Arthritis Research Canada at EULAR 2021

The EULAR European Congress of Rheumatology is the primary platform for exchange of scientific and clinical information in Europe. It seeks to provide a forum of the highest standard for scientific, educational and social exchange between professionals involved in rheumatology. It also incorporates liaising with patient organizations in order to achieve progress in the clinical care of people with rheumatic diseases.

The EULAR Congress attracts more than 18,000 delegates from over 130 countries and usually takes place in a major European city. Due to the ongoing COVID-19 pandemic, the EULAR Congress moved to a virtual format this year and took place over four days between June 2 and 5.

To learn more about Arthritis Research Canada research presented at the 2021 EULAR European Congress of Rheumatology, please scroll down.

Day 1: June 2, 2021

Identifying meaningful change in the RA flare questionnaire scores in rheumatoid arthritis

In this large cohort of adults with early rheumatoid arthritis, a questionnaire designed to assess flares in rheumatoid arthritis was found to respond well to change in disease states and to distinguish differences that represent meaningful improvement and worsening.

Research Team: Bartlett SJ, Bingham C, Schieir O, Valois MF, Hazlewood G, Pope J, Thorne CD, Tin D, Hitchon C, Bessette L, Boire G, Keystone E, Bykerk V; on behalf of CATCH Investigators.

Dietary hyperinsulinemic potential and risk of incident gout: 3 prospective cohort studies of US men and women.

Using data collected from 217,000 adults over 30 years, a diet that promoted insulin resistance (i.e. sugary beverages, fries, red and processed meats) was associated with a higher risk of gout, independent of overweight/obesity and other factors. Replacing these foods with more green leafy vegetables, whole fruits, coffee, and potentially high-fat dairy products, may reduce the risk of gout.

Research Team: McCormick N, Yokose C, Lu N, Joshi A, Choi HK

Increased risk of severe infections and mortality in patients with newly diagnosed systemic lupus erythematosus: A population-based study

This is the first study to evaluate the risk of severe infections in a large population-based and incident cohort of lupus. We observed that almost one in five lupus patients developed severe infection. Compared to the general population, lupus patients had a higher risk of getting a first severe infection, a higher total number of severe infections and higher risk of infection-related death.

Research Team: Zhao K, Xie H, Li L, Esdaile JM, Aviña-Zubieta JA.

Diagnostic accuracy of conventional radiography of the knee for calcium pyrophosphate deposition disease an ancillary study of the OMERACT Ultrasound – CPPD Group

We assessed how accurate regular x-rays are for diagnosing calcium pyrophosphate deposition disease (CPPD) of the knee – a disease where crystals develop on the joint and surrounding tissues. In patients with osteoarthritis, we found that x-rays performed well in correctly identifying patients who also had CPPD, but did not perform well in identifying patients who did not have CPPD.

Research Team: Sirotti S, Becce F, L. Sconfienza M, Pineda C, Gutierrez M, Serban T, Maccarter D, Adinolfi A, Naredo E, Scanu A, Scirè CA, Möller I, Sarzi-Puttini P, Abhishek A, Choi H, Dalbeth N, Tedeschi S, D’agostino MA, Keen H, Terslev L, Iagnocco A, Filippou G on behalf of OMERACT Ultrasound working group, subgroup CPPD

Reliability of conventional radiography of the knee for the assessment of chondorcalcinosis: An ancillary study of the OMERACT Ultrasound – CPPD Group

We assessed how reliable regular x-rays are for diagnosing calcium pyrophosphate deposition disease (CPPD) of the knee – a disease where crystals develop on the joint and surrounding tissues. In patients with osteoarthritis, we found there was poor agreement between radiologists assessing the x-rays. However, agreement within radiologists (i.e., one radiologist examining the same image at different times) was good.

Research Team: Sirotti S, Becce F, Sconfienza LM, Pineda C, Gutierrez M, Serban T, Maccarter D, Adinolfi A, Naredo E, Scanu A, Möller I, Sarzi-Puttini P, Abhishek A, Choi H, Dalbeth N, Tedeschi S, D’agostino MA, Keen H, Terslev L, Iagnocco A, Filippou G, on behalf of OMERACT Ultrasound working group, CPPD subgroup

Day 2: June 3, 2021

Extrapolation of long-term outcomes in systemic lupus erythematosus: Replicating a Hopkins Lupus Cohort analysis with the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

As part of an effort to refine an existing disease model of short- and long-term risk outcomes that was developed in an SLE cohort at Johns Hopkins in the US, this study aims to replicate the model in an international cohort of SLE patients. The relationships between short- and long-term outcomes identified in the original analysis were broadly replicated, with differences observed likely reflecting differences in the patient populations, structure of the cohorts, and frequency of patient visits.

Research Team: Clarke AE, St-Pierre Y, Paly V, Bruce IN, Malmberg C, Briggs A, Zhang Y, Choi J, Brennan A

Factors associated with baseline hypertension in early rheumatoid arthritis: Data from a real-world large incident cohort

Approximately 1 in 4 diagnosed with rheumatoid arthritis had hypertension (HTN) reported by their rheumatologists, which is similar to that of the general population. This suggests that increased risk of HTN in rheumatoid arthritis (RA) patients may develop as RA disease or treatment time progresses. Factors that may be predictive of this excess risk will be explored in further analysis.

Research Team: Hadwen B, Stranges S, Klar N, Bindee K, Pope J, Bartlett SJ, Boire G, Bessette L, Hitchonn C, Hazlewood G, Keystone E, Schieir O, Thorne C, Tin D, Valois MF, Bykerk V, Barra L; on behalf of CATCH Investigators

National burden of rheumatoid arthritis in Canada 1990-2017: Findings from the Global Burden of Disease Study 2017

We evaluated the impact of rheumatoid arthritis (RA) on the length and quality of life of the population of Canada. Our study 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, Xu A, Sidi S, Alandejani A, Mansourian M, Sarrazadegan N, Kopec J

Does imaging of the sacroiliac joint differ in patients presenting with undiagnosed back pain and psoriasis, acute anterior uveitis, and colitis: An inception cohort study

There has been some debate as to whether patients with psoriasis and inflammation of the spine have different findings on imaging of the spine, compared to other patients with inflammation of the spine. We did not find any differences in X-ray or MRI of the sacroiliac joints suggesting there is no major difference between these subgroups as far as imaging is concerned.

Research Team: Maksymowych WP, Weber U, Chan J, Carmona R, Yeung J, Aydin S, Reis J, Martin L, Masetto A, Ziouzina O, Mosher D, Keeling , Rohekar S, Dadashova R, Paschke J, Carapellucci A, Lambert RG

Validation of ANCA-associated vasculitis as the cause of end-stage renal disease in the United States Renal Data System

Kidney complications such as end-stage renal disease (ESRD) are common in patients with ANCA-associated vasculitis – a group of diseases characterized by inflammation and damage of small blood vessels. We examined whether diagnoses of ANCA-associated vasculitis were the primary cause of ESRD in a national registry of ESRD patients and found that there was accurate classification of ESRD due to ANCA-associated vasculitis in this database.

Research Team: Cook C, Choi H, Wallace Z

Day 3: June 4, 2021

The Neuro-QOL Upper Extremity Function Scale: New opportunities to more reliably and precisely measure self-reported hand function and self-care activities in people with rheumatoid arthritis

Clinicians, researchers, and patients benefit from practical self-report tools that reliably and precisely monitor hand function in rheumatoid arthritis. This study provides evidence in support of using a self-report tool, called the Neuro-QoL UEF, for patients to assess how arthritis in their hands affects their day-to-day experiences.

Research Team: Bartlett SJ, Schieir O, Valois MF, Boire G, Pope J, Keystone E, Thorne C, Tin D, Hitchon C, Bessette L, Hazlewood G, Bykerk V, on behalf of CATCH Investigators et al.

Pro-Inflammatory Diet and risk of incident gout: 3 prospective cohort studies of US men and women

We analyzed data from 217,000 adults followed over 30 years and found those who ate more pro-inflammatory foods (i.e. red/processed meats, tomato products, sugary beverages, and refined grains) were more likely to develop gout. Eating less of these foods may reduce the risk of developing gout.

Research Team: McCormick N, Yokose C, Lu N, Joshi A, Choi HK

Characteristics associated with severe COVID-19 outcomes in systemic lupus erythematosus (SLE): Results from the COVID-19 Global Rheumatology Alliance (COVID-19 GRA)

To understand the characteristics associated with severe COVID-19 outcomes in SLE patients, this study investigated the association between COVID-19 severity and demographic and disease characteristics amongst an adult SLE patient registry. Factors including age, male sex, glucocorticoid use, chronic kidney and heart disease, and moderate/high disease activity were associated with more severe COVID-19 outcomes.

Research Team: Ugarte-Gil MF, Alarcon GS, Seet A, Izadi Z, Sokolova Reategui C, Clark AE, Wise L, Pons-Estel G, Santos MJ, Bernatsky S, Mathias L, Lim N, Sparks J, Wallace Z, Hyrich K, Strangfeld A, Gossec L, Carmona L, Mateus E, Lawson-Tovey S, Trupin L, Rush S, Schmajuk G, Katz P, Jacobsohn L, Al Emadi S, Gilbert E, Yazdany J et al.

LLDAS (Low Lupus Disease Activity State), Low Disease Activity (LDA) and Remission (on- or off-treatment) Prevent Damage Accrual in Systemic Lupus Erythematosus (SLE) Patients in a Multinational Multicenter Cohort

This study aims to understand the impact of low lupus disease activity state, low disease activity , and remission on the development of organ damage over time in lupus. Results indicate that remission and low disease activity were associated with accruing less damage in a long-term, multinational lupus cohort.

Research Team: Ugarte-Gil MF, Hanly J, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg D, Rahman A, Merrill JT, Fortin P, Gladman DD, Bruce IN, Petri MA, Ginzler EN, DooleyMA, Ramsey-Goldman R, Manzi S, Jonsen A, Van Vollenhoven R, Aranow C, Mackay M, Ruiz-Irastorza G, Sam Lim S, Inanc M, Kalunian KC, Jacobsen S, Peschken C, Kamen DL, Askanase A, Pons-Estel B, Alarcon GS

Does excess weight affect gout risk differently among genetically predisposed individuals? – Sex-specific prospective cohort findings over >26 years

The aim of this study was to examine how the genetic predisposition for developing gout may modify the relationship between obesity and gout development. Among women, excess weight may play a larger role in the development of gout for those with a genetic predisposition for gout, but maintaining a healthy weight is an important gout prevention strategy, regardless of underlying genetic risk.

Research Team: Yokose C, McCormick N, Lu L, Joshi A, Choi HK

Gene-diet interaction on the risk of incident gout among women – prospective cohort study over 32 years

Research has shown that the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, nuts, legumes, whole grains, and low-fat dairy, is associated with a lower risk of gout. A Western diet, characterized by high intake of red and processed meats, sugary drinks, desserts, French fries, and refined grains, is associated with a higher risk of gout. We studied 18,512 women and found that these associations were still true, regardless of any underlying genetic predisposition for gout.

Research Team: Yokose C, McCormick N, Lu L, Joshi A, Choi HK

Day 4: June 5, 2021

Identifying meaningful and detectable change from the patient perspective across common fatigue measures in rheumatoid arthritis

This study provides the patient perspective on what amount of change in fatigue, when evaluated with different fatigue questionnaires, represents a meaningful improvement or worsening between visits. This information is useful to researchers and people designing clinical trials, to see the impact of treatments on fatigue, and to clinicians who monitor fatigue in people with RA.

Research Team: Bartlett SJ, Haque U, Bykerk V, Curtis JR, Jones M, Bingham C

Anatomical locations and correlates of calcium pyrophosphate crystalk deposits of the spine – pathologic examination of 77 surgical cases

Calcium pyrophosphate deposition disease (CPPD) is a type of arthritis where crystals develop on the joints and surrounding tissues, causing pain, similar to gout. For people with CPPD, crystal formation on the spine was thought to be rare. We identified 77 patients with CPPD of the spine treated at Massachusetts General Hospital between 2009 and 2014 and found that the crystals occurred most often on the ligaments that connect spinal vertebrae and the discs between spinal vertebrae.

Research Team: Dau, J, Ho G, Choi HK, Schwab J, Kohler M

Risk factors for polyarticular gout flares – analysis of a longitudinal online gout follow-up study

Using data from an internet-based study, we looked at the risk factors for gout flares affecting multiple joints at the same time. We found that obesity, heart failure, and osteoarthritis increased the risk of having this type of gout flare, but higher education levels were associated with a lower risk.

Research Team: Dau J, McCormick N, Stratton S, Yokose C, Chen C, Neogi T, Hunter D, Saag K, Zhang Y, Choi HK

Patient-perceived aspects of rheumatoid arthritis flare evolve over time, as reflected by the flare RA Questionnaire: Post-hoc analysis of TapERA

A questionnaire designed to assess flares in rheumatoid arthritis was compared in the context of reducing anti TNF medications, compared to when it was initially designed. The study underlines the usefulness of the questionnaire in providing a multi-faceted view of patients’ conceptions of RA flare. However, these aspects and their relative importance seem to evolve over time, or depending on the clinical context.

Research Team: Doumen M, Pazmino s, Bertrant D, De Cock D, Joly J, Westhovens R, Verschueren P, Bartlett SJ

Hyperinflammation and clinical outcomes for patients with systemic rheumatic diseases hospitalized for COVID-19: A comparative cohort study

Individuals with rheumatic diseases, such as rheumatoid arthritis, may be at increased risk of poor COVID-19 outcomes. We compared 57 hospitalized rheumatic disease patients with COVID-19 to 232 hospitalized COVID-19 patients without a rheumatic disease and found that those with a rheumatic disease had a greater risk of admission to the intensive care unit or receiving mechanical ventilation.

Research Team: Hsu T, D’silva K, Serling-Boyd N, Wang J, Mueller A, Fu X, Prisco L, Martin L, Vannni K Zaccardelli A, Cook C, Choi HK, Zhang Y, Gravallese E, Wallace Z, Sparks J

Underserved populations identify barriers and propose solutions for self-managing arthritis and chronic conditions

The study objective was to bring together people living with arthritis and other chronic conditions from underserved communities, to identify common barriers they face in taking care of their conditions in daily life, and to determine their solutions to the identified challenges. Individuals who were ethnic minorities, immigrants, refugees, low-income, over 65, and/or housing insecure and living with arthritis identified 35 common barriers and made recommendations in the areas of financial difficulties, social services, access to health services, quality of health services, lack of knowledge, and mental health.

Research Team: Mills S, Khehra K, Ghuman P, Au D, Koehn C, Maynard R, Clark N, Davis C, Cui A, Hamilton C, Lacaille D

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 electronic medical records as reminders for family physicians to screen their patients with inflammatory arthritis for other chronic illnesses 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

Identifying potential classification criteria for calcium pyrophosphate deposition disease (CPPD): Results from the initial phases

We report interim results on the selection of disease features for the development of classification criteria for calcium pyrophosphate deposition disease (CPPD), an arthritis similar to gout that involves the development of crystals on joints and surrounding tissues. These criteria will facilitate clinical CPPD research by distinguishing between CPPD and other arthritis types. The 56 candidate items include clinical, imaging, and laboratory features.

Research Team: Tedeschi S, Pascart T, Latourte A, Godsave C, Kundaki B, Naden R, Taylor W, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andrés M, Bardin T, Doherty M, Ea HK, Filippou G, Fitzgerald J, Gutierrez1 M, Iagnocco A, Jansen T, Kohler M, Lioté F, Matza M, Mccarthy G, Ramonda R, Reginato A, Richette P, Singh J, Sivera F, So A, Stamp L, Yinh J, Yokose C, Terkeltaub R, Choi HK, Abhishek A

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