Diane Lacaille

Senior Research Scientist of Rheumatoloy, MD, MHSc, FRCPC

Appointments

  • Mary Pack Chair in Rheumatology,
  • Professor and Associate Head Academic Affairs, Division of Rheumatology,  Department of Medicine, University of British Columbia

Research Interests

  • Impact of arthritis on employment and preventing work disability
  • Evaluating the quality of health care services received by people with Rheumatoid Arthritis

Diane Lacaille is a Professor in the Division of Rheumatology at the University of British Columbia, and a Senior Research Scientist at the Arthritis Research Centre of Canada, in Vancouver. She practices rheumatology at the Mary Pack Arthritis Centre and she has a hospital appointment at Vancouver Hospital Health Sciences Centre (VHHSC). She completed medical school and internal medicine training at McGill University in Montreal, and her Rheumatology training and a Master’s in Health Sciences, clinical epidemiology track, at the University of British Columbia.

Learn more

Her research focuses on two areas: 1) Studying the impact of arthritis on employment and preventing work disability, and 2) Evaluating the quality of health care services received by people with RA, using a population-based cohort of RA for the province of BC.

She currently holds the Mary Pack Chair in Arthritis Research, funded by the Arthritis Society and the University of British Columbia. For the previous five years, she was funded by an Investigator Award from the Arthritis Society of Canada. She has also been funded by a New Investigator Award from Canadian Institutes of Health Research (CIHR) and The Arthritis Society of Canada, and a Research Scholar Award from Vancouver Hospital and Health Sciences Centre and the Canadian Arthritis Network (CAN)

She holds peer-reviewed operating grant funding for her research from CIHR, CAN, and Vancouver Foundation. She has published her research in Arthritis and Rheumatism, Annals of Rheumatic Diseases, Arthritis Care and Research, Journal of Rheumatology, Journal of Vocational Rehabilitation, Canadian Medical Association Journal, Human Immunology, Health Policy, Lancet, and Journal of Clinical Epidemiology.

She is a member of the Canadian Arthritis Network and was a member of their Research Management Committee and their Training and Education Committee. She is a member of the OMERACT Special Interest Group working on measures for evaluating employment. She is also a member of the Quality of Care Committee of the Canadian Rheumatology Association, and the Quality Indicators Subcommittee of the American College of Rheumatology. She is co-chair of the BC Practice Support Program for arthritis. She sits on the editorial boards of the Arthritis Care and Research Journal and the Journal of the Canadian Rheumatology Association.

She has received distinction awards for her contribution to rheumatology research, including the Jeff Shiroky Award for excellence in RA research, the Young Investigator Award from the Canadian Rheumatology Association and the Quality of Life Research Award from the Institute of Musculoskeletal Health and Arthritis (IMHA)—a distinction award for having obtained the highest score of all applications in Arthritis, Pain and Disability. Finally, she was a recipient of the Martin M. Hoffman Award for Excellence in Research at the University of British Columbia.

Building on her research on employment and arthritis, she has developed the first comprehensive program specifically designed to prevent Work Disability (WD) in employed people with inflammatory arthritis, such as RA. The program enhances self-management of problems encountered at work due to arthritis and modifies risk factors for WD. The program was pilot tested and showed promising results. It resulted in concrete changes and improved self-confidence and self-rated productivity at work. Her team has converted this program into a web-based version, in order to make this valuable resource more accessible to people with RA all over the province. She has received CIHR funding to test the program’s effectiveness at reducing WD and improving at work productivity in a randomized controlled trial. By preventing WD, this research will reduce the tremendous economic and social burden of RA.

As part of her research evaluating the quality of care for RA at the population level, she has assembled a population-based cohort of RA patients in BC. This research has exposed important gaps in care for RA. She found that the majority of RA patients do not receive the care that is recommended for their disease. More than half are not using the medications considered essential for RA (DMARDs) and few are followed by rheumatologists. These results point to the need for educating family physicians and people with RA about the shift in treatment paradigms in RA, and to the need for increased rheumatologist access and manpower. She is now evaluating the impact of educational interventions, such as academic detailing to Family Physicians, on the quality of care delivered to people with rheumatoid arthritis.

She is also evaluating the effect of medications used to treat RA on cardiovascular disease. Her research has been looking at other chronic medical conditions that people with RA are at risk of, such as cardiovascular diseases, infections and osteoporosis, and evaluating how these are treated and how medications used for RA may impact these conditions.

This research is important to people with RA and their health care providers, and has potential to improve the quality of care and outcome of RA.

Publications

van Genderen S, Plasqui G, van der Heijde D, van Gaalen F, Heuft L, Luime J, Spoorenberg A, Arends S, Lacaille D, Gignac M, Landewé R, Boonen A. Social role participation and satisfaction with life: A study among patients with ankylosing spondylitis and population controls. Arthritis Care Res (Hoboken). 2017 Jun 16. doi: 10.1002/acr.23304. [Epub ahead of print] PubMed PMID: 28622457. https://www.ncbi.nlm.nih.gov/pubmed/28622457

 

Chhina H, Hall W, Kaczorowski J, Marra C, Lacaille D. Family physicians’ perceptions of academic detailing for rheumatoid arthritis: a qualitative study. Quality in Primary Care. 2017. Accepted. http://primarycare.imedpub.com/qualitative-insights-into-family-physicians-perceptions-of-academic-detailing-for-rheumatoid-arthritis.php?aid=19316

 

Li LC, Shaw C, Lacaille D, Yacyshyn E, Jones CA, Koehn C, Hoens AM, Geldman J, Sayre EC, Macdonald G, Leese J, Bansback N. Effects of a Web-Based Patient Decision Aid on Biologic and Small Molecule Agents for Rheumatoid Arthritis, ANSWER-2: A Proof-of-Concept Study. Arthritis Care Res (Hoboken). 2017 May 23. doi: 10.1002/acr.23287. [Epub ahead of print] PubMed PMID: 28544648. https://www.ncbi.nlm.nih.gov/pubmed/28544648

 

Petkovic J, Barton JL, Flurey C, Goel N, Bartels CM, Barnabe C, de Wit MP, Lyddiatt A, Lacaille D, Welch V, Boonen A, Shea B, Christensen R, Maxwell LJ, Campbell W, Jull J, Toupin-April K, Singh JA, Goldsmith CH, Sreih AG, Pohl C, Hofstetter C, Beaton DE, Buchbinder R, Guillemin F, Tugwell PS. Health Equity Considerations for Developing and Reporting Patient-reported Outcomes in Clinical Trials: A Report from the OMERACT Equity Special Interest Group. J Rheumatol. 2017 Feb 15. pii: jrheum.160975. doi: 10.3899/jrheum.160975. [Epub ahead of print] PubMed PMID: 28202740. https://www.ncbi.nlm.nih.gov/pubmed/28202740

 

Lacaille D, Avina-Zubieta JA, Sayre EC, Abrahamowicz M. Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population-closing the mortality gap. Ann Rheum Dis. 2017 Jun;76(6):1057-1063. doi: 10.1136/annrheumdis-2016-209562. Epub 2016 Dec 28. PubMed PMID: 28031164. https://www.ncbi.nlm.nih.gov/pubmed/28031164

 

Barber CE, Jewett L, Badley EM, Lacaille D, Cividino A, Ahluwalia V, Averns H, Baillie C, Ellsworth J, Pope J, Levy D, Charnock C, McGowan C, Thorne JC, Barnabe C, Zummer M, Lundon K, McDougall RS, Thomson JG, Yacyshyn EA, Mosher D, Brophy J, Ruban TN, Marshall DA. Stand Up and Be Counted: Measuring and Mapping the Rheumatology Workforce in Canada. J Rheumatol. 2017 Feb;44(2):248-257. doi: 10.3899/jrheum.160621. Epub 2016 Dec 1. PubMed PMID: 27909087. https://www.ncbi.nlm.nih.gov/pubmed/27909087

 

van Genderen S, Plasqui G, Landewé R, Lacaille D, Arends S, van Gaalen F, van der Heijde D, Heuft L, Luime J, Spoorenberg A, Gignac M, Boonen A. Social Role Participation in Patients With Ankylosing Spondylitis: A Cross-Sectional Comparison With Population Controls. Arthritis Care Res (Hoboken). 2016 Dec;68(12):1899-1905. doi: 10.1002/acr.22907. Epub 2016 Oct 28. PubMed PMID: 27059161. https://www.ncbi.nlm.nih.gov/pubmed/27059161

 

Yazdany J, Robbins M, Schmajuk G, Desai S, Lacaille D, Neogi T, Singh JA, Genovese M, Myslinski R, Fisk N, Francisco M, Newman E. Development of the American College of Rheumatology’s Rheumatoid Arthritis Electronic Clinical Quality Measures. Arthritis Care Res (Hoboken). 2016 Nov;68(11):1579-1590. doi: 10.1002/acr.22984. PubMed PMID: 27564778. https://www.ncbi.nlm.nih.gov/pubmed/27564778

 

Khodyakov D, Grant S, Barber CE, Marshall DA, Esdaile JM, Lacaille D. Acceptability of an online modified Delphi panel approach for developing health services performance measures: results from 3 panels on arthritis research. J Eval Clin Pract. 2017 Apr;23(2):354-360. doi: 10.1111/jep.12623. Epub 2016 Sep 13. PubMed PMID: 27619536. https://www.ncbi.nlm.nih.gov/pubmed/27619536

 

Rai SK, Aviña-Zubieta JA, McCormick N, De Vera MA, Lacaille D, Sayre EC, Choi HK. Trends in Gout and Rheumatoid Arthritis Hospitalizations in Canada From 2000 to 2011. Arthritis Care Res (Hoboken). 2017 May;69(5):758-762. doi: 10.1002/acr.23012. PubMed PMID: 27565008; PubMed Central PMCID: PMC5326689. https://www.ncbi.nlm.nih.gov/pubmed/27565008

 

Yazdany J, Myslinski R, Miller A, Francisco M, Desai S, Schmajuk G, Lacaille D, Barber CE, Orozco C, Bunyard M, Bergman MJ, Passo M, Matteson EL, Olson R, Silverman S, Warren R, Nola K, Robbins M. Methods for Developing the American College of Rheumatology’s Electronic Clinical Quality Measures. Arthritis Care Res (Hoboken). 2016 Oct;68(10):1402-9. doi: 10.1002/acr.22985. Epub 2016 Sep 16. PubMed PMID: 27390129. https://www.ncbi.nlm.nih.gov/pubmed/27390129

 

Bansback N, Shojania K, Lacaille D. Improving patient-centred care for rheumatoid arthritis. CMAJ. 2016 Oct 4;188(14):999-1000. Epub 2016 Jun 27. PubMed PMID: 27354676; PubMed Central PMCID: PMC5047811. https://www.ncbi.nlm.nih.gov/pubmed/27354676

 

van Genderen S, Plasqui G, Lacaille D, Arends S, van Gaalen F, van der Heijde D, Heuft L, Keszei A, Luime J, Spoorenberg A, Landewé R, Gignac M, Boonen A. Social Role Participation Questionnaire for patients with ankylosing spondylitis: translation into Dutch, reliability and construct validity. RMD Open. 2016 Feb 1;2(1):e000177. doi: 10.1136/rmdopen-2015-000177. eCollection 2016. PubMed PMID: 26870393; PubMed Central PMCID: PMC4746579. https://www.ncbi.nlm.nih.gov/pubmed/26870393

 

Leggett S, van der Zee-Neuen A, Boonen A, Beaton D, Bojinca M, Bosworth A, Dadoun S, Fautrel B, Hagel S, Hofstetter C, Lacaille D, Linton D, Mihai C, Petersson IF, Rogers P, Sciré C, Verstappen SM; at-work productivity global measure working group. Content validity of global measures for at-work productivity in patients with rheumatic diseases: an international qualitative study. Rheumatology (Oxford). 2016 Aug;55(8):1364-73. doi: 10.1093/rheumatology/kev435. Epub 2016 Jan 21. PubMed PMID: 26796771. https://www.ncbi.nlm.nih.gov/pubmed/26796771

 

Barber CE, Marshall DA, Mosher DP, Akhavan P, Tucker L, Houghton K, Batthish M, Levy DM, Schmeling H, Ellsworth J, Tibollo H, Grant S, Khodyakov D, Lacaille D; Arthritis Alliance of Canada Performance Measurement Development Panel. Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada. J Rheumatol. 2016 Mar;43(3):530-40. doi: 10.3899/jrheum.150839. Epub 2016 Jan 15. PubMed PMID: 26773106. https://www.ncbi.nlm.nih.gov/pubmed/26773106

 

Leggett S, van der Zee-Neuen A, Boonen A, Beaton DE, Bojinca M, Bosworth A, Dadoun S, Fautrel B, Hagel S, Hofstetter C, Lacaille D, Linton D, Mihai C, Petersson IF, Rogers P, Sergeant JC, Sciré C, Verstappen SM; At-work Productivity Global Measure Working Group. Test-retest Reliability and Correlations of 5 Global Measures Addressing At-work Productivity Loss in Patients with Rheumatic Diseases. J Rheumatol. 2016 Feb;43(2):433-9. doi: 10.3899/jrheum.141605. Epub 2015 Dec 1. PubMed PMID: 26628608. https://www.ncbi.nlm.nih.gov/pubmed/26628608

 

Beaton DE, Dyer S, Boonen A, Verstappen SM, Escorpizo R, Lacaille DV, Bosworth A, Gignac MA, Leong A, Purcaru O, Leggett S, Hofstetter C, Peterson IF, Tang K, Fautrel B, Bombardier C, Tugwell PS. OMERACT Filter Evidence Supporting the Measurement of At-work Productivity Loss as an Outcome Measure in Rheumatology Research. J Rheumatol. 2016 Jan;43(1):214-22. doi: 10.3899/jrheum.141077. Epub 2015 Sep 1. Review. PubMed PMID: 26329339. https://www.ncbi.nlm.nih.gov/pubmed/26329339

 

McCormick N, Bhole V, Lacaille D, Avina-Zubieta JA. Validity of Diagnostic Codes for Acute Stroke in Administrative Databases: A Systematic Review. PLoS One. 2015 Aug 20;10(8):e0135834. doi: 10.1371/journal.pone.0135834. eCollection 2015. PubMed PMID: 26292280; PubMed Central PMCID: PMC4546158. https://www.ncbi.nlm.nih.gov/pubmed/26292280

 

Moura CS, Abrahamowicz M, Beauchamp ME, Lacaille D, Wang Y, Boire G, Fortin PR, Bessette L, Bombardier C, Widdifield J, Hanly JG, Feldman D, Maksymowych W, Peschken C, Barnabe C, Edworthy S, Bernatsky S; CAN-AIM. Early medication use in new-onset rheumatoid arthritis may delay joint replacement: results of a large population-based study. Arthritis Res Ther. 2015 Aug 3;17:197. doi: 10.1186/s13075-015-0713-3. PubMed PMID: 26235697; PubMed Central PMCID: PMC4522999. https://www.ncbi.nlm.nih.gov/pubmed/26235697

 

Barber CE, Marshall DA, Alvarez N, Mancini GB, Lacaille D, Keeling S, Aviña-Zubieta JA, Khodyakov D, Barnabe C, Faris P, Smith A, Noormohamed R, Hazlewood G, Martin LO, Esdaile JM; Quality Indicator International Panel. Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process. J Rheumatol. 2015 Sep;42(9):1548-55. doi: 10.3899/jrheum.141603. Epub 2015 Jul 15. PubMed PMID: 26178275; PubMed Central PMCID: PMC4758831. https://www.ncbi.nlm.nih.gov/pubmed/26178275

 

Stolwijk C, Castillo-Ortiz JD, Gignac M, Luime J, Boonen A; Lacaille D, OMERACT Worker Productivity Group. Importance of Contextual Factors When Measuring Work Outcome in Ankylosing Spondylitis: A Systematic Review by the OMERACT Worker Productivity Group. Arthritis Care Res (Hoboken). 2015 Sep;67(9):1316-27. https://www.ncbi.nlm.nih.gov/pubmed/25732705

 

Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol. 2015 Jan;68(1):3-14. doi:10.1016/j.jclinepi.2014.09.010. Epub 2014 Oct 31. Review. PubMed PMID: 25441702. https://www.ncbi.nlm.nih.gov/pubmed/25441702

 

Hoving JL, Lacaille D, Urquhart DM, Hannu TJ, Sluiter JK, Frings-Dresen MH. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database Syst Rev. 2014 Nov 6;(11):CD010208. doi: 10.1002/14651858.CD010208.pub2. Review. PubMed PMID: 25375291. https://www.ncbi.nlm.nih.gov/pubmed/25375291

 

De Vera MA, Bhole V, Burns LC, Lacaille D. Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review. Br J Clin Pharmacol. 2014 Oct;78(4):684-98. Review. PubMed PMID: 25364801; PubMed Central PMCID: PMC4239963. https://www.ncbi.nlm.nih.gov/pubmed/25364801

 

McCormick N, Lacaille D, Bhole V, Avina-Zubieta JA. Validity of heart failure diagnoses in administrative databases: a systematic review and meta-analysis. PLoS One. 2014 Aug 15;9(8):e104519. doi: 10.1371/journal.pone.0104519. eCollection 2014. Review. PubMed PMID: 25126761; PubMed Central PMCID: PMC4134216. https://www.ncbi.nlm.nih.gov/pubmed/25126761

 

Barber CE, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GB, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D. Best practices for cardiovascular disease prevention in rheumatoid arthritis: a systematic review of guideline recommendations and quality indicators. Arthritis Care Res (Hoboken). 2015 Feb;67(2):169-79. doi: 10.1002/acr.22419. Review. PubMed PMID: 25074725. https://www.ncbi.nlm.nih.gov/pubmed/25074725

 

Carruthers EC, Rogers P, Backman CL, Goldsmith CH, Gignac MA, Marra C, Village J, Li LC, Esdaile JM, Lacaille D. “Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol). BMC Med Inform Decis Mak. 2014 Jul 21;14:59. doi: 10.1186/1472-6947-14-59. PubMed PMID: 25043631; PubMed Central PMCID: PMC4123503. https://www.ncbi.nlm.nih.gov/pubmed/25043631

 

McCormick N, Lacaille D, Bhole V, Avina-Zubieta JA. Validity of myocardial infarction diagnoses in administrative databases: a systematic review. PLoS One. 2014 Mar 28;9(3):e92286. doi: 10.1371/journal.pone.0092286. eCollection 2014. PubMed PMID: 24682186; PubMed Central PMCID: PMC3969323. https://www.ncbi.nlm.nih.gov/pubmed/24682186

 

Li LC, Adam PM, Backman CL, Lineker S, Jones CA, Lacaille D, Townsend AF, Yacyshyn E, Yousefi C, Tugwell P, Leese J, Stacey D. Proof-of-concept study of a Web-based methotrexate decision aid for patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2014 Oct;66(10):1472-81. doi: 10.1002/acr.22319. PubMed PMID: 24623617. https://www.ncbi.nlm.nih.gov/pubmed/24623617

 

Broten L, Aviña-Zubieta JA, Lacaille D, Joseph L, Hanly JG, Lix L, O’Donnell S, Barnabe C, Fortin PR, Hudson M, Jean S, Peschken C, Edworthy SM, Svenson L, Pineau CA, Clarke AE, Smith M, Bélisle P, Badley EM, Bergeron L, Bernatsky S. Systemic autoimmune rheumatic disease prevalence in Canada: updated analyses across 7 provinces. J Rheumatol. 2014 Apr;41(4):673-9. doi: 10.3899/jrheum.130667. Epub 2014 Mar 1. PubMed PMID: 24584928. https://www.ncbi.nlm.nih.gov/pubmed/24584928

 

Gignac MA, Lacaille D, Beaton DE, Backman CL, Cao X, Badley EM. Striking a balance: work-health-personal life conflict in women and men with arthritis and its association with work outcomes. J Occup Rehabil. 2014 Sep;24(3):573-84. doi: 10.1007/s10926-013-9490-5. PubMed PMID: 24370635; PubMed Central PMCID: PMC4118040. https://www.ncbi.nlm.nih.gov/pubmed/24370635

 

Li LC, Adam PM, Townsend AF, Lacaille D, Yousefi C, Stacey D, Gromala D, ShawCD, Tugwell P, Backman CL. Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis. BMC Med Inform Decis Mak. 2013 Dec 1;13:131. doi: 10.1186/1472-6947-13-131. PubMed PMID: 24289731; PubMed Central PMCID: PMC4220621. https://www.ncbi.nlm.nih.gov/pubmed/24289731

 

Chhina HK, Bhole VM, Goldsmith C, Hall W, Kaczorowski J, Lacaille D. Effectiveness of academic detailing to optimize medication prescribing behaviour of family physicians. J Pharm Pharm Sci. 2013;16(4):511-29. Review. PubMed PMID: 24210060. https://www.ncbi.nlm.nih.gov/pubmed/24210060

 

Leong A, Dasgupta K, Bernatsky S, Lacaille D, Avina-Zubieta A, Rahme E. Systematic review and meta-analysis of validation studies on a diabetes case definition from health administrative records. PLoS One. 2013 Oct 9;8(10):e75256. doi: 10.1371/journal.pone.0075256. eCollection 2013. Review. PubMed PMID: 24130696; PubMed Central PMCID: PMC3793995. https://www.ncbi.nlm.nih.gov/pubmed/24130696

 

Tang K, Boonen A, Verstappen SM, Escorpizo R, Luime JJ, Lacaille D, Fautrel B, Bosworth A, Cifaldi M, Gignac MA, Hofstetter C, Leong A, Montie P, Petersson IF, Purcaru O, Bombardier C, Tugwell PS, Beaton DE. Worker productivity outcome measures: OMERACT filter evidence and agenda for future research. J Rheumatol. 2014 Jan;41(1):165-76. doi: 10.3899/jrheum.130815. Epub 2013 Oct 15. PubMed PMID: 24128774. https://www.ncbi.nlm.nih.gov/pubmed/24128774

 

Tang K, Beaton DE, Lacaille D, Gignac MA, Bombardier C; Canadian Arthritis Network (CAN) Work Productivity Group. Sensibility of five at-work productivity measures was endorsed by patients with osteoarthritis or rheumatoid arthritis. J Clin Epidemiol. 2013 May;66(5):546-56. doi: 10.1016/j.jclinepi.2012.12.009. Epub 2013 Mar 1. PubMed PMID: 23466017. https://www.ncbi.nlm.nih.gov/pubmed/23466017

 

Hudson M, Avina-Zubieta A, Lacaille D, Bernatsky S, Lix L, Jean S. The validity of administrative data to identify hip fractures is high–a systematic review. J Clin Epidemiol. 2013 Mar;66(3):278-85. doi: 10.1016/j.jclinepi.2012.10.004. Review. PubMed PMID: 23347851. https://www.ncbi.nlm.nih.gov/pubmed/23347851

 

Barber C, Lacaille D, Fortin PR. Systematic review of validation studies of the use of administrative data to identify serious infections. Arthritis Care Res (Hoboken). 2013 Aug;65(8):1343-57. doi: 10.1002/acr.21959. Review. PubMed PMID: 23335588. https://www.ncbi.nlm.nih.gov/pubmed/23335588

 

Gignac MA, Backman CL, Davis AM, Lacaille D, Cao X, Badley EM. Social role participation and the life course in healthy adults and individuals with osteoarthritis: are we overlooking the impact on the middle-aged? Soc Sci Med. 2013 Mar;81:87-93. doi: 10.1016/j.socscimed.2012.12.013. Epub 2012 Dec 20. PubMed PMID: 23312300. https://www.ncbi.nlm.nih.gov/pubmed/23312300

 

Man A, Shojania K, Phoon C, Pal J, de Badyn MH, Pi D, Lacaille D. An evaluation of autoimmune antibody testing patterns in a Canadian health region and an evaluation of a laboratory algorithm aimed at reducing unnecessary testing. Clin Rheumatol. 2013 May;32(5):601-8. doi: 10.1007/s10067-012-2141-y. Epub 2013 Jan 6. PubMed PMID: 23292519. https://www.ncbi.nlm.nih.gov/pubmed/23292519