Arthritis Research Canada at
CRA & AHPA Annual Scientific Meeting 2022
Results from the 2020 Canadian Rheumatology Association’s Workforce and Wellness Survey.
The Canadian Rheumatology Association surveyed rheumatologists across Canada to learn 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, Lee J, Thorne C, Yacyshyn E, Batthish M, Jerome D, Shupak R, Jilkine K, Purvis J, Shamis J, Roberts J, Kur J, Burt J, Johnson N, Barnabe C, Spencer N, Harrison M, Pope J, Barber CEH.
To learn more about Arthritis Research Canada research presented on February 4 at the CRA & AHPA Annual Scientific Meeting, please scroll down. We have research on COVID-19 and arthritis, rheumatoid arthritis, osteoarthritis, lupus, and much more.
Improvement in Overall Survival, Skin Fibrosis and Lung Function with Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis.
Systemic sclerosis is rare but potentially very severe disease where scarring occurs in the skin and various vital organs. This study provides crucial real-world evidence about good long-term clinical outcomes supporting the use of stem cell transplantation in patients with severe systemic sclerosis.
Research Team: Maltez N, Wang M, Wells G, Tugwell P, Baron M, Marjnovic Z, Lansiaux P, Farge D, Hudson M.
Riding multiple waves of uncertainty: The impact of COVID-19 on RA patients in the Canadian Early Arthritis Cohort (CATCH).
During the COVID-19 pandemic, Canadians with rheumatoid arthritis 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 COVID-19 (April – June 2020 and Oct – Jan 2021) in adults with RA. As compared to 6 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.
Bartlett S, Schieir O, Valois MF, Pope J, Hazlewood G, Bessette L, Boire G, Tin D, Thorne C, Keystone E, Hitchon C, Bykerk V, CATCH Investigators.
Characteristics and Evolution of Patients with Difficult-to-Treat Rheumatoid Arthritis.
Despite advances in treatments available for rheumatoid arthritis, including biologic agents, some people continue to have active inflammation despite receiving multiple biologic agents with at least two different mechanisms of action. Deciding how to treat these patients and figuring out to what extent persistent pain is due to inflammation vs. other causes of pain is challenging but important for guiding treatment decisions.
Research Team: Qi W, Robert A, Singbo N, Ratelle L, Bessette L, Brown J, Michou L.
Investigating the Determinants of Accessing Social and News Media and Experiencing Negative Impacts during COVID-19 in an International SLE Sample.
This international study of patients with lupus identified that the likelihood of going to social and news media as a source of health information during the COVID-19 pandemic and the likelihood of reporting negative impacts from accessing health information through these sources varied according to where people live, their age, gender, and education, as well as the ease with which they could access family physicians. This study emphasizes the need for targeted health messaging based on demographics and geography.
Research Team: Cardwell F, Elliott S, Chin R, Rowbottom L, St. Pierre Y, Choi M, Urowitz M, Ruiz-Irastorza G, Bernatsky S. Petri M, Peschken C, Ramsey-Goldman R, Fortin P, Bae SC, Mak A, Hanly J, Askanase A, Romero-Diaz J, Pons-Estel B, Bruce I, Wallace D, Clarke A.
Health Information Use by SLE Patients Pre and During COVID-19.
Although lupus specialists and family physicians were ranked as the most preferred sources of health information during the COVID-19 pandemic, patients accessed these sources less frequently during the pandemic and accessed news media, a less trusted source, more frequently. To increase accessibility to preferred and trusted sources, virtual visits should be promoted where not already in place. This research will improve the pathways valued by patients for disseminating health information.
Research Team: Cardwell F, Elliott S, Choi M, Chin R, St Pierre Y, Rowbottom L, St., Urowitz M, Ruiz-Irastorza G, Bernatsky S. Petri M, Manzi S, Peschken C, Ramsey-Goldman R, Fortin P, Bae SC, Mak A, Hanly J, Askanase A, Romero-Diaz J, Pons-Estel B, Bruce I, Wallace D, Clarke A.
Key factors for the development and implementation of a patient dashboard in rheumatology: Review of literature.
This study reviewed the literature on patient dashboards, which are e-health tools designed to provide to physicians feedback about how their patients are treated for the purpose of quality improvement. The review found that several key factors can increase the likelihood of successful implementation of a patient dashboard including a user-centered approach to co-design, simple graphics with descriptions of the measures, a broad range of holistic measures, and the application of motivational strategies.
Research Team: Pirhalova T, Sandhu N, Benseler SM, Marshall DA, Gjata I, Twilt M, Stevenson M, Olaosebikan O, Mosher D on behalf of the Rheum4U Team.
Prevalence and titre distribution of antinuclear antibodies in juvenile idiopathic arthritis – A systematic review.
We reviewed the scientific literature on ANA testing for patients with JIA, including those that went on to develop uveitis.
Research Team: Storwick J, Brett A, Buhler K, Chin A, Schmelling H, Johnson N, Choi M, Fritzler M.
Evaluating frailty in rheumatoid arthritis: A scoping review.
Frailty is an emerging concept that can help us understand why certain individuals living with rheumatoid arthritis (RA) experience worse health outcomes than others. We found that many different measures and tools have been used to assess frailty in patients with RA, yielding a wide range of estimates for its prevalence. Studies consistently show that frailty is more common among RA patients when compared to individuals without RA, suggesting that frailty is a relevant concept in RA that warrants further study.
Research Team: Legge A, Lacaille D.
Assessing a nursing inter-professional model of care in rheumatology.
We assessed whether a collaborative inter-professional model of care in which nurses provide intake for inflammatory arthritis patients improves access to rheumatologist care while providing a high standard of care. We found that this model of care allows greater access to care in underserviced areas while maintaining high quality care, thus improving efficiency of service delivery in areas with few rheumatologists, and reducing inequities in access to arthritis care. However we found that patients still often wait too long for consults.
Research Team: Kelsall A, Teo M, Lacaille D.
Impact of Early antimalarial adherence on future acute care utilization in patients with newly diagnosed rheumatoid arthritis and systemic lupus erythematosus: A population-based study.
We examine the association between antimalarial (AM) adherence and acute care utilization among newly diagnosed rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients. RA and SLE patients adhering to AM therapy are found to be associated with a lower risk of future acute care utilization (13 per cent reduction in the risk of hospital admission and 22 per cent reduction in the number of hospitalized days) than non-adherent patients.
Research Team: Hoque MR, Avina-Zubieta JA, De Vera MA, Qian Y, Esdaile JM, Xie H.
SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to 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: Buhler KA, Mathew H, Choi M, Gukova K, Cardwell F, Waldhauser H, Clarke A, Fritzler M.
Hospitalizations for COVID in Canadian SLE Patients Followed in Clinical Cohorts in the Pre-vaccination Period.
This study found that of the 1,375 patients with lupus followed in specialized lupus clinics in Canada, none were hospitalized for COVID-19 during the period of March 2020 to April 01 2021, which covers the first and second wave of the pandemic when vaccines were not yet available to lupus patients unless they were elderly or health care workers.
Research Team: Liu JL, Pineau C, Hanly J, Clarke A, Peschken C, Fortin P, Vinet E, Hitchon C, Bernatsky S.
Economic evaluation of hydroxychloroquine use in an international SLE inception cohort.
Lupus (SLE) patients reported higher annual health related costs when not taking hydroxychloroquine (HCQ) vs. taking the drug. This could be due to HCQ helping to reduce long-term damage from SLE patients. In addition to its well-established efficacy at improving clinical outcomes of SLE, there may be an economic benefit for HCQ use in SLE patients.
Research Team: Barber MRW, St Pierre Y, Hanly JG, Urowitz M, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill J, Fortin PR, Gladman D, Bruce I, Petri MM, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, Van Vollenhoven R, Aranow C, Mackay MM, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian K, Jacobsen s, Peschken CA, Kamen D, Askanase A, Clarke AE.
Can a questionnaire reliably identify improvement and worsening in the RA disease activity? Implications for use of RA-FQ for telehealth.
The Rheumatoid Arthritis Flare Questionnaire (RA-FQ), a brief patient-reported measure that asks about pain, function, fatigue, stiffness and participation, can be used to identify disease flares in RA. We evaluated how well the RA-FQ performed in 808 adults with RA, and found it could detect even small changes in disease activity and distinguish between patients with minimal and meaningful improvement and worsening of their RA. Results suggest the RA-FQ may be particularly useful for assessing disease activity when in person visits are not feasible.
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.
Accessing care for rheumatoid arthritis: A critical interpretive synthesis.
We examined what the scholarly literature on the experiences of people living with rheumatoid arthritis (RA) tells us about the challenges they experience in accessing care from diagnosis through disease management. We were especially interested in understanding the role of the primary care physician (GP or family doctor) in their access journey. We conclude that in order to improve access to RA care, changes are needed at many levels (individual, patient-physician interaction, health system organization, broader community). To optimize the care of people living with RA, family doctors need to be knowledgeable about the disease, but also value the experiential knowledge gained from living with RA.
Research Team: Koehn S, Pham A, Barber C, Lindeman C, Drummon N, Jones A.
Development of a new ‘Resource of Resources’ to support physical activity in people living with chronic conditions.
‘Active For Health’ is an Arthritis Research Canada supported and Physical Therapy Knowledge Broker led project involving more than 150 clinicians, researchers, students and persons living with chronic health conditions. The online toolkit provides high quality, vetted resources to help people living with arthritis and other chronic conditions to be more physically active. More information here: https://www. healthlinkbc.ca/healthy-eating-physical-activity/active-for-health
Research Team: Westby M, Hoens AM.
Upper extremity function scale: Better ways to measure perceived function and self-care in RA in the era of virtual medicine.
Self-assessment tools that can reliably and precisely quantify hand/wrist function are needed to assess inflammatory activity when a physical exam is not feasible. In a study of 262 participants with rheumatoid arthritis, we compared NEURO-QOL Upper Extremity Function scores with widely used measures of disability, RA symptoms, and disease activity indicators. Our results offer initial evidence supporting use of Neuro-QOL to self-assess inflammatory activity in the hands 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, CATCH Investigators. Neuro-QOL
Experiences using wearable technology by persons with rheumatoid arthritis participating in a physical activity counselling intervention study: A relational ethics analysis.
Little is known about the ethical issues (positives or negatives) that people with arthritis may experience when using a physical activity wearable to support self-management in everyday life. By advancing understanding of ethical issues experienced, this study contributes important insights that can help to develop physical activity programs involving a wearable.
Research Team: Leese J, Zhu S, Townsend AF, Backman CL, Nimmon L, Li LC.
Anti-MPP1 autoantibodies are associated with peripheral neuropathy in systemic lupus erythematosus.
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 KA, Cardwell F, Fritzler M, Clarke A, Choi M.
The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO): A nationwide multi-center prospective cohort.
The initial sample of 103 patients from the CanRIO prospective national cohort of people with rheumatic diseases treated with cancer immunotherapy, suggested that most patients presented with joint manifestations as toxicities to cancer immunotherapies and most of them were treated with prednisone. Patients with pre-existing autoimmune disease had similar demographic characteristics and tumor representation than those without pre-existing autoimmune disease but were more likely to have tumor progression while receiving their cancer immunotherapy.
Research Team: Gonzalez Arreola L, Tan J, Ye C, Roberts J, Fifi-Mah A, Hudson M, Hoa S, Pope J, Maltez NN, Appleton T, Choi M, Colmegna I, Dutz J, Ennis D, Himmel M, Rottapel R, Saltman A, Tisseverasinghe A, Jamal S.