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Love T.J.,Reykjavik University | Zhu Y.,Boston University | Zhang Y.,Boston University | Wall-Burns L.,Arthritis Research Centre of Canada | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Background: Obesity is associated with an increased risk of psoriasis; however, its potential impact on the risk of psoriatic arthritis (PsA) remains unclear. Objectives: To evaluate the association between body mass index (BMI) and the risk of PsA among patients with psoriasis from the general population. Methods: The authors conducted a cohort study using data from The Health Improvement Network, an electronic medical records database representative of the UK general population, collected between 1995 and 2010. The exposure of interest was the first BMI measured after psoriasis diagnosis and endpoints were incident cases of physician-diagnosed PsA. The authors estimated the RR of PsA after adjusting for age, sex, and histories of trauma, smoking and alcohol consumption. Results: Among 75 395 individuals with psoriasis (43% male, mean follow-up of 5 years, and mean age of 52 years), 976 developed PsA (incidence rate, 26.5 per 10 000 person-years). The PsA incidence rates increased with increasing BMI. Compared with psoriasis patients with BMI <25 kg/m 2, the RRs for developing PsA were 1.09 (0.93-1.28) for BMIs from 25.0 to 29.9, 1.22 (1.02-1.47) for BMIs from 30.0 to 34.9 and 1.48 (1.20-1.81) for BMIs ≥35.0. In our secondary analysis among all individuals, regardless of psoriasis (∼2 million), the corresponding multivariate RRs tended to be stronger (1.0, 1.17, 1.57, 1.96; p for trend <0.001). Conclusions: This general population study suggests that obesity is associated with an increased risk of incident PsA and supports the importance of weight reduction among psoriasis patients who often suffer from the metabolic syndrome and obesity.

Bernatsky S.,McGill University | Lix L.,University of Saskatchewan | O'Donnell S.,Public Health Agency of Canada | Lacaille D.,Arthritis Research Centre of Canada
Journal of Rheumatology | Year: 2013

Objective. Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada. Methods. We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting. Results. Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic. Conclusion. Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences. The Journal of Rheumatology Copyright © 2013. All rights reserved.

Westby M.D.,Vancouver Coastal Health Research Institute | Brittain A.,Vancouver Coastal Health Research Institute | Backman C.L.,University of British Columbia | Backman C.L.,Arthritis Research Centre of Canada
Arthritis Care and Research | Year: 2014

Objective To synthesize professional and patient expertise with available evidence to recommend best practices for post-acute rehabilitation following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA). Methods Two expert panels of clinicians, researchers, and patients from Canada and the US participated in a 3-round, online Delphi survey. Results Consensus was reached on 22 THA and 24 TKA best practice key statements. Recommendations common to both procedures included the need for supervised rehabilitation interventions provided by trained health professionals early after discharge from the acute care setting to optimize patient outcomes. Personal and environmental contextual factors were identified as influencing the process and outcomes of THA and TKA rehabilitation. Routine outcome assessment was recommended and several standardized outcome tools identified. Short-term followup care in the first 2 years postsurgery was recommended for both procedures. Specifics on timing, rehabilitation providers, need for long-term followup, and interventions differed for THA and TKA. Some recommendations received different levels of support based on the type of panelist (patient, physical therapist, surgeon), professional role (clinician, researcher), and/or country. Conclusion A rigorous consensus method led to key recommendations for post-acute rehabilitation after primary THA and TKA for OA, which together with available evidence and acknowledgment of contextual factors will inform the development of clinical practice guidelines. This is an important step toward reducing practice variation, closing the evidence-practice gap, and improving the quality of rehabilitation services after THA and TKA. Copyright © 2014 by the American College of Rheumatology.

Barber C.,University of Toronto | Barber C.,University of Calgary | Lacaille D.,Arthritis Research Centre of Canada | Fortin P.R.,University of Toronto | Fortin P.R.,Laval University
Arthritis Care and Research | Year: 2013

Objective To conduct a systematic review of the literature on the validation of algorithms identifying infections in administrative data for future use in populations with rheumatic diseases. Methods Medline and EMBase were searched using the themes "administrative data" and "infection" between 1950 and October 2012. Inclusion criteria consisted of validation studies of administrative data identifying infections in adult populations. Article quality was assessed using a validated tool. Results A total of 5,941 articles were identified, 90 articles underwent detailed review, and 24 studies were included. The majority (17 of 24) examined bacterial infections and 9 examined opportunistic infections. Eighteen studies were from the US and all but 4 studies used International Classification of Diseases, Ninth Revision codes. Rheumatoid arthritis patients were studied in 6 of 24 articles. The studies on bacterial infections in general reported highly variable sensitivity and positive predictive value (PPV) for the diagnosis of infections using administrative data (sensitivity range 4.4-100%, PPV range 21.7-100%). Algorithms to identify opportunistic infections similarly had a highly variable sensitivity (range 20-100%) and PPV (range 1.3-100%). Thirteen studies compared the diagnostic accuracy of different algorithms, which revealed that strategies including a comprehensive algorithm using a greater number of diagnostic codes or codes in any position had the highest sensitivity for the diagnosis of infection. Algorithms that incorporated microbiologic or pharmacy data in combination with diagnostic codes had improved PPV for identification of tuberculosis. Conclusion Algorithms for identifying infections using administrative data should be selected based on the purpose of the study, with careful consideration as to whether a high sensitivity or PPV is required. Copyright © 2013 by the American College of Rheumatology.

Yurkovich M.,University of British Columbia | Vostretsova K.,University of British Columbia | Chen W.,University of British Columbia | Avina-Zubieta J.A.,University of British Columbia | Avina-Zubieta J.A.,Arthritis Research Centre of Canada
Arthritis Care and Research | Year: 2014

Objective To determine the magnitude of risk from all-cause and cause-specific mortality in patients with systemic lupus erythematosus (SLE) compared to the general population through a meta-analysis of observational studies. Methods We searched the Medline and Embase databases from their inception to October 2011. Observational studies that met the following criteria were assessed: 1) a prespecified SLE definition; 2) overall and/or cause-specific deaths, including cardiovascular disease (CVD), infections, malignancy, and renal disease; and 3) reported standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs). We calculated weighted-pooled summary estimates of SMRs (meta-SMRs) for all-cause and cause-specific mortality using the random-effects model and tested for heterogeneity using the I 2 statistic by using Stata/IC statistical software. Results We identified 12 studies comprising 27,123 patients with SLE (4,993 observed deaths) that met the inclusion criteria. Overall, there was a 3-fold increased risk of death in patients with SLE (meta-SMR 2.98, 95% CI 2.32-3.83) when compared with the general population. The risks of death due to CVD (meta-SMR 2.72, 95% CI 1.83-4.04), infection (meta-SMR 4.98, 95% CI 3.92-6.32), and renal disease (SMR 7.90, 95% CI 5.50-11.00) were significantly increased. Mortality due to malignancy was the only cause-specific entity not increased in SLE (meta-SMR 1.19, 95% CI 0.89-1.59). Conclusion The published data indicated a 3-fold increase in all-cause mortality in patients with SLE compared to the general population. Additionally, all cause-specific mortality rates were increased except for malignancy, with renal disease having the highest mortality risk. Copyright © 2014 by the American College of Rheumatology.

Yurkovich M.,University of British Columbia | Yurkovich M.,Arthritis Research Centre of Canada | Avina-Zubieta J.A.,University of British Columbia | Avina-Zubieta J.A.,Arthritis Research Centre of Canada | And 4 more authors.
Journal of Clinical Epidemiology | Year: 2015

Objectives To conduct a systematic review of studies reporting on the development or validation of comorbidity indices using administrative health data and compare their ability to predict outcomes related to comorbidity (ie, construct validity).Study Design and Setting We conducted a comprehensive literature search of MEDLINE and EMBASE, until September 2012. After title and abstract screen, relevant articles were selected for review by two independent investigators. Predictive validity and model fit were measured using c-statistic for dichotomous outcomes and R2 for continuous outcomes.Results Our review includes 76 articles. Two categories of comorbidity indices were identified: those identifying comorbidities based on diagnoses, using International Classification of Disease codes from hospitalization or outpatient data, and based on medications, using pharmacy data. The ability of indices studied to predict morbidity-related outcomes ranged from poor (C statistic ≤ 0.69) to excellent (C statistic >0.80) depending on the specific index, outcome measured, and study population. Diagnosis-based measures, particularly the Elixhauser Index and the Romano adaptation of the Charlson Index, resulted in higher ability to predict mortality outcomes. Medication-based indices, such as the Chronic Disease Score, demonstrated better performance for predicting health care utilization.Conclusion A number of valid comorbidity indices derived from administrative data are available. Selection of an appropriate index should take into account the type of data available, study population, and specific outcome of interest. © 2015 Elsevier Inc. All rights reserved.

Avina-Zubieta J.A.,Arthritis Research Centre of Canada | Avina-Zubieta J.A.,University of British Columbia | Thomas J.,University of British Columbia | Sadatsafavi M.,University of British Columbia | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objective: To determine the magnitude of the risk of incident cardiovascular disease (CVD; fatal and non-fatal), including acute myocardial infarction (MI), cerebrovascular accidents (CVA) and congestive heart failure (CHF), in patients with rheumatoid arthritis (RA) compared to the general population through a metaanalysis of controlled observational studies. Methods: The authors searched the Medline, Embase, LILACS and Cochrane databases from their inception to June 2011. Observational studies meeting the following criteria were included: (1) prespecified RA criteria; (2) predefined CVD criteria for incident CVD (MI, CVA or CHF); (3) a comparison group; and (4) RR estimates, 95% CI or data for calculating them. The authors calculated the pooled RR using the random-effects model and tested for heterogeneity using the bootstrap version of the Q statistic. Results: Fourteen studies comprising 41 490 patients met the inclusion criteria. Overall, there was a 48% increased risk of incident CVD in patients with RA (pooled RR 1.48 (95% CI 1.36 to 1.62)). The risks of MI and CVA were increased by 68% (pooled RR 1.68 (95% CI 1.40 to 2.03)) and 41% (pooled RR 1.41 (95% CI 1.14 to 1.74)). The risk of CHF was assessed in only one study (RR 1.87 (95% CI 1.47 to 2.39)). Significant heterogeneity existed in all main analyses. Subgroup analyses showed that inception cohort studies were the only group that did not show a significantly increased risk of CVD (pooled RR 1.12 (95% CI 0.97 to 1.65)). Conclusions: Published data indicate that the risk of incident CVD is increased by 48% in patients with RA compared to the general population. Sample and cohort type influenced the estimates of RR.

Cibere J.,Arthritis Research Centre of Canada
Arthritis care & research | Year: 2010

To determine the prevalence of pre-radiographic osteoarthritis (ROA) and ROA of the knee in a symptomatic population-based cohort, and to evaluate the clinical correlates of pre-ROA and ROA. Subjects ages 40-79 years with knee pain were recruited as a random population sample and classified using magnetic resonance cartilage (MRC) scores (range 0-4) and Kellgren/Lawrence (K/L) scale grades (range 0-4) as no OA (MRC score<2, K/L grade<2), pre-ROA (MRC score ≥2, K/L grade<2), and ROA (MRC score≥2, K/L grade≥2). Logistic regression was used to evaluate the association of clinical variables with cartilage defects, comparing subjects with any cartilage defects (pre-ROA/ROA) with those without, and to determine associations with individual OA subgroups. Of 255 symptomatic subjects, no OA, pre-ROA, and ROA were seen in 13%, 49%, and 38%, respectively. The prevalence of pre-ROA/ROA compared with no OA was associated with age (odds ratio [OR] 2.89, 95% confidence interval [95% CI] 1.59-5.26), sports activity (OR 1.35, 95% CI 1.07-1.70), abnormal gait (OR 10.86, 95% CI 1.46-1,388.4), effusion (OR 16.58, 95% CI 2.22-2,120.5), and flexion contracture (OR 2.37, 95% CI 1.50-3.73). The prevalence of ROA versus no OA was significantly associated with age, body mass index, pain frequency, pain duration, severe knee injury, sports activity, gait, effusion, bony swelling, crepitus, flexion contracture, and flexion. The prevalence of pre-ROA versus no OA was increased with age, sports activity, effusion, and flexion contracture, and reduced with valgus malalignment. Cartilage defects were highly prevalent in this symptomatic population-based cohort, with 49% of subjects having pre-ROA and 38% having ROA. Prevalent cartilage defects were significantly associated with age, sports activity, abnormal gait, effusion, and flexion contracture. Copyright © 2010 by the American College of Rheumatology.

Townsend A.,Arthritis Research Centre of Canada
Chronic Illness | Year: 2012

Objectives: Chronic illness is well researched. Broadly, empirical enquiry has focused on either determinants of behaviors or exploring lived experiences. This paper attempts to advance understandings of the lived experience of multimorbidity in broader cultural and structural settings.Methods: Twenty-three people in their early 50s were recruited from a community health survey in Scotland. The participants had 4 or more chronic illnesses and were interviewed twice. Key concepts of Bourdieu were applied to the data setResults: The analysis presented here is organized around 4 sections: 1) Habitus, capitals and the ill body; 2) Relational positioning; 3) Illness and symbolic violence; 4) The GP as dispenser of capitals. Applying Bourdieu's theory to the accounts highlighted how broader cultural structures worked their way into personal illness narratives and illustrated how living with multimorbidity is a dialectic of structure and agency.Discussion: Interventions and support for those with multimorbidity need to take into account the tensions of opposing habitus underpinning medical encounters and the ongoing negotiation of structure and agency which is integral to living with chronic illness and underpins illness actions such as help-seeking and self-managing. © 2011 The Author(s) Reprints and permissions.

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