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Arthritis Research Canada at

ACR Convergence 2022

November 14

More Than Half of RA Patients with a Lifetime History of Mood Disorders were Anxious and Depressed During COVID-19 Pandemic

A study of people with RA across Canada (the CATCH cohort) found that people with RA experienced increased rates of depression and anxiety, especially during the early phases of the COVID pandemic and with each subsequent waves, compared to before the pandemic This was more marked in individuals with a prior history of mood disorders; they were twice as likely to report anxiety or depression. Whereas rates of depression peaked early in the pandemic, anxiety increased with each successive COVID-19 wave.

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

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Remission and Low Disease Activity Are Associated with Lower Health Care Costs in an International Inception Cohort of Patients with Systemic Lupus Erythematosus

This international study of lupus found that getting the disease into remission or a low disease activity state translates into lower health care costs.

Research Team: Clarke AE, Ugarte-Gil M, Barber M, Hanly J, Urowitz M, 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, Bruce IN, Petri M, GinzlerEM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, van Vollenhoven R, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen D, Askanase A, Pons-Estel B, Alarcón G.

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Using Administrative Health Data to Construct a Frailty Index as a Measure of Susceptibility to Adverse Health Outcomes Among Individuals with Rheumatoid Arthritis

We created a new tool, known as a frailty index, to measure the risk of worse health outcomes among individuals living with rheumatoid arthritis (RA). Using administrative health data for the province of British Columbia, we found that frailty index scores measured shortly after RA diagnosis predicted later risk of emergency department visits, hospital admissions, and death.

Research Team: Legge A, Lacaille D

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How Did a Mandatory Switching Policy for Biosimilars in Canada Impact Uptake and Spending?

This study looked at the impact of the BC policy mandating that all prescriptions of biologics for which a less expensive biosimilar alternative is available, use the biosimilar version of the drug, for the ministry of health to cover the cost. They found that mandating all new prescriptions to use a biosimilar led to a small gradual increase in their use; whereas mandating all current users to switch to a biosimilar version had a marked, immediate and sustained impact on increasing the use of biosimilars.

Research Team: McClean A, Bansback N, Cheng L, Clemont F, Tadrous M, Harrison M, Law M.,

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Decision-Making around Vaccination and Other Public Health Measures during the COVID-19 Pandemic: Experiences of Individuals with Rheumatoid Arthritis

In this qualitative study, researchers interviewed adults with rheumatoid arthritis n British Columbia to better understand how they made decisions around adopting public health measures to reduce COVID-19 transmission. Ethical issues raised included the need to respect their and others’ freedom of choice, even though others’ choices complicated their self-care, a sense of social responsibility to protect the welfare of others, and differing trust in sources of information. These insights can help to support decision-making about public health measures in ways that value experiences of individuals with RA and other autoimmune diseases during the pandemic and beyond.

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

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Genetic Risk, Adherence to a Healthy Lifestyle, and Incident Gout in US Women and Men

In a long-term study of ~30,000 men and women, we found that adopting an overall healthy lifestyle was associated with a reduced risk of developing gout, especially among people born with a higher genetic risk for gout. Alongside more established factors like keeping a healthy body weight and reducing alcohol consumption, lifestyle factors like physical activity and smoking may also impact future risk of gout.

Research Team: Lin K, McCormick N, Lu N, Joshi AD, Yokose C, Choi HK

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PROs and Sociodemographic Factors in Year Prior to COVID Predict Trajectories of Depressive Symptoms in Adults with RA in First 2 Years of Pandemic: Data from the Canadian Early Arthritis Cohort.

Although 60% of Canadian RA patients had consistently good mental health during the first 2 years of the COVID-19 pandemic, more than 1 in 5 reported deteriorating mood suggesting a cumulative impact over time; 9% had persistent depression and 8% improving mood. The proportion of adults with RA with at least mild symptoms of depression may be more than twice that reported for the general Canadian population. As compared with those with good mental health throughout, participants with worsening depressive symptoms during the pandemic were more likely to be female, obese, have higher pre-pandemic disease activity, symptoms, disability, and higher impairments in participation. Given the impact of depression on quality of life, inflammation, and disease management, vulnerable groups may benefit from more frequent evaluation and additional support from rheumatology providers.

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

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Effect of Short-Term Fruit Juice and Sugared Beverage Intake on Risk of Recurrent Gout Flares

Long-term consumption of sugared beverages has been associated with an increased risk of developing gout, and in this study of people who already had gout, we also found that greater consumption of fruit juices and other sugared beverages could lead to flares within the next 1-2 days.

Research Team: McCormick N, Yokose C, Kohler MJ, Yinh J, Chen CA, Neogi T, Merriman TR, Saag KG, Zhang Y, Choi HK.

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Comparison of the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) and the FRAIL Scale for Identifying Frailty Among Individuals with Systemic Lupus Erythematosus.

This study compared two instruments that measure frailty in people with lupus for different purposes and found moderate agreement between the two. Each frailty measure has distinct advantages in different settings. The FRAIL scale may be a more useful tool to use in clinical care, while the SLICC-FI is more suited to identifying frailty for research purposes.

Research Team: Legge A, Lieber S, Hanly J.

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Reading the Waves: Identifying Distinct Phenotypes of Multisystem Inflammatory Syndrome in Children During the 2020-2021 COVID-19 Pandemic

Children with COVID-19 are at risk of a severe disease that causes inflammation in multiple systems, called MIS-C which can require ICU admission. This study found that over the course of the COVID-19 pandemic, the clinical presentation changed, likely due distinct SARS-CoV-2 variants.

Research Team: Renson T, Forkert N, Amador K, Miettunen P, Parsons S, Dhalla M, Johnson N, Luca N, Schmeling H, Stevenson R, Twilt M, Hamiwka L, Benseler S.

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Contemporary Racial/Ethnic Disparities in Emergency Department Visits and Hospitalizations for Gout in the United States – 2019 Nationwide Analysis

We found that Black adults had much higher rates of emergency room visits and hospitalisations for gout than White adults, and longer hospital stays.  These findings could reflect a higher risk of gout among Black adults than White, and potentially lower quality of care.

Research Team: Yokose C, McCormick N, Lu N, Joshi AD, Jackson L, Kohler MJ, Yinh J, Zhang Y, Hsu J, Saag KG, Choi HK.

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The Independent Impact of Gout on Mortality and Risk of Coronary Heart Disease Among Women – a Prospective Cohort Analysis of Women over 34 Years

We analysed data from >100,000 women followed over 34 years and found that women with gout had more cardiovascular risk factors (i.e., high blood pressure, high cholesterol) than women without gout and tended to die earlier, particularly from cardiovascular diseases.

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

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Hydroxychloroquine Dosing Less Than 5 Mg/kg/day Leads to Increased Hospitalizations for Systemic Lupus Erythematosus Flares

Recent guidelines have recommended a lower dose of hydroxychloroquine in lupus based on weight (≤5 mg per kg) to reduce the risk of toxicity to the retina of the eye. This study found that people with lupus who were treated with this doses of HCQ (compared to those treated with > 5 mg/kg) had a four times higher risk of hospitalizations for a lupus flare. These results indicate the need to reassess the optimal dosing of hydroxychloroquine for patients with SLE.

Research Team: Nestor J, Mancini C, Zhou B, Zhang Y, Costenbader K, Choi H, Jorge A.

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A Genome-Wide Association Analysis of 2,622,830 Individuals Reveals New Pathogenic Pathways in Gout

This study of performed genome-wide scanning on more than 2.5 Million individuals and identified new genes and new metabolic pathways that may be involved in causing gout.

Research Team: Merriman T, Matsuo H, Takei R, Leask M, Topless R, Shirai Y, Li Z, Cadzow M, Reynolds R, Saag K, Fadason T, O’Sullivan J, Dalbeth N, Stamp L, Abhishek A, Doherty M, Roddy E, Jacobsson L, Kapetanovic M, Andrès M, Perez-Ruiz F, Torres Jimenez R, Radstake T, Jansen T, Janssen M, Joosten L, Octavia Crisan T, Huizinga T, Choi HK, On behalf of Japan Gout Genomics Consortium (J-Gout)44, On behalf of Japan Multi-Instl Collab Cohort Study (J-MICC), Stahl E, Miner J, Solomon D, Cui J, Giacomini K, Brackman D, Jorgenson E, On behalf of 23andMe Research Team, et al.

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Impact of Colchicine Prophylaxis on Cardiovascular Outcome Among Gout Patients: A Secondary Analysis of CARES Trial

This study used data from a clinical trial comparing gout treatments to see if the use of colchicine to prevent flares also prevented cardiovascular events, like heart attacks and strokes. No benefit was found, but colchicine use was only 6 months on average, which may not have been long enough to see a benefit on cardiovascular diseases.

Research Team: Hayashi K, Zhang Y, Choi H, Yoshida K.

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Sex Differences in Employment Outcomes in Patients with Recent Onset Rheumatoid Arthritis

Both men and women report impairments with work and leisure activities that improve over time but plateau. A small proportion of ERA patients stop work due to RA or report retiring early with sex differences between those that stop vs continue driven mostly by age, number of people living in the household, pain and mental health. Women that stop working due to RA are less likely than men to report returning to work. Interventions to optimize continued engagement in work may improve productivity outcomes for RA patients and their employers.

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

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The Systemic Lupus Erythematosus International Collaborating Clinics (SLICC), American College of Rheumatology (ACR), and Lupus Foundation of America (LFA) Damage Index Revision – Item Generation Phase

This study aims to revise a previous tool that measures the cumulative impact of lupus on different parts of the body, by adding new items. In this phase of the process, the scientist looked at studies of lupus manifestations, and consulted with lupus experts and people living with lupus, in a large group consensus type discussion. This approach proved very helpful at expanding the scope of new items, and underscores the value of consultations with a wide and diverse group of contributors.

Research Team: Kundakci B, Barber MRW, Clarke AE, Johnson SR, Brunner H, Cho J, Costedoat-Chalumeau N, Ginzler EM, Hanly J, Hasan A, İnanç M, Kabani N, Legge A, Lima K, Lindoso L, Mak A, Ramsey-Goldman R, Ruiz-Irastorza G, Silva CA, Tamirou F, Trindade VC, Vinet E, Bruce I.

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Employment Trajectory of Canadian Young Adults with Systemic Lupus Erythematosus

This study looked at the employment trajectory of young adults with lupus. Contrary to what is seen in youth from the general population, rates of employment did not increase with increasing age, and little to no increases in transitions from non-employed states to employment were observed. Difficulties in establishing employment during young adulthood is a major concern for this population.

Research Team: Lim L, Konstanidis M, Touma Z, Lacaille D, Oguzoglu U, Peschken C, Anderson N, Kaur R, Pullenayegum E.

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More Meticulously Following Treat-To-Target in RA Does Not Lead to Less Radiographic Progression: A Longitudinal Analysis in BIODAM

A study of people with Rheumatoid Arthritis followed as part of a registry of patients using biologics agents (BIODAM) did not find any difference in radiographic progression over 6 months when people were treated with a strict application of the Treat-to-Target approach to treatment compared to when a more liberal treat-to-target approach was applied.

Research Team: Ramiro S, Landewe R, van der Heijde D, Sepriano A, Fitzgerald O, Ostergaard M, Homik J, Elkayam O, Thorne C, Larche M, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel A, Allaart C, Barnabe C, Bingham C, van Schaardenburg D, Hammer H, Dadashova R, Hutchings E, Paschke J, Maksymowych W.

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Recurrent Thrombosis Risk in Non-anticoagulated Antiphospholipid Syndrome Patients: A Prospective Case-Control Study from Anti-Phospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (“Registry”)

This international registry of people with anti-phospholipid syndrome, a disease that causes an increased risk of clotting, found that 14% were not receiving anticoagulation treatment, and the majority of these patients received an anti-platelet agent. Their risk of having an event due to a blood clot was not significantly increased, compared to people who received anticoagulation. . These findings support an urgent need for clinical trials to prevent future blood clotting events in people with anti-phospholipid syndrome, based on risk stratification at baseline.

Research Team: Yelnik C, Belce Erton Z, Drumez E, Cheildze D, Oliveira de Andrade DC, Clarke AE, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Aguirre MA, Fortin P, Gerosa M, Signorelli FV, Atsumi T, Zhang Z, Cohen H, Branch W, Wahl D, Andreoli L, Rodriguez Almaraz E, Petri MM, Cervera R, Zuo Y, Artim-Esen B, Pons-Estel G, Willis R, Bertolaccini ML, Roubey R, Erka D; and on behalf of APS ACTION

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Anti-NET Antibodies in Antiphospholipid Antibody-positive Patients: Results from the Antiphospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (“Registry”)

This study evaluated novel antibodies, called anti-NET antibodies, which they found to be positive in 45% of people with anti-phospholipid syndrome, and tried to understand their role in causing clotting in this disease.

Research Team: Zuo Y, Navaz S, Tsodikov A, Kmetova K, Hoy C, Yalavarthi S, Oliveira de Andrade DC, Tektonidou MG, Sciascia S, Pengo V, Ruiz-Irastorza G, Belmont HM, Gerosa M, Fortin P, de Jesús G, Branch DW, Andreoli L, Rodriguez Almaraz E, Petri M, Cervera R, Willis R, Erkan D, Knight DS.

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