Summer 2023 (Volume 33, Number 2)
The CRA's 2023 Emerging Investigator: Dr. Lihi Eder
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You have a broad background in
rheumatology with specific training
and expertise in psoriatic arthritis,
musculoskeletal ultrasound and
cardiovascular diseases in rheumatic
patients. You are Director of the Psoriatic
Arthritis program at Women’s College
Hospital and co-Director of the Cardio-Rheumatology Program (University of
Toronto), an interdisciplinary program
that aims to improve the management of
cardiovascular morbidities in rheumatic
patients by developing novel models of
care through research and educational
activities. Can you tell us more about
your research and its implications?
My research questions are triggered by
questions that arise during my encounters
with patients in the clinic. My main
area of research is psoriatic arthritis (PsA), which is such a
fascinating, heterogeneous disease with many unresolved
issues. I combine clinical research using both large patient
registries and population-based data with translational research
using both imaging and laboratory biomarkers to improve
our understanding of PsA. Specifically, my research
on the transition from psoriasis to PsA aims to improve early
diagnosis of PsA by developing new clinical prediction tools
and employing targeted use of musculoskeletal ultrasound.
I also use ultrasound to improve phenotyping of PsA by integrating
imaging data with laboratory biomarker data. Using
this combination, I aim to find ways to personalize the selection
of advanced therapies.
Our cardio-rheumatology network, the first of its kind
in Canada, involves a collaboration of rheumatologists
and cardiologists. We aim to optimize the management of
cardiovascular risk factors in patients with inflammatory
rheumatic disease through early screening and the use of
vascular imaging, such as coronary calcium score, to identify
high-risk individuals. This allows the initiation of early
therapies, such as statins, to reduce cardiovascular risk. We
have seen more than 400 patients with rheumatic diseases
since we opened the clinic in 2017 and approximately half
of them required initiation or modification of medications
following their visit to the clinic to reduce their cardiac risk.
We also have a few anecdotal cases of patients who were
found to have critical coronary artery blockages that were
identified and successfully treated following their clinic visits.
Overall, I am satisfied with the fact that my research
contributes to the understanding of rheumatic diseases, and
also influences the care of individual patients.
You were awarded the Canada
Research Chair in Inflammatory
Rheumatic Diseases (2021-2026) for
studying barriers to equitable care in
rheumatology, including the role of sex
and gender as determinants of disease
outcomes. Can you describe some of
the most significant findings in this
research area?
This is a recent area of research for me
that stemmed from a study that I published
as a PsA research fellow with
Dr. Dafna Gladman. We found that
female patients with PsA do worse
than male patients considering their
level of pain, physical function, and
quality of life. This is despite the fact
that male patients tend to develop
more joint damage. More recently, we
studied population-based data and showed that female
patients with PsA, ankylosing spondylitis (AS) and rheumatoid
arthritis (RA) require more visits to the rheumatologist
before receiving a diagnosis of these conditions. In
addition, I analyzed randomized clinical trial (RCT) data
and found that female patients are less likely to achieve
the minimal disease activity state in PsA compared to
male patients. It is unclear what are the mechanisms
underlying these differences in clinical features and response
to treatment. I lead a Canadian Institute of Health
Research (CIHR)- and Group for Research and Assessment
of Psoriasis and Psoriatic Arthritis (GRAPPA)-funded
study with 40 sites across the world, which will attempt
to tease out sex-related biological factors such as pharmacokinetics
and immune factors from gender-related
socio-cultural factors, such as pain reporting and coping
mechanisms, in patients with PsA starting advanced therapies.
We hope that by better understanding these sex
and gender mechanisms, we can develop sex/gender-specific
approaches to improve care of both men and women
living with PsA.
Are there other areas of interest that you would like to
investigate in the future?
I hope to study the role of obesity in PsA, as I believe it has
a major influence on disease susceptibility, course and response
to therapy. My group is conducting an RCT that studies
the role of dietary modification as an adjunct therapy
in PsA. I hope to explore more closely the use of behavioural
and pharmacologic interventions to improve eating habits
and lower weight as ways to manage PsA, especially in
people who do not achieve optimal outcomes.
Dr. Lihi Eder receiving her award from CRA President
Dr. Nigil Haroon at the CRA Annual Scientific Meeting in
Quebec City, which took place in February 2023.
Your research efforts have resulted in over 140 peer-reviewed
publications in medical journals, book chapters
and editorials. You are frequently invited to present
the results of your studies in national and international
conferences in the fields of rheumatology, dermatology
and cardiology. You are an elected member of the GRAPPA
steering committee and President of the Canadian
Rheumatology Ultrasound Society. As a recognized expert
in rheumatology, you received a New Investigator Award
from the Arthritis Society (2016) and an Early Research
Award from the Ontario Ministry of Research Innovation and
Science (2018). What has been your proudest professional
accomplishment to date?
I am proud of all of these awards and achievements; it is very
hard to choose just one as they happened at different stages
of my career and were all meaningful. They mostly remind
me to pause, take a deep breath and recognize how very fortunate
I am to have the opportunity to get paid for doing
something that I enjoy so much.
What are some of the highlights and challenges you
have experienced thus far in your career? How have you
overcome these challenges?
My career path has been long and somewhat unplanned. As
an international fellow who did not originally plan to become
a scientist, I spent more than six years doing PhD and
postdoc training. Moving with two babies to Toronto, going
back to Israel, and then moving back to Toronto was also not
easy, especially with all our extended family living on the
other side of the globe. However, I do not regret any of the
choices I made.
I have always liked travelling and being a scientist has
given me the opportunity to visit many new places and meet
people from different countries, many of whom became
good friends. This is definitely one of the highlights of my
job. I also enjoy the fact that I can effect change through my
research. Studying clinical questions that arise during my
encounters with patients and being able to provide answers
to patients through my research as well as influence the field
is a huge bonus.
What was your first thought when you learned that you
would receive this award?
It is great to receive such recognition from the CRA. This
award means a lot to me since it comes from my peers, the
Canadian rheumatology community. I feel very honoured.
For those wanting to pursue rheumatology and a career in
research, what advice would you give them? Have you had
key mentors who supported your career path? If yes, what
were the key learnings you gained from them?
My best advice is to keep an open mind, explore different career
options, and not be discouraged by the length of training
needed to become a scientist. I had really good mentors
who supported my career and continue to do so. A key piece
of advice that I was given by one of my mentors is to always
work with people who can teach you something that you
don’t know.
If you weren’t pursuing research as a career, what would you
be doing?
I would be a veterinarian. That was my childhood dream.
If you had an extra hour in the day, how would you spend it?
Sleeping in an extra hour in the morning.
You are marooned on a desert island. What book would you
like to have on hand with you?
"A Tale of Love and Darkness" by Amos Oz. A highly recommended
Israeli novel.
What is your favourite food or cuisine?
I usually don’t say no to any type of chocolate dessert.
What is your dream vacation destination?
Any place with warm weather, a sandy beach, and good
food.
How many cups of coffee does it take to make a productive
day?
No more than two.
Lihi Eder, MD, PhD
Canada Research Chair in
Inflammatory Rheumatic Diseases (Tier 2)
Associate Professor of Medicine, University of Toronto
Women’s College Research Institute,
Women’s College Hospital
Toronto, Ontario
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