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Arthritis Research Canada at

ACR Convergence 2021

ACR Convergence is the American College of Rheumatology’s annual meeting. The event, which took place online between November 3-9, 2021, brought together rheumatology experts from around the globe.

Please scroll down to view the research that Arthritis Research Canada scientists, trainees and patient partners are proud to be leading and involved in.

November 6

Risk of hospitalization, admission to intensive care and mortality due to COVID-19 in patients with rheumatic diseases: A population-based matched cohort study

We used information from BC health databases to see whether people with rheumatic diseases have a higher risk of severe outcomes if they get COVID19.  We found that COVID-19 patients with certain rheumatic diseases, such as rheumatoid arthritis ankylosing spondylitis and lupus, were more likely to be admitted to hospital, and to need ICU care,  than COVID-19 patients without rheumatic disease; but they were not at a higher risk of death from COVID-19.

Research Team: Avina-Galindo AM, Marozoff S, Fazal Z, Kwan J, Lu N, Hoens A, Lacaille D, Kopec J, Xie H, Avina-Zubieta JA

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Who gets influenza vaccinations prior to and after a diagnosis of rheumatoid arthritis? Results from the Canadian Early Arthritis Cohort (CATCH)

Using data from the Canadian Early Arthritis Cohort (CATCH), we found that flu vaccination rate is suboptimal in patients recently diagnosed with rheumatoid arthritis (RA), with 37% being vaccinated prior to RA diagnosis and 42% after diagnosis. Characteristics of individuals who were more likely to receive a flu shot included male sex, white racial background, not smoking, having higher beliefs about the importance of RA medications versus concerns about taking them, taking advanced therapeutics, and having a previous flu shot. Our work suggests that it is important to have conversations with new patients about their vaccination history and medication attitudes.

Research Team: Ta V, Schieir O, Valois MF, Colmegna I, Hitchon C, Bessette L, Hazlewood G, Thorne C, Pope J, Boire G, Tin D, Keystone E, Bykerk V, Bartlett S; CATCH Investigators

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Anti-MPP-1 autoantibodies in systemic lupus erythematosus: A potential biomarker for neuropsychiatric manifestations

In this lupus study, we found that a blood marker called anti-MPP1 antibody could be important for identifying people with peripheral nervous system symptoms of lupus.

Research Team: Krustev E, Buhler K, Cardwell F, Fritzler M, Clarke A, Choi M

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Increased risk of severe infections and mortality in patients with newly diagnosed anti-neutrophil cytoplasmic antibody–associated vasculitis: A population-based study

We conducted a study of all patients with newly diagnosed anti-neutrophil cytoplasmic antibody–associated vasculitis (AAV) in British Columbia and found AAV is associated with a 3.8 fold higher risk of infection and infection-related mortality and a 3.2 fold greater total number of infections.

Research Team: Zhao K, Xie H, Esdaile J, Avina-Zubieta JA

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Damage accrual measured by DIAPS in Antiphospholipid Antibody (aPL)-positive patients: Results from AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (“Registry”)

The aim of this study was to evaluate damage from clots in patients with antiphospholipid syndrome followed as part of an international study. The study showed that a new score, named Damage Index in APS, is able to pick up damage.

Research Team: Balbi G, Ahmadzadeh Y, Tektonidou M, Pengo V, Sciascia S, Ugarte A, Belmont HMM, Gerosa M, P Fortin PR, Lopez-pedrera C Petri M,  Rodriguez-Almaraz E, Barilaro G, Knight J, Artim-Esen B, Willis R, Bertolaccini ML, Roubey R, Erkan D, De Andrade D, and on Behalf of APS ACTION2

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First and recurrent thrombosis risk after 3842 patient-years of follow-up: Prospective results from Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) clinical database and repository

The objective of this study was to update information on the risk of clots in patients with antiphospholipid syndrome followed as part of an international study. Based on 886 patients followed for one to eight years, the risk of developing new clots remained relatively low.

Research Team: Ahmadzadeh Y, Andrade D, Tektonidou M, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Aguirre MA, Ji L, Atsumi T, Cohen H, Ramires de Jesus G, Branch DW, Tincani A, Kello N, Petri M, Rodriguez-Almaraz E, Ríos-Garcés R, Zuo Y, Artim-Esen B, Willis R, Bertolaccini ML, Roubey R, Erkan D; and on Behalf of APS ACTION1

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Anti-domain 1 antibody fluctuation over time in patients with persistently positive antiphospholipid antibodies: Results from the Aps Action Clinical Database and Repository (“Registry”)

The aim of this project was to evaluate the quantity of an antibody, named anti-D1, in people with antiphospholipid syndrome, as data on its fluctuation are scarce. Results indicate that anti-D1 antibodies vary significantly over time and it becomes negative in approximately 10% during follow up.

Research Team: Chighizola C, Pregnolato F, De Andrade D, Tektonidou M, Pengo V, Ugarte A, Belmont HM, Fortin PR, Atsumi T, Efthymiou M, Ramires de Jesus G, Branch DW, Nalli C, Petri M, Rodriguez-Almaraz E, Cervera R Zuo Y, Willis R, Bison E, Mackie I, Cohen H, Roubey R, Erkan D, Bertolaccini ML

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Serologic phenotypes distinguish systemic lupus erythematosus (SLE) patients with myositis and/or interstitial lung disease (ILD)

In a lupus study, we found potential blood markers that identify patients with muscle inflammation and lung fibrosis.

Research Team: Cotton T, Fritzler M, Choi M, Zheng B, Niaki OZ, Grenier LP, Vinet E, Pineau C, Lukusa L, Kalache F, Bernatsky S

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Pregnancy outcomes of antiphospholipid antibody positive patients: Prospective results from AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (“Registry”)

The objective of this study was to describe the pregnancy outcomes of patients with antiphospholipid syndrome followed as part of an international study. We found that 26% of pregnancies ended in loss of the fetus and 28% had pregnancy complications.

Research Team: Erton ZB, Sevim E, Ramires de Jesus G, Cervera R, Ji L, Pengo V, Ugarte A, Andrade D, Andreoli L, Atsumi T, Fortin PR, Gerosa M, Zuo Y, Petri M, Sciascia S, Tektonidou M, Aguirre MA, Branch DW, Erkan D, and on Behalf of APS ACTION

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Immunosuppression use in primary antiphospholipid antibody positive patients: Descriptive analysis of the AntiPhospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) Clinical Database and Repository (“Registry”)

The objective of this study was to characterize the use of immunosuppressant medications in patients with antiphospholipid syndrome followed as part of an international study. We found that information on immunosuppressant use was not consistently reported.

Research Team: Erton ZB Karp-Leaf R, Andrade D, Tektonidou M, engo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, lopez-pedrera C, Ji L, Atsumi T, Cohen H, Ramires de Jesus G, Branch1 DW Nalli C, Kello N, Petri M, Rodriguez-Almaraz E, Cervera R, Knight J, Artim-Esen B, Willis R, Bertolaccini ML, Roubey R, Erkan D, and on Behalf of APS ACTION1

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SARS-CoV-2 seroprevalence and seroconversion in a systemic lupus erythematosus cohort and comparison to general population controls

In a group of lupus patients, we found that lupus patients did not appear to be at higher risk of developing COVID-19 compared to the general population.

Research Team: Mathew H, Choi M, Buhler K, Clarke A, Gukova X, Cardwell F, Fritzler M

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Retrospective study on the prognostic value of cardiac magnetic resonance imaging abnormalities in systemic sclerosis

As heart disease is a leading cause of death in systemic sclerosis, the aim of this study was to describe patients with abnormalities on cardiac magnetic resonance in a large cohort of patients with systemic sclerosis. Results indicate that abnormalities are found in 12% of patients.

Research Team: Shen HC, Faucher C, Chin A, Chartrand-Lefebvre C, Chehata R, Cadrin-Tourigny J, Mongeon FP, Makhzoum JP, Landon-Cardinal O, Bourré-Tessier J, Rich E, Goulet JR, Fortin PR, Senécal JL, Hoa S

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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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November 8

Validation of a novel lupus multivariable outcome score as an outcome measure for systemic lupus erythematosus trials

The ability to demonstrate, in clinical trials, that new drugs are effective for lupus has been limited by the lack of good outcome measures. The challenge is that lupus can have a wide variety of disease manifestations. A new lupus outcome measure (LuMOS) has been developed to address this, and it was found to be better than previous lupus outcome measures at showing that treatments make a difference in two recent trials of a new lupus drug.

Research Team:Abrahamowicz M, Lipsky P

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Experiences of self-care during the COVID-19 pandemic among individuals with rheumatoid arthritis: A qualitative study

The aim of this qualitative study was to explore how the pandemic influenced self-care from the perspectives of individuals living with rheumatoid arthritis. Insights gained may help support adaptation and resilience among persons with arthritis during the pandemic and beyond.

Research Team: Leese J, Backman CL, Ma JK, Koehn C,  Hoens AM, English K, Davidson E, McQuitty S, Gavin J, Adams J,Therrien S, Li LC

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A change in a Patient Informed Clinical Disease Activity Index (PTCDAI) is similar to their rheumatologists CDAI when following patients with early rheumatoid arthritis in the Canadian Early Arthritis Cohort (CATCH) Study

The Clinical Disease Activity Index (CDAI) is often used in rheumatoid arthritis to assess disease activity to guide treatment decisions. We compared changes in patient-generated CDAI scores with rheumatologist-generated scores and found there was good agreement suggesting patient CDAI scores may be useful in virtual care and telemedicine.

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

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The Neuro-QOL Upper Extremity Function Scale: New opportunities to more reliably and precisely measure self-reported hand function and self-care activities in people with rheumatoid arthritis

Brief questionnaire-type tools that can reliably and precisely quantify hand/wrist function are needed to assess how active rheumatoid arthritis (RA) inflammation is when a physical exam is not possible. In a study of 262 participants with RA, we compared scores from the NEURO-QOL Upper Extremity Function with widely used measures of RA symptoms, disease activity and disability. Our results offer initial evidence supporting the use of this questionnaire to self-assess hand inflammation and day to day experiences of living with RA.

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

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Widespread but not regional non-articular pain influences patient and rheumatologist reported change in Clinical Disease Activity Index Scores over time – implications for using patient ratings in telehealth – a Study from the Canadian Early Arthritis Cohort

When seeing patients via telehealth during COVID-19, many rheumatologists have had to rely on patient reports of rheumatoid arthritis disease activity. We compared assessments of disease activity by patients and by rheumatologists during in-person visits, and found, generally good agreement between the two, except in patients with widespread pain not related to their joints.

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

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Fish oil supplementation and pro-inflammatory and pro-resolving lipid mediators in patients with and without systemic lupus erythematosus

We looked at whether taking fish oil supplementation influenced levels of different types of fats in the blood of lupus patients compared to non-lupus patients.

Research Team: Choi M, Cook N, Stevens E, Gomelskaya N, Kotler G, Manson J, Lasky-Su J, Tatituri R, Mora D, I Lee IM, Serhan C, Costenbader K

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Survey on treatment practices in subclinical interstitial lung disease in systemic sclerosis

We conducted an international survey of experts to understand screening and treatment practices for patients with mild lung disease in scleroderma. We found considerable variability, which was not surprising as there are no good studies in these patients. Optimizing the outcomes of patients with scleroderma lung disease is an important priority and urgent studies are needed to do this especially in those with mild disease who have the potential to progress to more severe lung involvement.

Research Team: Hoa S, Baron M, Hudson M

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The rheumatology workforce in Canada: Results of the Workforce and Wellness Survey

The Canadian Rheumatology Association surveyed rheumatologists across Canada to learn more about the workforce. Two important findings were: 1) there is a shortage of rheumatologists in Canada; and 2) rheumatologists are facing burnout.

Research Team: Kulhawy-Wibe S, Widdifield J, Kur J, Lee J, Thorne C, Yacyshyn E, Batthish M, Jerome D, Shupak R, Jilkine K, Purvis J, Shamis J, Roberts J, Burt J, Johnson N, Barnabe C, Spencer N, Barber CEH

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Experiences of wearable technology by persons with knee osteoarthritis participating in a physical activity counselling intervention study: A relational ethics lens

To our knowledge, this is the first qualitative study that uses an ethics lens to explore how persons with arthritis experience changes in their relationship with a health professional when using a physical activity wearable during research participation. Findings describe a range of experiences (positive and negative) among persons with knee osteoarthritis who used a wearable as part of a physical activity counselling intervention study involving a physiotherapist.

Research Team: Leese J, MacDonald G, Townsend AF, Backman CL, Nimmon L, Li LC

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Patient preferences for hydroxychloroquine in systemic lupus (SLE)

Research Team: Dollinger J, Brasil C, Wong M, Hazlewood G, Dollinger R, Singer W, Pineau C, Vinet E, Clarke A, Lee J, Bernatsky S

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Studying clusters of patients with systemic lupus erythematosus according to cognitive function, self-reported outcomes, disease activity, and clusters dynamic over 1 Year

Using artificial intelligence, we identified different subgroups of lupus patients according to their ability to think, process information, how active their lupus is, and self-reported symptoms.

Research Team: Gupta A, Johnson S, Su J, Bingham K, Knight A, Diaz-Martinez J, 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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Improvement in overall survival, skin fibrosis and lung function with autologous hematopoietic stem cell transplantation in systemic sclerosis

Trials have demonstrated that stem cell transplant is a helpful treatment for early scleroderma. Our study explored the use of this therapy in the real-world setting. The results were consistent with a better improvement in skin thickening and lung function with stem cell transplant as compared to other standard medications used in daily practice.

Research Team: Maltez N, Wang M, Wells G, Tugwell P, Baron M, Marjanovic Z, Lansiaux P, Farge D, Hudson M

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Telemedicine enriched care model to optimize care for patients with autoinflammatory diseases

Research Team: Oefelein L, Klotsche J, Benseler S, Kuemmerle-Deschner J, Welzel T

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Predictors of remission (on and off treatment) and lupus low disease activity state (LLDAS) in systemic lupus erythematosus (SLE): Data from a Multinational, Multicenter SLICC (Systemic Lupus International Collaborating Clinics) Cohort

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

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November 9

“From where I stand”: Using multiple anchors yields different benchmarks for meaningful improvement and worsening in the rheumatoid arthritis flare Questionnaire (RA-FQ)

The RA-Flare Questionnaire is a patient-reported measure designed to capture increases in disease activity, i.e. flares, in rheumatoid arthritis (RA). Among 808 Canadian adults with RA, we found that it was highly responsive to changes when evaluated in relation to other widely used measures of RA disease activity. Our results add to growing evidence about the usefulness of this new measure and offer initial guidance about the amount of change needed to show meaningful improvement or worsening of RA.

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

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Identifying clusters of longitudinal autoantibody profiles associated with systemic lupus erythematosus disease outcomes

Using artificial intelligence, we found that long-term blood marker results could be used to identify subgroups of lupus patients with different disease outcomes.

Research Team: Choi M, Chen I, Clarke A, Fritzler M, Buhler K, Urowitz M, Hanly J, Gordon C, St.Pierre Y, Bae SC, Romero-Diaz J, Sanchez-Guerrero F, Bernatsky S, Wallace D, Isenberg D, Rahman A, Merrill J, Fortin PR, Gladman D, Bruce I, Petri M, Ginzler E, Dooley MA, Ramsey-Goldman R, Manzi S, Jansen A, Alarcn 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, Sontag D, Costenbader K

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Impact of antimalarial adherence on cardiovascular mortality among patients with newly diagnosed rheumatoid arthritis and systemic lupus erythematosus: A population-based study

This population-based study aimed to examine the association between adherence to hydroxychloroquine and risk of cardiovascular events (heart attacks, strokes and venous clots) and of mortality among newly diagnosed lupus and rheumatoid arthritis patients (RA). Using a novel statistical method, we found that when lupus and RA patients took at least 90% of their prescribed doses of hydroxychloroquine, they had a reduction in risk of cardiovascular events by more than half (53%) and in mortality by about one third (30%), compared to when they took less than 90% of the doses.

Research Team: Hoque R, Avina-Zubieta JA, Lacaille D, De Vera MA, Qian Y, Esdaile JM, Xie H

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Effectiveness of the Making it Work™ program at improving absenteeism in workers with inflammatory arthritis – Results of a randomized controlled trial

A Canadian randomized controlled trial evaluating the effectiveness of the Making it WorkTM program over two years found that, in addition to improving productivity while at work, the program was effective at reducing sick days and preventing work interruptions in workers with inflammatory arthritis. The program, designed to help workers with arthritis deal with employment issues, consists of five online modules, online group meetings, an ergonomic assessment and vocational counselling.

Research Team: Luquini A, Zheng Y, Xie H, Backman C, Rogers P, Kwok A, Knight A, Gignac M, Mosher D, Li L, Esdaile J, Thorne C, Lacaille D

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Riding multiple waves of uncertainty: Real world Canadian rheumatoid arthritis patient outcomes over 1 year of COVID-19 restrictions

During the COVID-19 pandemic, Canadians with rheumatoid arthritis (RA) faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care due to pandemic-related restrictions. We examined trends in perceived stress, physical, emotional, and social health, self-assessed disease activity and RA flares prior to and during the first two waves of the COVID-19 pandemic (April – June 2020 and Oct – Jan 2021) in adults with RA. As compared to six months pre-pandemic, the first two waves of COVID were associated with increased stress, worsening physical, emotional, and social health, higher disease activity and more frequent flares. More than 1 in 3 experienced moderate-severe pain and disability; 1 in 4 had moderate-severe anxiety, depression and fatigue; and 1 in 5 had moderate-severe sleep disturbance and reduced participation.

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

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Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based incident cohort study 1995–2015

Our study followed for 10 years all newly diagnosed rheumatoid arthritis (RA) and osteoarthritis (OA) patients in British Columbia to compare the patterns of total joint replacement surgery in people diagnosed from 1995 to 2015. We found a 26.9% and 12.6% reduction in total hip and knee replacements for RA patients diagnosed five years after the introduction of biologics, in stark contrast with 11.7% and 16.6% increases in those procedures in OA over the same time period. This suggests that contemporary treatment of RA has been effective at reducing the need for joint replacement surgery.

Research Team: Zhou V, Lacaille D, Lu N, Kopec J, Garbuz D, Qian Y, Avina-Zubieta JA, Esdaile J, Xie H

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COVID-19 vaccine hesitancy among patients with rheumatic and other diseases

Prior to vaccine roll-out, Covid-19 vaccine hesitancy among rheumatic disease patients was higher than among other immunosuppressed patients and the general population. Factors associated with vaccine hesitancy are not unique to rheumatic diseases. Education about the benefits and safety of COVID-19 vaccines might enhance vaccine uptake among patients with a rheumatic disease.

Research Team: Valerio V, Rampakakis E, Hudson M, Bernatsky S, Hazel EM, Colmegna I

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Many better, many worse: Mean PROMIS-29 scores mask significant shifts during COVID-19 in rheumatoid arthritis

The COVID pandemic has been particularly challenging for people with rheumatic diseases. We evaluated changes in health-related quality of life in the initial months of the COVID-19 pandemic in adults in Baltimore, USA with rheumatic diseases. While the average quality of life scores evaluated at the group level did not change much, a substantial proportion of people experienced worse (30%) or improved (27%) anxiety. Similar patterns of change were seen in disease activity and other aspects of quality of life.

Research Team: Bartlett S, DiRenzo D, Jones M, Bingham C

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Identification of mitochondrial antigens targeted by autoantibodies in systemic lupus erythematosus (SLE)

The aim of this study was to identify new auto-antibodies in patients with lupus. The target of two new antibodies were identified.

Research Team: Becker Y, Gagné JF, Julien AS, Lévesque T, Gougeard N, Rubio V, Boisvert FM, Jean D, Poirier G, Fortin PR, Boilard E

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Sex-stratified patterns of multimorbidity at rheumatoid arthritis onset and associated longitudinal impacts on disability over the first year follow up: Results from the Canadian Early Arthritis Cohort (CATCH)

We looked at the other chronic diseases that people with rheumatoid arthritis have at the time of diagnosis and estimated their effect on disability over the first year of living with rheumatoid arthritis (RA) in 2576 Canadian women and men. Hypertension, lung disease and depression were the most common conditions in women, while hypertension and cardiovascular diseases were the most common in men. Depression, lung disease and hypertension were associated with higher disability over time in both men and women, highlighting the importance of identifying and treating those conditions.

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

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