Skip header and navigation

Refine By

5 records – page 1 of 1.

Early management of newly diagnosed rheumatoid arthritis by Canadian rheumatologists: a national, multicenter, retrospective cohort.

https://arctichealth.org/en/permalink/ahliterature131696
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Publication Type
Article
Date
Nov-2011
Author
Ruben Tavares
Janet E Pope
Jean-Luc Tremblay
Carter Thorne
Vivian P Bykerk
Juris Lazovskis
Kenneth L N Blocka
Mary J Bell
Diane Lacaille
Carol A Hitchon
Avril A Fitzgerald
Wesley K Fidler
Arthur A M Bookman
James M Henderson
Dianne P Mosher
Dalton E Sholter
Majed Khraishi
Boulos Haraoui
Hong Chen
Xiuying Li
Andreas Laupacis
Gilles Boire
George Tomlinson
Claire Bombardier
Author Affiliation
McMaster University, Hamilton, Canada. ruben.tavares@sympatico.ca
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - therapeutic use
Canada - epidemiology
Cohort Studies
Disability Evaluation
Disease Management
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Physician's Practice Patterns
Retrospective Studies
Rheumatic Fever - diagnosis - drug therapy - epidemiology
Severity of Illness Index
Treatment Outcome
Abstract
To describe early rheumatologic management for newly diagnosed rheumatoid arthritis (RA) in Canada.
A retrospective cohort of 339 randomly selected patients with RA diagnosed from 2001-2003 from 18 rheumatology practices was audited between 2005-2007.
The most frequent initial disease-modifying antirheumatic drugs (DMARD) included hydroxychloroquine (55.5%) and methotrexate (40.1%). Initial therapy with multiple DMARD (15.6%) or single DMARD and corticosteroid combinations (30.7%) was infrequent. Formal assessment measures were noted infrequently, including the Health Assessment Questionnaire (34.6%) and Disease Activity Score for 28 joints (8.9%).
Initial pharmacotherapy is consistent with guidelines from the period. The infrequent reporting of multiple DMARD combinations and formal assessment measures has implications for current clinical management and warrants contemporary reassessment.
Notes
Comment In: J Rheumatol. 2011 Nov;38(11):2287-922045932
PubMed ID
21885485 View in PubMed
Less detail

Effectiveness and safety of etanercept in patients with psoriatic arthritis in a Canadian clinical practice setting: the REPArE trial.

https://arctichealth.org/en/permalink/ahliterature134507
Source
J Rheumatol. 2011 Jul;38(7):1355-62
Publication Type
Article
Date
Jul-2011
Author
Dafna D Gladman
Claire Bombardier
Carter Thorne
Boulos Haraoui
Majed Khraishi
Proton Rahman
William Bensen
Jerry Syrotuik
Melanie Poulin-Costello
Author Affiliation
Toronto Western Hospital (University of Toronto) and University Health Network, Toronto, Ontario, Canada. dafna.gladman@utoronto.ca
Source
J Rheumatol. 2011 Jul;38(7):1355-62
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - adverse effects - therapeutic use
Arthritis, Psoriatic - drug therapy - physiopathology
Canada
Disability Evaluation
Efficiency - physiology
Fatigue - epidemiology - physiopathology
Female
Health status
Humans
Immunoglobulin G - adverse effects - therapeutic use
Incidence
Interviews as Topic
Longitudinal Studies
Male
Middle Aged
Receptors, Tumor Necrosis Factor - therapeutic use
Treatment Outcome
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
To describe the longterm effectiveness and safety of etanercept in Canadian patients with psoriatic arthritis (PsA), treated over 24 months in clinical practice.
Patients with active PsA (= 3 tender and = 3 swollen joints) were recruited from 22 centers. Etanercept was administered at 50 mg/week subcutaneously. In addition to clinical assessment of skin and joint disease, conducted at baseline and at Months 6, 12, 18, and 24, regular patient interviews were conducted by telephone. Patient responses related to health status, disability, and work productivity were scored using the patient global assessment tool, the Health Assessment Questionnaire (HAQ), the Health and Labour Questionnaire (HLQ), and the Fatigue Severity Scale.
Out of 110 patients, 71 (65%) maintained etanercept treatment through the end of our study. All clinical measures of disease severity, including joint tenderness/pain, joint swelling, and Psoriasis Area and Severity Index score, improved significantly between baseline and Month 6 of etanercept treatment and remained constant thereafter. By the end of our study, 79% of patients achieved a Psoriatic Arthritis Response Criteria response, and 56% of patients achieved a 0.5-point improvement on HAQ, indicating clinically significant improvement in disability; 14% of patients finished our study free of disability (HAQ = 0). Patients' work productivity and fatigue improved significantly in parallel with these clinical and functional improvements.
Continuous treatment with etanercept over 2 years in a clinical setting improved clinical symptoms of PsA while reducing fatigue, improving work productivity, and ameliorating or eliminating disability.
PubMed ID
21572156 View in PubMed
Less detail

Implementing evidence-based guidelines for radiography in acute low back pain: a pilot study in a chiropractic community.

https://arctichealth.org/en/permalink/ahliterature180224
Source
J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):170-9
Publication Type
Article
Author
Carlo Ammendolia
Sheilah Hogg-Johnson
Victoria Pennick
Richard Glazier
Claire Bombardier
Author Affiliation
Canadian Memorial Chiropractic College, and Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada. cammendol@iwh.on.ca
Source
J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):170-9
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Chiropractic - education - standards
Education, Medical, Continuing - standards
Evidence-Based Medicine - education - standards
Female
Humans
Low Back Pain - radiography
Male
Middle Aged
Ontario
Outcome Assessment (Health Care)
Physician's Practice Patterns
Pilot Projects
Practice Guidelines as Topic
Questionnaires
Radiography - utilization
Radiology - education
Abstract
To evaluate the ability of a systematic educational intervention strategy to change the plain radiography ordering behavior of chiropractors toward evidence-based practice for patients with acute low back pain (LBP).
A quasi-experimental method was used comparing outcomes before and after the intervention with those of a control community.
Two communities in southern Ontario.
Mailed survey data on the management of acute LBP. Outcome Measures Plain radiography use rates for acute LBP based on responses to mailed surveys.
Following the intervention, there was a 42% reduction in the self-report need for plain radiography for uncomplicated acute LBP (P .05).
The educational intervention strategy used in this study appeared to have an effect in reducing the perceived need for plain radiography in acute LBP.
PubMed ID
15129199 View in PubMed
Less detail

Time to disease-modifying antirheumatic drug treatment in rheumatoid arthritis and its predictors: a national, multicenter, retrospective cohort.

https://arctichealth.org/en/permalink/ahliterature121575
Source
J Rheumatol. 2012 Nov;39(11):2088-97
Publication Type
Article
Date
Nov-2012
Author
Ruben Tavares
Janet E Pope
Jean-Luc Tremblay
Carter Thorne
Vivian P Bykerk
Juris Lazovskis
Kenneth L N Blocka
Mary J Bell
Diane Lacaille
Carol A Hitchon
Avril A Fitzgerald
Wesley K Fidler
Arthur A M Bookman
James M Henderson
Dianne P Mosher
Dalton E Sholter
Majed Khraishi
Boulos Haraoui
Hong Chen
Xiuying Li
Andreas Laupacis
Gilles Boire
George Tomlinson
Claire Bombardier
Author Affiliation
McMaster University, Hamilton, ON, Canada. ruben.tavares@sympatico.ca
Source
J Rheumatol. 2012 Nov;39(11):2088-97
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy - epidemiology
Canada
Cohort Studies
Comorbidity
Disease Management
Female
Fibromyalgia - epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Osteoarthritis - epidemiology
Retrospective Studies
Time Factors
Abstract
To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors.
A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model.
Within 6 months from symptom onset, 41% (95% CI 36%-46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8-24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model.
Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation.
Notes
Comment In: J Rheumatol. 2012 Nov;39(11):2059-6123118276
PubMed ID
22896027 View in PubMed
Less detail

Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community.

https://arctichealth.org/en/permalink/ahliterature188141
Source
J Manipulative Physiol Ther. 2002 Oct;25(8):511-20
Publication Type
Article
Date
Oct-2002
Author
Carlo Ammendolia
Claire Bombardier
Sheilah Hogg-Johnson
Richard Glazier
Author Affiliation
Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. ammendol@sympatico.ca
Source
J Manipulative Physiol Ther. 2002 Oct;25(8):511-20
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Attitude of Health Personnel
Chiropractic - standards
Female
Focus Groups
Humans
Low Back Pain - radiography
Male
Middle Aged
Ontario
Outcome Assessment (Health Care)
Physician's Practice Patterns
Questionnaires
Radiography - utilization
Referral and Consultation
Abstract
Recent studies suggest that chiropractors continue to widely use radiography for assessing patients with acute low back pain. This practice is contrary to growing evidence that suggests only a small percentage of patients with acute low back pain require radiographic evaluation.
To assess quantitatively and qualitatively the views of chiropractors in a selected community in Ontario on the use of radiography for evaluating patients with acute low back pain.
Mailed surveys and focus group interview.
Surveys were mailed to all chiropractors (N = 26) in a selected community in Ontario, followed by a focus group session with local chiropractors (n = 7). Surveys requested information on personal and practice characteristics and the management of low back pain, including the use of radiography. The focus group, led by a facilitator, discussed issues surrounding practice guidelines and radiography use.
There was a 76% response rate to the mailed surveys. Of those who responded, 63% stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week; 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low back pain lasting less than 1 month. Most reasons given for use of radiography in this patient population are not supported by existing evidence.
There appears to be a high rate of radiographic use by chiropractors in the study community, which is consistent with findings in previous studies. Many of the reasons given for use of radiography are not supported by existing evidence and may contribute to the gap between current chiropractic practice and available evidence with respect to use of radiography for acute low back pain.
Notes
Comment In: J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):218-9; author reply 21915129204
PubMed ID
12381973 View in PubMed
Less detail