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Agreement with guidelines from a large database for management of systemic sclerosis: results from the Canadian Scleroderma Research Group.

https://arctichealth.org/en/permalink/ahliterature127963
Source
J Rheumatol. 2012 Mar;39(3):524-31
Publication Type
Article
Date
Mar-2012
Author
Janet Pope
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Author Affiliation
Department of Medicine, University of Western Ontario, London, Ontario, Canada. janet.pope@sjhc.london.on.ca
Source
J Rheumatol. 2012 Mar;39(3):524-31
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Databases, Factual
Disease Management
Europe
Female
Gastrointestinal Diseases - therapy
Guideline Adherence
Humans
Hypertension, Pulmonary - therapy
Male
Middle Aged
Practice Guidelines as Topic
Raynaud Disease - therapy
Retrospective Studies
Scleroderma, Systemic - therapy
Abstract
We determined congruence with published guidelines from the European League Against Rheumatism (EULAR)/EULAR Scleroderma Trials and Research group, for systemic sclerosis (SSc) investigations and treatment practices within the Canadian Scleroderma Research Group (CSRG).
Investigations and medication use for SSc complications were obtained from records of patients with SSc in the CSRG to determine adherence to guidelines for patients enrolled before and after the guidelines were published.
The CSRG database of 1253 patients had 992 patients with SSc enrolled before publication of the guidelines and 261 after. For pulmonary arterial hypertension (PAH) treatment, there were no differences in use before and after the guidelines, yet annual echocardiograms for PAH screening were done in 95% of patients enrolled before the guidelines and in only 86% of those enrolled after (p 80% with gastroesophageal reflux disease before and after the guidelines. One-quarter with gastrointestinal symptoms were taking prokinetic drugs. For those with past SSc renal crisis, use of angiotensin-converting enzyme inhibitors was not different before and after the guidelines. For early diffuse SSc
PubMed ID
22247347 View in PubMed
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Association of C-reactive protein with high disease activity in systemic sclerosis: results from the Canadian Scleroderma Research Group.

https://arctichealth.org/en/permalink/ahliterature124693
Source
Arthritis Care Res (Hoboken). 2012 Sep;64(9):1405-14
Publication Type
Article
Date
Sep-2012
Author
Chayawee Muangchan
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Janet Pope
Author Affiliation
University of Western Ontario, London, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2012 Sep;64(9):1405-14
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biological Markers - blood
Blood Sedimentation
C-Reactive Protein - analysis
Canada
Creatinine - blood
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Lung - physiopathology
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prognosis
Prospective Studies
Questionnaires
Registries
Respiratory Function Tests
Risk assessment
Risk factors
Scleroderma, Diffuse - blood - diagnosis - immunology
Scleroderma, Limited - blood - diagnosis - immunology
Scleroderma, Systemic - blood - diagnosis - immunology - mortality - physiopathology
Severity of Illness Index
Skin - pathology
Time Factors
Total lung capacity
Up-Regulation
Abstract
This study was performed to determine the prevalence of elevated C-reactive protein (CRP) levels and the significance of CRP in clinical parameters in systemic sclerosis (SSc; scleroderma) patients.
Canadian Scleroderma Research Group data were used. Statistical comparisons were made for CRP levels =8 mg/liter versus >8 mg/liter, early (=3 years from first non-Raynaud's phenomenon symptom) versus late SSc, and diffuse cutaneous SSc (dcSSc) versus limited cutaneous SSc (lcSSc). A survival analysis was analyzed between patients with normal versus elevated CRP levels.
A total of 1,043 patients (mean ± SD age 55.4 ± 12.1 years, mean ± SD disease duration of 11.0 ± 9.5 years) were analyzed; elevation of CRP level and erythrocyte sedimentation rate (ESR; >20 mm/hour) occurred in 25.7% and 38.2%, respectively. Mean ± SD baseline CRP level in dcSSc (11.98 ± 25.41 mg/liter) was higher than in lcSSc (8.15 ± 16.09 mg/liter; P = 0.016). SSc patients with an early disease duration had a higher mean ± SD CRP level (12.89 ± 28.13 mg/liter) than those with a late disease duration (8.60 ± 17.06 mg/liter; P = 0.041). Although not consistent in all subsets, CRP was significantly associated (P
PubMed ID
22556030 View in PubMed
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Best practices in scleroderma: an analysis of practice variability in SSc centres within the Canadian Scleroderma Research Group (CSRG).

https://arctichealth.org/en/permalink/ahliterature122345
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Publication Type
Article
Author
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Janet Pope
Author Affiliation
University of Western Ontario, London, ON, Canada. sarahharding@rcsi.ie
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Consensus
Databases, Factual
Diagnostic Tests, Routine - standards
Evidence-Based Medicine - standards
Female
Guideline Adherence - standards
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - standards
Physician's Practice Patterns - standards
Practice Guidelines as Topic - standards
Predictive value of tests
Prospective Studies
Quality Indicators, Health Care - standards
Rheumatology - standards
Scleroderma, Systemic - complications - diagnosis - therapy
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
There is currently no consensus on best practice in systemic sclerosis (SSc). To determine if variability in treatment and investigations exists, practices among Canadian Sclerodermia Research Group (CSRG) centres were compared.
Prospective clinical and demographic data from adult SSc patients are collected annually from 15 CSRG treatment centres. Laboratory parameters, self-reported socio-demographic questionnaires, current and past medications and disease outcome measures are recorded. For centres with >50 patients enrolled, treatment practices were analysed to determine practice variability.
Data from 640 of 938 patients within the CSRG database met inclusion criteria, where 87.3% were female, the mean ± SEM age was 55.3±0.5, 48.9% had limited SSc and 47.8% had diffuse SSc (and 3.3% uncharacterised). Some investigation and treatment practices were inconsistent among 6 centres including proportion receiving: PDE5 (phosphodiesterase type 5) inhibitors for Raynaud's phenomenon (p=0.036); cyclophosphamide (p=0.037) and azathioprine (p=0.037) for treatment of ILD; and current use of D-penicillamine, although uncommon, varied among sites. Annual echocardiograms and PFTs were frequently done and did not vary among sites but the rate of pulmonary arterial hypertension (PAH) was directly related to site size and this was not the case for other organ involvement.
Despite routine tests within a database, site variation in SSc with respect to investigations and management among CSRG centres exists suggesting a need for a standardised approach to the investigation and treatment of SSc. One can speculate that larger centres are more export in detecting PAH.
PubMed ID
22691207 View in PubMed
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Canadian variation by province in rheumatoid arthritis initiating anti-tumor necrosis factor therapy: results from the optimization of adalimumab trial.

https://arctichealth.org/en/permalink/ahliterature140779
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Publication Type
Article
Date
Dec-2010
Author
Christopher Pease
Janet E Pope
Carter Thorne
Boulos Paul Haraoui
Don Truong
Claire Bombardier
Jessica Widdifield
Eliofotisti Psaradellis
John S Sampalis
Ashley Bonner
Author Affiliation
University of Western Ontario, London, Ontario, Canada.
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - pathology - physiopathology
Canada
Female
Humans
Insurance, Health, Reimbursement
Middle Aged
Multicenter Studies as Topic
Questionnaires
Randomized Controlled Trials as Topic
Registries
Treatment Outcome
Tumor Necrosis Factor-alpha - immunology
Abstract
We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.
Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.
In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p
PubMed ID
20843910 View in PubMed
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Low socioeconomic status (measured by education) and outcomes in systemic sclerosis: data from the Canadian Scleroderma Research Group.

https://arctichealth.org/en/permalink/ahliterature116246
Source
J Rheumatol. 2013 Apr;40(4):447-54
Publication Type
Article
Date
Apr-2013
Author
Samah Mansour
Ashley Bonner
Chayawee Muangchan
Marie Hudson
Murray Baron
Janet E Pope
Author Affiliation
Western University, Schulich School of Medicine and Dentistry, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada.
Source
J Rheumatol. 2013 Apr;40(4):447-54
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Cohort Studies
Educational Status
Female
Humans
Incidence
Male
Middle Aged
Prevalence
Prognosis
Registries
Scleroderma, Systemic - epidemiology - mortality
Severity of Illness Index
Social Class
Abstract
In systemic lupus erythematosus, socioeconomic status (SES) affects outcomes. SES can modify outcomes by altering timing of access to care and adherence. It is unknown whether SES affects systemic sclerosis (SSc) outcomes. Disease can affect income and cause work disability, thus education (completed long before SSc onset) may be a proxy for SES.
The Canadian Scleroderma Research Group collects annual data on patients with SSc. Baseline data were used from a prevalent cohort. Education was stratified by whether participants completed high school. Regression models assessed effects of education on organ complications and survival.
In our study, 1145 patients with SSc had 11.0 ± 9.5 years' disease duration; 86% were women, with a mean age of 55.4 ± 12.1 years. About one-quarter did not complete high school; this was more common in older patients (p
PubMed ID
23418377 View in PubMed
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