Arthritis Research Canada at

ACR Convergence 2023

November 13

Voices Unheard: Unmasking the Hidden Challenges of Youth with Rheumatic Diseases

Take a Pain Check Foundation (TAPC) and the Canadian Arthritis Patient Alliance (CAPA) surveyed young people with lived experience of rheumatic disease. Our survey provided valuable insights into the experiences and perceptions of young individuals living with rheumatic diseases and shows the need for targeted interventions and enhanced social support.

Authors: Trehan N, Proulx L, Dukes I.



Impact of Immunosuppression on the Safety and Efficacy of Immune Checkpoint Inhibitors in Patients with Rheumatic Autoimmune Disease: Experience from the Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO)

Information on the efficacy and safety of immune checkpoint inhibitors (ICI), a new class of drugs that treat cancer by turning on the immune system, is limited in patients with pre-existing autoimmune rheumatic disease and prior studies had suggested that patients receiving immunosuppressant medications for their rheumatic disease may have poorer cancer outcomes. In contrast, the results of this study suggest that receiving immunosuppression therapy at the time of starting this type of treatment for cancer does not increase the risk of tumor progression and immune check-point inhibitors can be effective treatment for cancer in these patients. However, immunosuppressive treatment did not seem to protect from flares of the underlying rheumatic disease when these medications were used.

Research Team: Gonzalez-Arreola L, Ye C, Hudson M, Roberts J, Pope J, Appleton T, Hoa S, Fifi-Mah A, Maltex N, Saltman A, Himmel M, Colmegna I, Ladouceur A, Obrzut A, Tan J, Moon D, Nevskaya T, Schmidt E, Cho L, Toban N, Jamal S.



Comparison of Survival on Treatment and Severe Infection Among New Users of Biosimilar vs. Originator Biologics in Inflammatory Arthritis: Population-based Evidence from a Natural Experiment Due to a Policy Change

Biologic medications have transformed the treatment of inflammatory types of arthritis due to their unparalleled effectiveness at stopping inflammation and preventing joint damage. But they are very costly. Biosimilars are near identical copies that are available at a lower cost, once the patent of the original drug expires. This study evaluated the BC Ministry of Health’s policy mandating that all new biologic prescriptions use a biosimilar when available. Using real world data from everyone in BC, the study showed that people prescribed biosimilars for etanercept and infliximab remain on treatment as long as people prescribed the originator, and the risk of infections requiring hospitalization is the same, indicating that biosimilars are as safe and as effective.

Research Team: Lacaille D, Avina-Zubieta JA, Zheng Y, Lu N, Xie H.



Identifying Inflammatory Arthritis Ambulatory Care Service Model Enhancements Needed to Reduce Avoidable Emergency Department Use

This study used an online survey of Albertans living with inflammatory arthritis to understand their decisions to attend an emergency department for care, their experiences during the visit, as well as their ability to meet discharge recommendations such as follow up with their rheumatologist. Based on the results, recommendations were made to reduce avoidable emergency department use, which include better urgent rheumatology care access and coordination, resources, and education for health providers in emergency departments on assessment and management of arthritis conditions.

Research Team: Pianarosa E, Roach P, McLane P, Eliott M, Holroyd B, McQuitty S, Katz S, Russon N, Lin K, Barber CEB,



Increased Risk of Severe Infection in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitides: A Population-based Trend Analysis

Our findings showed that one in three patients with a type of vasculitis called Antineutrophil Cytoplasmic Antibody-associated Vasculitides (AAV) developed severe infection. The chance of having a severe infection was greatest within the first month after diagnosis, and remained higher in the first year, with a much smaller increase in risk after the second year.

Research Team: Zhao K, Xie H, Dehghan N, Esdaile JM, Avina-Zubieta JA



Impact of Aging on Rheumatic Immune-related Adverse Events Secondary to Immune Checkpoint Inhibitors: Experience from the Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO)

New cancer treatments continue to revolutionize cancer treatment for patients of all ages, but their use is unfortunately limited by side effects, which are not yet well-understood. To better understand and apply these potentially life-saving treatments for cancer patients of different age groups, this study looked at whether and how aging is related to side effects experienced by patients treated with these cancer treatments.

Research Team: Li J, Hudson M, Ye C, Roberts J, Fifi-Mah A, Choi M, Hoa S, Appleton T, Pope J, Maltez N, Gonzalez-Arreola L, Obrzut A, Jamal S.




Prevalence of Frailty Among Individuals Living with Rheumatoid Arthritis: A Population-based Cohort Study

Using administrative health data for the population of British Columbia, we found that people living with rheumatoid arthritis (RA) were more than twice as likely to be frail when compared to similarly aged individuals without inflammatory arthritis. This relationship persisted even after accounting for other important factors, including differences in socioeconomic status, urban versus rural residence, and rates of comorbid medical conditions.

Research Team: Legge A, Lacaille D.



PROMIS Symptom Clusters Predict Disease Activity in the First 6 Months in Newly Diagnosed RA Patients Starting MTX Therapy: Data from the Canadian Early Arthritis Cohort

We used scores related to physical symptoms (like pain and fatigue) and emotional symptoms (such as anxiety and depression) to classify patients with early rheumatoid arthritis (RA) into four groups. Data from adults enrolled in the Canadian Early Arthritis Cohort (CATCH) study were used. We explored how the four different groups of RA patients responded to treatment with MTX therapy over six months. Disease activity improved over six months in all four groups; however, not to the same degree – patients with higher emotional symptoms and intense physical symptoms had worse disease activity, indicating a less favorable prognosis.

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




Investigating the Experiences of Patients Living with Antiphospholipid Antibodies: A Qualitative Study

We interviewed 12 adult patients (92% female) with either antiphospholipid antibodies (aPLs) or antiphospholipid syndrome (APS), with or without systemic lupus erythematous (SLE), to understand experiences of their diagnosis, daily life effects, and healthcare and treatment. Patients reported facing various challenges and emotional impacts around the time of their diagnosis, and they also experienced changes in daily life activities, employment, and relationships. Patients also discussed difficulties related to healthcare and treatment, including lifestyle impacts and medication side effects, and noted family planning as a big concern (e.g., fear about impact on future pregnancies).

Research Team: Cardwell F, Kobza A, Elliot S, Gibson P, Soilman N, Skeith L, Clarke AE, Barber MRW.



Cancer Outcomes in Cancer Patients with Immune Checkpoint Inhibitor-induced Inflammatory Arthritis Treated with Glucocorticoids: Data from the CanRIO Retrospective Cohort

Our study asked the question whether glucocorticoids, a commonly used treatment for side effects of cancer immunotherapies, could interfere with the effect of the immunotherapies and lead to cancer progression or death. We found that the dose, timing, and duration of glucocorticoids used to treat side effects of cancer immunotherapies did not affect cancer outcomes. Although more research is needed to confirm these results, our findings offer some reassurance regarding the safety of glucocorticoids in this setting.

Research Team: Savarimuthu V, Ladouceur A, Terry O, Roberts J, Pope J, Appleton T, Hoa S, Fifi-Mah A, Maltez N, Saltman A, Himmel M, Colmegna I, Cho L, Schmidt E, Berger C, Barnetche T, Gonzalez-Arreola L, Ye C, Jamal S, Hudson M.



Target Serum Urate Levels, Recurrent Gout Flare Rates, and Gout-Primary Hospitalizations: Nationwide Prospective Cohort Study of 3,613 Gout Patients

In this study, we found that serum urate levels measured in gout patients were strongly associated with the number of gout attacks (flares) patients would experience over the next 5 to 10 years. As increased urate levels contribute to the development of gout flares, regular monitoring and medication adjustments could help prevent painful flares.

Research Team: McCormick N, Yokose C, Challener GJ, Joshi A, Tanikella S, Choi HK.



The Current State of Sodium-Glucose Cotransporter Type 2 Inhibitor Use Among Patients with Gout at a Tertiary Academic Healthcare System

Sodium-glucose cotransporter-2 inhibitors are a class of medications approved for use in type 2 diabetes, chronic kidney disease, and heart failure, conditions that are more common in people with gout, and may also help prevent gout attacks (flares). However, our chart review suggests these medications are underused in patients with gout, highlighting a potential place to improve gout care.

Research Team: Yokose C, Zhou B, McCormick N, Tanikella S, Kohler MJ, Yinh J, Zhang Y, Wexler D, Choi HK.



Serum Urate Change Among Gout Patients Initiating Sodium-Glucose Cotransporter Type 2 Inhibitors (SGLT2i) vs. Sulfonylureas: A Comparative Effectiveness Analysis

In this study, we found that levels of urate, a blood marker contributing to the development of gout flares, decreased within three months among gout patients after they started taking a sodium-glucose cotransporter-2 inhibitor, a class of medication used for diabetes, heart failure and kidney disease.  This may become a dual-purpose therapy for people with gout and these additional conditions.

Research Team: Yokose C, Challener G, Zhou B, McCormick N, Tanikella S, Panchot, K, Kohler MMJ, JYinh J, Zhang Y, Bates D, Januzzi J, Sise M, Wexler D, Choi HK.



Association of Serum Analytes with SLE Cognitive Impairment Phenotypes Formed by Machine Learning: MMP-9, S100A8/A9, IL-6, IL-10, and NGAL

People with lupus often report cognitive issues. This study tried to identify markers in the blood that can help identify and differentiate people in whom lupus affects their cognition. Lupus patients with different types of cognitive issues had different levels of inflammation proteins S100A8/A9, MMP-9, NGAL/lipocalin, and IL-6 proteins in their blood.

Research Team: Barraclough M, Munoz-Grajales C, Erdman L, Diaz Martinez JP, Bingham K, Kakvan M, Kretzmann R, Tartaglia C, Ruttan L, Choi M, Appenzeller S, Marzouk S, Bonilla D, Katz P, Beaton D, Goldenberg A, Green r, Wither J, Touma Z.



Having More Tender Than Swollen Joints Is Associated with Worse Functional Outcomes in Patients with Early RA in a Prospective Real-World Cohort

Early rheumatoid arthritis (RA) patients may experience persistently tender joints more than swollen ones, which can be challenging for treatment decisions. This study assessed the distribution and impact of differences between tender and swollen joint counts during the first year following RA diagnosis, to examine the relationship with patient’s function in their day to day life, using data from the Canadian Early Arthritis Cohort (CATCH). The study found that a greater difference between tender and swollen joints, especially when it affected larger joints, was associated with worse functional outcomes.

Research Team: Meng C, Lee Y, Schieir O, Valois MF, Butler M, Boire G, Hazelwood G, Hitchon C, Keystone E, Tin D, Thorne C, Bessette L, Pope J, Bartlett S, Bykerk V.



Health Care Access in an Indigenous North American Population of Rheumatoid Arthritis Patients and Their At-risk First-Degree Relatives

This study in Manitoba surveyed access to healthcare for First Nations People living with rheumatoid arthritis and their first-degree relatives, over 12 years. To tackle the increased challenges reported by those living in rural locations, solutions need to address issues such as transportation and availability of healthcare providers, while also taking into consideration factors related to sex, gender and age.

Research Team: Wiens D, Robinson D, Smolik I, Barnabe C, El-Gabalawy H, O’Neil L.



Comparison of Malignancies and Serious Infections Between Etanercept Biosimilar and Bio-Originator Initiators: Population-Based Analyses

This study assessed the safety of biosimilar for the biologic drug etanercept, by comparing risk of cancer and serious infections in patients who started taking the originator versus the biosimilar between 2015 and 2019, using data from the National Prescription Drug Utilization Information System (NPDUIS). The results did not show any differences in the occurrence of malignancy or serious infections.

Research Team: Birck M, Lukusa L, Abrahamowicz M, Boire G, Choquette D, Maksymowych WP, Bernatsky S.



Sodium-Glucose Co-transporter-2 Inhibitors and the Risk of Cardiac and Renal Outcomes in Systemic Lupus Erythematosus

Sodium-glucose cotransporter-2 inhibitors, a new class of medications first approved for type 2 diabetes, were associated with a lower risk of cardiovascular events and lower risk of kidney disease progression in patients with lupus in addition to their diabetes. It is possible that this medication may become an additional treatment option for lupus kidney disease (lupus nephritis).

Research Team: Jorge A, Zhou B, McCormick N, Yokose C, Zhang Y, Choi HK.



Cost-related Medication Burden for Patients with and Without Systemic Autoimmune Rheumatic Diseases

Many patients with autoimmune rheumatic diseases reported in a large survey that they cannot afford their medications and can’t take their medications as prescribed because of cost.

Research Team: Yee J, Feldman C, Oakes EG, Ellrodt J, Choi M, Karlson E,  Costenbader K.



Comparing Uptake of Biosimilar Infliximab Among Patients with Medicare, Medicaid and Private Insurance in U.S. Rheumatology Practices 2016-2022

Biosimilars were developed to be lower cost alternatives to biologics – but their uptake, particularly in the US has been slower than hoped. This analysis of a large US registry finds that uptake of biosimilar infliximab was fastest in patients with Medicaid followed by patients with private insurance (after the release of the most recent biosimilar), but still slow uptake in patients with Medicare. The study shows the importance of payor mechanisms on uptake of biosimilars.

Research Team: Roberts N, Li J, Bansback N, Tseng CW, Shiboski S, Schmajuk G, Yazdany J.



First and Recurrent Thrombosis Risk After 4,454 Patient-Years of Follow-Up: Prospective 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 update the risk of thrombosis (blood clots) in patients with a specific inflammatory disease (i.e. patients with antiphospholipid antibody, which predisposes to blood clots). Results indicate that the thrombosis risk remains relatively low in these patients.

Research Team: Thaler J, Ahmadzadeh Y, Andrade D, Skeith L, Tektonidou M, Sciascia S, Pengo V, Pardos-Gea J, Ruiz-Irastorza G, Lopez-Pedrera C, Belmont HM, Nina K, Fortin PR, Wahl D, Gerosa M, De Jesús G, Zhang Z, Atsuma T, Efthymiou M, Ware Branch D, Andreoli L, Rodriguez Almaraz E, Petri M, Pazzola G, Cervera R, Artim Esen B, Shi H, Knight J, Pons-Estel G, Willis R, Duarte-Garcia A, Bertolaccini ML, Cohen H, Erkan D, and On Behalf Of APS ACTION.



Complement Activation as a Marker of Thrombosis Risk in Antiphospholipid Antibody Positive Patients: Prospective Results from AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (“Registry”)

This study aimed to evaluate biologic indices associated with thrombosis (blood clot) in patients with a specific inflammatory disease (i.e. patients with an antiphospholipid antibody which predisposes to blood clots). Preliminary findings suggest that several molecules (named complement activation markers) are associated with a higher risk of thrombosis.

Research Team: Yelnik C, Chaturvedi S, Labreuche J, Pan XP, Belmont HM, Nina K,  Fortin PR, Ware Branch D, Zuo Y, Willis R, Brodsky R, Salmon J, Bertolaccini ML, Cohen H, Petri M, Erkan D and On Behalf Of APS ACTION.



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