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Hazlewood GS, Akhavan P, Pardo JP, Agarwal A, Schieir O, Barber CEH, Proulx L, Richards DP, Bombardier C, Pope JE, Barnabe C, Tugwell P, Jamal S, Thorne JC, Nikolic RPA, Khraishi M, Bansback N, Legge A, Bykerk V, Taylor-Gjevre R. Canadian Rheumatology Association Living Guidelines for Rheumatoid Arthritis: Update #1. J Rheumatol 2023; 50:1198-1199. [PMID: 37527865 DOI: 10.3899/jrheum.2023-0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Orit Schieir
- Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shahin Jamal
- Division of Rheumatology, University of British Columbia, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - J Carter Thorne
- The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Roko P A Nikolic
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Majed Khraishi
- Department of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Nick Bansback
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Legge
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medicine (Cornell University), New York, New York, USA
| | - Regina Taylor-Gjevre
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Manitoba, Canada
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Ramiro S, Landewé R, van der Heijde D, Sepriano A, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford) 2023; 62:2989-2997. [PMID: 36645243 DOI: 10.1093/rheumatology/kead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. METHODS Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. RESULTS In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. CONCLUSIONS In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Ireland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- The Arthritis Program Research Group, University of Toronto, Toronto, Canada
| | - Maggie J Larché
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), University of Sherbrooke, Sherbrooke, Canada
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, France
| | - Alain Saraux
- LBAI, U1227, Université Brest, Inserm, CHU Brest, Brest, France
| | - Maxime Dougados
- Rheumatology Department, Paris Cité University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Davtyan A, Lee JJY, Eder L, Hawker GA, Luo J, Barber CEH, Thorne JC, Widdifield J. The Effects of Continuity of Rheumatology Care on Emergency Department Utilization and Hospitalizations for Individuals With Early Rheumatoid Arthritis: A Population-Based Study. J Rheumatol 2023:jrheum.220996. [PMID: 36725062 DOI: 10.3899/jrheum.220996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if continuity of rheumatology care influences rates of emergency department (ED) visits and hospitalizations in patients with rheumatoid arthritis (RA). METHODS A closed inception cohort of patients with RA diagnosed between 2000 and 2009 were followed until December 31, 2019. During the first 5 years following diagnosis, we categorized patients into 3 rheumatology care continuity groups (high, intermediate, and not retained in rheumatology care). Using a landmark analysis, we compared rates of ED visits and hospitalizations during follow-up. Multivariable Poisson regression models were used to estimate rate ratios (RRs), adjusting for demographics, comorbidities, and health services access and supply measures. RESULTS The cohort included 38,528 patients, of which 57.7% (n = 22,221) were classified in the high rheumatology continuity group, 17.2% (n = 6636) were in the intermediate group, and 25.1% (n = 9671) were not retained in rheumatology care. Relative to the high continuity group, both the intermediate and nonretention groups had higher ED rates (RR 1.14, 95% CI 1.08-1.20, and RR 1.12, 95% CI 1.08-1.16, respectively). The intermediate group also experienced higher adjusted hospitalization rates (207.4, 95% CI 203.0-211.8 per 1000 person-years [PY]) than the high continuity group (193.5, 95% CI 191.4-195.6 per 1000 PY). CONCLUSION Patients with RA with higher continuity of rheumatology care had lower rates of ED visits and hospitalizations compared to those who did not receive continuous rheumatology care during the first 5 years of follow-up. These findings provide evidence to support the value of early and continuous rheumatology care for reducing hospitalizations and ED visits.
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Affiliation(s)
- Abel Davtyan
- A. Davtyan, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, University of Toronto, Department of Medicine, Toronto, The Hospital for Sick Children (SickKids), Toronto, and ICES, Toronto, Ontario
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, and Women's College Hospital Research Institute, Toronto, Ontario
| | - Gillian A Hawker
- G.A Hawker, MD, MSc, Institute of Health Policy, Management, & Evaluation, University of Toronto, Department of Medicine, University of Toronto, ICES, Toronto, and Women's College Hospital Research Institute, Toronto, Ontario
| | - Jin Luo
- J. Luo, MSc, ICES, Toronto, Ontario
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, The Cumming School of Medicine, University of Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - J Carter Thorne
- J.C. Thorne, MD, Southlake Regional Health Centre, Newmarket, Ontario
| | - Jessica Widdifield
- J. Widdifield, PhD, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ICES, Toronto, and Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, Ontario, Canada
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Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Proulx L, Richards DP, Tugwell P, Bansback N, Akhavan P, Bombardier C, Bykerk V, Jamal S, Khraishi M, Taylor-Gjevre R, Thorne JC, Agarwal A, Pope JE. Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs. J Rheumatol 2022; 49:1092-1099. [PMID: 35840155 DOI: 10.3899/jrheum.220209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada. METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for the tapering of biologic and targeted synthetic disease-modifying antirheumatic drug (b/ts DMARD) therapy in patients in sustained remission using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network. RESULTS In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and reestablish their medications if needed. In patients where rapid access to care or reestablishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation. CONCLUSION This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries, and Evidence to Decision summaries available through the CRA website (www.rheum.ca).
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada;
| | - Jordi Pardo Pardo
- J. Pardo Pardo, Ldo, Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Orit Schieir
- O. Schieir, PhD, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Bansback
- N. Bansback, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- P. Akhavan, MD, MSc, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Claire Bombardier
- C. Bombardier, MD, Professor, Division of Rheumatology, Mount Sinai Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, Professor, Hospital for Special Surgery, New York, New York, USA
| | - Shahin Jamal
- S. Jamal, MD, MSc, Clinical Associate Professor, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Majed Khraishi
- M. Khraishi, MD, Clinical Professor, Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regina Taylor-Gjevre
- R. Taylor-Gjevre, MD, MSc, Professor, Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Carter Thorne
- J.C. Thorne, MD, Assistant Professor, The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Arnav Agarwal
- A. Agarwal, MD, Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor, Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
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Barber CEH, Marshall DA, Szefer E, Barnabe C, Shiff NJ, Bykerk V, Homik J, Thorne JC, Ahluwalia V, Benseler S, Mosher D, Twilt M, Lacaille D. A Population-Based Approach to Reporting System-Level Performance Measures for Rheumatoid Arthritis Care. Arthritis Care Res (Hoboken) 2021; 73:640-648. [PMID: 32144843 DOI: 10.1002/acr.24178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada. METHODS All patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease-modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population. RESULTS The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow-up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow-up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14-day benchmark. CONCLUSION This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Vivian Bykerk
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Joanne Homik
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanne Benseler
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
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Maksymowych WP, FitzGerald O, Østergaard M, Homik J, van der Heijde D, Lambert RG, Elkayam O, Ramiro S, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Burmester GR, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel A, Barnabe C, Bingham CO, Tak PP, van Schaardenburg D, Hammer HB, Paschke J, Dadashova R, Hutchings E, Sepriano A, Landewé R. Outcomes and Findings of the International Rheumatoid Arthritis (RA) BIODAM Cohort for Validation of Soluble Biomarkers in RA. J Rheumatol 2020; 47:796-808. [PMID: 31474600 DOI: 10.3899/jrheum.190302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology Soluble Biomarker Working Group initiated an international, multicenter, prospective study, the Rheumatoid Arthritis (RA) BIODAM cohort, to generate resources for the clinical validation of candidate biomarkers predictive of radiographic progression. This first report describes the cohort, clinical outcomes, and radiographic findings. METHODS Patients with RA from 38 sites in 10 countries starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required to adhere to a treat-to-target strategy. Biosamples (serum, urine) were acquired every 3 months, radiography of hands and feet every 6 months, and ultrasound of hands and feet every 3 months in a subset. Primary endpoint was radiographic progression by the Sharp/van der Heijde score. RESULTS A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. At baseline, the majority was female (76%), mean age 55.7 years, and mean disease duration 6.5 years. Patients had a mean of 8.4 swollen and 13.6 tender joints, 44-joint count Disease Activity Score (DAS44) 3.8, 77.7% rheumatoid factor-positive or anticitrullinated protein antibody-positive. Percentage of patients in DAS and American College of Rheumatology remission at 2 years was 52.2% and 27.1%, respectively. Percentage of patients with radiographic progression (> 0.5) at 1 and 2 years was 38.2% and 59.9%, respectively. CONCLUSION The RA BIODAM prospective study succeeded in generating an extensive list of clinical, imaging (2343 radiographs), and biosample (4638 sera) resources that will be made available to expedite the identification and validation of biomarkers for radiographic damage endpoints. (Clinicaltrials.gov: NCT01476956, clinicaltrials.gov/ct2/show/NCT01476956).
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Affiliation(s)
- Walter P Maksymowych
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd. .,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center.
| | - Oliver FitzGerald
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Mikkel Østergaard
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Joanne Homik
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Désirée van der Heijde
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Robert G Lambert
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Ori Elkayam
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Sofia Ramiro
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - J Carter Thorne
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Maggie J Larché
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Gianfranco Ferraccioli
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Marina Backhaus
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Gerd R Burmester
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Gilles Boire
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Bernard Combe
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Thierry Schaeverbeke
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Alain Saraux
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Maxime Dougados
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Maurizio Rossini
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Marcello Govoni
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Luigi Sinigaglia
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Alain Cantagrel
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Cheryl Barnabe
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Clifton O Bingham
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Paul P Tak
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Dirkjan van Schaardenburg
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Hilde Berner Hammer
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Joel Paschke
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Rana Dadashova
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Edna Hutchings
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Alexandre Sepriano
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
| | - Robert Landewé
- From the Departments of Medicine and Radiology, University of Alberta; CaRE Arthritis Ltd., Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, CHU Montpellier, Montpellier; Service de rhumatologie, CHU Brest, and Lymphocyte B et Autoimmunité (LBAI), U1227, Université de Brest, INSERM, F-29200 Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis Ltd.,W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd.; O. FitzGerald, MD, Newman Clinical Research Professor, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; R.G. Lambert, FRCP(C), Department of Radiology, University of Alberta; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Service de rhumatologie, CHU Brest, and LBAI, U1227, Université Brest, INSERM, F-29200 Brest; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital; L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, Project Manager, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; A. Sepriano, MD, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, Academic Medical Center, University of Amsterdam, and Zuyderland Medical Center
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Mendel A, Bernatsky S, Thorne JC, Lacaille D, Johnson SR, Vinet É. Hydroxychloroquine shortages during the COVID-19 pandemic. Ann Rheum Dis 2020; 80:e31. [DOI: 10.1136/annrheumdis-2020-217835] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/27/2022]
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Kulhawy-Wibe SC, Zell J, Michaud K, Yazdany J, Davis AM, Ehrlich-Jones L, Thorne JC, Everix D, Cappelli LC, Suter LG, Limanni A, Barber CEH. Systematic Review and Appraisal of the Cross-Cultural Validity of Functional Status Assessment Measures in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:798-805. [PMID: 30980507 PMCID: PMC7317906 DOI: 10.1002/acr.23904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022]
Abstract
Objective We conducted a systematic review and appraisal of the cross‐cultural adaptation and cross‐cultural validity of the Health Assessment Questionnaire (HAQ) and its derivatives, and of the more recent Patient‐Reported Outcomes Measurement Information System (PROMIS) functional status assessment measures (FSAMs) in rheumatoid arthritis. Methods Four electronic medical databases were searched from inception until April 4, 2018 according to the Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) group search strategy. Included studies were evaluated using the COSMIN tool for cross‐cultural validity and were scored as excellent, good, fair, or poor. Results Of 58 articles identified by our search strategy and 3 by manual search, 39 were included: 29 described the translation, cultural adaptation, or cross‐cultural validity of the HAQ disability index, 8 other HAQ derivatives, and 2 PROMIS measures, representing 22 languages. Of the 39 articles reviewed, 3 examined the cross‐cultural validity of translated versions. These studies were rated as follows: 2 as excellent, 3 good, 13 fair, and 21 poor. Two studies examining cross‐cultural validity noted differential item functioning (DIF) between Dutch and US populations for the HAQ‐II and PROMIS measures, and a third study found DIF between Turkish and UK populations on the HAQ, indicating cultural differences in questionnaire response. Conclusion This review highlights a paucity of data on the cross‐cultural validity of FSAMs and the mostly poor‐ or fair‐quality methods by which they were translated and adapted, which needs to be considered when using these measures for multinational clinical trials and for day‐to‐day use in clinical practice.
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Affiliation(s)
| | - JoAnn Zell
- Denver Health and University of Colorado, Denver
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | - Aileen M Davis
- Krembil Research Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Claire E H Barber
- Cumming School of Medicine, University of Calgary, and Arthritis Research Canada, Calgary, Alberta, Canada
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Ramiro S, Landewé RB, van der Heijde D, Sepriano A, FitzGerald O, Ostergaard M, Homik J, Elkayam O, Thorne JC, Larche M, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, Tak PP, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM). Ann Rheum Dis 2020; 79:453-459. [PMID: 32094157 DOI: 10.1136/annrheumdis-2019-216819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target. METHODS RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models. RESULTS In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52). CONCLUSION In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Bm Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Oliver FitzGerald
- St Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Larche
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunolgoy and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bernard Combe
- CHU Montpellier and Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, Bordeaux, France
| | | | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Paul P Tak
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Ghent University, Ghent, Belgium.,Department of Medicine, Cambridge University, Cambridge, United Kingdom
| | | | | | | | | | - Joel Paschke
- CaRE Arthritis LTD, University of Alberta, Edmonton, Alberta, Canada
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Barber CEH, Zell J, Yazdany J, Davis AM, Cappelli L, Ehrlich-Jones L, Everix D, Thorne JC, Bohm V, Suter L, Limanni A, Michaud K. 2019 American College of Rheumatology Recommended Patient-Reported Functional Status Assessment Measures in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 71:1531-1539. [PMID: 31709771 DOI: 10.1002/acr.24040] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA). METHODS We convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings. RESULTS The search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ. CONCLUSION This work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.
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Affiliation(s)
| | | | | | - Aileen M Davis
- Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Donna Everix
- Mills Peninsula Health Services, Burlingame, California, and OnMyCare Home Health, Fremont, California
| | | | | | - Lisa Suter
- Yale University, New Haven, Connecticut, and Veterans Affairs Medical Center, West Haven, Connecticut
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas
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Sepriano A, Ramiro S, FitzGerald O, Østergaard M, Homik J, van der Heijde D, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Burmester GR, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel A, Barnabe C, Bingham CO, Tak PP, van Schaardenburg D, Hammer HB, Paschke J, Dadashova R, Hutchings E, Landewé R, Maksymowych WP. Adherence to Treat-to-target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort. J Rheumatol 2019; 47:809-819. [DOI: 10.3899/jrheum.190303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/22/2022]
Abstract
Objective.Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T.Methods.Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model).Results.A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02–1.19), smoking (OR 1.32, 95% CI 1.08–1.63) and high number of tender joints (OR 1.03, 95% CI 1.02–1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50–0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model.Conclusion.Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].
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Kuriya B, Schieir O, Valois MF, Pope JE, Boire G, Bessette L, Hazlewood G, Thorne JC, Tin D, Hitchon C, Bartlett SJ, Keystone EC, Bykerk VP, Barra L. Prevalence and Characteristics of Metabolic Syndrome Differ in Men and Women with Early Rheumatoid Arthritis. ACR Open Rheumatol 2019; 1:535-541. [PMID: 31777836 PMCID: PMC6858015 DOI: 10.1002/acr2.11075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Metabolic syndrome (MetS) prevalence in early rheumatoid arthritis (ERA) is conflicting. The impact of sex, including menopause, has not been described. We estimated the prevalence and factors associated with MetS in men and women with ERA. Methods A cross‐sectional study of the Canadian Early Arthritis Cohort (CATCH) was performed. Participants with baseline data to estimate key MetS components were included. Sex‐stratified logistic regression identified baseline variables associated with MetS. Results The sample included 1543 participants; 71% were female and the mean age was 54 (SD 15) years. MetS prevalence was higher in men 188 (42%) than women 288 (26%, P < 0.0001) and increased with age. Frequent MetS components in men were hypertension (62%), impaired glucose tolerance (IGT, 40%), obesity (36%), and low high‐density lipoprotein cholesterol (36%). Postmenopausal women had greater frequency of hypertension (65%), IGT (32%), and high triglycerides (21%) compared with premenopausal women (P < 0.001). In multivariate analysis, MetS was negatively associated with seropositivity and pulmonary disease in men. Increasing age was associated with MetS in women. In postmenopausal women, corticosteroid use was associated with MetS. Psychiatric comorbidity was associated with MetS in premenopausal women. MetS status was not explained by disease activity or core RA measures. Conclusion The characteristics and associations of MetS differed in men and women with ERA. Sex differences, including postmenopausal status, should be considered in comorbidity screening. With this knowledge, the interplay of MetS, sex, and RA therapeutic response on cardiovascular outcomes should be investigated.
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Affiliation(s)
- B Kuriya
- Sinai Health System University of Toronto CA
| | - O Schieir
- Dalla Lana School of Public Health University of Toronto Toronto CA
| | | | | | - G Boire
- Université de Sherbrooke Sherbrooke CA
| | | | | | - J C Thorne
- Southlake Regional Health Center Newmarket CA
| | - D Tin
- Southlake Regional Health Center Newmarket CA
| | | | - S J Bartlett
- McGill University Montreal CA.,Johns Hopkins School of Medicine Baltimore USA
| | | | - V P Bykerk
- Hospital for Special Surgery Weill Cornell Medical College New York USA
| | - L Barra
- Western University London CA
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Barber CE, Lix LM, Lacaille D, Marshall DA, Kroeker K, Benseler S, Twilt M, Schmeling H, Barnabe C, Hazlewood GS, Bykerk V, Homik J, Thorne JC, Burt J, Mosher D, Katz S, Shiff NJ. Testing population-based performance measures identifies gaps in juvenile idiopathic arthritis (JIA) care. BMC Health Serv Res 2019; 19:572. [PMID: 31412858 PMCID: PMC6694666 DOI: 10.1186/s12913-019-4379-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 07/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.
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Affiliation(s)
- Claire E.H. Barber
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Lisa M. Lix
- University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Diane Lacaille
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Kristine Kroeker
- George & Fay Yee Centre for Healthcare Innovation, 3rd floor, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Susanne Benseler
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | - Marinka Twilt
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Glen S. Hazlewood
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, 535 E 70th St, New York, NY USA
| | - Joanne Homik
- 3A Medicine Clinic, Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | | | - Jennifer Burt
- Rheumatology Services, St. Clare’s Mercy Hospital, 154 LeMarchant Road, St. John’s, NL A1C 5B8 Canada
| | - Dianne Mosher
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Steven Katz
- Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | - Natalie J. Shiff
- Department of Community Health & Epidemiology, University of Saskatchewan, Box 7, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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Nagaraj S, Barnabe C, Schieir O, Pope J, Bartlett SJ, Boire G, Keystone E, Tin D, Haraoui B, Thorne JC, Bykerk VP, Hitchon C. Early Rheumatoid Arthritis Presentation, Treatment, and Outcomes in Aboriginal Patients in Canada: A Canadian Early Arthritis Cohort Study Analysis. Arthritis Care Res (Hoboken) 2019; 70:1245-1250. [PMID: 29125904 DOI: 10.1002/acr.23470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Health inequities exist in chronic diseases for Aboriginal people. This study compared early rheumatoid arthritis (RA) presentation, treatment, and outcomes between Aboriginal and white patients in a large Canadian cohort study. METHODS Longitudinal data from the Canadian Early Arthritis Cohort, a prospective multicenter early RA study, were analyzed for participants who self-identified as Aboriginal or white ethnicity. Disease characteristics at presentation, prognostic factors, frequency of remission, and disease-modifying therapy strategies were contrasted between population groups. Linear mixed models were used to estimate rates of change for disease activity measures over a 5-year period. RESULTS At baseline, 2,173 participants (100 Aboriginal and 2,073 white) had similar mean ± SD symptom duration (179 ± 91 days), 28-joint Disease Activity Scores (DAS28; 4.87 ± 1.48), and Health Assessment Questionnaire (0.88 ± 0.68) scores. Factors associated with poor prognosis were more frequently present in Aboriginal participants, but disease-modifying therapy selection and frequency of therapy escalation was similar between the 2 groups. DAS28 remission was achieved less frequently in Aboriginal than in white participants (adjusted odds ratio 0.39 [95% confidence interval 0.25-0.62]). Results were primarily driven by slower improvement in swollen joint counts and nonsignificant improvement in patient global scores in Aboriginal participants. Pain levels remained higher in Aboriginal patients. CONCLUSION Aboriginal early RA patients experienced worse disease outcomes than their white counterparts. This may reflect unmeasured biologic differences and/or disparities in prognostic factors informed by inequities in determinants of health. The appropriateness of current treatment strategies applied in different contexts should be considered.
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Affiliation(s)
| | | | | | - Janet Pope
- University of Western Ontario and St. Joseph's Health Care, London, Ontario, Canada
| | | | - Gilles Boire
- CHUS-Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Boulos Haraoui
- Institut de Rhumatologie de Montreal, Montreal, Quebec, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Widdifield J, Bernatsky S, Pope JE, Ahluwalia V, Barber CEH, Eder L, Kuriya B, Ling V, Paterson JM, Thorne JC. Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study. J Rheumatol 2019; 47:468-476. [PMID: 31203224 DOI: 10.3899/jrheum.190034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To quantify population-level and practice-level encounters with rheumatologists over time. METHODS We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified. RESULTS From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists' practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time. CONCLUSION Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.
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Affiliation(s)
- Jessica Widdifield
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. .,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre.
| | - Sasha Bernatsky
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Janet E Pope
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Vandana Ahluwalia
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Claire E H Barber
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Lihi Eder
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Bindee Kuriya
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Vicki Ling
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - J Michael Paterson
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - J Carter Thorne
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
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Wong J, Tu K, Bernatsky S, Jaakkimainen L, Thorne JC, Ahluwalia V, Paterson JM, Widdifield J. Quality and continuity of information between primary care physicians and rheumatologists. BMC Rheumatol 2019; 3:1. [PMID: 31149655 PMCID: PMC6533707 DOI: 10.1186/s41927-019-0067-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Good communication is central to a high-quality consultation process. We assessed the quality of referral information from primary care physicians (PCPs) to rheumatologists and the quality and timeliness of consultation letters from rheumatologists back to PCPs. Methods We sampled referral letters between 2000 and 2013 from 168 PCPs and performed a retrospective chart review of 2430 patients referred to 146 rheumatologists. We assessed the completeness and timeliness of referral and consultation letters. Results Osteoarthritis (n = 787, 32%) and systemic inflammatory rheumatic diseases (n = 745, 31%) comprised the top reasons for referral. Only 55% of referral letters summarized the patients’ medical history. Referral letters provided some details of diagnostic tests (51% labs, 34% imaging) but there was underreporting of this information on referral letters. Almost all referral letters (92%) contained details of at least one patient symptom, with the most common complaint being joint pain (54%). Only half of all referral letters provided symptom duration. The PCP only stressed an urgent consultation among 211 patients (9%). Overall, 69% of consultation letters were returned to PCPs within 30 days of consultation visit. Conclusion We found that basic items necessary for appropriate triage, including a description of symptoms or other relevant history and results of investigations were often lacking in referral letters. The delay of receipt of consultation letters may further represent a lost opportunity for coordination and continuity of care, and may affect the quality of care patients receive.
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Affiliation(s)
- Jenna Wong
- 1Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario Canada
| | - Karen Tu
- 2Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Sasha Bernatsky
- 3McGill University, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liisa Jaakkimainen
- 4Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, ICES, University of Toronto, Toronto, Ontario Canada
| | - J Carter Thorne
- 5Southlake Regional Health Centre, Newmarket, Ontario Canada
| | - Vandana Ahluwalia
- 6William Olser Health System, Brampton Civic Hospital, Brampton, Ontario Canada
| | - J Michael Paterson
- 7Department of Family Medicine, McMaster University, Hamilton, Ontario Canada.,8Chronic Disease & Pharmacotherapy Program, ICES, Toronto, Ontario Canada.,9University of Toronto Institute of Health Policy, Management and Evaluation, MG 352 - 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Jessica Widdifield
- 1Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario Canada.,8Chronic Disease & Pharmacotherapy Program, ICES, Toronto, Ontario Canada.,9University of Toronto Institute of Health Policy, Management and Evaluation, MG 352 - 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
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Lau AN, Thorne JC, Movahedi M, Rampakakis E, Cesta A, Li X, Couto S, Sampalis J, Bombardier C. Effect of Concomitant Disease-modifying Antirheumatic Drugs and Methotrexate Administration Route on Biologic Treatment Durability in Rheumatoid Arthritis: OBRI Cohort Results. J Rheumatol 2019; 46:874-886. [DOI: 10.3899/jrheum.180486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Objective.Prior studies have suggested that concurrent conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy enhances the efficacy of biologic DMARD (bDMARD). Here, we assessed the effect of concomitant csDMARD use and methotrexate (MTX) route of administration on time to bDMARD discontinuation in a large Canadian (Ontario), observational, rheumatoid arthritis (RA) cohort.Methods.Patients from the Ontario Best Practices Research Initiative (OBRI) who initiated bDMARD therapy and had ≥ 1 followup assessment were included. The effect of concomitant csDMARD use (primary analysis) and MTX route of administration (secondary analysis) on bDMARD discontinuation owing to (1) any reason, (2) ineffectiveness, (3) adverse events (AE), and (4) both (2) and (3), were assessed with multivariate Cox regression.Results.Among the 814 patients included, 153 (18.8%) received bDMARD monotherapy and 661 (81.2%) combination csDMARD/bDMARD therapy. Over a mean followup of 1.9 years, bDMARD were discontinued in 38.7% of patients. In multivariate analysis, there was a nonsignificant trend toward lower discontinuation for the csDMARD/bDMARD group compared to bDMARD monotherapy for any reason (HR 0.76, 95% CI 0.55–1.05) and owing to ineffectiveness/AE (HR 0.73, 95% CI 0.50–1.06). Further, patients taking combination therapy had significantly lower risk of bDMARD discontinuation due to AE (HR 0.43, 95% CI 0.24–0.76). In the secondary analysis, no statistical association between MTX dose or route of administration and bDMARD durability was observed.Conclusion.Concomitant csDMARD use was associated with a significantly lower hazard for bDMARD discontinuation due to AE among patients with RA followed in routine clinical practice in Ontario, Canada. Neither MTX route of administration nor dose were significant predictors of bDMARD durability.
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Widdifield J, Abrahamowicz M, Paterson JM, Huang A, Thorne JC, Pope JE, Kuriya B, Beauchamp ME, Bernatsky S. Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis. J Rheumatol 2018; 46:467-474. [PMID: 30504508 DOI: 10.3899/jrheum.180427] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We evaluated the associations between time-varying methotrexate (MTX) use and risk of cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). METHODS We studied an inception cohort of 23,994 patients with RA diagnosed after their 65th birthday. Multivariable Cox regression models were fit to evaluate the associations between time-varying MTX use, controlling for other risk factors, and time to CVE. Alternative models assessed the cumulative duration of MTX use over the (1) first year, (2) previous year (recent use), and (3) entire duration of followup. We also assessed whether the strength of the association varied over time. RESULTS Over 115,453 patient-years (PY), 3294 (13.7%) patients experienced a CVE (28.5 events per 1000 PY; 95% CI 27.6-29.5). In the multivariable analyses, the model assessing time-varying continuous use in the most recent year yielded the best fit. Increasing recent MTX use was associated with lower CVE risks (HR 0.79 for continuous use vs no use in past 12 months, 95% CI 0.70-0.88; p < 0.0001). Greater MTX use in the first year after cohort entry was also protective (HR 0.84, 95% CI 0.72-0.96; p = 0.0048), but this effect decreased with increasing followup. In contrast, longer MTX use during the entire followup was not clearly associated with CVE risk (HR 0.98, 95% CI 0.95-1.01; p = 0.1441). CONCLUSION We observed about a 20% decrease in CVE associated with recent continuous MTX use. Greater MTX use in the first year of cohort entry also appeared to be important in the association between MTX and CVE risk.
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Affiliation(s)
- Jessica Widdifield
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada. .,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation.
| | - Michal Abrahamowicz
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Michael Paterson
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Anjie Huang
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - J Carter Thorne
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Janet E Pope
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Bindee Kuriya
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Marie-Eve Beauchamp
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
| | - Sasha Bernatsky
- From the Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Ontario; McGill University, Department of Epidemiology, Biostatistics and Occupational Health; Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, and Centre for Outcomes Research and Evaluation, Montreal, Quebec; ICES; University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto; McMaster University, Department of Family Medicine, Hamilton; Southlake Regional Health Centre, Department of Medicine, Newmarket; Western University, Department of Epidemiology and Biostatistics; St. Joseph's Health Care, Department of Medicine, London; Mount Sinai Hospital, Department of Medicine, Toronto, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Research Program, and McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Department of Clinical Epidemiology, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation; M. Abrahamowicz, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; J.M. Paterson, MSc, ICES, and University of Toronto, Institute of Health Policy, Management and Evaluation, and McMaster University, Department of Family Medicine; A. Huang, MSc, ICES; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre, Department of Medicine; J.E. Pope, MD, FRCPC, MPH, Western University, Department of Epidemiology and Biostatistics, and St. Joseph's Health Care, Department of Medicine; B. Kuriya, MD, FRCPC, SM, Mount Sinai Hospital, Department of Medicine; M.E. Beauchamp, PhD, Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, Biostatistics and Occupational Health, and Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation
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19
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Schulman E, Bartlett SJ, Schieir O, Andersen KM, Boire G, Pope JE, Hitchon C, Jamal S, Thorne JC, Tin D, Keystone EC, Haraoui B, Goodman SM, Bykerk VP. Overweight, Obesity, and the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results From a Multicenter Prospective Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:1185-1191. [PMID: 29193840 DOI: 10.1002/acr.23457] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/17/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Obesity is implicated in rheumatoid arthritis (RA) development, severity, outcomes, and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the 3 years following RA diagnosis. METHODS Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of early RA patients treated by rheumatologists using guideline-based care. sREM was defined as Disease Activity Score in 28 joints (DAS28) <2.6 for 2 consecutive visits. Patients were stratified by body mass index (BMI) as healthy (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), and obese (≥30 kg/m2 ). Cox regression was used to estimate the effect of the BMI category on the probability of achieving sREM over the first 3 years, controlling for age, sex, race, education, RA duration, smoking status, comorbidities, baseline DAS28, Health Assessment Questionnaire disability index, C-reactive protein level, and initial treatment. RESULTS Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI, overweight patients (hazard ratio [HR] 0.75 [95% confidence interval (95% CI) 0.58-0.98]) and obese patients (HR 0.53 [95% CI 0.39-0.71]) were significantly less likely to achieve sREM. CONCLUSION Rates of overweight and obesity were high (69%) in this early RA cohort. Overweight patients were 25% less likely, and obese patients were 47% less likely, to achieve sREM in the first 3 years, despite similar initial disease-modifying antirheumatic drug treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RA patients.
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Affiliation(s)
- Elizabeth Schulman
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | | | | | - Kathleen M Andersen
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Janet E Pope
- St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada
| | | | - Shahin Jamal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Edward C Keystone
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Vivian P Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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O'Dell JR, Cohen SB, Thorne JC, Kremer J. Treatment of rheumatoid arthritis in the USA: premature use of tumor necrosis factor inhibition and underutilization of concomitant methotrexate. Open Access Rheumatol 2018; 10:97-101. [PMID: 30013407 PMCID: PMC6037273 DOI: 10.2147/oarrr.s169152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective of this study was to assess the treatment for patients with rheumatoid arthritis (RA) in the USA. Patients and methods This study entailed analysis of claims data for patients with RA who initiated treatment with oral methotrexate (MTX) or a biologic in 2009 (n=48,910) or 2012 (n=107,636) and had follow-up for 4 years (2009 cohort) or 2 years (2012 cohort). Results A biologic was initiated before MTX for 27% of the 2009 cohort and 36% of the 2012 cohort. Concomitant use of MTX and a biologic declined from 74.1% (2009 cohort) to 45.4% (2012 cohort). Conclusion MTX is underused in the treatment of RA in the USA.
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Affiliation(s)
- James R O'Dell
- Department of Rheumatology, Division of Rheumatology and Immunology, University of Nebraska Medical Center and the Omaha VA, Omaha, NE, USA,
| | - Stanley B Cohen
- Department of Internal Medicine, Metroplex Clinical Research Center, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - J Carter Thorne
- Division of Rheumatology, University of Toronto, Southlake Regional Health Centre, Toronto, ON, Canada
| | - Joel Kremer
- The Center for Rheumatology, Albany Medical College, Albany, NY, USA
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21
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Barber CEH, Thorne JC, Ahluwalia V, Burt J, Lacaille D, Marshall DA, Hazlewood GS, Mosher D, Denning L, Szamko I, Chin R, Hamilton S, Benseler S, Twilt M, Shiff NJ, Bykerk V, Homik J, Barnabe C. Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care. J Rheumatol 2018; 45:1501-1508. [PMID: 29907674 DOI: 10.3899/jrheum.171284] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care. METHODS The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA. RESULTS A number of feasibility issues were encountered in performance measure evaluation because of differences in site data collection and/or the duration of the model of care. For example, while 4/5 programs maintained clinical or research databases, chart reviews were still required to report on WT. Median WT for care in 2015 varied by site between 21 and 75 days. Yearly FU rates could only be calculated in 2 sites (combined owing to small numbers) and varied between 83% and 100%. Percentage of patients taking a DMARD and time to DMARD could be calculated in 3 models, and rates of DMARD use were between 90% and 100%, with median time to DMARD of 0 days in each. CONCLUSION Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.
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Affiliation(s)
- Claire E H Barber
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada.
| | - J Carter Thorne
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Vandana Ahluwalia
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Jennifer Burt
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Diane Lacaille
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Deborah A Marshall
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Glen S Hazlewood
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Dianne Mosher
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Lisa Denning
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Ildiko Szamko
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Ricky Chin
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Sean Hamilton
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Susanne Benseler
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Marinka Twilt
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Natalie J Shiff
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Vivian Bykerk
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Joanne Homik
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
| | - Cheryl Barnabe
- From the departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; J. Burt, Physiotherapist, Advanced Clinician Practitioner in Arthritis Care (ACPAC) program-trained Extended Role Practitioner (ERP), Rheumatology Services, St. Clare's Mercy Hospital, Eastern Health; D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health; G.S. Hazlewood, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, and Research Scientist, Arthritis Research Canada; D. Mosher, MD, FRCPC, Professor, Rheumatology Division Head, Department of Medicine, Cumming School of Medicine, University of Calgary; L. Denning, Physiotherapist, ACPAC program-trained ERP, William Osler Health System; I. Szamko, The Arthritis Program, Southlake Regional Health Centre; R. Chin, MSc, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; S. Hamilton, MD, FRCPC, Associate Professor of Medicine, Rheumatology Division Chief, St. Clare's Mercy Hospital, Memorial University of Newfoundland; S. Benseler, MD, PhD, Professor, Section Chief, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; M. Twilt, MD, MSCE, PhD, Assistant Professor, Pediatric Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary; N.J. Shiff, MD, MHSc, Associate Professor, Department of Pediatrics, University of Florida, and adjunct professor, Department of Community Health and Epidemiology, University of Saskatchewan; V. Bykerk, MD, FRCPC, Associate Professor of Medicine, Cornell University, and Associate Scientist, Division of Rheumatology, Hospital for Special Surgery; J. Homik, MD, MSc, FRCPC, Associate Professor, Department of Medicine, University of Alberta; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary, and Research Scientist, Arthritis Research Canada
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Barber CEH, Schieir O, Lacaille D, Marshall DA, Barnabe C, Hazlewood G, Thorne JC, Ahluwalia V, Bartlett SJ, Boire G, Haraoui B, Hitchon C, Keystone E, Tin D, Pope JE, Denning L, Bykerk VP. High Adherence to System-Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years. Arthritis Care Res (Hoboken) 2018; 70:842-850. [PMID: 29450976 PMCID: PMC6001563 DOI: 10.1002/acr.23439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess adherence to 3 system-level performance measures in a national early rheumatoid arthritis (RA) cohort. METHODS Patients enrolled in the Canadian Early Arthritis Cohort (2007-2015) who met 1987 or 2010 American College of Rheumatology/European League Against Rheumatism criteria with <1 year of symptom duration and ≥1 year of followup after enrollment were included. Performance measures assessed were the percentage of RA patients seen in yearly followup, and the number of gaps between visits of >12 or >14 months, the percentage of RA patients treated with a disease-modifying antirheumatic drug (DMARD), and days from RA diagnosis to initiation of a DMARD. Results are shown stratified by enrollment year to assess for temporal changes in performance. RESULTS A total of 1,763 early RA patients were included (mean age 54 years, 73% female, and 82% white). At enrollment, mean ± SD disease duration was 6 ± 3 months, and Disease Activity Score in 28 joints was 5.1 ± 1.5. Over 8 years, the proportion of patients seen in annual followup declined from 100% to 91%. Over followup, 42% of patients had 0 gaps in care of >12 months, and 64% had 0 gaps >14 months. The percentage of DMARD-treated early RA patients was and remained high (95-87%), and the percentage receiving DMARDs within 14 days of diagnosis was 75%. Median time-to-DMARD therapy was 1 day, indicating DMARDs were initiated at diagnosis (90th percentile 93 days). CONCLUSION There was evidence of high adherence to system-level performance measures in this early RA cohort following a protocol. Small declines in performance were noted with increasing length of patient followup. Our findings are useful for performance measure benchmarking.
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Affiliation(s)
- Claire E. H. Barber
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | - Diane Lacaille
- Arthritis Research Canada, Richmondand University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Deborah A. Marshall
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canadaand Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | | | | | | | | | | | | | - Diane Tin
- Southlake Regional Health CentreNewmarketOntarioCanada
| | | | - Lisa Denning
- William Osler Health SystemEtobicokeOntarioCanada
| | - Vivian P. Bykerk
- Arthritis Research Canada, Richmond, British Columbia, Canadaand Hospital for Special SurgeryNew YorkNew York
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Widdifield J, Ivers NM, Bernatsky S, Jaakkimainen L, Bombardier C, Thorne JC, Ahluwalia V, Paterson JM, Young J, Wing L, Tu K. Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2017; 69:1495-1503. [DOI: 10.1002/acr.23178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Noah M. Ivers
- Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital; Toronto Ontario Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto; Toronto Ontario Canada
| | - Claire Bombardier
- University of Toronto and University Health Network; Toronto Ontario Canada
| | - J. Carter Thorne
- University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre; Newmarket Ontario Canada
| | | | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University; Hamilton Ontario Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network; Toronto Ontario Canada
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Rohr MK, Mikuls TR, Cohen SB, Thorne JC, O'Dell JR. Underuse of Methotrexate in the Treatment of Rheumatoid Arthritis: A National Analysis of Prescribing Practices in the US. Arthritis Care Res (Hoboken) 2017; 69:794-800. [DOI: 10.1002/acr.23152] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/17/2016] [Accepted: 11/15/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Melanie K. Rohr
- University of Nebraska Medical Center, Omaha, and Veterans Affairs Nebraska-Western Iowa Health Care System; Omaha
| | - Ted R. Mikuls
- University of Nebraska Medical Center, Omaha, and Veterans Affairs Nebraska-Western Iowa Health Care System; Omaha
| | | | | | - James R. O'Dell
- University of Nebraska Medical Center, Omaha, and Veterans Affairs Nebraska-Western Iowa Health Care System; Omaha
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25
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Barber CEH, Jewett L, Badley EM, Lacaille D, Cividino A, Ahluwalia V, Averns H, Baillie C, Ellsworth J, Pope J, Levy D, Charnock C, McGowan C, Thorne JC, Barnabe C, Zummer M, Lundon K, McDougall RS, Thomson JG, Yacyshyn EA, Mosher D, Brophy J, Ruban TN, Marshall DA. Stand Up and Be Counted: Measuring and Mapping the Rheumatology Workforce in Canada. J Rheumatol 2016; 44:248-257. [PMID: 27909087 DOI: 10.3899/jrheum.160621] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To characterize the practicing rheumatologist workforce, the Canadian Rheumatology Association (CRA) launched the Stand Up and Be Counted workforce survey in 2015. METHODS The survey was distributed electronically to 695 individuals, of whom 519 were expected to be practicing rheumatologists. Demographic and practice information were elicited. We estimated the number of full-time equivalent rheumatologists per 75,000 population from the median proportion of time devoted to clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association. RESULTS The response rate was 68% (355/519) of expected practicing rheumatologists (304 were in adult practice, and 51 pediatric). The median age was 50 years, and one-third planned to retire within the next 5-10 years. The majority (81%) were university-affiliated. Rheumatologists spent a median of 70% of their time in clinical practice, holding 6 half-day clinics weekly, with 10 new consultations and 45 followups seen per week. Work characteristics varied by type of rheumatologist (adult or pediatric) and by practice setting (community- or university-based). We estimated between 0 and 0.8 full-time rheumatologists per 75,000 population in each province. This represents a deficit of 1 to 77 full-time rheumatologists per province/territory to meet the CRA recommendation of 1 rheumatologist per 75,000 population, depending on the province/territory. CONCLUSION Our results highlight a current shortage of rheumatologists in Canada that may worsen in the next 10 years because one-third of the workforce plans to retire. Efforts to encourage trainees to enter rheumatology and strategies to support retention are critical to address the shortage.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada. .,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health.
| | - Lauren Jewett
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Elizabeth M Badley
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Alfred Cividino
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Vandana Ahluwalia
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Henry Averns
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Cory Baillie
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Janet Ellsworth
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Janet Pope
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Deborah Levy
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Christine Charnock
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Claire McGowan
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - J Carter Thorne
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Michel Zummer
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Katie Lundon
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Robert S McDougall
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - John G Thomson
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Elaine A Yacyshyn
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Dianne Mosher
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Julie Brophy
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Thanu Nadarajah Ruban
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health; Department of Geography, and Department of Community Health Sciences, University of Calgary, Calgary; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Krembil Research Institute, Toronto Western Hospital; Dalla Lana School of Public Health, University of Toronto; Hospital for Sick Children; Pediatrics, University of Toronto; Faculty of Medicine, University of Toronto, Toronto; Rheumatology, McMaster University, Hamilton; William Osler Health System, Brampton; Private Practice, Kingston; Canadian Rheumatology Association; The Arthritis Program at Southlake Regional Health Centre, Newmarket; Division of Rheumatology, University of Western Ontario, London; Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa; Private Practice, Guelph; Private Practice, Markham, Ontario; University of Manitoba, Winnipeg, Manitoba; Rheumatology, Hôpital Maisonneuve-Rosemont; Université de Montréal, Montreal, Quebec; University of Saskatchewan, Regina, Saskatchewan, Canada.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and Research Scientist, Arthritis Research Canada; L. Jewett, MGIS (Candidate), Department of Geography, University of Calgary; E.M. Badley, PhD, Krembil Research Institute, Toronto Western Hospital, and Dalla Lana School of Public Health, University of Toronto; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada; A. Cividino, MD, FRCPC, Professor, Division Director, Rheumatology, McMaster University; V. Ahluwalia, MD, FRCPC, Corporate Chief of Rheumatology, William Osler Health System; H. Averns, MB, ChB, FRCP ( UK), FRCPC, Rheumatologist, Private Practice; C. Baillie, MD, FRCPC, Assistant Professor, University of Manitoba, and Past President Canadian Rheumatology Association; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; D. Levy, MD, MS, FRCPC, Staff Rheumatologist, Hospital for Sick Children, and Assistant Professor of Pediatrics, University of Toronto; C. Charnock, CAE, CEO/PDF, Canadian Rheumatology Association; C. McGowan, Project Coordinator, Canadian Rheumatology Association; J.C. Thorne, MD, FRCPC, Assistant Professor, University of Toronto, and Medical Director, The Arthritis Program at Southlake Regional Health Centre; C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, and Associate Professor, Université de Montréal; K. Lundon, BScPT, MSc, PhD, Advanced Clinician Practitioner in Arthritis Care, Program Director, Faculty of Medicine, University of Toronto; R.S. McDougall, MD, FRCPC, Clinical Professor, University of Saskatchewan; J.G. Thomson, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Rheumatology, University of Ottawa; E.A. Yacyshyn, MD, FRCPC, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; J. Brophy, MD, FRCPC, Rheumatologist, Private Practice; T.N. Ruban, MD, FRCPC, Rheumatologist, Private Practice; D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, Department of Community Health Sciences, Cumming School of Medicine, and Division of Rheumatology, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health
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Widdifield J, Tu K, Carter Thorne J, Bombardier C, Michael Paterson J, Liisa Jaakkimainen R, Wing L, Butt DA, Ivers N, Hofstetter C, Lyddiatt A, Ahluwalia V, Bernatsky S. Patterns of Care Among Patients Referred to Rheumatologists in Ontario, Canada. Arthritis Care Res (Hoboken) 2016; 69:104-114. [PMID: 27110847 DOI: 10.1002/acr.22910] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Our aim was to characterize referrals to rheumatologists, the early care management of patients with rheumatic diseases, and timeliness of care and treatment. METHODS We conducted a retrospective observational study involving patients with first-time rheumatology referrals between 2000 and 2013 in the primary care Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Referrals were characterized in terms of diagnoses, patient demographics, diagnostic tests, treatment initiated by family physicians and rheumatologists, and other specialists seen prior to rheumatology consultation. Timeliness of referrals, rheumatologist consultations, and treatment were determined overall and for each diagnostic category. RESULTS Among 2,430 patients referred to a rheumatologist, 69% were female, with an average age of 53 years. The principal diagnosis associated with the referral included osteoarthritis (32%), systemic inflammatory rheumatic diseases (31%), regional musculoskeletal conditions (16%), chronic pain conditions (14%), osteoporosis (2%), and other/miscellaneous (5%). Family physicians most frequently prescribed nonsteroidal antiinflammatory drugs/cyclooxygenase 2 inhibitors (38%), and their pre-referral diagnostic testing practice varied considerably. The duration of time from symptom onset to rheumatology consultation varied by diagnoses, with the shortest being for patients with systemic rheumatic diseases; for rheumatoid arthritis (RA), the median time to consultation was 327 days. Most of the delay occurred prior to referral; 36% of RA patients initiated a disease-modifying antirheumatic drug within 6 months of symptom onset. CONCLUSION Approximately 1 in 3 referrals to rheumatologists were for a systemic inflammatory rheumatic disease. We observed substantial delays to rheumatology consultations and variations in patterns of care that could be amenable to quality improvement interventions.
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Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and McGill University, Montreal, Quebec, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, and University Health Network, Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada
| | | | | | - J Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada
| | - R Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Debra A Butt
- University of Toronto and Scarborough Hospital, Toronto, Ontario, Canada
| | - Noah Ivers
- Institute for Clinical Evaluative Sciences and Women's College Hospital, Toronto, Ontario, Canada
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Toupin April K, Rader T, Hawker GA, Stacey D, O’Connor AM, Welch V, Lyddiatt A, McGowan J, Thorne JC, Bennett C, Pardo Pardo J, Wells GA, Tugwell P. Development and Alpha-testing of a Stepped Decision Aid for Patients Considering Nonsurgical Options for Knee and Hip Osteoarthritis Management. J Rheumatol 2016; 43:1891-1896. [DOI: 10.3899/jrheum.150736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
Abstract
Objective.To develop an innovative stepped patient decision aid (StDA) comparing the benefits and harms of 13 nonsurgical treatment options for managing osteoarthritis (OA) and to evaluate its acceptability and effects on informed decision making.Methods.Guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards, the process involved (1) developing a decision aid with evidence on 13 nonsurgical treatments from the 2012 American College of Rheumatology OA clinical practice guidelines; and (2) interviewing patients with OA and healthcare providers to test its acceptability and effects on knowledge and decisional conflict.Results.The StDA helped make the decision explicit, and presented evidence on 13 OA treatments clustered into 5 steps or levels according to their benefits and harms. Probabilities of benefits and harms were presented using pictograms of 100 faces formatted to allow comparisons across sets of options. It also included a values clarification exercise and knowledge test. Feedback was obtained from 49 patients and 7 healthcare providers. They found that the StDA presented evidence in a clear manner, and helped patients clarify their values and make an informed decision. Some participants found that there was too much information and others said that there was not enough on each treatment option.Conclusion.This innovative StDA allows patients to consider both the evidence and their values for multiple options. The findings are being used to revise and plan future evaluation. The StDA is an example of how research evidence in guidelines can be implemented in practice.
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Omair MA, Keystone E, Bykerk V, Lin D, Xiong J, Sun Y, Boire G, Thorne JC, Tin D, Pope J, Hitchon C, Haraoui B, Akhavan PS. Predicting Low Disease State and Remission in Early Rheumatoid Arthritis in the First Six Months, Comparing the Simplified Disease Activity Index and European League Against Rheumatism Response Measures: Results From an Early Arthritis Cohort. Arthritis Care Res (Hoboken) 2016; 69:737-741. [PMID: 27564591 DOI: 10.1002/acr.22983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the European League Against Rheumatism (EULAR) and Simplified Disease Activity Index 50% (SDAI50) response measures (RMs) and their impact on future response to treatment in patients with early rheumatoid arthritis (ERA). METHODS Biologic agent-naive ERA patients from the Canadian Early Arthritis Cohort study with complete data at baseline, 3, and 6 months were evaluated. Kappa statistics were used to evaluate the agreement between the EULAR (moderate or good response) and SDAI50 RMs. The RMs at 3 months were also compared for their ability to predict low disease activity state (LDAS) or remission (REM) at 6 months. RESULTS A total of 1,124 patients were evaluated. Of those, 215 patients (30%) and 294 patients (45%) failed to achieve a EULAR and SDAI50 response, respectively. There was a good agreement between EULAR and SDAI50 RMs with a kappa of 0.59 (95% confidence interval 0.53-0.66). Throughout the range of disease activity, the SDAI50 response was shown to be more stringent than the EULAR response. Multivariable linear regression analysis demonstrated that both RMs at 3 months were associated with LDAS or REM at 6 months, and SDAI50 had a more significant impact on this outcome compared to the EULAR response. CONCLUSION There is a good agreement between the EULAR and SDAI50 RMs. Although a minority of patients have discordant RMs at each end of the disease activity spectrum at baseline, the SDAI50 response at 3 months appears to be a more significant predictor of outcomes at 6 months than EULAR response.
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Affiliation(s)
- Mohammed A Omair
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, and King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Edward Keystone
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Bykerk
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, and Hospital for Special Surgery, New York, New York
| | - Daming Lin
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan Xiong
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ye Sun
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Janet Pope
- St. Joseph Health Care, University of Western Ontario, London, Ontario, Canada
| | - Carol Hitchon
- Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Pooneh S Akhavan
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Bykerk VP, Bingham CO, Choy EH, Lin D, Alten R, Christensen R, Furst DE, Hewlett S, Leong A, March L, Woodworth T, Boire G, Haraoui B, Hitchon C, Jamal S, Keystone EC, Pope J, Tin D, Thorne JC, Bartlett SJ. Identifying flares in rheumatoid arthritis: reliability and construct validation of the OMERACT RA Flare Core Domain Set. RMD Open 2016; 2:e000225. [PMID: 27252895 PMCID: PMC4885442 DOI: 10.1136/rmdopen-2015-000225] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16–32% were flaring at the second visit. Agreement of flare status was low–strong (κ's 0.17–0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49–0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29–0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1–3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.
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Affiliation(s)
- Vivian P Bykerk
- Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA; Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Clifton O Bingham
- Division of Rheumatology , Johns Hopkins School of Medicine , Baltimore, Maryland , USA
| | - Ernest H Choy
- Section of Rheumatology , Arthritis Research UK & Health and Care Research Wales CREATE Centre, Cardiff University , Cardiff , UK
| | - Daming Lin
- Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto , Toronto, Ontario , Canada
| | - Rieke Alten
- Schlosspark Klinik, Charité University Medicine , Berlin , Germany
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Department of Rheumatology , The Parker Institute , Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
| | - Daniel E Furst
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, California, USA (Emeritus); University of Washington, Seattle Wash; University of Florence, Florence, Italy
| | | | - Amye Leong
- Bone and Joint Decade, Healthy Motivation , Santa Barbara, California , USA
| | - Lyn March
- Department of Rheumatology , University of Sydney, Institute of Bone and Joint Research, Royal North Shore Hospital , St Leonards, New South Wales , Australia
| | - Thasia Woodworth
- Division of Rheumatology , University of California, Los Angeles , Los Angeles, California , USA
| | - Gilles Boire
- Division of Rheumatology , Université de Sherbrooke , Sherbrooke, Québec , Canada
| | - Boulos Haraoui
- Rheumatic Disease Unit , Institut de Rheumatologie , Montreal, Québec , Canada
| | - Carol Hitchon
- Arthritis Center, University of Manitoba , Winnipeg, Manitoba , Canada
| | - Shahin Jamal
- Vancouver Coastal Health Institute , Vancouver, British Columbia , Canada
| | - Edward C Keystone
- Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto , Toronto, Ontario , Canada
| | - Janet Pope
- Division of Rheumatology , St. Joseph's Health Care London, University of Western Ontario , London, Ontario , Canada
| | - Diane Tin
- Southlake Regional Health Centre , Newmarket, Ontario , Canada
| | - J Carter Thorne
- Southlake Regional Health Centre , Newmarket, Ontario , Canada
| | - Susan J Bartlett
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Clinical Trials Unit, McGill University, Montreal, Québec, Canada
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Widdifield J, Bernatsky S, Thorne JC, Bombardier C, Jaakkimainen RL, Wing L, Paterson JM, Ivers N, Butt D, Lyddiatt A, Hofstetter C, Ahluwalia V, Tu K. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data. CMAJ Open 2016; 4:E205-12. [PMID: 27398365 PMCID: PMC4933643 DOI: 10.9778/cmajo.20150116] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. METHODS We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. RESULTS Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. INTERPRETATION Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.
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Affiliation(s)
- Jessica Widdifield
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Sasha Bernatsky
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - J Carter Thorne
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Claire Bombardier
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - R Liisa Jaakkimainen
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Laura Wing
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - J Michael Paterson
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Noah Ivers
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Debra Butt
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Anne Lyddiatt
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Catherine Hofstetter
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Vandana Ahluwalia
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
| | - Karen Tu
- Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont
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Curtis JR, Yang S, Chen L, Pope JE, Keystone EC, Haraoui B, Boire G, Thorne JC, Tin D, Hitchon CA, Bingham CO, Bykerk VP. Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients. Arthritis Care Res (Hoboken) 2015; 67:1345-53. [PMID: 25988705 DOI: 10.1002/acr.22606] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/18/2015] [Accepted: 04/21/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Simplified measures to quantify rheumatoid arthritis (RA) disease activity are increasingly used. The minimum clinically important differences (MCID) for some measures, such as the Clinical Disease Activity Index (CDAI), have not been well-defined in real-world clinic settings, especially for early RA patients with low/moderate disease activity. METHODS Data from Canadian Early Arthritis Cohort patients were used to examine absolute change in CDAI in the first year after enrollment, stratified by disease activity. MCID cut points were derived to optimize the sum of sensitivity and specificity versus the gold standard of patient self-reported improvement or worsening. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated against patient self-reported improvement (gold standard) and for change in pain, Health Assessment Questionnaire (HAQ), and Disease Activity Score in 28 joints (DAS28) improvement. Discrimination was examined using the area under receiver operator curves. Similar methods were used to evaluate MCIDs for worsening for patients who achieved low disease activity. RESULTS A total of 578 patients (mean ± SD age 54.1 ± 15.3 years, 75% women, median [interquartile range] disease duration 5.3 [3.3, 8.0] months) contributed 1,169 visit pairs to the improvement analysis. The MCID cut points for improvement were 12 (patients starting in high disease activity: CDAI >22), 6 (moderate: CDAI 10-22), and 1 (low disease activity: CDAI <10). Performance characteristics were acceptable using these cut points for pain, HAQ, and DAS28. The MCID for CDAI worsening among patients who achieved low disease activity was 2 units. CONCLUSION These minimum important absolute differences in CDAI can be used to evaluate improvement and worsening and increase the utility of CDAI in clinical practice.
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Affiliation(s)
| | - S Yang
- University of Alabama at Birmingham
| | - L Chen
- University of Alabama at Birmingham
| | - J E Pope
- St. Joseph's Health Center and Western University, London, Ontario, Canada
| | - E C Keystone
- Mount Sinai Hospital/University of Toronto, Toronto, Ontario, Canada
| | - B Haraoui
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - G Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - J C Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - D Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - C A Hitchon
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - C O Bingham
- Johns Hopkins University, Baltimore, Maryland
| | - V P Bykerk
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada, and Hospital for Special Surgery, New York, New York
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Widdifield J, Bernatsky S, Paterson JM, Tomlinson G, Tu K, Kuriya B, Thorne JC, Pope JE, Hollands S, Bombardier C. Trends in Excess Mortality Among Patients With Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2015; 67:1047-53. [PMID: 25623141 DOI: 10.1002/acr.22553] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/08/2014] [Accepted: 01/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate excess mortality over time, comparing rheumatoid arthritis (RA) patients with the general population. METHODS We computed all-cause mortality rates among Ontario residents age ≥15 years with RA versus without RA from 1996 to 2009. Age- and sex-standardized mortality rates were expressed as the number of deaths per 1,000 population. Excess mortality rates were calculated as the difference between death rates among RA patients and those in the general population. We estimated standardized mortality ratios (SMRs) and mortality rate ratios (MRRs) to assess relative excess mortality over time. RESULTS From 1996 to 2009, SMRs in RA ranged from 13.0 (95% confidence interval [95% CI] 12.2, 13.9) to 9.2 deaths per 1,000 RA patients (95% CI 8.4, 10.0); and for those without RA from 8.7 (95% CI 8.6, 8.7) to 6.0 deaths (95% CI 5.9, 6.0) per 1,000 general population. Over the study period, the excess mortality rate among RA patients was approximately 3 excess deaths per 1,000 population. Relative reductions in standardized mortality rates occurred over time for those with and without RA (-21.4% versus -13.4%). The SMRs for RA patients in 1996-1997, 2000-2001, 2004-2005, and 2008-2009 were 1.51 (95% CI 1.43, 1.59), 1.50 (95% CI 1.43, 1.57), 1.43 (95% CI 1.37, 1.50), and 1.41 (95% CI 1.35, 1.47), respectively. We did not find a significant change in the MRR by calendar time. CONCLUSION Mortality for RA patients has decreased over time but remains elevated compared to the general population, with 40-50% more deaths among RA patients. The relative excess mortality over time (mortality gap) remains unchanged in our sample.
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Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, and McGill University, Montreal, Quebec, Canada
| | | | - J Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, and McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Tu
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada
| | | | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Keystone EC, Pope JE, Thorne JC, Poulin-Costello M, Phan-Chronis K, Vieira A, Haraoui B. Two-year radiographic and clinical outcomes from the Canadian Methotrexate and Etanercept Outcome study in patients with rheumatoid arthritis. Rheumatology (Oxford) 2015; 55:327-34. [PMID: 26361879 PMCID: PMC4710802 DOI: 10.1093/rheumatology/kev338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
Objective. To evaluate radiographic and clinical outcomes up to 24 months in patients with RA enrolled in the Canadian Methotrexate and Etanercept Outcome study. Methods. In this open-label non-inferiority trial, patients with inadequate response to MTX received etanercept plus MTX for 6 months and then were randomized to either etanercept monotherapy or continued etanercept plus MTX until 24 months. Radiographic data were analysed using the modified total Sharp score (mTSS), joint space narrowing and erosion scores. Secondary outcomes included the 28-joint DAS with ESR (DAS28-ESR), Simplified Disease Activity Index, Clinical Disease Activity Index, HAQ Disability Index (HAQ-DI) and safety. Results. Two hundred five of 258 patients enrolled were randomized (98 etanercept, 107 etanercept plus MTX). At month 24, the mean increase from baseline to month 24 for the etanercept and etanercept plus MTX arms, respectively, for the mTSS were 0.4 (s.d. 1.9) and 0.0 (s.d. 1.4); for joint space narrowing, 0.1 (s.d. 0.6) and 0.0 (s.d. 0.7) and for erosion, 0.3 (s.d. 1.5) and 0.0 (s.d. 1.0). At month 24, the mean increase from month 6 mean scores/count increases for DAS28-ESR were 0.56 (s.d. 1.26) and 0.08 (s.d. 1.50); for Simplified Disease Activity Index, 4.7 (s.d. 13.1) and 0.9 (s.d. 12.5); for Clinical Disease Activity Index, 4.1 (s.d. 12.3) and 1.0 (s.d. 12.3) and for HAQ-DI, 0.20 (s.d. 0.45) and 0.02 (s.d. 0.54). Patients with DAS28-ESR low disease activity (LDA)/remission at month 6 had numerically better outcomes at month 24 than patients with moderate to high disease activity at month 6. In patients with LDA/remission at month 6, outcomes were similar at month 24 between etanercept monotherapy and etanercept plus MTX, whereas patients with moderate to high disease activity at month 6 had numerically better outcomes with etanercept plus MTX than etanercept at month 24. There were no new safety signals and serious adverse events were not different between groups. Conclusion. These results support the possibility of discontinuing MTX in patients who have tolerability issues with MTX if they achieve LDA/remission. Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov/; NCT00654368).
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Affiliation(s)
| | - Janet E Pope
- St Joseph's Health Centre, Rheumatology Centre, London
| | - J Carter Thorne
- Southlake Regional Health Centre, Division of Rheumatology, Newmarket
| | | | | | - Andrew Vieira
- Amgen Canada Inc., Medical Development, Mississauga, ON and
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Shu J, Bykerk VP, Boire G, Haraoui B, Hitchon C, Thorne JC, Tin D, Keystone EC, Pope JE. Missing Anticitrullinated Protein Antibody Does Not Affect Short-term Outcomes in Early Inflammatory Arthritis: From the Canadian Early Arthritis Cohort. J Rheumatol 2015; 42:2023-8. [DOI: 10.3899/jrheum.150260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
Objective.Anticitrullinated protein antibody (ACPA) is as sensitive as, but more specific than, rheumatoid factor (RF) and is detected earlier in rheumatoid arthritis (RA). Although part of the RA classification criteria, ACPA testing is not routinely paid for/accessible in all jurisdictions. The effect of missing ACPA testing was studied to determine whether failure to perform ACPA testing could cause a care gap in early inflammatory arthritis.Methods.Nearly 2000 patients (n = 1998) recruited to an early inflammatory arthritis cohort were allocated into 3 groups: (1) seropositive (either RF+ or ACPA+), (2) seronegative (RF− and ACPA−), and (3) missing ACPA and RF−. Analyses were adjusted for age, sex, symptom duration, and smoking status if p < 0.1. Disease Activity Score at 28 joints (DAS28) at 3 months was studied, because beyond then, disease activity is expected to determine ongoing treatment.Results.More seropositive patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria than seronegative patients. Group 3 was slightly older and had a smaller percentage of females, as well as shorter symptom duration and less smoking. At 3 months, group 3 was treated with fewer disease-modifying antirheumatic drugs and methotrexate (p < 0.00002) than groups 1 and 2, but there were no significant differences in DAS28, Health Assessment Questionnaire-Disability Index (HAQ-DI), proportion receiving corticosteroids, or physician’s/patient’s global assessments.Conclusion.There was no care gap in the RF-negative, unknown ACPA group because there were no significant differences in the DAS28, 3-month change in DAS28, or HAQ-DI, despite less treatment. Cost-effectiveness of ensuring ACPA testing availability in suspected RA is unknown because early outcomes did not differ, whether or not ACPA was available.
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Barnabe C, Sun Y, Boire G, Hitchon CA, Haraoui B, Thorne JC, Tin D, van der Heijde D, Curtis JR, Jamal S, Pope JE, Keystone EC, Bartlett S, Bykerk VP. Heterogeneous Disease Trajectories Explain Variable Radiographic, Function and Quality of Life Outcomes in the Canadian Early Arthritis Cohort (CATCH). PLoS One 2015; 10:e0135327. [PMID: 26301589 PMCID: PMC4547697 DOI: 10.1371/journal.pone.0135327] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/21/2015] [Indexed: 11/18/2022] Open
Abstract
Our objective was to identify distinct trajectories of disease activity state (DAS) and assess variation in radiographic progression, function and quality of life over the first two years of early rheumatoid arthritis (ERA). The CATCH (Canadian early ArThritis CoHort) is a prospective study recruiting ERA patients from academic and community rheumatology clinics in Canada. Sequential DAS28 scores were used to identify five mutually exclusive groups in the cohort (n = 1,586) using growth-based trajectory modeling. Distinguishing baseline sociodemographic and disease variables, treatment required, and differences in radiographic progression and quality of life measures over two years were assessed. The trajectory groups are characterized as: Group 1 (20%) initial high DAS improving rapidly to remission (REM); Group 2 (21%) initial moderate DAS improving rapidly to REM; Group 3 (30%) initial moderate DAS improving gradually to low DAS; Group 4 (19%) initial high DAS improving continuously to low DAS; and Group 5 (10%) initial high DAS improving gradually only to moderate DAS. Groups differed significantly in age, sex, race, education, employment, income and presence of comorbidities. Group 5 had persistent steroid requirements and the highest biologic therapy use. Group 2 had lower odds (OR 0.22, 95%CI 0.09 to 0.58) and Group 4 higher odds (OR 1.94, 95%CI 0.90 to 4.20) of radiographic progression compared to Group 1. Group 1 had the best improvement in physical function (Health Assessment Questionnaire 1.08 (SD 0.68) units), Physical Component Score (16.4 (SD 10.2) units), Mental Component Score (9.7 (SD 12.5) units) and fatigue (4.1 (SD 3.3) units). In conclusion, distinct disease activity state trajectories explain variable outcomes in ERA. Early prediction of disease course to tailor therapy and addressing social determinants of health could optimize outcomes.
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Affiliation(s)
- Cheryl Barnabe
- Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ye Sun
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gilles Boire
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Carol A. Hitchon
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boulos Haraoui
- Rheumatic Disease Unit, Institut de Rheumatologie, Montreal, Quebec, Canada
| | | | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Jeffrey R. Curtis
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Shahin Jamal
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Edward C. Keystone
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Vivian P. Bykerk
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
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Wong LE, Huang WT, Pope JE, Haraoui B, Boire G, Thorne JC, Hitchon CA, Tin D, Keystone EC, Bykerk VP. Effect of age at menopause on disease presentation in early rheumatoid arthritis: results from the Canadian Early Arthritis Cohort. Arthritis Care Res (Hoboken) 2015; 67:616-23. [PMID: 25303739 DOI: 10.1002/acr.22494] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Studies suggest that hormonal states affect disease characteristics in women with rheumatoid arthritis (RA). This study investigated how age at menopause affects disease in women presenting with early RA. METHODS This was a cross-sectional study of postmenopausal women with early RA under age 65 years at time of enrollment in the Canadian Early Arthritis Cohort. RA-related disease characteristics in women who had early age at menopause (EM; age at menopause <45 years) were compared to those who had usual age at menopause (age at menopause ≥45 years). The t-test was applied to continuous variables and the chi-square test to categorical variables. Multivariate logistic regression analysis was used to adjust for age at menopause, smoking, and use of exogenous hormones. RESULTS A total of 534 women were included; 93 were in the EM group. The age at RA onset was similar between groups. The EM group had higher mean patient global and pain scores and was more likely to be rheumatoid factor (RF) positive and meet the 1987 American College of Rheumatology criteria for RA. Using multivariate logistic regression, the EM group was more likely to be RF positive (odds ratio 2.2 [95% confidence interval 1.3-3.8], P = 0.005). Symptom duration, joint counts, Disease Activity Score in 28 joints, Health Assessment Questionnaire scores, and inflammatory markers did not differ between groups. CONCLUSION These data suggest that early age at menopause, compared to usual age at menopause, is associated with seropositivity in women with early RA.
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Affiliation(s)
- Lauren E Wong
- Hospital for Special Surgery/Weill Cornell Medical College, New York, New York
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Hazlewood GS, Thorne JC, Pope JE, Lin D, Tin D, Boire G, Haraoui B, Hitchon CA, Keystone EC, Jamal S, Bykerk VP. The comparative effectiveness of oral versus subcutaneous methotrexate for the treatment of early rheumatoid arthritis. Ann Rheum Dis 2015; 75:1003-8. [PMID: 25979945 DOI: 10.1136/annrheumdis-2014-206504] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/05/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness of oral versus subcutaneous methotrexate (MTX) as initial therapy for patients with early rheumatoid arthritis (ERA). METHODS Patients with ERA (symptoms ≤1 year) initiating MTX therapy were included from a multicentre, prospective cohort study. We compared the effectiveness between starting with oral versus subcutaneous MTX over the first year. Longitudinal multivariable models, adjusted for potential baseline and time-varying confounders, were used to compare treatment changes due to inefficacy or toxicity and treatment efficacy (Disease Activity Score-28 (DAS-28), DAS-28 remission and Health Assessment Questionnaire-Disability Index (HAQ-DI)). RESULTS 666 patients were included (417 oral MTX, 249 subcutaneous MTX). Patients prescribed subcutaneous MTX were prescribed a higher dose of MTX (mean dose over first three months 22.3 mg vs 17.2 mg/week). At 1 year, 49% of patients initially treated with subcutaneous MTX had changed treatment compared with 77% treated with oral MTX. After adjusting for potential confounders, subcutaneous MTX was associated with a lower rate of treatment failure ((HR (95% CI) 0.55 (0.39 to 0.79)). Most treatment failures were due to inefficacy with no difference in failure due to toxicity. In multivariable models, subcutaneous MTX was also associated with lower average DAS-28 scores (mean difference (-0.38 (95% CI -0.64 to -0.10)) and a small difference in DAS-28 remission (OR 1.2 (95% CI 1.1 to 1.3)). There was no significant difference in sustained remission or HAQ-DI (p values 0.43 and 0.75). CONCLUSIONS Initial treatment with subcutaneous MTX was associated with lower rates of treatment changes, no difference in toxicity and some improvements in disease control versus oral MTX over the first year in patients with ERA.
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Affiliation(s)
- Glen S Hazlewood
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Medicine, University of Calgary, Calgary, Alberta, Canada McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Daming Lin
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Boulos Haraoui
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | | | | | - Shahin Jamal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivian P Bykerk
- Mount Sinai Hospital, Toronto, Ontario, Canada Hospital for Special Surgery, New York, New York, USA
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Chow SL, Carter Thorne J, Bell MJ, Ferrari R, Bagheri Z, Boyd T, Colwill AM, Jung M, Frackowiak D, Hazlewood GS, Kuriya B, Tugwell P. Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question. J Rheumatol 2015; 42:682-9. [DOI: 10.3899/jrheum.141140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/22/2022]
Abstract
Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.
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Yang G, Bykerk VP, Boire G, Hitchon CA, Thorne JC, Tin D, Haraoui B, Keystone EC, Pope JE. Does Socioeconomic Status Affect Outcomes in Early Inflammatory Arthritis? Data from a Canadian Multisite Suspected Rheumatoid Arthritis Inception Cohort. J Rheumatol 2014; 42:46-54. [DOI: 10.3899/jrheum.131382] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To assess the effect of socioeconomic status (SES) on outcomes in patients with early inflammatory arthritis, using data from the Canadian Early Arthritis Cohort (CATCH) study.Methods.In an incident cohort, 2023 patients were recruited, and allocated to low SES or high SES groups based on education and income. Outcomes at baseline and 12 months were analyzed in relation to SES including the 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), pain, patient’s global assessment scale (PtGA), the Health Assessment Questionnaire–Disability Index (HAQ-DI), and the SF12-v2 Health Survey, using the ANOVA, chi-squared test, and regression analyses.Results.The CATCH population had 43% with high school education or less and 37% in the low-income group (< 50,000 Can$ per annum household income). The low-education group had higher DAS28 at baseline (p = 0.045), becoming nonsignificant at 12 months and lower physical component score on SF12-v2 at baseline (p = 0.022). Patients in the low-income group presented with higher HAQ-DI (p = 0.017), pain (p = 0.035), PtGA (p = 0.004), and SDAI (p = 0.022). Low-income versus high-income groups were associated with an OR above the median for HAQ-DI (1.20; 95% CI 1.00–1.45), PtGA (1.27; 95% CI 1.06–1.53), and SDAI (1.25; 95% CI 1.02–1.52) at baseline. The association with low income persisted at 12 months for HAQ-DI (OR 1.30; 95% CI 1.02–1.67), but not for other variables.Conclusion.Low SES was initially associated with higher disease activity, pain, and PtGA, and poorer function. At 1 year, outcomes were similar to those with high SES, with the exception of HAQ-DI.
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Haraoui B, Karsh J, Pope JE, Thorne JC, Keystone EC. Is structural damage evaluation by traditional radiographs still relevant in rheumatoid arthritis clinical trials? J Rheumatol 2014; 41:2325. [PMID: 25362720 DOI: 10.3899/jrheum.140383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Boulos Haraoui
- Associate Professor, Department of Medicine, Université de Montréal, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec;
| | - Jacob Karsh
- Professor of Medicine, Division of Rheumatology, University of Ottawa, Department of Medicine, Ottawa Hospital, Ottawa
| | - Janet E Pope
- Professor, Department of Medicine, Western University, Rheumatology Division, St. Joseph's Health Care, London
| | - J Carter Thorne
- Head, Division of Rheumatology, Southlake Regional Health Centre, Newmarket
| | - Edward C Keystone
- Professor of Medicine, University of Toronto, Director, Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
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Barra L, Pope JE, Orav JE, Boire G, Haraoui B, Hitchon C, Keystone EC, Thorne JC, Tin D, Bykerk VP. Prognosis of seronegative patients in a large prospective cohort of patients with early inflammatory arthritis. J Rheumatol 2014; 41:2361-9. [PMID: 25274884 DOI: 10.3899/jrheum.140082] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe rheumatoid arthritis; however, studies in early inflammatory arthritis (EIA) have yielded conflicting results. Our study determined the prognosis of baseline ACPA-negative and RF-negative patients. METHODS Patients enrolled in the Canadian Early Arthritis Cohort had IgM RF and IgG anticyclic citrullinated peptide antibodies 2 (anti-CCP2) measured at baseline. Remission was defined as a Disease Activity Score of 28 joints (DAS28) < 2.6 using logistic regression accounting for confounders at 12-month and 24-month followup. RESULTS Of the 841 patients, 216 (26%) were negative for both RF and anti-CCP2. Compared to seropositive subjects, seronegative subjects were older (57 ± 15 vs 51 ± 14 yrs), more males proportionately (31% vs 23%), and had shorter length of symptoms (166 ± 87 vs 192 ± 98 days), and at baseline had higher mean swollen joint count (SJC; 8.8 ± 6.8 vs 6.5 ± 5.6), DAS28 (5.0 ± 1.6 vs 4.8 ± 1.5), and erosive disease (32% vs 24%, p < 0.05). Treatment was similar between the 2 groups. At 24-month followup, seronegative compared to seropositive subjects had greater mean change (Δ ± SD) in disease activity measures: ΔSJC counts (-6.9 ± 7.0 vs -5.1 ± 5.9), ΔDAS28 (-2.4 ± 2.0 vs -1.8 ± 1.8), and ΔC-reactive protein (-11.0 ± 17.9 vs -6.4 ± 17.5, p < 0.05). Accounting for confounders, antibody status was not significantly associated with remission. However, at 12-month followup, ACPA-positive subjects were independently more likely to have new erosive disease (OR 2.94, 95% CI 1.45-5.94). CONCLUSION Although seronegative subjects with EIA have higher baseline DAS28 compared to seropositive subjects, they have a good response to treatment and are less likely to develop erosive disease during followup.
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Affiliation(s)
- Lillian Barra
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Janet E Pope
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - John E Orav
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Gilles Boire
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Boulos Haraoui
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Carol Hitchon
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Edward C Keystone
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - J Carter Thorne
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Diane Tin
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
| | - Vivian P Bykerk
- From the Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London; Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; Rheumatology Division, Université de Sherbrooke, Sherbrooke; Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal, Montreal, Quebec; Arthritis Center, University of Manitoba, Winnipeg, Manitoba, Canada; Inflammatory Arthritis Center, Hospital for Special Surgery, Department of Biostatistics, Harvard University, Boston, Massachusetts; Weill Cornell Medical College, Cornell University, New York, New York, USA.Dr. Barra has received honoraria from Hoffmann-La Roche Ltd., Amgen Canada Inc., AbbVie, and United Chemicals of Belgium (UCB). The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoffmann-La Roche Ltd., UCB Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).L. Barra, MD, MPH; J.E. Pope, MD, MPH, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario; J.E. Orav, PhD, Department of Biostatistics, Harvard University; G. Boire, MD, MSc, Rheumatology Division, Université de Sherbrooke; B. Haraoui, MD, Rheumatic Disease Unit, Institut de Rheumatologie, Université de Montréal; C. Hitchon, MD, MSc, Arthritis Center, University of Manitoba; E.C. Keystone, MD, Rebecca McDonald Center for Arthritis and Autoimmune Disease, Mount Sinai Hospital, University of Toronto; J.C. Thorne, MD; D. Tin, BPharm, Southlake Regional Health Centre; V.P. Bykerk, MD, Rebecca McDonald Center for Arthritis and Autoimm
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Widdifield J, Bombardier C, Bernatsky S, Paterson JM, Green D, Young J, Ivers N, Butt DA, Jaakkimainen RL, Thorne JC, Tu K. An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on algorithm performance. BMC Musculoskelet Disord 2014; 15:216. [PMID: 24956925 PMCID: PMC4078363 DOI: 10.1186/1471-2474-15-216] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/10/2014] [Indexed: 11/12/2022] Open
Abstract
Background We have previously validated administrative data algorithms to identify patients with rheumatoid arthritis (RA) using rheumatology clinic records as the reference standard. Here we reassessed the accuracy of the algorithms using primary care records as the reference standard. Methods We performed a retrospective chart abstraction study using a random sample of 7500 adult patients under the care of 83 family physicians contributing to the Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Using physician-reported diagnoses as the reference standard, we computed and compared the sensitivity, specificity, and predictive values for over 100 administrative data algorithms for RA case ascertainment. Results We identified 69 patients with RA for a lifetime RA prevalence of 0.9%. All algorithms had excellent specificity (>97%). However, sensitivity varied (75-90%) among physician billing algorithms. Despite the low prevalence of RA, most algorithms had adequate positive predictive value (PPV; 51-83%). The algorithm of “[1 hospitalization RA diagnosis code] or [3 physician RA diagnosis codes with ≥1 by a specialist over 2 years]” had a sensitivity of 78% (95% CI 69–88), specificity of 100% (95% CI 100–100), PPV of 78% (95% CI 69–88) and NPV of 100% (95% CI 100–100). Conclusions Administrative data algorithms for detecting RA patients achieved a high degree of accuracy amongst the general population. However, results varied slightly from our previous report, which can be attributed to differences in the reference standards with respect to disease prevalence, spectrum of disease, and type of comparator group.
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Affiliation(s)
- Jessica Widdifield
- University of Toronto, Toronto, 200 Elizabeth St 13EN-224, Toronto, ON M5G 2C4, Canada.
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Widdifield J, Paterson JM, Bernatsky S, Tu K, Tomlinson G, Kuriya B, Thorne JC, Bombardier C. The Epidemiology of Rheumatoid Arthritis in Ontario, Canada. Arthritis Rheumatol 2014; 66:786-93. [DOI: 10.1002/art.38306] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/03/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica Widdifield
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
| | - J. Michael Paterson
- University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and McMaster University; Hamilton, Ontario Canada
| | | | - Karen Tu
- University of Toronto and Institute for Clinical Evaluative Sciences; Toronto, Ontario Canada
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Levy DM, Gunraj N, Berard RA, Dent PB, Pope JE, Thorne JC, Roth J, Fidler W, Berall M, Guttmann A, Silverman ED. A153: Long-term Outcomes of Childhood-Onset Systemic Lupus Erythematosus in Adulthood. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Nadia Gunraj
- Institute for Clinical Evaluative Sciences; Toronto ON
| | | | | | | | | | | | | | | | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, The Hospital for Sick Children and University of Toronto; Toronto ON
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Widdifield J, Paterson JM, Bernatsky S, Tu K, Thorne JC, Ivers N, Butt D, Jaakkimainen RL, Gunraj N, Ahluwalia V, Bombardier C. Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system. BMJ Open 2014; 4:e003888. [PMID: 24486677 PMCID: PMC3913026 DOI: 10.1136/bmjopen-2013-003888] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our objective was to estimate the percentage of patients with incident rheumatoid arthritis (RA) who were seen by a rheumatologist within 3, 6 and 12 months of suspected diagnosis by a family physician, and assess what factors may influence the time frame with which patients are seen. SETTING Ontario, Canada. PARTICIPANTS Over 2000-2009, we studied patients with incident RA who were initially diagnosed by a family physician. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed secular trends in rheumatology encounters and differences between patients who received versus did not receive rheumatology care. We performed hierarchical logistic regression analyses to determine whether receipt of rheumatology care was associated with patient, primary care physician and geographical factors. RESULTS Among 19 760 patients with incident RA, 59%, 75% and 84% of patients were seen by a rheumatologist within 3, 6 and 12 months, respectively. The prevalence of initial consultations within 3 months did not increase over time; however, access within 6 and 12 months increased over time. Factors positively associated with timely consultations included higher regional rheumatology supply (adjusted OR (aOR) 1.35 (95% CI 1.13 to 1.60)) and higher patient socioeconomic status (aOR 1.18 (95% CI 1.07 to 1.30)). Conversely, factors inversely associated with timely consultations included remote patient residence (aOR 0.51 (95% CI 0.41 to 0.64)) and male family physicians (aOR 0.88 (95% CI 0.81 to 0.95)). CONCLUSIONS Increasing access to rheumatologists within 6 and 12 months occurred over time; however, consultations within 3 months did not change over time. Measures of poor access (such as proximity to and density of rheumatologists) were negatively associated with timely consultations. Additional factors that contributed to disparities in access included patient socioeconomic status and physician sex.
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Affiliation(s)
- Jessica Widdifield
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Michael Paterson
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Tu
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Noah Ivers
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Debra Butt
- University of Toronto, Toronto, Ontario, Canada
| | - R Liisa Jaakkimainen
- University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nadia Gunraj
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Widdifield J, Paterson JM, Bernatsky S, Tu K, Thorne JC, Ahluwalia V, Ivers N, Butt D, Jaakkimainen RL, Tomlinson G, Bombardier C. The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario. Can J Public Health 2013; 104:e450-5. [PMID: 24495819 DOI: 10.17269/cjph.104.4115] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/16/2013] [Accepted: 10/17/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region. METHODS We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined. RESULTS The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160). CONCLUSION Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden.
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Harris JA, Bykerk VP, Hitchon CA, Keystone E, Thorne JC, Boire G, Haraoui B, Hazlewood G, Bonner AJ, Pope JE. Determining Best Practices in Early Rheumatoid Arthritis by Comparing Differences in Treatment at Sites in the Canadian Early Arthritis Cohort. J Rheumatol 2013; 40:1823-30. [DOI: 10.3899/jrheum.121316] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine site variation by comparing outcomes across sites in an early rheumatoid arthritis cohort.Methods.Sites from the Canadian Early Arthritis Cohort database with at least 40 patients were studied. Comparisons were made among sites in change in 28-joint Disease Activity Score (DAS28), proportion of patients in DAS28 remission, and treatment strategies.Results.The study included 1138 baseline patients at 8 sites, with baseline (SD) age 52 years (16.9); 72% women; 23% erosions; 54% ever smokers; 51% rheumatoid factor-positive; 37% anticitrullinated protein antibody-positive; disease duration 187 (203) days; DAS28 4.5 (1.4). Site had an effect on outcomes when adjusting for confounders. At 6 and 12 months, sites B and H, the 2 largest sites, had the best changes in DAS28 (−1.82 and −2.09, respectively, at 6 mos, and −2.27 for both at 12 mos; p < 0.001). Site H had the most patients in DAS28 remission at 6 months [64.5% compared to other sites that had from 34.1% to 51.7% (p < 0.001)], and at the last followup, sites B and H had the most in remission. Subcutaneous methotrexate was used more overall and earlier at sites B and H. Those sites used less steroid therapy, and site B had the second-highest use of triple disease-modifying antirheumatic drugs at any visit. Medications were increased more in 2 of the 3 smallest sites. Biologics were used by 9 months most in the smallest (50.0%) and then largest (19.6%) sites.Conclusion.Sites in an early inflammatory arthritis cohort yielded different outcomes. Better outcomes up to 12 months may result from initial treatment with early combination therapy and/or subcutaneous methotrexate.
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Pope JE, Haraoui B, Thorne JC, Vieira A, Poulin-Costello M, Keystone EC. The Canadian methotrexate and etanercept outcome study: a randomised trial of discontinuing versus continuing methotrexate after 6 months of etanercept and methotrexate therapy in rheumatoid arthritis. Ann Rheum Dis 2013; 73:2144-51. [PMID: 23979914 PMCID: PMC4251190 DOI: 10.1136/annrheumdis-2013-203684] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To determine if withdrawing methotrexate (MTX) after 6 months of combination etanercept (ETN)+MTX, in MTX-inadequate responders with active rheumatoid arthritis (RA), is non-inferior to continuing ETN+MTX. Methods Tumour necrosis factor-inhibitor naïve RA patients with disease activity score 28 (DAS28)≥3.2, swollen joint count≥3, despite stable MTX, were treated with ETN+MTX for 6 months, followed by randomisation to either continue ETN+MTX or switch to ETN monotherapy for an additional 18 months. The primary endpoint was change in DAS28 from 6-month randomisation to 12 months. The non-inferiority margin of change in DAS28 was 0.6, with prespecified analyses (DAS28<3.2 vs DAS28≥3.2). Results 205 patients were randomised. DAS28 was stable in patients on ETN+MTX and increased slightly in patients on ETN monotherapy from 6 to 12 months. Non-inferiority was not achieved, with an adjusted difference of 0.4 (0.1 to 0.7) between the ETN and the ETN+MTX groups, for the month 6–12 change in DAS28. However, patients who achieved low disease activity (LDA; DAS28<3.2) at 6 months had a similar disease activity at 12 months, whether on monotherapy or combination therapy (DAS28 change 0.7 ETN vs 0.57 ETN+MTX, p=0.8148). Conversely, for patients who did not reach LDA at 6 months, those on ETN monotherapy had increased disease activity at 12 months, while disease activity continued to decrease for patients on combination therapy, at 12 months (DAS28 change 0.4 ETN vs −0.4 ETN+MTX, p=0.0023). Conclusions Non-inferiority was not achieved. Withdrawing MTX after 6 months of continuation ETN+MTX in MTX inadequate responders did not yield the same degree of improvement between 6 and 12 months compared with continuing ETN+MTX. Trial Registration ClinicalTrials.gov−NCT00654368.
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Affiliation(s)
- Janet E Pope
- Division of Rheumatology, Department of Medicine, The University of Western Ontario, St Joseph's Health Centre, London, Ontario, Canada
| | - Boulos Haraoui
- Department of Rheumatology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | | | - Edward C Keystone
- Department of Rheumatology, Mount Sinai Hospital, Rebecca MacDonald Centre For Arthritis & Autoimmune Diseases, Toronto, Ontario, Canada
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Bykerk VP, Keystone EC, Kuriya B, Larché M, Thorne JC, Haraoui B. Achieving remission in clinical practice: lessons from clinical trial data. Clin Exp Rheumatol 2013; 31:621-632. [PMID: 23622099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 01/15/2013] [Indexed: 06/02/2023]
Abstract
This review examines the literature on the frequency of remission associated with different treatment approaches in early rheumatoid arthritis (ERA). Trials reporting remission outcomes were identified through searches of the CINAHL, EMBASE, and Medline (PubMed) databases from 2000 through August 2012. Additional literature was identified through hand searching. The proportion of patients achieving remission and/or radiographic non-progression was extracted from each study. Evidence was examined in the context of unified remission criteria and practical considerations for achieving and maintaining remission are discussed. The literature highlights the benefits of early treatment with disease-modifying anti-rheumatic drug (DMARD) combination therapy, combination therapy with a biologic, and tight control with a pre-specified treatment target in achieving remission in ERA. The added stringency of the 2011 remission criteria may increase the proportion of patients achieving true remission, while identifying predictors of sustained remission may also help patients achieve better radiographic and functional outcomes.
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Widdifield J, Bernatsky S, Paterson JM, Gunraj N, Thorne JC, Pope J, Cividino A, Bombardier C. Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013; 65:353-61. [PMID: 22833532 DOI: 10.1002/acr.21812] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 07/10/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess risk and risk factors for serious infections in seniors with rheumatoid arthritis (RA) using a case-control study nested within an RA cohort. METHODS We assembled a retrospective RA cohort age ≥66 years from Ontario health administrative data across 1992-2010. Nested case-control analyses were done, comparing RA patients with a primary diagnosis of infection (based on hospital or emergency department records) to matched RA controls. We assessed independent effects of drugs, adjusting for demographics, comorbidity, and markers of RA severity. RESULTS A total of 86,039 seniors with RA experienced 20,575 infections, for a rate of 46.4 events/1,000 person-years. The most frequently occurring events included respiratory infections, herpes zoster, and skin/soft tissue infections. Factors associated with infection included higher comorbidity, rural residence, markers of disease severity, and history of previous infection. In addition, anti-tumor necrosis factor agents and disease-modifying antirheumatic drugs were associated with a several-fold increase in infections, with an adjusted odds ratio (OR) ranging from 1.2-3.5. The drug category with the greatest effect estimate was glucocorticoids, which exhibited a clear dose response with an OR ranging from 4.0 at low doses to 7.6 at high doses. CONCLUSION Seniors with RA have significant morbidity related to serious infections, which exceeds previous reports among younger RA populations. Rural residence, higher comorbidity, markers of disease severity, and previous infection were associated with serious infections in seniors with RA. Our results emphasize that many RA drugs may increase the risk of infection, but glucocorticoids appear to confer a particular risk.
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