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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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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
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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 pathways in early rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature165304
Source
Can Fam Physician. 2006 Nov;52(11):1444-5
Publication Type
Article
Date
Nov-2006
Author
Sasha Bernatsky
Debbie Feldman
Ian Shrier
Karine Toupin
Jeannie Haggerty
Pierre Tousignant
Michel Zummer
Author Affiliation
Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
Can Fam Physician. 2006 Nov;52(11):1444-5
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy
Attitude of Health Personnel
Clinical Competence
Diagnosis, Differential
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Physician's Practice Patterns
Physicians, Family
Quebec
Questionnaires
Referral and Consultation
Abstract
To determine the proportion of family physicians who diagnose rheumatoid arthritis (RA) correctly and to note how they report they would manage RA patients.
Mailed survey (self-administered questionnaire) requesting comments on vignettes.
Province of Quebec.
Computer-generated random sample of family physicians registered with the Quebec College of Family Physicians.
The proportion of family physicians who recognized RA and their reported management strategies.
Most respondents recognized the vignette presentation as a case of RA; 133/138 (96.4%) indicated RA as their provisional diagnosis, and all but 1 of the remaining respondents listed RA as a differential diagnosis. Of those who considered RA as a provisional or possible diagnosis, 107 (77.5% of all respondents) suggested referring the patient to a rheumatologist. Among the physicians who suggested referral, none indicated they would initiate disease-modifying antirheumatic drugs (DMARDs).
Almost all respondents considered RA as a provisional or differential diagnosis. Although many suggested referring the patient to a rheumatologist, almost a quarter did not. Initiating DMARDs before referring patients to rheumatologists appears to be rare. Since DMARDs given during the early stages of RA are known to decrease damage and dysfunction, ways to increase their use and optimize care pathways for new-onset inflammatory arthritis are urgently needed.
Notes
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Cites: J Emerg Med. 2006 Apr;30(3):263-816677975
PubMed ID
17279204 View in PubMed
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Clinical and serologic factors associated with lupus pleuritis.

https://arctichealth.org/en/permalink/ahliterature145759
Source
J Rheumatol. 2010 Apr;37(4):747-53
Publication Type
Article
Date
Apr-2010
Author
Shikha Mittoo
Allan C Gelber
Carol A Hitchon
Earl D Silverman
Janet E Pope
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector Arbillaga
Dafna D Gladman
Murray B Urowitz
Michel Zummer
Ann E Clarke
Sasha Bernatsky
Marie Hudson
Lori B Tucker
Ross E Petty
Christine A Peschken
Author Affiliation
Department of Medicine, University of Manitoba, Manitoba, Canada. shikha.hopkins@gmail.com
Source
J Rheumatol. 2010 Apr;37(4):747-53
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Age of Onset
Autoantibodies - immunology
Canada - epidemiology
Cohort Studies
Female
Humans
Lupus Erythematosus, Systemic - complications - epidemiology - immunology
Male
Middle Aged
Multivariate Analysis
Pleurisy - complications - epidemiology - immunology
Prevalence
Regression Analysis
Severity of Illness Index
Abstract
Pleuritis is a common manifestation and independent predictor of mortality in systemic lupus erythematosus (SLE). We examined the prevalence of pleuritis and factors associated with pleuritis in a multicenter Canadian SLE cohort.
We studied consecutive adults satisfying the American College of Rheumatology (ACR) classification criteria for SLE who had a completed Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) score, at least 1 evaluable extractable nuclear antigen assay, and either a SLE Disease Activity Index (SLEDAI) or a SLE Activity Measure score. Pleuritis was defined as having pleuritis by satisfying the ACR criteria or the SLEDAI. Factors related to pleuritis were examined using univariate and multivariate logistic regression.
In our cohort of 876 patients, 91% were women, 65% Caucasian, mean age (+/- SD) was 46.8 +/- 13.5 years, and disease duration at study entry was 12.1 +/- 9.9 years; the prevalence of pleuritis was 34% (n = 296). Notably, greater disease duration (p = 0.002), higher SDI score (p
PubMed ID
20110526 View in PubMed
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Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study.

https://arctichealth.org/en/permalink/ahliterature160055
Source
Arthritis Rheum. 2007 Dec 15;57(8):1419-25
Publication Type
Article
Date
Dec-15-2007
Author
Debbie Ehrmann Feldman
Sasha Bernatsky
Jeannie Haggerty
Karen Leffondré
Pierre Tousignant
Yves Roy
Yongling Xiao
Michel Zummer
Michal Abrahamowicz
Author Affiliation
Université de Montréal and Public Health Department of Montréal, Montréal, Québec, Canada.
Source
Arthritis Rheum. 2007 Dec 15;57(8):1419-25
Date
Dec-15-2007
Language
English
Publication Type
Article
Keywords
Aged
Arthritis, Rheumatoid - therapy
Disease Progression
Female
Health Surveys
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - trends
Quebec
Referral and Consultation - statistics & numerical data
Regression Analysis
Rheumatology - statistics & numerical data
Sex Factors
Social Class
Specialization - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
Care in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new-onset RA in Québec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation.
Physician reimbursement administrative data were obtained for all adults in Québec. Suspected new-onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist.
Of the 10,001 persons coded as incident RA by a nonrheumatologist, only 27.3% consulted a rheumatologist within the next 2.5-3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity.
Our data suggest that the vast majority of patients suspected of having new-onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.
PubMed ID
18050182 View in PubMed
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Medication Use in Systemic Lupus Erythematosus.

https://arctichealth.org/en/permalink/ahliterature100061
Source
J Rheumatol. 2010 Nov 15;
Publication Type
Article
Date
Nov-15-2010
Author
Sasha Bernatsky
Christine Peschken
Paul R Fortin
Christi A Pineau
Murray B Urowitz
Dafna D Gladman
Janet E Pope
Marie Hudson
Michel Zummer
C Douglas Smith
Hector O Arbillaga
Ann E Clarke
Author Affiliation
From the Division of Clinical Epidemiology, McGill University Health Centre (MUHC); Division of Rheumatology, MUHC; Division of Clinical Immunology/Allergy, MUHC; Jewish General Hospital and McGill University; Hopital Maisonneuve-Rosemont and University of Montreal, Montreal, Quebec; University of Manitoba, Winnipeg, Manitoba; University Health Network, Toronto Western Hospital, Toronto Western Research Institute, Toronto; University of Western Ontario, London; University of Ottawa, Ottawa, Ontario; and Lethbridge Regional Hospital, Lethbridge, Alberta, Canada.
Source
J Rheumatol. 2010 Nov 15;
Date
Nov-15-2010
Language
English
Publication Type
Article
Abstract
OBJECTIVE: To evaluate factors affecting therapeutic approaches used in clinical practice for the management of systemic lupus erythematosus (SLE), in a multicenter cohort. METHODS: We combined data from 10 clinical adult SLE cohort registries in Canada. We used multivariate generalized estimating equation methods to model dichotomized outcomes, running separate regressions where the outcome was current exposure of the patient to specific medications. Potential predictors of medication use included demographic (baseline age, sex, residence, race/ethnicity) and clinical factors (disease duration, time-dependent damage index scores, and adjusted mean SLE Disease Activity Index-2K scores). The models also adjusted for clustering by center. RESULTS: Higher disease activity and damage scores were each independent predictors of exposure to nonsteroid immunosuppressive agents, and for exposure to prednisone. This was not definitely demonstrated for antimalarial agents. Older age at diagnosis was independently and inversely associated with exposure to any of the agents studied (immunosuppressive agents, prednisone, and antimalarial agents). An additional independent predictor of prednisone exposure was black race/ethnicity (adjusted RR 1.46, 95% CI 1.18, 1.81). For immunosuppressive exposure, an additional independent predictor was race/ethnicity, with greater exposure among Asians (RR 1.39, 95% CI 1.02, 1.89) and persons identifying themselves as First Nations/Inuit (2.09, 95% CI 1.43, 3.04) than among whites. All of these findings were reproduced when adjustment for disease activity was limited to renal involvement. CONCLUSION: Ours is the first portrayal of determinants of clinical practice patterns in SLE, and offers interesting real-world insights. Further work, including efforts to determine how differing clinical approaches may influence outcome, is in progress.
PubMed ID
21078722 View in PubMed
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Neuropsychiatric lupus: the prevalence and autoantibody associations depend on the definition: results from the 1000 faces of lupus cohort.

https://arctichealth.org/en/permalink/ahliterature124285
Source
Semin Arthritis Rheum. 2012 Oct;42(2):179-85
Publication Type
Article
Date
Oct-2012
Author
Alan M Borowoy
Janet E Pope
Earl Silverman
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector Arbillaga
Dafna Gladman
Murray Urowitz
Michel Zummer
Marie Hudson
Lori Tucker
Christine Peschken
Author Affiliation
Western University, London, Ontario, Canada.
Source
Semin Arthritis Rheum. 2012 Oct;42(2):179-85
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
American Native Continental Ancestry Group - ethnology - statistics & numerical data
Antibodies, Antiphospholipid - blood
Autoantibodies - blood
Canada - epidemiology
Cohort Studies
Female
Health status
Humans
Lupus Vasculitis, Central Nervous System - diagnosis - epidemiology - immunology
Male
Prevalence
Seroepidemiologic Studies
Severity of Illness Index
Terminology as Topic
Abstract
The (ever) prevalence of neuropsychiatric systemic lupus erythematosus (NPSLE) can vary widely depending on the definition used. We determined the prevalence of NPSLE in 1000 Faces of Lupus, a large multicenter Canadian cohort.
Adults enrolled at 10 sites who satisfied the American College of Rheumatology (ACR) classification for systemic lupus erythematosus (SLE) were included. NPSLE was defined as (i) NPSLE by ACR classification criteria (seizures or psychosis), (ii) ACR, SLEDAI (seizure, psychosis, organic brain syndrome, cranial nerve disorder, headache, and cerebrovascular accident (CVA)), SLAM (CVA, seizure, cortical dysfunction, and headache), and SLICC (cognitive impairment, psychosis, seizures, CVA, cranial or peripheral neuropathy, and transverse myelitis) with and (iii) without minor nonspecific NPSLE manifestations (including mild depression, mild cognitive impairment, and electromyogram-negative neuropathies), and (iv) by ACR and SLEDAI neuropsychiatric (NP) indexes alone. Factors associated with NPSLE were explored using regression models.
Cohort size was 1253, with mean disease 12 ± 10 years, mean age 41 ± 16 years, and 86% female. Subgroup size was dependent on the specific definition of NPSLE. Prevalence of NPSLE was 6.4% in group (i), n = 1253 (n = 80); 38.6% in group (ii), n = 681(n = 263); 28.7% in group (iii), n = 586 (n = 168); and 10.2% in group (iv), n = 1125 (n = 115). In univariate analysis, Aboriginals had a nearly 2-fold increase in frequency of NPSLE in all groups. Education level and income were not associated with NPSLE (P = 0.32 and 0.03, respectively). As well, number of ACR criteria, SLAM, age at diagnosis, disease duration, and gender were not associated with NPSLE. Anti-Ro was significantly associated in groups (i) and (iv) and antiphospholipid antibodies (aPL) were increased in groups (i), (ii), and (iii); however, this lost significance when thromboembolic events were excluded from SLICC, SLEDAI, and SLAM indexes. In group (iv), absence of anti-Sm was significant. In multivariate analysis, anti-Ro and aPL (i) and anti-Ro+ and lack of anti-Sm (iv) were significant. NPSLE was not increased in those with +anti-DNA, La, or ribonucleoprotein (RNP), lupus anticoagulant (LAC), or anticardiolipin (aCL) antibody.
The prevalence and factors associated with NPSLE varied depending on the definition used, was highest in Aboriginals, and may be higher if +anti-Ro or aPL are present. SLAM and SLICC include mild subjective disease manifestations, which contributed to a 10% higher prevalence of NPSLE compared to a more strict definition. NPSLE may be less in this database than other publications as its overall prevalence may be decreasing, or because of selection bias inherent to those who enter an observational cohort. NPSLE was associated with aPL and often anti-Ro and varied by ethnicity.
PubMed ID
22595642 View in PubMed
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Psoriatic arthritis in Canadian clinical practice: the PsA assessment in rheumatology.

https://arctichealth.org/en/permalink/ahliterature121974
Source
J Rheumatol. 2012 Sep;39(9):1850-3
Publication Type
Article
Date
Sep-2012
Author
Dafna D Gladman
Vinod Chandran
Arane Thavaneswaran
Michel Zummer
Author Affiliation
University of Toronto, Toronto Western Research Institute, Psoriatic Arthritis Program, University Health Network, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, Ontario M5T 2S8, Canada. dafna.gladman@utoronto.ca
Source
J Rheumatol. 2012 Sep;39(9):1850-3
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - therapeutic use
Arthritis, Psoriatic - diagnosis - drug therapy
Canada
Female
Health Care Surveys
Humans
Male
Middle Aged
Physician's Practice Patterns
Questionnaires
Rheumatology
Severity of Illness Index
Abstract
We aimed to determine disease severity and treatment of patients with psoriatic arthritis (PsA) in rheumatology practices in Canada through the PsA Assessment in Rheumatology (PAIR) study.
Rheumatologists who were members of the Canadian Rheumatology Association were asked to complete a form for each patient addressing demographic questions, history, clinical examination, and patient-reported outcomes. Results were compared with a cohort seen in a PsA clinic during the same period.
From across Canada, 22 rheumatologists from 5 provinces submitted information about 233 consecutive patients with PsA [145 men (62.2%), 88 women (37.8%), mean age 53.2 yrs (±12.7), 88.4% disease duration>2 yrs]. A majority (80.7%) fulfilled ClASsification for Psoriatic ARthritis (CASPAR) criteria, and 30% had taken no disease-modifying antirheumatic drugs. Clinical joint damage was documented in 60% of the patients, active skin disease in 70%, and nail lesions in 32%. Only 22% were rated as having moderate to high disease activity, while 52% were rated as low disease activity and 26% were deemed in remission. The decision was based on joint counts, patient global assessment, physician global assessment, and acute-phase reactants. Twenty-seven percent of the patients were to have their medications changed based on the current visit, the majority for inadequate response to medications. Patients in the PAIR cohort had more inflamed joints but similar damage to those in the PsA clinic.
Patients with PsA seen in regular rheumatology practice fulfill CASPAR criteria, have active disease, and more than half have joint damage. The majority have low activity or are in remission.
PubMed ID
22859361 View in PubMed
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Smoldering rheumatoid arthritis: is the Canadian healthcare system neglecting a significant disease population?

https://arctichealth.org/en/permalink/ahliterature156338
Source
J Rheumatol. 2008 Aug;35(8):1506-12
Publication Type
Article
Date
Aug-2008
Author
Steven Edworthy
Michel Zummer
Stephanie Garner
Gilles Boire
Sharon Leclercq
Vivian Bykerk
Gunner Kraag
Janet Markland
Diane Thomas
John Thomson
Jamie Henderson
Author Affiliation
University of Calgary, Calgary, Alberta, Canada. sedworth@ucalgary.ca
Source
J Rheumatol. 2008 Aug;35(8):1506-12
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - drug therapy - epidemiology
Canada - epidemiology
Female
Humans
Male
Medical Audit
Middle Aged
National Health Programs
Physician's Practice Patterns
Remission Induction
Abstract
To investigate rheumatology practice in Canada with regard to evaluating disease activity status and treatment regimens in patients with rheumatoid arthritis (RA). It was hypothesized that patients with "smoldering" disease activity were not being adequately treated.
Rheumatologists were invited to participate by the Canadian Rheumatology Association in an audit entitled the Assessment in Rheumatology (AIR) program. From across Canada, 65 rheumatologists participated. One thousand five hundred ninety-six consecutive patients with RA seen in regular clinics were classified according to 4 states of disease activity: remission, controlled adequately, smoldering, and uncontrolled. Demographics (age, sex, geographic region), therapy (nonsteroidal antiinflammatory drugs, disease modifying antirheumatic drugs, biologicals, steroids), joint counts (tender/swollen), comorbidity, and treatment decisions at the time of the visit were recorded. Data were collected at the time of the visit with personal digital assistants (PDA) and aggregated, without personal identifiers, for analysis in SPSS.
The majority of patients had "smoldering" (29%) or "uncontrolled" disease (23%), with the remainder in "remission" (15%) or "controlled adequately" (33%) at the time of their visit. Following the appointment, the uncontrolled group had a 100% increase (from 10.4% to 23.4%) in the addition of biological agents; however, there was no significant increase in the rates for those with smoldering disease (19.4% to 20.5%).
Despite Canada's universal healthcare system, current treatment regimens may not be optimized on the basis of disease activity. A large proportion of patients with RA (29%) seen in Canadian rheumatology practices may be experiencing unnecessary disease for a variety of reasons.
Notes
Comment In: J Rheumatol. 2009 Dec;36(12):2841; author reply 284219966195
PubMed ID
18597407 View in PubMed
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