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Arthritis Research Canada at

ACR Convergence 2021

November 7

Validation studies of rheumatoid arthritis patient-reported outcome measures in diverse populations at risk for inequity: A systematic review

Patients are asked to complete a variety of questionnaires to assess if their pain, disease activity, overall well-being and quality of life is improving with rheumatoid arthritis treatment. However, the studies to develop various outcome measures do not typically recruit patients who represent diverse populations characterized by their race or ethnicity, sex or gender, nor other aspects of social status and income levels. We reviewed the existing literature and found that there are a few studies that validate outcome measures by cultures or languages, but there are important gaps in knowing how these measures perform in other equity-deserving populations.

Research Team: Barnabe C, Wattiaux VA, Petkovic J, Beaton D, Shea B, Greer-Smith R, Humphreys J, Bartels C, Tugwell P, Umaefulam V

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Adaptation of a shared decision-making tool for early rheumatoid arthritis treatment decisions with Indigenous patients

The study adapted a decision aid to help people with early rheumatoid arthritis make treatment decisions, for use with Canadian Indigenous patients. Changes made to the decision aid included adding Indigenous images and colors, traditional healing practice options, information about lifestyle factors in managing RA, and addressing medical coverage for non-status First Nations patients.

Research Team: Umaefulam V, Fox TL, Hazlewood G, Bansback N, Barber C, Barnabe C

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HELP-seeking behaviours and treatment preferences for sleep problems among persons with lupus

An on-line survey with 119 individuals with lupus from across Canada found that 44.6% of persons with insomnia symptoms felt a need to talk to a health care provider about their sleep problems in the past year but decided not to seek care. Almost all the participants (98%) reported that they would be likely or very likely to try a non-medication approach delivered over the internet and tailored to lupus to improve sleep.

Research Team: Da Costa D, Savard J, Rahme E, Fortin PR

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Predictors of health-related quality of life in rheumatoid arthritis patients

This study evaluated the relative contribution of sociodemographic, rheumatoid arthritis related, comorbidities, and lifestyle factors in predicting the health-related quality of life (HRQoL) of rheumatoid arthritis patients. Comorbidities (depression) contributed the most to predicting HRQoL, while lifestyle and sociodemographic factors contributed very little. HRQoL of the previous year contributed most to predicting future HRQoL.

Research Team: Hassen N, Zheng Y, Xie H, Khan K, Kopec J, Lacaille D

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“Our arthritis may be chronic but we are definitely iconic” – two teens created a national podcast for youth with rheumatic diseases

We co-founded and launched a podcast called Take a Pain Check (TAPC) in March of 2021. It is available on Spotify, YouTube, Apple podcast, and Anchor. Every week, TAPC features a new guest who shares their unique lived experience of rheumatic disease, offering listeners different perspectives to learn from.

Research Team: Peters T, Trehan N

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Determinants of accessing social and news media and experiencing negative impacts during COVID-19 in an International SLE Sample

During the COVID-19 pandemic, several sociodemographic factors and access to their family doctors influenced how likely lupus patients were to get health information from social media and to report negative experiences in doing so.

Research Team: Cardwell F, Elliott S, Chin R, Rowbottom L, St.Pierre Y, Choi M, Urowitz M, Ruiz-Irastorza G, Bernatsky S, Petri M, Manzi S, Peschken C, Ramsey-Goldman R, Fortin PR, Shin J, Bae SC, Cho J, Mak A, Hanly J, Askanase A, Romero-Diaz J, Nieto R, Pons-Estel BA, Bruce IA, Wallace D, Clarke A

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Health information use by systemic lupus erythematosus patients pre and during COVID-19

During the COVID-19 pandemic, lupus patients accessed health information from news media, and less often from their lupus doctors and family doctors.

Research Team: Cardwell F, Elliott S, Choi M, Chin R, St.Pierre Y, Rowbottom L, Urowitz M, Ruiz-Irastorza G, Bernatsky S, Petri M, Manzi S, Peschken C, Ramsey-Goldman R, Fortin PR, Shin J, Bae SC, Cho J, Mak A, Hanly J, Askanase A, Romero-Diaz J, Nieto R, Pons-Estel BA, Bruce IN, Wallace D, Clarke A.

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Hyperinsulinemic diet and increased risk of female gout: 2 prospective cohort studies of US women over 30 years

Using data collected from 170,699 women over 30 years, we found that eating a diet that increases the risk of diabetes (e.g. sugary beverages, fries, red and processed meats) was also associated with a higher risk of gout, independent of being overweight or obese and other risk factors. Eating less of these foods may reduce the risk of gout.

Research Team: McCormick N, Yokose C, Lu N, Joshi A, Choi HK

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Pro-inflammatory diet and increased risk of incident female gout: 30-year prospective cohort study of >170,000 pre- and post-menopausal US women

We analyzed data from 170,879 women followed over 30 years and found those who ate more pro-inflammatory foods (i.e. red/processed meats, tomato products, sugary beverages, and refined grains) were more likely to develop gout. Replacing these foods with less inflammatory ones (i.e. coffee, vegetables) may reduce the risk of female gout and associated conditions like heart disease and diabetes.

Research Team: McCormick N, Yokose C, Lu N, Joshi A, Choi HK

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Risk factors for hydroxychloroquine retinopathy and its subtypes – prospective adjudication analysis of 4,899 incident users

Hydroxychloroquine (HCQ) is often used long-term in people with lupus, rheumatoid arthritis, and other types of arthritis. We identified subgroups of patients at higher risk of developing side effects of hydroxychloroquine on the retina that could affect vision if undetected. These patients would benefit from closer monitoring.

Research Team: Jorge A, Melles R, Conell C, Lu N, Marmor M, Young L, McCormick N, Zhang Y, Choi HK

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Low dose dual energy CT scan for the detection of bone marrow edema and erosions in axial spondyloarthritis

Contrary to what was taught in older textbooks, no difference was found in the imaging of the sacroiliac joints of patients with spondyloarthritis with and without extraarticular manifestations, such as psoriasis or inflammation of the eyes or bowel.

Research Team: Chan J, Nicolaou S, Yan YY, Osman M, Ouellette H, Jalal S

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Economic evaluation of neuropsychiatric (NP) lupus in an international inception cohort using a multistate model approach

An economic evaluation of the impact of lupus disease affecting the brain in patients enrolled in an international study.

Research Team: Clarke AE, Hanly J, St.Pierre Y, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace D, Isenberg D, Rahman A, Merrill J, Fortin PR, Gladman D, Urowitz M, Bruce IN, Petri M, Ginzler E, Dooley MA, Ramsey-Goldman R, Manzi S, Jansen A, Alarcon G, van Vollenhoven R, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen D, Askanase A, Farewelle V

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Primary total knee arthroplasty for knee osteoarthritis among younger versus older Individuals: Cross-sectional study of surgical appropriateness and surgeon decision-making

Rising rates of total knee replacement surgery in younger adults with knee osteoarthritis has prompted concern about surgical appropriateness. We compared patient appropriateness for knee replacement and surgeons’ recommendations for surgery according to patient age. Among 2,064 individuals in the BEST Knee cohort referred for consideration of knee replacement for osteoarthritis, we found that younger patients (<60 years old) had comparable need, readiness, and willingness for surgery as those older than 60 years.

Research Team: Hawker G, Bohm E, Dunbar M, Jones A, Noseworthy T, Marshall D

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Does obesity affect gout risk differently among genetically predisposed individuals? Sex-specific prospective cohort study findings over >32 years.

Although both genetics and body weight influence one’s risk of developing gout, we found that the rates of new gout were much higher among those with both overweight/obesity and a greater genetic tendency. Losing excess weight is important for reducing gout risk, especially for those more genetically predisposed.

Research Team: Yokose C, McCormick N, Lu N, Joshi A, Choi HK

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Does diet affect gout risk differently among genetically predisposed women? Prospective female cohort study findings over 34 years.

Building on our prior findings on dietary patterns and gout risk in men, we analyzed data from 18,247 US women over 34 years and found that a Western-style diet increased the risk of gout, while a DASH-style diet (originally designed to lower blood pressure) reduced the risk, more so for women with a greater genetic tendency for gout.

Research Team: Yokose C, McCormick N, Lu N, Joshi A, Choi HK

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Novel insights into systemic sclerosis using a sensitive computational method to analyze whole-genome bisulfite sequencing data

We applied a new, powerful method of analyzing genomic data to identify genes involved in scleroderma. In addition to some known genes, we identified new ones. These results help further our understanding of the disease process in scleroderma and provide potential new targets of intervention.

Research Team: Yu J, Lu T, Zhao K, Oros Klein K, Lora M, Colmegna I, C Greenwood CMT, Hudson M

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Risk prediction models for incident systemic lupus erythematosus using lifestyle/environmental risk factors and a genetic risk score

We developed a score that predicts whether someone is likely to get lupus based on their genes and lifestyle factors.

Research Team: Cui J, Malspeis S, Choi M, Lu B, Sparks J, Yoshida K, Costenbader K.

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Systemic lupus erythematosus phenotypes formed from machine learning and their associations with cognitive impairment

Artificial intelligence was used to identify different groups of lupus patients according to how their lupus affects their ability to think and process information.

Research Team: Barraclough M, Erdman L, Knight A, Diaz-Martinez J, Bingham K, Su J, Kakvan M, Tartaglia M, Ruttan L, Wither J, Choi M, Fritzler M, Bonilla D, Beaton D, Parker B, Green R, Katz P, Bruce IN, Touma Z

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Association of mycophenolate and azathioprine use with cognitive function in systemic lupus erythematosus

Lupus patients taking azathioprine medication may have a lower risk of developing issues with thinking and processing information compared to those not taking it. Mycophenolate likely does not make a difference.

Research Team: Dobrowolski C, Su J, McGinley J, Fazzari M, Bingham K, Anderson N, Beaton D, Ruttan L, Wither J, Tartaglia M, Kakvan M, Bonilla D, Choi M, Fritzler M, Katz P, Green R, Putterman C, Touma Z

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Impact of systemic lupus disease activity state on flare risk after hydroxychloroquine maintenance, reduction or discontinuation in a multinational inception cohort

This international study of patients with lupus showed that People with lupus who stay on their hydroxychloroquine have a lower risk of flaring than if they reduce the dose or stop it.

Research Team: Brasil C, Hanly J, Urowitz M, Clarke A, Ramsey-Goldman R, Gordon C, Petri M, Ginzler E, Wallace D, Bae S, JRomero-Diaz J, Dooley MA, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim SS, van Vollenhoven RF, Nived O, Jnsen A, Kamen D, Aranow C, Ruiz-Irastorza G, Sanchez-Guerrero J, Gladman D, Fortin PR, Alarcon G, Merrill J, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, AAskanase A, Khamashta M, Bruce IN, Inanc M, Bernatsky S

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Associations among antiphospholipid antibody types, isotypes, and titers: Results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) clinical database and repository (“Registry”)

The objective of this study was to further characterize the types of auto-antibodies seen in patients with antiphospholipid syndrome followed as part of an international study. The results confirmed that three tests are highly correlated: lupus anticoagulant, anticardiolipin antibodies and anti-b2 glycoprotein I antibodies.

Research Team: Gkrouzman E, Andrade D, Tektonidou M, Pengo V, Ugarte A, Belmont HM, Chighizola C, Fortin PR, Atsumi T, Efthymiou M, Ramires de Jesus G, Branch DW, Andreoli L, Petri M, Rodriguez-Almaraz E, Cervera R, Knight J, Gonzalez E, Bison E, Mackie I, Cohen H, Bertolaccini ML, Erkan D, Roubey R, and on behalf of APS ACTION

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The impact of comorbidities on the Simple Disease Activity Index (SDAI) and its components over the first year of follow-up – an analysis from the Canadian Early Arthritis Cohort (CATCH)

It is known that patients with established rheumatoid arthritis (RA) who have comorbid health conditions often have more difficulty reaching remission or low disease activity states and poorer health outcomes in general. We examined the disease course of 2248 patients over the first year of living with RA and found that having comorbidities at disease onset also negatively affected patient and physician reported disease activity.

Research Team: Chen LR, Schieir O, Valois MF, Pope J, Bartlett S, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Singbo N, Bykerk V, Bessette L

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Marked capillary basement membrane reduplication is the hallmark histopathological feature of scleromyositis

The evaluation of muscle capillaries by electron microscopy revealed distinctive features that distinguish scleromyositis, a form of muscle disease with scarring of the muscles, from other inflammatory diseases of the muscles. This will improve early diagnosis, so they can receive appropriate treatment.

Research Team: Ellezam B, Troyanov Y, Leclair V, Bersali I, Giannini M, Hoa S, Bourré-Tessier J, Satoh M, Fritzler M, Lannes B, Senécal JL, Hudson M, Meyer A, Landon-Cardinal O

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Association of subjective cognitive report using PDQ-20 to a neuropsychological battery in a cohort of systemic lupus erythematosus patients

To assess difficulty in thinking and information processing in patients with lupus, we compared a questionnaire called the perceived deficits questionnaires to a questionnaire that is regularly used.

Research Team: Gupta A, Johnson S, Su J, Knight A, Diaz-Martinez J, Bingham K, Kakvan M, Tartaglia M, Ruttan L, Wither J, Choi M, Fritzler M, Bonilla D, Beaton D, Katz P, Green R, Touma Z.

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Autoantibody testing in juvenile localized scleroderma and systemic sclerosis: Comparing antibody profiles and clinical correlations

We compared a series of blood markers called autoantibodies between children with two different types of scleroderma and evaluated how it influenced clinical manifestations.

Research Team: Li J, Mirizio E, Buhler K, Choi M, Hou H, Werner G, Sanyal A, Schollaert-Fitch K, Fritzler M, Torok K

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Insight into intraindividual variability across neuropsychological tests and its association with cognitive dysfunction in patients with systemic lupus erythematosus

We examined the variation in a score that is used to measure performance in thinking capability and information processing in patients with lupus.

Research Team: He J, Diaz-Martinez J, Bingham K, Su J, Kakvan M, Tartaglia M, Ruttan L, Beaton D, Wither J, Choi M, Fritzler M, Anderson N, Bonilla D, Green R, Katz P, Touma Z

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Persistent disease activity impairs work productivity and non-work activity in recent onset rheumatoid arthritis

On this study of 673 Canadians, we examined how a new diagnosis of rheumatoid arthritis affected work productivity and non-work activities. Our results suggested that in the first year, productivity at work and at home decreased by nearly 40%. While these impairments improved with treatment, persistent disease activity was associated with ongoing decreases in productivity in work and non-work activities.

Research Team: Hitchon C, Valois MF, Schieir O, Bartlett S, Bessette L, Boire G, Hazlewood G, Keystone E, Pope J, Thorne C, Tin D, Bykerk V; Canadian Early Arthritis Cohort (CATCH) Investigators

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Does imaging of the sacroiliac joint and spine differ in patients presenting with undiagnosed back pain and psoriasis, acute anterior uveitis, and colitis: An inception cohort study

Low dose CT is a new technique that uses less radiation than a traditional pelvic X-ray but has much higher resolution. We utilized dual energy CT scanning methods to see if we could detect inflammation in the SI joints and compared it to MRI. We found that DECT was very specific but not very sensitive for detecting inflammation. Most patients had evidence of erosions. This technology could be quite helpful since low dose CT is much easier to order and cheaper than an MRI.

Research Team: Maksymowych W, Weber U, Chan J, Carmona R, Yeung J, Aydin SZ, Reis J, Martin L, Masetto A, Ziouzina O, Mosher D, Keeling S, Rohekar S, Dadashova R, Paschke J, Carapellucci A, Lambert R

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Characteristics associated with poor COVID-19 outcomes in people with systemic lupus erythematosus: Data from the COVID-19 Global Rheumatology Alliance (GRA)

Research Team: Ugarte-Gil M, Alarcn G, Seet A, Izadi Z, Duarte-Garcia A, Reategui-Sokolova C, Clarke A, WiseL, Pons-Estel G, Santos MJ, Bernatsky S, Lúcia Ribeiro S, Al Emadi S, Sparks J, Hsu1 T, D’Silva K, Patel N, Gilbert E, Valenzuela-Almada M, Jnsen A, Landolfi G, Fredi M, Goulenok T, Devaux MM, Mariette X, Yazdany J et al.

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