Arthritis Research Canada at the
CRA & AHPA Annual Scientific Meeting
Adherence to system-level performance measures for rheumatoid arthritis care in Ontario
We examined measures of early access and good quality of care for rheumatoid arthritis (RA) from a population-based cohort of all RA patients seen by rheumatologists or other specialists in Ontario between 2002 and 2014. Gaps in care identified included patients not continuing to see a rheumatologist on an ongoing basis, as well as patients aged > 65 having delayed and lower than expected rates of treatment with disease modifying therapy, considered essential in the treatment of RA.
Research Team: Barber C, Lacaille D, Croxford R, Barnabe C, Marshall D, Xie H, Avina-Zubieta A, Esdaile J, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J
To learn more about Arthritis Research Canada research presented at the CRA & AHPA Annual Scientific Meeting, please scroll down. We have sections on COVID-19 & arthritis, rheumatoid arthritis, osteoarthritis, lupus, and other.
COVID-19 & Arthritis
Factors associated with depression and anxiety in people living with rheumatic disease: Findings from an international survey administered during the COVID-19 pandemic
This international survey of 687 individuals living with arthritis found that during the COVID-19 pandemic depression was present in 43% of participants, anxiety in 34%, and both depression and anxiety together in 27%. 30% of participants were socially isolated and 51% experienced loneliness. Factors associated with either depression or anxiety included loneliness, social isolation, and changes in health behaviours such as alcohol consumption and poor sleep.
Research Team: Howren A, Avina-Zubieta JA, Da Costa D, Puyat JH, Xie H, De Vera MA
Trends in RA symptoms, functional impacts, and work status prior to and during early months of the COVID-19 Pandemic: Results from the Canadian Early Arthritis Cohort (CATCH)
We used data from the Canadian Early Arthritis Cohort to evaluate how the early months of the COVID-19 pandemic affected Canadians with rheumatoid arthritis. We found that visits with rheumatologists were down in the first 6 months of 2020 by 31% as compared to 2019. RA disease activity, as assessed by participants, increased significantly with probable RA flares ranging from 10-12%. Higher disease activity and symptoms peaked in April, but mostly returned to pre-pandemic levels by June-July except for physical function. Only 4% had stopped working by June.
Research Team: Bartlett S, Schieir O, Valois MF, Boire G, Bessette L, Hazlewood G, Thorne C, Pope J, Hitchon C, Tin D, Keystone E, Bykerk V
Investigating SLE patients’ access to health information pre and during the COVID-19 pandemic
Media sources, in the face of COVID-19, have created a parallel infodemic (epidemic of mis/unproven information) that has particular relevance for patients with lupus. Conflicting health messages can exacerbate stress and acting on misinformation can contribute to detrimental health decisions. Investigators conducted an online survey of Canadians with lupus to assess how they accessed and trusted health information before and during the pandemic. Although physicians (specialists and GPs) ranked as the preferred and most trusted sources, they were less accessible during the pandemic. People relied on news and social media, which they trusted less, during the pandemic.
Research Team: Cardwell FS, Elliott SJ, Choi MY, Chin R, Peschken CA, Urowitz M, Hanly JG, Clarke AE
Effective, efficient, and convenient: Examiner and examinee experiences with a National Virtual Objective Structured Clinical Examination (OSCE) in a rheumatology Competence by Design Curriculum
Medical education and evaluation of trainees is challenging during the COVID-19 pandemic. The UBC rheumatology training program piloted a virtual way of testing rheumatology residents using an Objective Structured Clinical Examination (OSCE) performed online. Rheumatology residents and faculty perceived the virtual OSCE to be an effective, convenient, and practical evaluation tool. Virtual OSCEs may enable formal evaluation when physical distancing is required for public health reasons or when geographic proximity is challenging or unfeasible.
Research Team: Ellingwood L, Ahrari A, Kherani R, Jamal S
Real-world estimates of early rheumatoid arthritis patients at increased risk for severe COVID-19 to inform emerging vaccination strategies: Results from the Canadian Early Arthritis Cohort (CATCH)
A study of Canadians with rheumatoid arthritis found that risk factors for having severe COVID-19 were age>65yrs, presence of other chronic conditions such as lung disease (COPD), coronary disease and hypertension. This information will help determine who should be prioritized for vaccination.
Research Team: DCruz J, Schieir O, Valois MF, Pope J, Bartlett S, Bessette L Boire G, Hazlewood G, Hitchon C, Keystone E, Thorne C, Tin D, Bykerk V, CATCH Canadian Early Arthritis Cohort
The Rheum4U Precision Health Registry Platform: enabling quality care for patients with inflammatory arthritis during the COVID-19 pandemic in two outpatient rheumatology clinics
This study looked at the impact the COVID-19 pandemic on care for inflammatory arthritis at two university clinics in Calgary, using the Rheum4U data platform. Compared to the same time the previous year, there was a 61% decrease in new patients seen, with a similar number of total visits, but in-person visits were limited to urgent cases, with the remainder being virtual visits. Disease activity and quality of life were similar.
Research Team: Mosher D, Benseler S, Twilt M, MacMullan P, Giata , Sandhu N, Stevenson M, Brose A, Omotajo D, Marshall D, on behalf of the Rheum4U Team
Factors associated with fears due to COVID-19: a Scleroderma Patient-centered Intervention Network (SPIN) COVID-19 Cohort Study
Fears due to COVID-19 among people with scleroderma were greatest among participants from the United Kingdom, followed by Canada, the United States, and France. Fears due to COVID-19 were associated with clinical and functional vulnerabilities in this chronically ill population. This suggests that the needs of people living with chronic illness during a pandemic may differ depending on the social and political context in which they live.
Research Team: Wu Y, Kwakkenbos L, Henry R, Carrier ME, Gagarine M, Harb S, Bourgeault A, Tao L, Carboni-Jimenez A, Negeri Z, Patten S, Bartlett S, Mouthon L, Varga J, Benedetti A, Thombs B, Scleroderma Patient-centered Intervention Network (SPIN) Diet and Nutrition Education Patient Advisory Team (Montreal).
National Burden of RA in Canada 1990-2017: Findings from the Global Burden of Disease Study 2017
We evaluated the impact of Rheumatoid Arthritis (RA) on the longevity and quality of life on the population of Canada. It showed that fewer people died prematurely, while the number of years of healthy life lost due to RA disability increased from 1990 to 2017 as a result of increasing frequency of disease. These outcomes were greatest in females and older populations, particularly over the age of 75. Canada showed more favourable outcomes when compared to other countries with similar socio-economic development levels.
Research Team: Hassen N, Lacaille D, Sarrafzadegan N, Xu A, Sidi S, Alandejani A, Mansourian M, Kopec J
Patient characteristics and treatment patterns across four Canadian rheumatoid arthritis cohorts
We explored the treatment patterns of over 10,000 people living with rheumatoid arthritis (RA) from four Canadian cohorts. It is important to understand which medications are used most often to treat RA in Canada compared to what the Guidelines from the Canadian Rheumatology Association recommend. We found that the RA Guidelines were generally followed, but not as closely as one would hope.
Research Team: Hazlewood G, Bombardier C, Li X, Moyahedi M, Choquette D, Coupal L, Bykerk V, Shieir O, Mosher DP, Marshall DA, Bertnatsky S, Spencer N, Barber CE, OBRI, RHUMADATA, CATCH, Rheum4U Program
A Collaborative nurse-led model of care for stable patients with rheumatoid arthritis compared to rheumatologist-led care: A retrospective cohort study evaluating effectiveness and appropriateness of care
A chart review was conducted at two Alberta hospitals to assess the quality of care provided for stable patients with rheumatoid arthritis followed within a nurse-led care model compared to the traditional rheumatologist-led care model. We found that care led by a nurse was at least as effective and that screening for comorbidities, education about management of arthritis flares, and screening for vaccinations was documented more often.
Research Team: Lopatina E, Marshall DA, LeClercq S, Noseworthy T, Suter E, de la Rosa Jaimes C, Lauf AM, Mosher DP, Barber CE
Practical strength training prescription parameters for people with rheumatoid arthritis: a scoping review with recommendations for future research
Strength training is an important disease management strategy for people with rheumatoid arthritis, but very few people do strength training, likely because of barriers such as fatigue, pain, fear of causing damage to the joint etc. We summarize strength training prescription recommendations that are currently available and elaborate on the practical steps to prescribing that aim to help address barriers and support people with rheumatoid arthritis to strength train regularly.
Research Team: Ma JK, Wu ML, Collins JA, Davidson E, Hoens AM, Jiwa S, Tsui K, McQuitty S, Sequeria L, Li LC
Leveraging a behaviour change model to inform key elements for a national implementation plan of an early rheumatoid arthritis (RA) patient decision aid
We obtained perspectives from people living with rheumatoid arthritis and healthcare providers on how to use a patient decision aid (a tool to help shared decision-making) in early RA. The results were mapped to the Behavior Change Wheel (a way to classify barriers to behaviour change). The results informed recommendations for using the decision aid to improve shared decision making.
Research Team: Spencer N, Bansback N, Li L, Zimmermann G, Richards D, Proulx L, Mosher D, Hazlewood G
Outcomes of virtual rheumatoid arthritis care: A systematic review
We did a systematic review of studies on the use of virtual care for rheumatoid arthritis. Only studies where virtual care was intended to replace in-person visits were included. Only 6 studies were identified, half were randomized trials. While there was some evidence that virtual care could replace in person visits, longer term studies are needed.
Research Team: Han L, Hazlewood G, Barnabe C, Barber CEH
Who is receiving influenza vaccinations prior to and after a diagnosis of RA? Results from the Canadian Early Arthritis Cohort (CATCH)
We found that only 1 in 3 newly diagnosed patients with rheumatoid arthritis (RA) had had a flu vaccination in the year prior to diagnosis; 46% were vaccinated in the year after they were diagnosed. Predictors of vaccination after diagnosis were pre-diagnosis vaccination and not smoking. Our work suggest that it is important to have conversations with newly diagnosed patients about their vaccination history and attitudes, especially in people who smoke.
Research Team: Ta VO, Valois MF, Colmegna I, Hitchon C, Bessette L, Hazlewood G, Thorne C, Pope J, Boire G, Tin D, Keystone E, Bykerk V, Bartlett S and Canadian Early Arthritis Cohort (CATCH) Investigators
Rheumatologists vs primary care physicians: Who should be in charge of discussing influenza/pneumococcal vaccines with rheumatoid arthritis patients?
Health Care Professionals acknowledge the importance of discussing vaccination with RA patients. Most of them believe rheumatologists should take the lead in this task. Improving communication between health care professionals and enhancing awareness/knowledge of primary care physicians on vaccines in RA patients may promote influenza vaccine uptake in this group.
Research Team: Valerio V, Boucher V, Hazel E, Panopalis P, Lavoie K, Pelaez S, Colmegna I
How stable are medication necessity beliefs and safety concerns in the first year of rheumatoid arthritis?
We previously showed that around the time of diagnosis, 2/3rds of adults with rheumatoid arthritis were not convinced of the necessity of taking rheumatoid arthritis medicines, and had concerns about their long-term safety. We were interested to understand how these medication-related beliefs and safety concerns may change during the first year. Overall we found that necessity beliefs increased a little, and concerns went down a little, but it is unlikely these changes are meaningful, suggesting that the necessity of taking the medicine steadily outweighed concerns. Several factors were associated with beliefs and concerns.
Research Team: Ta V, Schieir O, Valois MF, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Pope J, Thorne C, Tin D, Andersen N, Bykerk V, Bartlett S, and Canadian Early Arthritis Cohort (CATCH) Investigators
What are the real-world predictors of initiating different advanced therapies in early rheumatoid arthritis? Data from the Canadian Early Arthritis Cohort (CATCH) Group
Both patient-related factors and physician-related factors were associated with different choices of advanced disease-modifying antirheumatic drugs (DMARDs). Patient formal education beyond high school was the strongest predictor of starting non-anti-TNF compared to an anti-TNF. Physician practice location within Ontario was the strongest predictor of starting JAK inhibitor compared to an anti-TNF.
Research Team: Weiler M, Schieir O, Valois MF, Bartlett S, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk V, Pope J, CATCH Canadian Early Arthritis Cohort Investigators
More than half of newly diagnosed rheumatoid arthritis patients are not convinced of the necessity of rheumatoid arthritis medicines: Associations with rheumatoid arthritis characteristics, symptoms, and function in the Canadian Early Arthritis Cohort (CATCH)
Medication beliefs have been shown to be one of the most reliable predictors of long-term adherence to treatment. In 362 people newly diagnosed with rheumatoid arthritis, we found two thirds were not convinced of their necessity, and were worried about the safety of taking them over long periods of time. Our work suggests that around the time of diagnosis, there is an important window of opportunity for conversations about rheumatoid arthritis medicines between rheumatologists and patients that will help people feel more confident about their treatment and the importance of taking it as prescribed.
Research Team: Ta V, Schieir O, Valois MF, Tin D, Hitchon C, Bessette L, Thorne C, Pope J, Boire G, Keystone E, Bykerk V, Bartlett S and Canadian Early Arthritis Cohort (CATCH) Investigators
Does statin use have an effect on progression of knee osteoarthritis on magnetic resonance imaging: The Vancouver Longitudinal Study of Early Knee Osteoarthritis (VALSEKO)
We evaluated whether statins (cholesterol lowering medications) have a beneficial effect on knee osteoarthritis using a cohort of people with predominantly early disease followed over 7 years. We found that there was no relationship between the use of statins and progression of knee osteoarthritis, (cartilage damage, bone bruising, bone spurs or knee swelling) on magnetic resonance imaging.
Research Team: Gill J, Sayre EC, Guermazi A, Nicolaou S, Cibere J
Do comorbidities limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis? The BEST Knee Prospective Cohort Study
We found that for individuals with knee osteoarthritis, having other chronic conditions does not limit improvement in pain, physical function, and walking ability after a knee replacement, and that people were as likely to report an acceptable symptom state. These results provide important information for clinicians to draw upon when discussing the risks and benefits of knee replacement with patients who have osteoarthritis and other chronic conditions.
Research Team: King L, Waugh E, Jones A, Marshall D, Hawker G
Systemic lupus erythematosus-related intestinal pseudo-obstruction (SLE-IPO): Case report and review of the literature of a rare and potentially fatal complication
Pseudo obstruction of the bowel is a dangerous complication of lupus, which should be considered in lupus patients with signs of bowel obstruction. Rapid institution of treatment is often lifesaving.
Research Team: Tan J, Xu G, Esdaile JM
Retinal toxicity in a multinational inception cohort of systemic lupus patients on hydroxychloroquine
Patients with lupus treated with hydroxychloroquine can, rarely, develop toxicity to the retina of the eye. We found that the risk of this side effect increases after 10 years of using hydroxychloroquine, and that the risk is higher among people who are older when they get lupus. We also found a higher risk that was not statistically significant in black patients, people receiving a higher dose (more than 5 mg per kg), and overweight patients.
Research Team: Almeida-Brasil C, Hanly J, Urowitz M, Clarke A, Ramsey-Goldman R, Gordon C, Petri M, Ginzler E, Wallace D, Bae S, Romero-Diaz J, Dooley M, Peschken C, Isenberg D, Rahman A, Manzi S, Aranow C, Sanchez-Guerrero J, Gladman D, Fortin P, Alarcón G, Merrill J, Khamashta M, Bruce I, Bernatsky S
Outcomes after hydroxychloroquine reduction or discontinuation in a multinational inception cohort of systemic lupus
In this international study following people since the time of their diagnosis with lupus, we found that when patients reduce or stop hydroxychloroquine, they are more likely to have worse disease than if they remain on the drug.
Research Team: Almeida-Brasil C, Hanly J, Urowitz M, Clarke A, Ramsey-Goldman R, Gordon C, Michelle Petri M, Ginzler E, Wallace D, Bae SC, Juanita Romero-Diaz J, Dooley M, Peschken C, Isenberg D, Rahman A, Susan Manzi S, Jorge Sanchez-Guerrero J, Gladman D, Fortin PR, Alarcón G, Merrill J, Khamashta M, Bruce I, Bernatsky S
Longitudinal relationships between cognitive domains and mood and anxiety symptoms in SLE
Lupus patients suffering from depression and anxiety are more likely to have issues with cognition e.g. thinking, memory, problem-solving etc. and this association was stable over the duration of their disease.
Research Team: Bingham K, Martinez J, Green R, Tartaglia C, Su J, Wither J, Kakvan M, Anderson N, Bonilla D, Choi M, Fritzler M, Beaton D, Katz P, Touma Z
Autoantibody profiles of SLE patients with cognitive impairment
Cognitive impairment is very common in people with lupus, but what causes it is unclear. We examined the relationship between 25 lupus related autoantibodies and cognitive impairment, but did not find any significant associations.
Research Team: Buhler K, Choi M, Fritzler M, Wither J, Diaz-Martinez JP, Green R, Beaton D, Kakvan M, Ruttan L, Tartaglia M, Su J, Bonilla J, Anderson N, Katz P, Touma Z
Patient preferences for hydroxychloroquine in systemic lupus (SLE): Preliminary analyses
We present preliminary evidence of patient preferences and themes related to patient choices regarding hydroxychloroquine. While common themes were identified, a large range of factors may affect patient decisions. The final results of our study will inform discrete choice experiments to help further develop personalized approaches to hydroxychloroquine treatment for lupus.
Research Team: Dollinger J, Wong M, Hazlewood G, Dollinger R, Singer W, Pineau C Vinet E, Almeida-Brasil C, Clarke A, Lee J, Bernatsky S
Insight into intraindividual variability across neuropsychological tests and its association with cognitive dysfunction in patients with systemic lupus erythematosus
This study examined a type of score called the dispersion score and whether it can be used as a marker of cognitive impairment in lupus patients.
Research Team: He J, Martinez J, Bingham K, Su J, Kakvan M, Tartaglia C, Ruttan L, Beaton D, Wither J, Choi M, Fritzler M, Anderson N, Bonilla D, Green R, Katz P, Touma Z
Assessment of the impact of interferon levels on cognitive dysfunction in patients with SLE
Blood levels of an important marker of lupus activity and disease severity called interferon gamma were not correlated with cognitive impairment e.g. difficulties with thinking, memory, problem solving in patients with lupus.
Research Team: Kwan A, Wither J, Martinez J, Green R, Beaton D, Bingham K, Kakvan M, Ruttan L, Tartaglia C, Fritzler M, Choi M, Su J, Bonilla D, Anderson N, Katz P, Touma Z
Hearing loss in SLE patients taking hydroxychloroquine: A literature review of reported cases
We reviewed 12 reports of hearing loss in lupus patients taking hydroxychloroquine, mostly occurring within five years of treatment and where the medication was felt to be the cause. Since hearing loss may also occur as a result of lupus in patients unexposed to hydroxychloroquine, further studies are needed to understand the cause of hearing loss in patients with lupus.
Research Team: Liu JL, Hazlewood G, Pineau C, Mendel A, Vinet E, Bernatsky S
Identifying cognitive impairment in patients with systemic lupus erythematosus using Bayesian statistical learning
This study used advanced statistical modelling called Hidden Markov Models to determine whether patients have cognitive impairment e.g. difficulties with thinking, memory, problem-solving.
Research Team: Martinez J, Bingham K, Green R, Tartaglia C, Ruttan L, Su J, Wither J, Kakvan M, Anderson N, Bonilla D, Choi M, Fritzler M, Beaton D, Katz P, Touma Z
Systemic lupus erythematosus and systemic sclerosis overlap with paroxysmal nocturnal hemoglobinuria: A Case Report and Review of the Literature
This is an interesting case about a patient who developed signs and symptoms seen in lupus and scleroderma, but her final diagnosis was likely another rare disease called paroxysmal nocturnal hemoglobinuria. This case reminds clinicians to keep their list of possible diseases broad as there can be many mimickers.
Research Team: Powell M, Choi M, Barr S, Fritzler M
Evaluation of comorbidities and damage in Canadian patients with systemic lupus erythematosus
Canadian lupus patients have a greater burden of other chronic conditions related to inflammation, compared to the general population. Identifying the risk factors associated with these conditions and disease damage is a very important step in treating those patients.
Research Team: Thai J, Peschken C, Pan B, Al Hamarneh Y, Reynolds J, Avina-Zubieta JA, Clarke A, Hitchon C, Tisseverasinghe A, Fortin P, ivory C, Haaland D, Legault K, Matsos M, Pope J, Keeling S
Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review
This review of the literature on cognitive impairment in lupus patients showed that the definition and tests used to detect cognitive impairment are highly variable.
Research Team: Yuen K, Green R, Bingham K, Ruttan L, Lee-Kim V, Tartaglia C, Anderson M, Zandy M, Choi M, Fritzler M, Wither J, Beaton D, Katz P, Touma Z
Is the Montreal Cognitive Assessment (MoCA) a suitable screening tool for assessing cognitive impairment in patients with systemic lupus erythematosus (SLE) compared to the American College of Rheumatology Neuropsychological Battery (ACR-NB)?
This study showed that the Montreal Cognitive Assessment tool to screen for cognitive impairment in the general population is not an accurate tool to screen for cognitive impairment in SLE.
Research Team: Yuen K, Kakvan M, Su J, Bingham K, Katz P, Martinez J, Tartaglia C, Ruttan L,Wither J, Anderson N, Bonilla D, Choi M, Fritzler M, Beaton D, Touma Z
Prevention of chronic diseases due to inflammation in inflammatory arthritis: Results of a Delphi process to select care recommendations for an electronic medical record (EMR) intervention
We developed a list of care recommendations that will be programmed into the electronic medical records of British Columbia family physicians to automatically remind them to screen their patients with inflammatory arthritis for other chronic illnesses related to inflammation, like diabetes, heart disease and osteoporosis. The recommendations were pulled from local, national and international clinical guidelines and voted on by a group of physicians and patients; the goal of the intervention is to help prevent chronic disease in patients with inflammatory arthritis.
Research Team: Sheriff I, Lima A, Tseng O, Avina-Zubieta JA, Dawes M, Barber C, Esdaile J, Shojania K, Koehn C, Hoens AM, McQuitty S, Singh S, Yap J, Page D. Kur J. Hobson B, Price M, Lacaille D
The development of a national collaboration for research, advocacy, education and optimizing patient care in an emerging and complex domain
This abstract describes a national collaboration of clinicians and researchers called the CanRIO network who are interested in understanding more about patients treated with new cancer therapies, called immune check-point inhibitors, which prolong/save lives but can cause auto-immune rheumatic diseases, like lupus or arthritis, as a side-effect.
Research Team: Arreola L, Hudson M, Ye C, Roberts J, Fifi-Mah A, Appleton T, Colmegna I, Dutz J, Ennis D, Fritzler M, Choi M, Himmel M, Hoa S, Maltez N, Pope J, Rottape R, Saltman A, Tisseverasinghe A, Jamal S, The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO)
Disentangling the web of costs associated with Juvenile Idiopathic Arthritis (JIA)
We assessed the real-world health care resource use and costs of hospital admissions, emergency visits, physician’s visits, medication, and ambulatory care in a cohort of children diagnosed with JIA in Canada. The care pathway for children diagnosed with JIA was expensive, long, and complex – and varies by JIA subtype. Although the mean overall cost was stable the distribution of costs over time is explained by the introduction of biologic therapies later in the care pathway.
Research Team: Grazziotin L, Twilt M, Currie G, Kip MMA, IJzerman MJ, Marshall DA
Shared decision-making for inflammatory arthritis treatment decisions: Preferences of Indigenous patients
We looked at the preferred approach for Indigenous patients living with inflammatory arthritis to be involved in making treatment decisions with their doctors and aspects of care they found important. The study participants suggested that the approach provides Indigenous-related information about arthritis treatment benefits and risks and how to add traditional healing practices in arthritis care, and an approach that includes a person that supports and guides them in making treatment decisions.
Research Team: Umaefulam V, Fox T-L, Barnabe C
Cervical ulceration caused by granulomatosis with polyangiitis: A case report and review of the literature
We reported a case of biopsy-proven cervical ulceration caused by a vasculitis, called granulomatosis with polyangiitis, who was treated with prednisone, rituximab and azathioprine.
Research Team: Byrne G, Stewart M, Amiri N, Ennis D, Shojania K
A retrospective study on the effectiveness of Ixekizumab after treatment with secukinumab for patients with active psoriatic arthritis
This study looked at a new class of biologic medications for psoriatic arthritis to see if it was worthwhile to switch from one anti-IL17 agent to another if the first one was not effective. The chart review revealed that most of the 10 patients reviewed benefited from the switch.
Research Team: Darabian S, Badii M, Dutz J, Chan J
Instruments to assess patient complexity in rheumatology: A scoping review
Patient complexity refers to medical, psychological, social and environmental factors that may exist for patients rendering their care more complex. We did a review of the literature to better understand how patient complexity is measured in patients with rheumatic conditions. We identified only two tools to help measure complexity that have been used in rheumatology.
Research Team: Hawker K, Barnabe C, Barber CEH
Sex differences in inflammatory myopathies: A cross sectional study
Little is known about sex differences in autoimmune inflammatory myopathies (AIM) and how they influence clinical presentation and patient-reported outcomes (PROs). We found that in our AIM cohort, more women had severe disease than men, and women had significantly more functional and physical health-related quality of life impairment than men. These novel findings may suggest biologic differences in the disease and in the health care trajectories of women and men with early AIM.
Research Team: Marmen MB, Albert A, Leclair V, Wang M, Vinet E, Fortin PR, Hudson M
#ArthritisThenNow: Reflecting on treatment changes in inflammatory arthritis
The #ArthritisThenNow campaign was successful in increasing awareness of the fundamental changes in arthritis diagnosis and treatment over the last twenty years. CAPA is continuing this campaign to ensure policy makers, the patient community and the general public recognize the evolution in treatment and related outcomes.
Research Team: Richards D, Proulx L, Robertson N, Wilhelm L, Kuluva M, McKinnon A, Gunderson J, Sirois A, Sirotich E, Lane T, Andersen L
Rheumatic complications of cancer immunotherapy: Answering the call and meeting the educational needs of Canadian rheumatologists
We identified significant knowledge gaps in the emerging field of rheumatic immune-related adverse events nature (RhirAE). A small group case-based educational session resulted in knowledge acquisition. Future research will focus on long-term knowledge acquisition with questionnaires sent to participants 3-6 months following module completion.
Research Team: Roberts J, Jamal S, Hudson M, Fifi-Mah A, Ye C
A rare case of systemic sclerosis and ANCA associated vasculitis overlap
We describe a rare case of biopsy-proven systemic sclerosis and ANCA associated vasculitis overlap. This case is highly atypical given our patient was on maintenance therapy with Rituximab.
Research Team: Tan J, Friedmann J, Shojania K, Barbour S, Ennis D, Dehghan N, Kim H
Screening, monitoring, and treatment of juvenile idiopathic arthritis–associated uveitis in the Canadian context: Adolopment of the American College of Rheumatology/Arthritis Foundation guidelines
Uveitis is a form of eye inflammation that can be serious and lead to permanent vision loss. We used adolopment (adoption, adaptation and new development) to efficiently evaluate and modify the ACR/AF guidelines for JIA-associated uveitis to be applicable in the Canadian context with a lens for cost, equity and access.
Research Team: Berard R, Piskin D, Ng HY, Pardo J, Hazlewood G, Levy D
Safety of low dose methotrexate (MTX) and tuberculosis (TB)
This study looked at the safety of using methotrexate, the most commonly used medication for rheumatic diseases, in areas of the world where tuberculosis is common, and emphasized the importance of screening for tuberculosis, and prescribing medications to prevent reactivation of tuberculosis if needed, when methotrexate is prescribed in those areas.
Research Team: Davidson A, Gunay A, Colmegna I, Lacaille D, Loewen H, Meltzer M, Scuccimarri R, Yirsaw Z, Mengistu Y, Bernatsky S, Hitchon C
Ultrasound versus temporal artery biopsy in the diagnosis of giant cell arteritis
Ultrasound has been recommended as a first line investigation for suspected giant cell arteritis, a disease causing inflammation of the blood vessels to the eyes. Rapid and accurate diagnosis is essential to prevent blindness. The study reports the accuracy of ultrasound compared to temporal artery biopsy to diagnose this disease in the Canadian population.
Research Team: Yip A, Bowie D, Jhaji A, Bardi M, Dehghan N, Avina-Zubieta JA, Shojania K, Diamantopoulos A, Ming W, Docherty G, Nathoo N
Barriers and facilitators to physical activity for people with scleroderma: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort Study
We found that medically related barriers to physical activity were common, with Raynaud’s phenomenon and fatigue being the most common barriers to physical activity in people with scleroderma. Facilitators patients thought they were likely to use included adapting the type of exercise or the setting for exercising, healthy behaviours that take care of the body, and using clothing or materials to protect the skin or to keep warm.
Research Team: Harb S, Pelaez S, Carrier ME, Kwakkenbos L, Bartlett S, Hudson M, Mouthnn L, Sauve M, Welling J, Shrier I, Thombs B, SPIN – Physical Activity Enhancement Patient Advisory Team, SPIN Investigators
Association between gastroprotective agents and risk of incident interstitial lung disease in systemic sclerosis
We evaluated whether taking stomach medications that protect against acid reflux were associated with a lower risk of getting Interstitial Lung Disease (ILD) in systemic sclerosis. We found that taking these medications did not alter the risk. This study does not support the use of anti-heartburn medications for the purpose of preventing ILD in systemic sclerosis patients.
Research Team: Hurtubise R, Hudson M, Gyger G, Baron M, Wang M, Steele R, Hoa S
Variations in pediatric rheumatology workforce and care processes across Canada
Our study highlights the shortages of both Canadian pediatric rheumatologists and Allied Health Professionals. Most rheumatologists work in multidisciplinary teams, and support from Allied Health Professionals is likely inadequate at most centers.
Research Team: Lee J, Laxer R, Feldman B, Barber C, Batthish M, Berard R, Tucker L, Levy D
Combination therapy with tofacitinib and IL-17A or IL-23 inhibition for the treatment of refractory psoriatic arthritis
This study reports on four cases where tofacitnib was added to a biologic agent in psoriatic arthritis patients with severe active disease despite treatment with an Anti-IL17 or IL-23. The combination resulted in improved disease control without side effects.
Research Team: Yip A, Chan J, Dutz J
Safety of low dose methotrexate (MTX) in human immunodeficiency virus infection
Research Team: Gunay A, Davidson A, Colmegna I, Lacaille D, Loewen H, Meltzer M, Mengistu Y, Scuccimarri R, Yirsaw Z, Bernatsky S, Hitchon C
Efficacy of Ixekizumab versus Adalimumab in psoriatic arthritis (PsA) patients with and without moderate-to-severe psoriasis: 52-week results from a multicentre, randomised open-label study
Research Team: Kristensen LE, Okada M, Tillett W, Liu-Leage S, El Baou C, Bradley A, Meszaros G, de Vlam K, Dutz J