes of specific interest to them, have used our data to develop
prediction methods for these outcomes, and are now embarking
on an ambitious trial of using these prediction methods
in clinical shared decision-making across Canada. The skills, passion,
and hard work of so many pediatric rheumatologists across
the country in moving this research along into real clinical change
is truly wonderful to see.
I also want to recognize that the initial work of ReACCh-Out,
with Ciaran Duffy, Kiem Oen, Rae Yeung, led to other really
important projects obtaining funding — Alan Rosenberg and
BBOP (Biologically Based Predictors of JIA), and Rae Yeung and
Susa Benseler with UCAN-CAN DU (Understanding Childhood
Arthritis Network). These projects provide on-going collaborative
research, Canadian-led, in pediatric rheumatology.
In addition to your clinical and research activities, you have
worked tirelessly in patient advocacy and in strengthening clinical
team/parent/ patient partnerships as the Medical Advisor and
Board member for Cassie and Friends: A Society for Children
with Arthritis and Rheumatic Diseases. This national parent and
patient-run organization has become the strongest voice for
pediatric rheumatology in Canada, raising funds for direct patient
needs and research, providing on-line information and education
sessions, and developing parent and youth support programs.
Why was getting involved in patient advocacy important to you?
Can you provide a concrete example of how Cassie and Friends
has improved pediatric rheumatology care for patients?
I have always believed that our patients count on us to speak up on
their behalf, and with them, for equitable access to care that will
lead to the best outcomes. This is one of our responsibilities as
pediatric specialists. I am interested in how we, as physicians, the
medical experts, can work with government, administration and
others to improve care. And, when you work with children with
rheumatic diseases, you learn very quickly that basic awareness of
these diseases and their challenges is very low, making it difficult
to get attention for them.
Children with arthritis and other rheumatic diseases and their
families, never really had a strong visible public voice in Canada,
and there was no group solely dedicated to issues important to our
patients. Cassie and Friends is now that group. Started as a provincial-based group in BC, it is now national. It is absolutely breathtaking
to see Cassie and Friends viewed as the credible voice for
pediatric rheumatic disease in Canada — with the clinic teams,
research funders, government, and media. Pediatric rheumatologists
across the country are working with their own teams and
Cassie and Friends on local and national projects. We now have a
dynamic youth program, providing youth with rheumatic disease a
way to meet others and develop support programs, participate and
drive research. The virtual education programming that Cassie and
Friends have done since the start of the pandemic is incredible, and
so many of our families use the education “library” at the point of
need. I love working with Cassie and Friends, because I see the impact
of our work every day in the clinic, talking to families.
What major changes to the landscape of pediatric rheumatology
have you witnessed over the course of your career?
There are several, but the most impactful is the introduction of
methotrexate and subsequently biologics to the treatment of JIA.
The changes in treatment of children with JIA, driven by scientific
knowledge, have completely transformed the outcomes of most
children with these diseases. Our photos from Arthritis Camp in
BC from 25 years ago show children using crutches and wheelchairs,
growth limited from use of steroids, whereas today we see
healthy, well-appearing kids.
One other fascinating change is the evolution and expansion
of our understanding of auto-inflammatory diseases, driven by basic
and translational research. Pediatric rheumatologists now have
a whole new set of diseases to diagnose and treat, and there are
new things to learn every day.
What do you foresee as challenges to Canadian pediatric
rheumatologists in the future and what can individual
rheumatologists and the CRA do to meet these challenges?
Our challenges in pediatric rheumatology are related to improving
care for children and youth with rheumatic diseases in Canada,
and increasing our research capacity and output, and translating
these new insights into better care. We still see children referred
for rheumatologic diagnosis and care late in their disease onset,
and there are still serious problems with access to care and needed
treatment for many children with rheumatic diseases.
What was your first thought when you learned that you would
be receiving the CRA Distinguished Rheumatologist Award?
I was shocked, surprised, and very honoured, to be honest. I value
my pediatric colleagues and collaborators as work partners and
friends, and it means so much to me to be recognized by the rheumatology
community for the work I have done over the years. I
also have so much respect for the work that the CRA does, with
rheumatologist volunteers, on behalf of our profession and our
patients. This makes the honour even more special to me, coming
from this organization that holds a special place in my heart.
Dr. Tucker receiving the CRA Distinguished Rheumatologist
Award during
the virtual gala in February 2022.
You are marooned on a desert island? What book would you
like to have on hand with you?
I would want to have a sketchbook, pencils and drawing pens.
If you had an extra hour in the day, how would you spend it?
In sunny weather — a bike ride in Vancouver. In rainy weather
(always have to be prepared in Raincouver) — knitting or baking.
What is your favourite food or cuisine?
I will never turn down ice cream, and I love a complex, interesting
dessert.
What is your dream vacation destination?
Hiking in Patagonia.
How many cups of coffee does it take to make a productive
day?
I might be a Vancouver coffee snob — it’s not just the number of
cups but the quality.
Two cups, and my preference is not Starbucks, but either my
own home brew or a cup from one of the many local coffee shops
around my home.
Lori Tucker, MD, FRCPC,
Clinical Professor in Pediatrics,
Division Head, Division of Rheumatology,
Department of Pediatrics
Clinical Investigator,
BC Children’s Hospital Research Institute
BC Children’s Hospital and University of British Columbia
Vancouver, British Columbia
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