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Discontinuation of methotrexate therapy in older patients with newly diagnosed rheumatoid arthritis: analysis of administrative health databases in Qu├ębec, Canada.

https://arctichealth.org/en/permalink/ahliterature155074
Source
Drugs Aging. 2008;25(10):879-84
Publication Type
Article
Date
2008
Author
Sasha Bernatsky
Debbie Ehrmann Feldman
Author Affiliation
Department of Clinical Epidemiology, McGill University, Montreal, Québec, Canada. sasha.bernatsky@mail.mcgill.ca
Source
Drugs Aging. 2008;25(10):879-84
Date
2008
Language
English
Publication Type
Article
Keywords
Administration, Oral
Age Factors
Aged
Antirheumatic Agents - administration & dosage - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy
Chronic Disease
Databases, Factual - statistics & numerical data
Female
Health Services for the Aged - statistics & numerical data
Humans
Male
Medication Adherence - statistics & numerical data
Methotrexate - administration & dosage - therapeutic use
Population Surveillance - methods
Quebec
Rural Population - statistics & numerical data
Treatment Outcome
Urban Population - statistics & numerical data
Abstract
Rheumatoid arthritis (RA) is a potentially devastating form of chronic arthritis. Methotrexate is the cornerstone of drug therapy of the disorder, and may slow or prevent joint damage. Unfortunately, this agent is not without adverse effects. Furthermore, increasing age has been been invoked as a predictor of greater toxicity and drug discontinuation by some, but not all, investigators.
To assess the effect of age and other covariates on methotrexate discontinuation in a population-based sample of older patients with newly diagnosed RA.
We studied the health administrative databases covering residents of the province of Québec, Canada. In these databases, we identified 246 individuals aged>or=65 years with newly diagnosed RA who had been started on methotrexate. We assessed discontinuation of methotrexate therapy using Cox proportional hazards regression models, with potential predictors of discontinuation being age, sex, co-morbidity, methotrexate dose and route (oral vs intramuscular), folic acid coadministration and disease severity.
Five patients died or were lost to follow-up in the database at 6 months, and there were ten such patients at 1 year. Six months after the initial prescription of methotrexate therapy, about 80% (n=192) of remaining subjects continued to be prescribed the drug. By 1 year, 161 of 236 (68.2%) subjects continued to be prescribed the drug; by 2 years, only 108 of 217 (49.8%) subjects continued to receive the drug. Increasing age was associated with a greater risk of methotrexate discontinuation.
Our population-based data indicate that increasing age is associated with a greater tendency for methotrexate discontinuation in patients with newly diagnosed RA. These results emphasize the need to ensure that older patients with RA are provided with effective therapy to minimize the effects of this chronic, potentially disabling disease.
PubMed ID
18808212 View in PubMed
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Lung cancer after exposure to disease modifying anti-rheumatic drugs.

https://arctichealth.org/en/permalink/ahliterature162110
Source
Lung Cancer. 2008 Feb;59(2):266-9
Publication Type
Article
Date
Feb-2008
Author
Sasha Bernatsky
Ann Clarke
Samy Suissa
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Guebec, Canada. sasha.bernatsky@mail.mcgill.ca
Source
Lung Cancer. 2008 Feb;59(2):266-9
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications - drug therapy - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Lung Neoplasms - epidemiology - etiology - pathology
Male
Middle Aged
Prognosis
Quebec - epidemiology
Retrospective Studies
Risk factors
Time Factors
Abstract
To assess the effects of disease modifying anti-rheumatic drugs (DMARDs) on lung cancer risk in a large rheumatoid arthritis (RA) cohort.
We assembled a cohort of RA patients (N=23,810) from population-based administrative healthcare databases. We ascertained cases of lung cancer in the cohort using physician billing and hospitalization records. Each lung cancer case was age and sex matched to 10 controls. We used conditional logistic regression to determine the effects of DMARDs on lung cancer risk, calculating the adjusted rate ratio (RR) attributable to each DMARD.
Subjects were followed for a total of 157,204 person-years. During this time, 960 cases of lung cancer were recorded. The frequency of exposures to various DMARDs was similar in cases and controls; our adjusted RR estimates, reflecting the independent effects of each DMARD exposure, did not associate any of the drugs with an increased risk of lung cancer.
Our data do not suggest that DMARD exposures are the primary mediator of lung cancer risk in RA. An increased risk of lung cancer in RA patients may be related to other determinants, including shared risk factors for the development of both RA and lung cancer.
PubMed ID
17673329 View in PubMed
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Observation period effects on estimation of systemic lupus erythematosus incidence and prevalence in Quebec.

https://arctichealth.org/en/permalink/ahliterature113020
Source
J Rheumatol. 2013 Aug;40(8):1334-6
Publication Type
Article
Date
Aug-2013
Author
Ryan Ng
Sasha Bernatsky
Elham Rahme
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.
Source
J Rheumatol. 2013 Aug;40(8):1334-6
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Child
Child, Preschool
Female
Humans
Incidence
Infant
Infant, Newborn
Lupus Erythematosus, Systemic - epidemiology
Male
Middle Aged
Prevalence
Quebec - epidemiology
Retrospective Studies
Time Factors
Young Adult
Abstract
To determine how duration of observation affects estimation of incidence and prevalence of systemic lupus erythematosus (SLE).
SLE incidence and prevalence estimates from data periods as brief as 3 years (2001-2003) were compared to estimates from a 15-year period (1989-2003).
The 15-year period incidence was 5.6/100,000 (95% CI 5.0-6.1) and the prevalence was 59.1/100,000 (95% CI 57.4-60.8). When a 3-year period was used, incidence was overestimated by 238.1% and prevalence underestimated by 66.0%.
SLE incidence and prevalence estimates vary considerably according to the observation period; more than 5 years of data is likely required.
Notes
Comment In: J Rheumatol. 2013 Aug;40(8):1241-323908527
PubMed ID
23772078 View in PubMed
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Demyelinating events in rheumatoid arthritis after drug exposures.

https://arctichealth.org/en/permalink/ahliterature149512
Source
Ann Rheum Dis. 2010 Sep;69(9):1691-3
Publication Type
Article
Date
Sep-2010
Author
Sasha Bernatsky
Christel Renoux
Samy Suissa
Author Affiliation
Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Institute, 3755 Cote Ste-Catherine, Montreal, Quebec, Canada.
Source
Ann Rheum Dis. 2010 Sep;69(9):1691-3
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - adverse effects - therapeutic use
Arthritis, Rheumatoid - drug therapy - epidemiology
Canada - epidemiology
Case-Control Studies
Demyelinating Diseases - chemically induced - epidemiology
Female
Humans
Interleukin 1 Receptor Antagonist Protein - adverse effects - therapeutic use
Male
Middle Aged
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
To estimate the effects of biological drugs on the risk of demyelinating events in rheumatoid arthritis (RA).
Case-control analyses nested in an administrative database cohort.
Initially the risk of demyelinating events appeared to be increased after exposure to anakinra and decreased after exposure to antitumour necrosis factor (anti-TNF) agents. However, this apparent differential risk was due to more anakinra use (and avoidance of anti-TNF agents) in persons at high risk for demyelinating events. In individuals not at high risk, the adjusted rate ratio was 1.31 (95% CI 0.68 to 2.50) after exposure to anti-TNF agents and 0.80 (95% CI 0.29 to 2.24) after exposure to anakinra.
When accounting for differential prescription patterns, there was a trend towards more events after exposure to anti-TNF agents. When studying rare but important potential drug associations, pharmacoepidemiological studies are valuable but must be carefully performed.
PubMed ID
19628820 View in PubMed
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The accuracy of administrative data diagnoses of systemic autoimmune rheumatic diseases.

https://arctichealth.org/en/permalink/ahliterature134892
Source
J Rheumatol. 2011 Aug;38(8):1612-6
Publication Type
Article
Date
Aug-2011
Author
Sasha Bernatsky
Tina Linehan
John G Hanly
Author Affiliation
Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Quebec, Canada. sasha.bernatsky@mail.mcgill.ca
Source
J Rheumatol. 2011 Aug;38(8):1612-6
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Autoimmune Diseases - diagnosis - immunology
Databases, Factual - standards
Hospital Administration - standards
Humans
Nova Scotia
Organization and Administration - standards
Reproducibility of Results
Rheumatic Diseases - diagnosis - immunology
Sensitivity and specificity
Abstract
To examine the validity of case definitions for systemic autoimmune rheumatic diseases [SARD; systemic lupus erythematosus (SLE), systemic sclerosis (SSc), myositis, Sjögren's syndrome, vasculitis, and polymyalgia rheumatica] based on administrative data, compared to rheumatology records.
A list of rheumatic disease diagnoses was generated from population-based administrative billing and hospitalization databases. Subjects who had been seen by an arthritis center rheumatologist were identified, and the medical records reviewed.
We found that 844 Nova Scotia residents had a diagnosis of one of the rheumatic diseases of interest, based on administrative data, and had had = 1 rheumatology assessment at a provincial arthritis center. Charts were available on 824 subjects, some of whom had been identified in the administrative database with > 1 diagnosis. Thus a total of 1136 diagnoses were available for verification against clinical records. Of the 824 subjects, 680 (83%) had their administrative database diagnoses confirmed on chart review. The majority of subjects who were "false-positive" for a given rheumatic disease on administrative data had a true diagnosis of a similar rheumatic disease. Most sensitivity estimates for specific administrative data-based case definitions were > 90%, although for SSc, the sensitivity was 80.5%. The specificity estimates were also > 90%, except for SLE, where the specificity was 72.5%.
Although health administrative data may be a valid resource, there are potential problems regarding the specificity and sensitivity of case definitions, which should be kept in mind for future studies.
PubMed ID
21532057 View in PubMed
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Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada.

https://arctichealth.org/en/permalink/ahliterature152367
Source
Arthritis Rheum. 2009 Mar 15;61(3):300-4
Publication Type
Article
Date
Mar-15-2009
Author
Paul Brassard
Anne-Marie Lowe
Sasha Bernatsky
Abbas Kezouh
Samy Suissa
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada. paul.brassard@clinepi.mcgill.ca
Source
Arthritis Rheum. 2009 Mar 15;61(3):300-4
Date
Mar-15-2009
Language
English
Publication Type
Article
Keywords
Aged
Antirheumatic Agents - adverse effects
Arthritis, Rheumatoid - drug therapy - immunology
Canada - epidemiology
Case-Control Studies
Cohort Studies
Female
Humans
Immunocompromised Host
Immunosuppressive Agents - adverse effects
Incidence
Male
Middle Aged
Risk
Tuberculosis - epidemiology
Abstract
To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease-modifying antirheumatic drugs (DMARDs).
We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980-2003. TB incidence rates were determined for the period 1992-2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case-control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.
Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person-years compared with 4.2 cases per 100,000 person-years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9-15.0). The adjusted RR of TB was 2.4 (95% CI 1.1-5.4) with corticosteroid use and 3.0 (95% CI 1.6-5.8) with nonbiologic DMARD use.
The age- and sex-standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.
PubMed ID
19248128 View in PubMed
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Wait times for rheumatology consultation: is rheumatoid arthritis prioritized?

https://arctichealth.org/en/permalink/ahliterature120342
Source
J Clin Rheumatol. 2012 Oct;18(7):341-4
Publication Type
Article
Date
Oct-2012
Author
Ashley Delaurier
Sasha Bernatsky
Murray Baron
Jean Légaré
Debbie Ehrmann Feldman
Author Affiliation
University of Montreal, Faculty of Medicine, School of Rehabilitation, Montreal, Quebec, Canada.
Source
J Clin Rheumatol. 2012 Oct;18(7):341-4
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Appointments and Schedules
Arthritis, Rheumatoid - diagnosis
Cross-Sectional Studies
Female
Health Care Rationing
Humans
Logistic Models
Middle Aged
Osteoarthritis - diagnosis
Physicians, Primary Care
Quebec
Referral and Consultation - statistics & numerical data
Time Factors
Waiting Lists
Abstract
Patients with rheumatoid arthritis (RA) should be seen by a rheumatologist promptly; however, there are no recommendations for patients with osteoarthritis (OA). Our goal was to describe wait times from referral by the primary care provider to rheumatology consultation and to explore whether wait times are associated with type of arthritis diagnosis, geographic area, or type of rheumatology office.
Appointments were requested by telephone using case scenarios that were created by a group of experts and included (1) presumed RA, (2) possible RA, and (3) presumed OA. Wait times were evaluated as the time between the initial request and the appointment date provided. We used descriptive statistics, bivariate analysis, and logistic regression in the analysis.
For all scenarios combined, 34% were given an appointment with a rheumatologist within 3 months of referral, 32% waited longer than 3 months, and 34% were told that the rheumatologist was not accepting new referrals at the time the request was made. Patients with presumed RA were much more likely to be seen within 3 months of referral compared with those with presumed OA (odds ratio, 13; 95% confidence interval, 1.70-99.38).
Rheumatoid arthritis is prioritized over OA for rheumatology appointments. However, most patients with RA are still not receiving an appointment to a rheumatologist in a timely manner. Effective triage tools to decrease these delays should be instituted.
PubMed ID
23013849 View in PubMed
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Predictors of health status in women with fibromyalgia: a prospective study.

https://arctichealth.org/en/permalink/ahliterature169211
Source
Int J Behav Med. 2006;13(2):101-8
Publication Type
Article
Date
2006
Author
Patricia L Dobkin
Mirella De Civita
Michal Abrahamowicz
Murray Baron
Sasha Bernatsky
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada. patricia.dobkin@mcgill.ca
Source
Int J Behav Med. 2006;13(2):101-8
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Female
Fibromyalgia - physiopathology - psychology
Health status
Humans
Middle Aged
Pain Measurement
Predictive value of tests
Prognosis
Prospective Studies
Quebec
Abstract
Although cross-sectional studies have identified correlates of dysfunction in fibromyalgia (FM) patients (e.g., psychological distress and pain), predictors of health status have not been previously investigated using a longitudinal research design. We gathered data from 156 women who met American College of Rheumatology criteria for primary FM recruited from both tertiary care and community settings. Stepwise multiple linear regression analysis indicated that poorer health status (p
PubMed ID
16712427 View in PubMed
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Care partnerships between family physicians and rheumatologists.

https://arctichealth.org/en/permalink/ahliterature133685
Source
J Rheumatol. 2011 Sep;38(9):1981-5
Publication Type
Article
Date
Sep-2011
Author
Benjamin Lou
Mirella DE Civita
Debbie Ehrmann Feldman
Asvina Bissonauth
Sasha Bernatsky
Author Affiliation
Montreal General Hospital, Clinical Epidemiology, 1650 Cedar Ave., L10-424, Montreal H3G 1A4, Quebec, Canada.
Source
J Rheumatol. 2011 Sep;38(9):1981-5
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Family Practice - organization & administration - trends
Female
Humans
Interdisciplinary Communication
Male
National Health Programs - organization & administration - trends
Partnership Practice - organization & administration - trends
Patient Care Team - organization & administration - trends
Physician's Practice Patterns - organization & administration - trends
Quality of Health Care - trends
Quebec
Questionnaires - standards
Referral and Consultation - organization & administration - trends
Rheumatology - organization & administration - trends
Abstract
To describe care partnerships between family physicians and rheumatologists.
A random sample (20%, n = 478) of family physicians was mailed a questionnaire, asking if there was at least 1 particular rheumatologist to whom the physician tended to refer patients. If the answer was affirmative, the physician would be considered as having a "care partnership" with that rheumatologist. The family physician then rated, on a 5-point scale, factors of importance regarding the relationship with that rheumatologist.
The questionnaire was completed by 84/462 (18.2%) of family physicians; 52/84 (61.9%) reported having rheumatology care partnerships according to our definition. Regarding interactions with rheumatologists, most respondents rated the following as important (score = 4): adequate communication and information exchange (44/50, 88.0%); waiting time for new patients (40/50, 80.0%); clear and appropriate balance of responsibilities (39/49, 79.6%); and patient feedback and preferences (34/50, 68%). Male family physicians were more likely than females to accord high importance to personal knowledge of the rheumatologist, and to physical proximity of the rheumatologist's practice. Regarding relationships with rheumatologists, 30/50 (60.0%) of respondents felt communication and information exchange were adequate, and 35/50 (70.0%) felt they had a clear balance of responsibilities.
Almost two-thirds of family physicians have rheumatology care partnerships, according to our definition. In this partnership, establishing adequate communication and shorter waiting time seem of paramount importance to family physicians. A balanced sharing of responsibilities and patients' preferences are also valued. Although many physicians reported adequate communication and clear and appropriate balance of responsibilities in their current interactions with rheumatologists, there appears to be room for improvement.
PubMed ID
21677002 View in PubMed
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Early consultation with a rheumatologist for RA: does it reduce subsequent use of orthopaedic surgery?

https://arctichealth.org/en/permalink/ahliterature120988
Source
Rheumatology (Oxford). 2013 Mar;52(3):452-9
Publication Type
Article
Date
Mar-2013
Author
Debbie Ehrmann Feldman
Sasha Bernatsky
Michelle Houde
Marie-Eve Beauchamp
Michal Abrahamowicz
Author Affiliation
CRIR, IRSPUM, Université de Montréal, Montréal, Québec H3C 3J7, Canada. debbie.feldman@umontreal.ca
Source
Rheumatology (Oxford). 2013 Mar;52(3):452-9
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - surgery - therapy
Cohort Studies
Disease Progression
Early Medical Intervention - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Orthopedic Procedures - utilization
Proportional Hazards Models
Quebec
Referral and Consultation - statistics & numerical data
Retrospective Studies
Rheumatology - statistics & numerical data
Time Factors
Abstract
Optimal care in RA includes early use of DMARDs to prevent joint damage and hopefully decrease the need for costly surgical interventions. Our objective was to determine whether a reduced rate of orthopaedic surgery was evident for persons with RA who saw a rheumatologist early in the disease course.
We studied persons who had a diagnosis of RA based on billing code data in the province of Quebec in 1995, and for whom the initial date of RA diagnosis by a non-rheumatologist could be established before the confirmatory diagnosis by the rheumatologist. We followed these patients until 2007. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 3 months of being diagnosed with RA by their referring physician. The outcome, orthopaedic surgery, was defined using International Classification of Diseases (ICD) procedure codes ICD9 and ICD10. Multivariate Cox regression with time-dependent covariates estimated the effect of early consultation on the time to orthopaedic surgery.
Our cohort consisted of 1051 persons; mean age at diagnosis was 55.7 years, 68.2% were female and 50.7% were early consulters. Among all patients, 20.5% (215) had an orthopaedic surgery during the observation interval. Early consulters were less likely to undergo orthopaedic surgery during the 12-year follow-up period (adjusted hazard ratio 0.60, 95% CI 0.44, 0.82).
Persons with RA who consult a rheumatologist later in the disease course have a worse outcome in terms of eventual requirement for orthopaedic surgery.
Notes
Comment In: Rheumatology (Oxford). 2013 Mar;52(3):411-223086516
PubMed ID
22949726 View in PubMed
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44 records – page 1 of 5.