Arthritis Research Canada at
CRA & AHPA Annual Scientific Meeting 2023
Research Spotlight
More than Half of Canadians with RA with a Lifetime History of Mood Disorders were Anxious or Depressed during the COVID-19 Pandemic.
We compared trends in the prevalence of anxiety and depression prior to and during the COVID-19 pandemic in people with rheumatoid arthritis with and without a prior history of these disorders. During the first 2 years of the pandemic, depression and anxiety increased in all groups; whereas depression peaked early in the pandemic, anxiety generally increased with each wave, peaking in the third wave (May-Jun 2021). Participants reporting having had mood disorders in the past were more than twice as likely to report anxiety and depression, indicating the importance of applying a lifetime perspective as previous episodes of anxiety and depression may be an important indicator of increased vulnerability and recurrence in patients with rheumatoid arthritis.
Research Team: Bartlett S, Schieir O, Valois MF, Tin D, Hazlewood G, Bessette L, Boire G, Hitchon C, Pope J, Thorne C, Keystone E, Bykerk V, CATCH Canadian Early Arthritis Cohort Investigators.
To learn more about Arthritis Research Canada research presented at the CRA & AHPA Annual Scientific Meeting on February 10, please scroll down. We have research on rheumatoid arthritis, osteoarthritis, lupus, and much more.
Treatment patterns of scleroderma renal crisis in the International Scleroderma Renal Crisis Survey II.
Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis where uncontrolled hypertension leads to kidney damage. This international study of SRC is the first to describe real-world treatment patterns for this condition. The study found that the majority of SRC patients required at least two anti-hypertension medications to control blood pressure, and that time to control blood pressure was sub-optimal. Almost half of patients required dialysis.
Research Team:Chan R, Banina M, Denton C, Hudson M
Lived Experiences that Influenced Self-Perception and Identity among Individuals with Rheumatoid Arthritis during the COVID-19 Pandemic.
We conducted one-to-one interviews with adults with rheumatoid arthritis (RA) to explore their lived experiences during the COVID-19 pandemic related to things such as parenting, working, self-reflection and perceptions of others. Our findings may be helpful for designing self-care programs and to assist healthcare professionals to recognize the invisible work done by people with RA as they negotiate valued social roles, identity and sense of self during the pandemic.
Research Team: Therrien S, Ramachandran S, Leese J, Backman C, Ma J, English K, Davidson E, McQuitty S, Koehn C, Hoens A, Gavin J, Adams J, Li L
Safety Profile of COVID-19 Vaccinations in Patients with Rheumatoid Arthritis (RA) and Systemic Sclerosis (SSc).
Side effects and disease flares after COVID-19 vaccination were evaluated in 64 patients with Rheumatoid Arthritis or Systemic Sclerosis. No severe side-effects requiring urgent care or hospitalization were observed. The most common side effects were sore arm/pain, and fatigue (mainly for people with scleroderma), and disease flares for both groups were more common after the first vaccine and in those who received the Moderna vaccine.
Research Team:Zimming Yan E, Lodhi S, Heesels L, Yerubandi A, Bellini J, Baker B, Benoit J, Mbuagbaw L, Bowdish D, Larche M, Kaplan G, Avina-Zubieta JA, Fortin PR, Gingras AC, Chandran V, Boire G, Lacaille D, Colmegna I,Hitchon C, Lee JL, Bernatsky S, SUCCEED Investigators Safety and immUnogenicity of Covid-19 vaCcines in systemic immunE mediated inflammatory Diseases.
The association between exposure to gut dysbiosis-inducing medication and immune related adverse events from immune checkpoint inhibitor therapy.
This study looked at how exposure to antibiotics and other medications that affect the gut microbiome may affect the risk of immune related adverse effects of immune checkpoint inhibitors, a new class of drugs used to treat cancer. No increased risk was found. Although based on small numbers, the findings are reassuring for patients with cancer who often have to take medications that affect the gut microbiome. Larger studies are needed to confirm these findings.
Research Team: Terry O, Ladouceur A, Esfahani K, Miller W, Hudson M
M-Phase Phosphoprotein 1 Autoantibodies as a Biomarker for Cranial Neuropathies in an International SLE Inception Cohort.
This study of an international cohort of 795 people with newly diagnosed lupus evaluated a novel biomarker, an antibody against the self called Anti-MPP-1. People with this antibody were five times more likely to develop involvement of cranial nerves from lupus. Further studies are needed to understand how these antibodies contribute to disease pathogenesis.
Research Team:Krustev E, Hanly JG, Chin R, Buhler K, Cardwell FS, Fritzler M, Clarke AE, Choi M, SLICC The Systemic Lupus Erythematosus International Collaborating Clinics.
Serum Cytokine Profiling Reveals Elevated Levels of S100A8/A9 and MMP-9 in Systemic Lupus Erythematosus Patients with Cognitive Impairment Independently of Disease Activity and Inflammatory Markers.
Cognitive impairment is one of the most common manifestations of lupus affecting the brain or nervous system and can occur when the rest of lupus is not active. Currently why or how this occurs is not understood. This study evaluated the serum levels of cytokines that previous studies have suggested may play a role in developing lupus in the brain or nervous system to identify biomarkers of cognitive impairment.
Research Team: Munoz-Grajales C, Barraclough M, Diaz-Martinez J, Su J, Bingham K, Kakvan M, Ruttan l, Tartaglia C, Choi M, Bonilla D, Appenzeller S, Katz P, Beaton D, Green R, Wither J, Touma Z.
Occupation as a Gendered-Role and Outcome in Systemic Sclerosis.
This study of a Canadian cohort of patients with scleroderma examined the association between occupation, a gender-related role, and various outcomes in SSc and did not find any independent associations. These results should be interpreted with caution as occupation may be a poor measure of gender. Future research using a validated measure of gender are needed to assess the effect of gender in SSc.
Research Team:Alkhamees F, Yu O, Wang M, Hudson M
Effectiveness of Upadacitinib in Patients with Rheumatoid Arthritis in Canadian Real World Practice: Interim Results from the CLOSE-UP Post-Marketing Observational Study.
This study evaluated the effectiveness of upadacitnib, a new medication belonging to the class of JAK-inhibitors, when used in real-world clinical practice for the treatment of rheumatoid arthritis. Consistent with clinical trial data, interim analysis of this real-world Canadian study showed that disease activity was reduced, and patient reported improved outcomes with an overall favorable benefit to risk profile for Canadian patients receiving upadacitnib.
Research Team: Haaland D, Chan J, Lisnevskaia L, Chow A, Girard T, Fournier PA, Bessette L.
“How are you?” A thematic analysis of patient experiences and perspectives using text-messaging based care.
The goal of this project was to understand the perspectives of patients with rheumatoid arthritis regarding the use of text-messaging as part of rheumatology care. Overall, patients found text-messaging with their healthcare providers to be timely, leading to better patient-centered care. Patients also perceived this model of care to be equitable, reliable, and efficient.
Research Team: Zafar S, Hazlewood G, Dhiman K, Charlton A, Then K, Dempsey E, Lester R, Barnabe C, Hoens AM, Lacaille D, Rankin J, Barber CEH.
The Presence of Non-Inflammatory Articular Pain is associated with Work Impairment, Worse Function and Health-related Quality of Life Outcomes in patients with Early RA participating in a Prospective Observational Real-world Canadian Early Inflammatory Arthritis Cohort (CATCH).
This Canadian study of people with rheumatoid arthritis enrolled in the CATCH cohort looked at pain in the joints that is not due to inflammation. It found that over half of RA patients have non-inflammatory pain at disease onset, and this persists in up to 30% of people. Having non-inflammatory pain was also associated with worse outcomes, such as poorer physical function, quality of life and more impairment in work and other activities over 1-year of follow-up.
Research Team:Meng C, Lee Y, Schieir O, Valois MF, Butler M, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bessette L, Pope L, Bartlett S, Bykerk V.
Assessing the Diversity of Rheumatoid Arthritis Participants in the Rheum4U Precision Health Registry Cohort
Rheum4U is a study that collects information over time using a web-based platform on patients seen at two Rheumatology clinics in Calgary. This project evaluated the diversity of participants. It found that Rheum4U captures a diverse cohort of patients with RA, reflecting the characteristics of the population of Alberta. However, the percent of patients from rural communities was lower than expected. This finding raises a potential issue of equity based on geography.
Research Team: Mosher D, Gjata I, Benseler S, Stevenson M, Marshall D, Rheum4U Team.
Women with Early Rheumatoid Arthritis Less Likely to Achieve Rapid and Sustainable Remission: Results from The Canadian Early Arthritis Cohort Study.
This study compared rates of early and sustained remission in men and women who received guideline-based care at Canadian clinics. Time to remission was longer for women than men, and sustained remission 12 and 24 months after first remission was also lower in women than men. The results point to smoking and residual disability at remission in men, and obesity and chronic comorbidity management in women as potentially modifiable targets for sustaining remission.
Research Team:Schieir O, Bartlett S, Valois MF, Hazlewood G, Bessette L, Boire G, Hitchon C, Keystone E, Pope J, Thorne C, Tin D, Bykerk V.
Consideration of patient perspective is key when planning RA trials: A focus group study.
Before conducting a randomized clinical trial (RCT) to explore novel biomarkers to personalize therapy for rheumatoid arthritis (RA), we undertook this study to investigate patient perspectives regarding randomized and personalized RA care. We found that Trust facilitates treatment discussions between patients and physicians, and could increase acceptance of treatments and novel tests in order to personalize care. Poor communication between physicians was identified as a barrier to optimal personalized care. These findings will be used to help design a future trial of advanced therapies in RA.
Research Team:Banina M, Charles C, Colmegna I, Hudson M, Pelaez S, Bernatsky S.
Patient Mobilization for Vaccine Access and Improved Care during the COVID Pandemic.
We present the initiative and the collaborative work of patients, clinicians and researchers of the PIRA group (Patients Interested in Research on Arthritis) Quebec. A research project that allowed immunocompromised patients with autoimmune inflammatory diseases to document their response to the SARS-CoV-2 vaccine and to access vaccination.
Research Team: Beaulieu MC, Fortin PR, Colmegna I, Légaré J, Amiable N.
The Effect of Sex on Patients with Pre-existing Rheumatoid Arthritis and Immune Checkpoint Inhibitor-induced Inflammatory Arthritis: Data from the Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) Prospective Cohort.
This study explored sex-related differences between patients with pre-existing rheumatoid arthritis who received cancer treatment with immune checkpoint inhibitors, a new class of cancer drugs that turns on the immune system to fight off cancer, and patients who developed inflammatory arthritis as a side effects of these medications. A few sex differences were found. Unlike rheumatoid arthritis, the inflammatory arthritis from check point inhibitors does not preferentially affect women. Women in both instances were more likely to have positive auto-antibodies linked to arthritis (Rheumatoid Factor and anti-CCP antibodies). Severe flares were more common in women than men with pre-existing rheumatoid arthritis, while severe inflammatory arthritis as a side effects of these drugs was more common in men, and they more often discontinued immune check point inhibitor treatment.
Research Team: Ladouceur A, Arreola L, Ye C, Roberts J, Fif-Mah A, Maltez N, Hoa S, Pope J, Appleton T, Choi M, Colmegna I, Dutz J, Ennis D, Himmel M, Rottapel R, Saltman A, Tisseverasinghe A, Jamal S, Hudson M.
Organizational Interventions to Prevent and Reduce Burnout Among Physicians: a Systematic Review of Systematic Reviews.
This study reviewed the literature on interventions to reduce physician burnout. Most interventions that were effective involved targeting workflow and flexible schedules, as well as individual-level strategies that organizations could implement to better support staff, including group mindfulness programs. This work is currently being evaluated by the Canadian Rheumatology Association (CRA) human resources committee to develop recommendations to support the current rheumatology workforce.
Research Team: Kheirkhah H, Hartfeld NMS, Widdifield J, Kulhawy-Wibe S, Roberts J, Yacyshyn E, Lee J, Jilkine K, Barber CE.
New-Onset Immune-Mediated Disease following SARS-CoV-2 Vaccination: A Case Series.
This case series describes 37 British Columbians who developed symptoms of a new-onset immune-mediated disease within 30 days of receiving a COVID-19 vaccine between December 2020 and March 2022. Inflammatory arthritis was the most common diagnosis (almost half), ten patients (a quarter) had severe or life-threatening disease, and almost two thirds developed chronic disease requiring long term immunosuppression. It is not known how these rates differ from baseline population rates or risk following other vaccines.
Research Team: Dhillon I, Hansen S, Dehghan N, Reynolds J
Exploring Canadian Patient Experiences of Living with Lupus Nephritis.
In this study, individuals with lupus nephritis, a kidney complication from lupus, were interviewed to better understand the patient perspective of this diagnosis and their lived experience. In addition to reporting challenges with seeking, receiving and adjusting to their diagnosis, patients reported that the diagnosis raised concerns in various areas from career aspirations to family planning to managing stress, the cost of medications, and their possible side-effects. Lack of understanding of lupus nephritis along with uncertainties of living with the renal disease emphasize the need for improved awareness and patient resources to increase understanding and support decision-making.
Research Team: Cardwell F, George S, Boucher A, Barber MRW, Cheema K, Elliott SJ, Clarke AE.
