Arthritis Research Canada at

CRA & AHPA Annual Scientific Meeting 2024

Research Spotlight



Direct Health Care Costs Differ by SLE Autoantibody Machine Learning Clusters in an International Inception Cohort


 This study applied machine learning to data from an international cohort of lupus patients to understand patterns of health care utilization for different groups of patients with lupus. They found that the group of lupus patients who incurred the highest cost were people with antiphospholipid antibodies and this was largely driven by hospitalizations for clotting events, such as clots to the veins and cardiovascular events.


Research Team: Choi M,Costenbader K, Fritzler M, Clarke AE,SLICC The Systemic Lupus Erythematosus International Collaborating Clinics.


To learn more about Arthritis Research Canada research presented at the CRA & AHPA Annual Scientific Meeting on March 1, please scroll down. We have research on rheumatoid arthritis, osteoarthritis, lupus, and much more.

Mesenchymal Stromal Cells in Scleroderma Have an Incomplete Myofibroblast-Like Phenotype with Preserved in Vitro Anti-Inflammatory and Anti-Fibrotic Effects.

This study aimed to understand what might cause tightness of the skin (fibrosis) in people with scleroderma and looked at the characterization of unique cells called ‘multipotent mesenchymal stromal cells’ that are isolated from the fat present below the skin from people with and without scleroderma. These cells normally have an anti-fibrotic effect and the researchers wondered if their function was impaired in people with scleroderma, causing fibrosis. The study found no difference in the anti-inflammatory and anti-fibrotic functions of these cells. The authors will investigate other compensatory mechanisms as a potential cause of fibrosis in scleroderma.

Research Team: Brizio M, Lora M, Moraes C,Hudson M, Colmegna I.



Survival on Treatment After Transition to a Biosimilar: Population-Based Evidence from a Natural Experiment Due to a Policy Change.

This study evaluated the BC Ministry of Health’s policy mandating that all current biologic users switch to the corresponding biosimilar when available. Using real world data from everyone in BC, the study showed that people with inflammatory arthritis who transitioned from etanercept and infliximab originator to a biosimilar remained on treatment as long as people prescribed an originator prior to the transition policy, indicating that the biosimilar drugs are as effective and as safe as the original biologic medications.

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



Equity, Diversity, and Inclusion in Canadian Rheumatology Research: a Qualitative Study Exploring Researcher Perspectives.

People represented in arthritis research in Canada do not reflect the diversity of our population, which limits our ability to apply the research results to everyone and provide personalized care. To address health inequities (preventable differences in health outcomes) for people with arthritis, the authors interviewed Canadian arthritis researchers to explore their thoughts on equity, diversity, and inclusion (EDI) in research. They identified challenges and solutions for EDI approaches in research, highlighting that starting early in the research process is key. This work is important because we need to improve representation in research, so we can better understand patients’ needs and begin to improve their access to care.

Research Team:Thomas M, Harrison M, Barnabe C, Avina-Zubieta A, Ronquillo C, Kuluva M, Samson A, Trehan N, De Vera M.



Artificial Intelligence Models for Computer-Assisted Joint Detection and Sharp-Van Der Heijde Score Prediction in Hand Radiographs from Patients with Rheumatoid Arthritis.

This study used machine learning and data from a Canadian study of early Rheumatoid Arthritis, the CATCH cohort, to develop and validate automated deep-learning systems that could accurately identify and predict joint damage in hand X-Rays from patients with rheumatoid arthritis. This may become a useful tool to monitor people’s X-rays for the development of joint damage.

Research Team: Hitchon C, Islam S, Fung D, Liu Q, Lac L, Bartlett S, Bessette L, Boire G, Hazlewood G, Keystone E, Pope J, Schieir O, Thorne C, Tin D, Valois MF, Bykerk V; CATCH Canadian Early Arthritis Cohort (CATCH) Investigators, van der Heijde D, O’Neil L, Hu P.



Predictors of Adherence to Cervical Cancer Screening Guidelines Among Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is associated with increased risk of cervical dysplasia/cancer. Because of this, recent guidelines from the Canadian Rheumatology Association recommend annual Pap tests for cervical cancer screening in this population, rather than once every 3 years, as recommended for women without lupus. We reviewed the records of women with lupus in the Dalhousie Lupus Clinic Registry and we found that only 1 in 5 SLE patients undergoes cervical cancer screening annually and only 1 in 2 receives screening once every 3 years. Future work will aim to identify barriers and facilitators to cervical cancer screening in women with SLE.

Research Team: Cho L, Legge A.



Knowledge Gaps in Treatment and Biomarkers for Melanoma Differentiation-Associated Gene 5 Dermatomyositis with Rapidly Progressive Interstitial Lung Disease.

This is a case report of a 69 year old man with a rare and severe disease that causes skin rash, weakness in the muscles and rapidly progressive inflammation in the lungs and respiratory failure requiring mechanical ventilation.

Research Team: Nikolic R, Krustev E, Fritzler M, Choi M, Moran Toro C.



When Should I Get My Next Booster? Active Surveillance of COVID-19 Breakthrough Infections in Canadian Patients with Immune-Mediated Inflammatory Diseases.

This study of Canadians with immune-mediated inflammatory diseases which monitored for COVID-19 infections through monthly saliva tests, found that 5% had COVID-19 infections after vaccination, a rate similar to the general population. Those who tested positive had a longer time elapsed since their last vaccination, with most infections occurring 7-8 months after their last vaccine dose.

Research Team: Tan J, Aviña-Zubieta A. Lee J LF, Fortin PR, Colmegna I, Gonzalez Arreola L, Berger C, Larché M, Hitchon C, Richards D, Lalonde N, Bernatsky S.



Safety & Immunogenicity of Covid-19 Vaccines in Systemic Immune Mediated Inflammatory Diseases (SUCCEED): Preliminary Results on Severe Adverse Events

This Canadian study evaluated the safety of COVID-19 vaccines in 1,556 people with immune mediated inflammatory diseases recruited from 8 Canadian centres. In the 31 days after SARS-CoV-2 vaccination, serious adverse events requiring emergency room visits or hospitalization occurred only in 11 people (0.7%), and no deaths were observed. One person experienced a severe flare of their disease requiring hospitalization. Overall, the vaccine was safe in people with Immune Mediated Inflammatory Diseases.

Research Team: Tsyruk O, Kaplan GG,Fortin PR, Hitchon C, Chandran V, Larché ML,Avina-Zubieta JA,Boire G,Colmegna I, Lacaille D, Lalonde N, Proulx L, Gunderson J, Richards DP, Allard-Chamard H, Roux S, Kirmani A, Lodhi S, Heesels L, Markovinovic A, Lukusa L, Pereira D, Lee J, Bernatsky S.



Cannabis Use Among People with Arthritis: Evaluating Disease and Psychosocial Factors Associated with Being a Cannabis User

This study compared mental and physical health outcomes in people with arthritis who used cannabis regularly and in non-users. Results showed that 27% of people surveyed used cannabis regularly, and men were twice as likely to report cannabis use. Users and non-users had the same levels of pain, fatigue, depression, anxiety, stress, and perceived health. Also, cannabis users were much more likely to be men.

Research Team: Andersen N, Lacaille D, McGuire E, Savard J, Fortin P, Rahme E, Da Costa D.



Exploring Experiences and Perspectives of Canadian Patients with Lupus Nephritis Through Photovoice.

This study used a unique research approach where participants shared photos to describe their experiences of lupus nephritis (when lupus affects the kidney). Results found that although participants discussed activities that contribute to their wellbeing, the physical, emotional, and lifestyle impacts of lupus nephritis and the medication journey remain challenging.

Research Team: Cardwell FS, Elliot SJ, Barber MRW, Cheema K, George S, Boucher A, Clarke AE.



Exploring The Experiences and Perspectives of Patients Living with Antiphospholipid Antibodies: a Qualitative Study.

The research team conducted interviews to explore patient experiences of antiphospholipid syndrome/antiphospholipid antibodies. Patients shared a range of experiences at diagnosis and in daily life, and discussed how management-related challenges affect their physical and emotional wellbeing.

Research Team: Cardwell F, Kobza AO, Elliot SJ, Gibson PS, Soliman N, Skeith L.Clarke AE, Barber MRW.



Confidence in Covid-19 Vaccine Among At-Risk and Under-Vaccinated Groups: Migrants Living with Systemic Autoimmune Rheumatic Diseases.

This study evaluates reasons for COVID-19 vaccine acceptance or refusal in long-term English-speaking migrants living with systemic autoimmune rheumatic diseases. The most common themes that migrants indicate as barriers for vaccination include fear of vaccines side effects and complications, being worried about the fast-track approval of COVID-19 vaccines, considering that alternative measures are sufficient (wearing masks, lockdowns, etc.) to be protected against COVID, and the lack of confidence in the vaccine. All these barriers overlap with those found in people born in Canada not living with an autoimmune disease. This information suggests that behavioral interventions addressing the concerns of the general population might also be relevant for long-term migrants with systemic autoimmunity.

Research Team: Fouad MH, Audet LA, Légaré MP, Costiniuk C, Pelaez S, Merry L, Légaré J, Colmegna I.



All Cause Emergency Visits and Hospitalizations in Persons with Inflammatory Arthritis and Gout: a Systematic Review.

By reviewing results from 78 studies conducted globally, the authors determined the proportion of persons with different inflammatory arthritis conditions who had an emergency department visit in each year, and the proportion who required hospitalization. For emergency department visits, 14% of people with PsA, 17% with AS, 26% with gout and 28% with RA had at least 1 visit per year. For hospitalizations, 18% of people with RA, 18% with PsA, 20% with AS and 23% with gout were admitted to hospital each year.

Research Team: Irwin K, Huo R, Barber C, Barnabe C.



Health Information Use by Patients Living with Antiphospholipid Antibodies and Antiphospholipid Syndrome

This study surveyed patients with antiphospholipid syndrome/antiphospholipid antibodies on how they access and trust a range of health information sources. Lupus specialists, family physicians and hematologists were the most accessed and trusted sources, and less than one third of participants accessed and trusted advocacy organizations, which is surprising since they exist to provide health information to affected individuals.

Research Team: Kobza AO, Cardwell F, Elliot SJ, Gibson PS, Soliman N, Skeith L. Clarke AE, Barber MRW.



Comparable Safety Among New Users of Biosimilar Versus Originator Anti-TNFs in Inflammatory Arthritis: Population-Based Evidence from a Natural Experiment Due to a Policy Change.

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 who were prescribed etanercept and infliximab biosimilars for inflammatory arthritis did not have higher rates of infections, hospitalizations, hospital length of stay, physician visits, and emergency department visits than people who were prescribed originator medications. This indicates that biosimilars are as safe as originators and that the health policy had no unintended consequences.

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



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).

This study examined patients who developed rheumatic immune-related adverse effects from cancer therapy with immune checkpoint inhibitors, a new class of cancer drugs, and found no significant difference in the severity or number of these side effects between older (≥65 years) and younger (<65 years) patients. Both groups received similar treatments, mostly involving prednisone and DMARDs. This study suggests that age does not influence the immune related side-effects of immune checkpoint inhibitors.

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



Predicting Response to Anti-Tumor Necrosis Factor Agents in Rheumatoid Arthritis Using an Extended Set of Clinical and Laboratory Variables Remains Suboptimal.

Anti-tumor necrosis factor (anti-TNF) agents are widely used for the treatment of rheumatoid arthritis (RA) but a significant proportion of individuals do not respond to them. This study developed a model to predict response of patients with RA to anti-TNF agents using an extended set of clinical and laboratory data, but the model only achieved modest ability to differentiate between people who will have a good response to treatment from those who won’t.

Research Team:Nguyen N, Bernatsky S,Colmegna I, Berger C, Carrier N, Allard-Chamard H, Liang P, Roux S, Boire G, Hudson M.



Work Disability in Patients with Systemic Lupus Erythematosus: a Pan-Canadian Qualitative Study

This study highlights the challenges that people with systemic lupus erythematosus (SLE) face in maintaining employment due to their condition. Key findings indicate that SLE impacts work ability, often due to fatigue, physical limitations, and mental health issues. The study also notes the stigma around disclosing the illness in the workplace and the importance of having supportive work accommodations. For SLE patients, work environments that offer flexibility, reduced physical and mental demands, and understanding of their condition may significantly help in preventing work disability.

Research Team: Nowrouzi-Kia B, Howe A, Li A, Jules K, Tan J, Sadek M, Kakvan M, Chattu VK, Bani-Fatemi A, Bonilla D, Nielsen W, Anderson N,Avina-Zubieta JA, Fox M, Shaw W, Haaland DA, Pope J,Fortin P, Bingham K, Peschken C, Rozenbojm N, Urowitz M, Reynolds J, Ivory C, ,Gladman D, Lim , Sanchez-Geuerrero J, Keeling S, Katz P, Touma Z.



Quinacrine in Systemic Lupus Erythematosus: An International and Canadian Survey of Availability, Effectiveness, and Safety

This survey reports on the experience of lupus experts with quinacrine, an old drug related to hydroxychloroquine that may be as beneficial and an option for the treatment of resistant lupus or when there is toxicity to hydroxychloroquine. Respondents reported limited availability in only some parts of the world (essentially North America and Europe). This limited clinical experience and there was a call for improved access and more data.

Research Team:Parastandehchehr G, Vinet E, Arnaud L, Costedoat-Chalumeau N, Fortin PR, Reynolds J, Thorne C, Touma Z, Wallace D, Werth V, Bernatsky S, Mendel A, on behalf of SLICC and CaNIOS investigators.



Reducing Avoidable Care Use and Improving Care Experience: a Focus on Emergency Department Use by Persons with Inflammatory Arthritis.

This was a survey of persons with inflammatory arthritis conditions residing in Alberta who used an emergency department. Approximately 1/3 attempted to access healthcare prior to an ED visit, whether from their primary care provider (44%), rheumatologist (7%) or another healthcare provider (17%), 24% attempted to get advice from a provincial nurse phone line, and 7% had a virtual visit before going to the ED. Close to 40% of participants had a visit specific for arthritis flare, of which 1/3 had to return to the ED a second time as they could not follow up with their rheumatologist (27%), primary care physician (18%), or had unresolved (18%) or worsening symptoms (36%).

Research Team:Pianarosa E, Roach P, McLane P, Elliott M, Holroyd B, McQuitty S, Katz S, Russon N, Lin K,Barber C, Barnabe C.



Osteoarthritis and Cognitive Function: a Population-Based Cross-Sectional Study.

Osteoarthritis may be a risk factor for Alzheimer’s disease, but studies to date are inconclusive. This study found that people with osteoarthritis did not have a higher risk of memory problems compared to people without osteoarthritis, taking into account general health, lifestyle, diet, physical activity, sleep, and social support.

Research Team:Prlic H, Sayre EC, Xie H, Ojo D, Tan J, Li LC, Lacaille D, Avina-Zubieta JA, Esdaile JM, Cibere J.



Expectant Anxiety: Impact of Medication Adjustments on Anxiety and Patient-Reported Outcomes in Pregnant Patients with Rheumatic Diseases.

In women living with an autoimmune rheumatic disease, utilizing medication to achieve low disease activity is important for optimizing pregnancy outcomes and reducing rates of pregnancy complications. This study included 49 women and found that women who required a change of medication during their pregnancy had worse self-reported health assessments and higher levels of anxiety.

Research Team: Tan J, Sergeant A, De Vera M, Amiri N.



Going Beyond Pain: Consensus Meetings to Expand The Jia Option Map with Other Symptoms and Functional Activities.

This study explored the expansion of the JIA Option Map, a web-based decision aid, for young people with juvenile idiopathic arthritis (YPJIA) in symptom management and activity participation. The research team, including patient partners and healthcare professionals, conducted virtual consensus meetings to identify key symptoms and activities for the app. They found that fatigue, stress/anxiety, and joint stiffness were critical symptoms to address, with school and daily living activities as top priorities for integration. The updated app will allow users to personalize their symptom and activity preferences and access tailored treatment options.

Research Team:Toupin-April K, Stringer E, Proulx L, Trehan N, Sirotich E, Abrahams N, Sirois A, Huber N, Duffy C, Morgan E, Cohen J, Gaboury I, Li L, Cavallo S, Connelly M, Décary S, El Tal T,  Guzman J, Ghio D, Knight A, Luca N, Martini R, Tugwell P, Stinson J.



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