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The 1000 Canadian faces of lupus: determinants of disease outcome in a large multiethnic cohort.

https://arctichealth.org/en/permalink/ahliterature151515
Source
J Rheumatol. 2009 Jun;36(6):1200-8
Publication Type
Article
Date
Jun-2009
Author
Christine A Peschken
Steven J Katz
Earl Silverman
Janet E Pope
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector O Arbillaga
Dafna D Gladman
Murray Urowitz
Michel Zummer
Ann Clarke
Sasha Bernatsky
Marie Hudson
Author Affiliation
Department of Medicine, University of Manitoba Arthritis Center, RR149-800 Sherbrook Street, Winnipeg, Manitoba R3A 1M4, Canada. cpeschken@exchange.hsc.mb.ca
Source
J Rheumatol. 2009 Jun;36(6):1200-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Continental Population Groups
Female
Health status
Humans
Income
Lupus Erythematosus, Systemic - economics - ethnology - physiopathology
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Prospective Studies
Questionnaires
Severity of Illness Index
Social Class
Abstract
To describe disease expression and damage accrual in systemic lupus erythematosus (SLE), and determine the influence of ethnicity and socioeconomic factors on damage accrual in a large multiethnic Canadian cohort.
Adults with SLE were enrolled in a multicenter cohort. Data on sociodemographic factors, diagnostic criteria, disease activity, autoantibodies, treatment, and damage were collected using standardized tools, and results were compared across ethnic groups. We analyzed baseline data, testing for differences in sociodemographic and clinical factors, between the different ethnic groups, in univariate analyses; significant variables from univariate analyses were included in multivariate regression models examining for differences between ethnic groups, related to damage scores.
We studied 1416 patients, including 826 Caucasians, 249 Asians, 122 Afro-Caribbeans, and 73 Aboriginals. Although the overall number of American College of Rheumatology criteria in different ethnic groups was similar, there were differences in individual manifestations and autoantibody profiles. Asian and Afro-Caribbean patients had more frequent renal involvement and more exposure to immunosuppressives. Aboriginal patients had high frequencies of antiphospholipid antibodies and high rates of comorbidity, but disease manifestations similar to Caucasians. Asian patients had the youngest age at onset and the lowest damage scores. Aboriginals had the least education and lowest incomes. The final regression model (R2=0.27) for higher damage score included older age, longer disease duration, low income, prednisone treatment, higher disease activity, and cyclophosphamide treatment.
There are differences in lupus phenotypes between ethnic populations. Although ethnicity was not found to be a significant independent predictor of damage accrual, low income was.
PubMed ID
19369456 View in PubMed
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Access to care for rheumatology patients may be compromised: results of a survey to members of the Canadian Rheumatology Association.

https://arctichealth.org/en/permalink/ahliterature173517
Source
J Rheumatol. 2005 Aug;32(8):1418-21
Publication Type
Article
Date
Aug-2005

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

https://arctichealth.org/en/permalink/ahliterature114676
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Publication Type
Article
Date
Oct-2013
Author
Jessica Widdifield
Sasha Bernatsky
J Michael Paterson
Karen Tu
Ryan Ng
J Carter Thorne
Janet E Pope
Claire Bombardier
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Algorithms
Arthritis, Rheumatoid - diagnosis - epidemiology
Data Mining - statistics & numerical data
Databases, Factual - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Fees and Charges - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Ontario - epidemiology
Reproducibility of Results
Retrospective Studies
Rheumatology - statistics & numerical data
Single-Payer System - statistics & numerical data
Abstract
Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
PubMed ID
23592598 View in PubMed
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Anticitrullinated protein antibodies and rheumatoid factor fluctuate in early inflammatory arthritis and do not predict clinical outcomes.

https://arctichealth.org/en/permalink/ahliterature116618
Source
J Rheumatol. 2013 Aug;40(8):1259-67
Publication Type
Article
Date
Aug-2013
Author
Lillian Barra
Vivian Bykerk
Janet E Pope
Boulos P Haraoui
Carol A Hitchon
J Carter Thorne
Edward C Keystone
Gilles Boire
Author Affiliation
Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada. lbarra2@uwo.ca
Source
J Rheumatol. 2013 Aug;40(8):1259-67
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Anti-Idiotypic - blood
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - blood - drug therapy
Biological Markers - blood
Canada
Cohort Studies
Disability Evaluation
Female
Follow-Up Studies
Humans
Male
Middle Aged
Peptides, Cyclic - immunology
Predictive value of tests
Questionnaires
Regression Analysis
Rheumatoid Factor - blood
Sensitivity and specificity
Severity of Illness Index
Treatment Outcome
Abstract
In inflammatory arthritis, rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe clinical outcomes. Our objective was to determine whether ACPA and RF remain stable in early inflammatory arthritis and whether their trajectories over time or baseline levels predicted clinical outcomes.
The study population consisted of patients enrolled in the Canadian Early Arthritis Cohort Study with baseline and at least 12-month followup values of RF and ACPA. Primary outcomes were Disease Activity Score (DAS) remission and the presence of erosions at 12 and 24 months. Other objectives included swollen joint count, Health Assessment Questionnaire score, and DAS.
At baseline, 225/342 (66%) patients were ACPA-positive and 334/520 (64%) were RF-positive. At 24 months, 15/181 (8%) ACPA-positive patients became negative. A larger number of patients changed from ACPA-negative to positive: 13/123 (11%). For RF, fluctuations were more common: 67/240 (28%) reverted from positive to negative and 21/136 (18%) converted from negative to positive. RF and ACPA fluctuations did not predict disease outcomes. Patients who remained ACPA-positive throughout followup were more likely to have erosive disease (OR 3.86, 95% CI 1.68, 8.92).
RF and ACPA have the potential to revert and convert during the early course of disease. Fluctuations in RF and ACPA were not associated with clinical outcomes.
PubMed ID
23378461 View in PubMed
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Are there differences between young- and older-onset early inflammatory arthritis and do these impact outcomes? An analysis from the CATCH cohort.

https://arctichealth.org/en/permalink/ahliterature105048
Source
Rheumatology (Oxford). 2014 Jun;53(6):1075-86
Publication Type
Article
Date
Jun-2014
Author
Michael B Arnold
Vivian P Bykerk
Gilles Boire
Boulos P Haraoui
Carol Hitchon
Carter Thorne
Edward C Keystone
Janet E Pope
Source
Rheumatology (Oxford). 2014 Jun;53(6):1075-86
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Age of Onset
Aged
Aged, 80 and over
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy - epidemiology
Biological Products - therapeutic use
Canada - epidemiology
Cohort Studies
Comorbidity
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Prognosis
Remission Induction
Severity of Illness Index
Sex Factors
Treatment Outcome
Young Adult
Abstract
The aim of this study was to determine the impact of age on disease and remission in suspected early RA (ERA).
Data from the Canadian Early Arthritis Cohort (CATCH) were examined at baseline, 6 and 12 months. Patients were divided into three groups based on age. Analysis of variance (ANOVA) and regression models were performed to determine the impact of age on the 28-joint DAS (DAS28) and remission at 12 months.
A total of 1809 patients were initially assessed: 442 (24.4%) young (
PubMed ID
24501240 View in PubMed
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The Canadian Early Arthritis Cohort (CATCH): patients with new-onset synovitis meeting the 2010 ACR/EULAR classification criteria but not the 1987 ACR classification criteria present with less severe disease activity.

https://arctichealth.org/en/permalink/ahliterature121576
Source
J Rheumatol. 2012 Nov;39(11):2071-80
Publication Type
Article
Date
Nov-2012
Author
Vivian P Bykerk
Shahin Jamal
Gilles Boire
Carol A Hitchon
Boulos Haraoui
Janet E Pope
J Carter Thorne
Ye Sun
Edward C Keystone
Author Affiliation
Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. vbykerk@gmail.com
Source
J Rheumatol. 2012 Nov;39(11):2071-80
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - therapeutic use
Canada
Cohort Studies
Europe
Female
Finger Joint - radiography
Humans
Male
Methotrexate - therapeutic use
Middle Aged
Patient Selection
Prospective Studies
Rheumatoid Factor - blood
Severity of Illness Index
Societies, Medical
Synovitis - classification - diagnosis - drug therapy
United States
Abstract
Our objective was to describe characteristics of Canadian patients with early arthritis and examine differences between those fulfilling 1987 and 2010 rheumatoid arthritis (RA) classification criteria.
The Canadian Early Arthritis Cohort (CATCH) is a national, multicenter, observational, prospective cohort of patients with early inflammatory arthritis, receiving usual care, recruited since 2007. Inclusion criteria include age > 16 years; symptom duration 6-52 weeks; swelling of = 2 joints or = 1 metacarpophalangeal/proximal interphalangeal joint; and 1 of rheumatoid factor = 20 IU, positive anticitrullinated protein antibodies (ACPA), morning stiffness = 45 min, response to nonsteroidal antiinflammatory drug, or positive metatarsophalangeal joint squeeze test. Data from patients enrolled to March 15, 2011, were analyzed.
In total, 1450 patients met the eligibility criteria (1187 were followed). At baseline, mean age was 53 ± 15 years, symptom duration was 6.1 ± 3.2 months, Disease Activity Score (DAS28) was 4.9 ± 1.6, Health Assessment Questionnaire-Disability Index was 1.0 ± 0.7. Forty-one percent (n = 450) of patients had moderate (3.2 5.1) disease activity; 28% of those with baseline radiographs (n = 250/908) had radiographic evidence of erosions. ACPA status was available for 70% (n = 831) of patients; 55% (n = 453) tested positive. Sixty percent (n = 718) of patients were treated with methotrexate (MTX) initially. Of 612 patients without erosions, 63% and 83% fulfilled 1987 and 2010 RA classification criteria, respectively. Seventy-three percent (n = 166) of those who did not fulfill 1987 criteria were newly identified by the 2010 criteria. These patients had less severe disease and more were MTX-naive compared to those satisfying the 1987 criteria. Forty-seven percent of all patients achieved remission at 1 year.
Patients with early RA present with moderate high disease activity;
Notes
Comment In: J Rheumatol. 2012 Nov;39(11):2062-323118277
PubMed ID
22896026 View in PubMed
Less detail

Canadian recommendations for clinical trials of pharmacologic interventions in rheumatoid arthritis: inclusion criteria and study design.

https://arctichealth.org/en/permalink/ahliterature132908
Source
J Rheumatol. 2011 Oct;38(10):2095-104
Publication Type
Article
Date
Oct-2011
Author
Jacob Karsh
Edward C Keystone
Boulos Haraoui
J Carter Thorne
Janet E Pope
Vivian P Bykerk
Walter P Maksymowych
Michel Zummer
William G Bensen
Majed M Kraishi
Author Affiliation
The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, ON K1H 7W9, Canada. jkarsh@ottawahospital.on.ca
Source
J Rheumatol. 2011 Oct;38(10):2095-104
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Arthritis, Rheumatoid - drug therapy
Canada
Clinical Trials as Topic
Humans
Patient Selection
Research Design
Abstract
Current clinical trial designs for pharmacologic interventions in rheumatoid arthritis (RA) do not reflect the innovations in RA diagnosis, treatment, and care in countries where new drugs are most often used. The objective of this project was to recommend revised entry criteria and other study design features for RA clinical trials.
Recommendations were developed using a modified nominal group consensus method. Canadian Rheumatology Research Consortium (CRRC) members were polled to rank the greatest challenges to clinical trial recruitment in their practices. Initial recommendations were developed by an expert panel of rheumatology trialists and other experts. A scoping study methodology was then used to examine the evidence available to support or refute each initial recommendation. The potential influence of CRRC recommendations on primary outcomes in future trials was examined. Recommendations were finalized using a consensus process.
Recommendations for clinical trial inclusion criteria addressed measures of disease activity [Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) > 3.2 PLUS = 3 tender joints using 28-joint count (TJC28) PLUS = 3 swollen joint (SJC28) OR C-reactive protein (CRP) or ESR > upper limit of normal PLUS = 3 TJC28 PLUS = 3 SJC28], functional classification, disease classification and duration, and concomitant RA treatments. Additional recommendations regarding study design addressed rescue strategies and longterm extension.
There is an urgent need to modify clinical trial inclusion criteria and other study design features to better reflect the current characteristics of people living with RA in the countries where the new drugs will be used.
Notes
Comment In: J Rheumatol. 2011 Oct;38(10):2087-821965690
PubMed ID
21765109 View in PubMed
Less detail

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
Less detail

Cancer risk in systemic lupus: an updated international multi-centre cohort study.

https://arctichealth.org/en/permalink/ahliterature116317
Source
J Autoimmun. 2013 May;42:130-5
Publication Type
Article
Date
May-2013
Author
Sasha Bernatsky
Rosalind Ramsey-Goldman
Jeremy Labrecque
Lawrence Joseph
Jean-Francois Boivin
Michelle Petri
Asad Zoma
Susan Manzi
Murray B Urowitz
Dafna Gladman
Paul R Fortin
Ellen Ginzler
Edward Yelin
Sang-Cheol Bae
Daniel J Wallace
Steven Edworthy
Soren Jacobsen
Caroline Gordon
Mary Anne Dooley
Christine A Peschken
John G Hanly
Graciela S Alarcón
Ola Nived
Guillermo Ruiz-Irastorza
David Isenberg
Anisur Rahman
Torsten Witte
Cynthia Aranow
Diane L Kamen
Kristjan Steinsson
Anca Askanase
Susan Barr
Lindsey A Criswell
Gunnar Sturfelt
Neha M Patel
Jean-Luc Senécal
Michel Zummer
Janet E Pope
Stephanie Ensworth
Hani El-Gabalawy
Timothy McCarthy
Lene Dreyer
John Sibley
Yvan St Pierre
Ann E Clarke
Author Affiliation
McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada. sasha.bernatsky@mail.mcgill.ca
Source
J Autoimmun. 2013 May;42:130-5
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Asia - epidemiology
Breast Neoplasms - epidemiology
Canada - epidemiology
Cohort Studies
Europe - epidemiology
Female
Follow-Up Studies
Humans
Incidence
International Cooperation
Lupus Erythematosus, Systemic - epidemiology
Lymphoma, Non-Hodgkin - epidemiology
Male
Neoplasms - epidemiology
Ovarian Neoplasms - epidemiology
Risk
United States - epidemiology
Abstract
To update estimates of cancer risk in SLE relative to the general population.
A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers.
Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23).
These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
Notes
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PubMed ID
23410586 View in PubMed
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Care gap in patients with early inflammatory arthritis with a high fracture risk identified using FRAX(®).

https://arctichealth.org/en/permalink/ahliterature141497
Source
J Rheumatol. 2010 Nov;37(11):2221-5
Publication Type
Article
Date
Nov-2010
Author
Carly K Cheng
Heather McDonald-Blumer
Gilles Boire
Janet E Pope
Boulos Haraoui
Carol A Hitchon
Carter Thorne
Ye Sun
Vivian P Bykerk
Author Affiliation
Division of Rheumatology, Mount Sinai Hospital, 60 Murray Street, 2nd floor, Toronto, Ontario M5T 3L9, Canada.
Source
J Rheumatol. 2010 Nov;37(11):2221-5
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Analysis of Variance
Arthritis - complications
Body Weight
Bone Density
Canada
Chi-Square Distribution
Female
Humans
Male
Middle Aged
Osteoporosis - complications
Osteoporotic Fractures - etiology
Questionnaires
Risk assessment
Risk factors
Severity of Illness Index
Abstract
To determine the proportion of patients with early inflammatory arthritis in a Canadian cohort who are at high risk for a major osteoporotic fracture using the Fracture Risk Assessment Tool (FRAX(®)), and to determine if a care gap exists in high-risk patients.
FRAX was applied to 238 patients enrolled in the Canadian Early Arthritis Cohort (CATCH) study based on norms from the United States and the United Kingdom, without the use of bone mineral density measurements.
FRAX identified 5%-13% of patients at high risk for fracture, using a conservative analysis. Based on US norms, there was a significant correlation between increasing fracture risk groups and oral glucocorticoid use (p = 0.012) and baseline erosions (p = 0.040). Calcium or vitamin D use did not vary among the different fracture risk groups (p = NS), nor did bisphosphonate use (p = NS). The Disease Activity Score with 28 joint count in the high-risk group was significantly higher compared to the low-risk group (p = 0.048).
Patients at increased risk had higher disease activity, more frequent glucocorticoid use, and more baseline erosions compared to patients at low risk. A care gap exists, in that a very low proportion of patients at high risk are being treated with calcium, vitamin D, and/or bisphosphonates. A higher fracture risk was calculated in our cohort using the US FRAX calculation tool compared to the UK calculation tool. These data highlight the need to identify and modify fracture risk in patients with early inflammatory arthritis.
PubMed ID
20716658 View in PubMed
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27 records – page 1 of 3.