Your participation in CATCH has allowed the team to look at a lot of data about people who are diagnosed with early rheumatoid arthritis and look at trends over a long period of time, to see what others like you have in common, or to see the most effective way to treat people with medications. The researchers then present these findings to other researchers at national and international scientific meetings - sometimes they give a talk and other times they will give a poster (at scientific meetings there are dedicated poster sessions where researchers really stand by posters that they've made about their research and findings at certain times and then talk to people who come by to read their posters). Researchers have to 'apply' to present their research and work at meetings, and they do that by creating an 'abstract' which is a shortened version of what they wish to present at a meeting.

All of the CATCH team research abstracts are provided here by year. Each abstract is split in to a 'short' version to give you a simple overview of the research, and if you click on the 'read more' section there is a longer version of the abstract with a few more details for you. If the CATCH team has published a scientific paper on this topic, we have also provided a link to the paper for you. We have tried to use simple language so that you can understand what the researchers did and what they found. You may wish to open our Glossary page beside the abstracts as you read them and we have also linked some more difficult terms directly to the Glossary so you can look up these words as you read (those words are shown in dark red).

If you are interested in reading the full scientific papers that have resulted from CATCH research, you can click here. The attachment provides you with information on all CATCH publications and links to the websites where they are found.

We thank you for your participation in CATCH - none of this research and none of these abstracts would be here without you.


Age, Sex, RF Antibodies, Baseline HAQ and DAS28 Score – But Not the Type of Initial Treatment – Are Predictive of Clinical Remission at 1 Year in Early Inflammatory Arthritis

Bindee Kuriya1, Boulos Haraoui2, Gilles Boire3, Carol A Hitchon4, Janet E Pope5,J Carter Thorne6,Diane S Ferland7, Ed C Keystone8,Vivian P Bykerk9. 1University of Toronto, 2Institut de Rhumatologie, Montreal, QC, 3CHUS - Sherbrooke University, Sherbrooke, QC, 4University of Manitoba, Winnipeg, MB, 5St. Joseph Health Care London, London, ON, 6South Lake Regional Health Centre, Newmarket, ON, 7Hospital Maisonneuve Rosemont, LaSalle, QC, 8Mt. Sinai Hospital, University of Toronto, Toronto, ON, 9Brigham and Women's Hospital, Toronto, ON

It is not known why early aggressive treatment of RA with disease-modifying anti-rheumatic drugs (DMARDs) is more effective when the goal is to get patients in to remission. The researchers wanted to see if they could figure out what will put an RA patient in to remission at 1 year after diagnosis. Of 288 patients with RA, 41% were in remission at one year, and most of those patients were younger males who had lower health assessment questionnaire (HAQ) scores, lower erythrocyte sedimentation rate and lower RA activity at the start. Five variables were related to remission: age, sex, rheumatoid factor, HAQ score and DAS28. While long-term treatment with DMARDs has good RA outcomes for patients, DMARD use during the first 3 months alone or in combination with a biologic did not predict who would be in remission at 1 year.

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What is the study purpose?
It is not known why early aggressive treatment of RA with disease-modifying anti-rheumatic drugs (DMARDs) is more effective when the goal is to put patients in to remission. In Canada, patients can only go on to biologic treatment after trying and not responding to more than 2 DMARDs, so identifying which patients will reach remission 1 year after diagnosis will help make decisions about treatment. The researchers wanted to identify baseline and early treatment predictors of remission.

How was the study done?
893 CATCH patients' records were reviewed and patients' demographic and clinical characteristics were analyzed.

What were the study results?
Of 288 patients with RA who had clinical records at one year after diagnosis, 41% were in remission at 1 year, and these patients were younger males, who had lower health assessment questionnaire (HAQ) scores, lower erythrocyte sedimentation rates and lower RA activity at the start of the study. No factors from patients' physical exams and x-rays were related to remission while rheumatoid factor antibodies were seen less in those in remission but anti-CCP antibodies were not different. The early use of DMARDs varied: methotrexate by itself was used less while combination DMARD therapy was used more frequently in patients who achieved remission. No patients started a biologic during the first 3 months.

Five variables were found to be related to remission: age, sex, rheumatoid factor, HAQ score and DAS28. 41% of early RA patients reached remission. While long-term treatment with DMARDs has good RA outcomes, DMARDs use during the first 3 months alone or in combination with a biologic did not predict which patients would be in remission at 1 year.


Care Gap in Patients with Early Inflammatory Arthritis with a High Fracture Risk Identified Using FRAX®

Carly K. Cheng, Heather McDonald-Blumer, Gilles Boire, Janet E. Pope, Boulos Haraoui, Carol A. Hitchon, Carter Thorne, Ye Sun, Vivian P. Bykerk

The CATCH researchers wanted to see how many patients with early inflammatory arthritis were at high risk to break a bone because of osteoporosis. They used something called the Fracture Risk Assessment Tool (FRAX) to measure this risk and to see if patients at risk are being monitored well. Out of 238 patients, 5-13% were identified as being at high risk for a bone break using FRAX. At the start of the study, compared to patients who were at lower risk for a bone break, patients who were considered higher risk for a bone break had higher RA activity, used drugs called glucocorticoids more often to treat their RA, and had more joint damage. Since a very low number of high-risk patients are being treated with calcium, vitamin D, and/or bisphosphonates (which are treatments that help increase bone strength), this shows there is a need to identify and watch fracture risk in patients with early inflammatory arthritis.

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What was the study purpose?
The CATCH researchers wanted to see how many patients with early inflammatory arthritis were at high risk to break a bone because of osteoporosis. They used something called the Fracture Risk Assessment Tool (FRAX) to measure this risk and to see if patients who are at risk are being monitored well.

How was the study done?
FRAX was applied to 238 patients in CATCH and compared against study results from the United States and the United Kingdom.

What were the study results?
FRAX identified that 5-13% of patients in the study were at high risk for a bone break. Based on US findings, there was a strong relationship between increasing fracture risk groups and taking glucocorticoid pills for RA and joint damage at the start of the study. Taking calcium, vitamin D, or bisphosphonate (which are all treatments that help bone strength) was not different between fracture risk groups in different places. The Disease Activity Score (DAS) in the high-risk group was higher compared to the low-risk group. Compared to patients in the low risk group, patients at increased risk of a bone break had higher RA disease activity, used glucocorticoids more to treat their RA, and had more joint damage at the start of the study. Overall it was found that a very low number of high-risk patients were being treated with calcium, vitamin D, and/or bisphosphonates which all help strengthen bones. These high risk patients are the ones who especially need preventative medications to help reduce bone breaks. This highlights the need to identify and modify fracture risk in patients with early inflammatory arthritis.


Care Gap in Patients with Rheumatoid Arthritis who are Eligible for Biologics Based on Provincial Access Criteria

Natasha Gakha1, Ye Sun1, Carter Thorne2, Janet Pope3; Vandana Ahluwalia4, Shahin Jamal5, Vivian Bykerk6. 1University Health Network- University of Toronto, Toronto, ON; 2Southlake Regional Health Center, Newmarket, ON; 3University of Western Ontario, London, ON; 4Brampton, ON, 5St. Michael’s Hospital, Toronto, ON; 6Mount Sinai Hospital, Toronto, ON.

Like other provinces, patients in Ontario who have RA can take drugs called biologics that are paid for by the healthcare system only when these patients meet certain criteria called 'access criteria'. Access criteria are set by the provincial health ministry and patients must be shown to have tried and not responded to many other medications before they can go on a biologic (partly because biologics are very expensive). The CATCH researchers wanted to see if patients with active early RA (ERA) who could be on biologic therapies based on Ontario access criteria are on a biologic after 12 months. At one year, 15% of 226 Ontarians in the study met the criteria to access biologics but only 7% were on biologic therapies, even though they all had moderate to high RA activity. This highlights that a lot of patients are not on biologic therapy that could be and the reasons for this need to be studied more.

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What was the study purpose?
Biologic drugs are very effective for treating rheumatoid arthritis (RA). Like other provinces, patients in Ontario who have RA can go on biologic therapy paid for by the healthcare system only when they meet certain criteria called 'access criteria.' These access criteria are set by the provincial health ministry and patients must be shown to have tried and not responded to many other medications before they can go on a biologic (partly because biologics are very expensive). This usually means trying weekly doses of at least 20 mg methotrexate, at least 1 to 2 other disease modifying anti-rheumatic drugs (DMARDs) often in combination, and in 7 out of 10 provinces a drug called Leflunomide must be tried and failed. The CATCH researchers wanted to see if patients with active early RA (ERA) who could be on biologic therapies based on Ontario access criteria are on a biologic after 12 months.

How was the study done?
All Ontario patients in CATCH with moderate to severe RA who were followed for at least 12 months were part of this study. Ontario access criteria for biologics were used which means that patients must have all of the following: (1) at least five swollen joints, (2) evidence of joint damage or rheumatoid factor or anti-cyclic citrullinated peptide, (3) taken and not responded to methotrexate at doses of 20 mg, Leflunomide and a combination of DMARDs.

What were the study results?
Of 226 Ontarians who were followed for 1 year, 15% met the criteria to access biologics but only 7% were on a biologic even though they all had moderate to high RA activity. The researchers want to further study why a number of patients who could have access to biologic therapies through public funding were not on these drugs after 12 months, despite having moderate to high RA activity.


DAS28 Level at Baseline Best Predicts Which Patients with New Onset Inflammatory Arthritis Will Ultimately Require Biologic Therapy

Vivian P Bykerk1, Gilles Boire2, Boulos Haraoui3, Carol Hitchon4, Diane Ferland5, Carter Thorne6, Ed C Keystone7, Janet E Pope8, CATCH Investigators. 1University of Toronto, Boston, MA, 2Université de Sherbrooke, Sherbrooke, QC, 3Institut de Rhumatologie de Montréal, Montreal, QC, 4University of Manitoba, Winnipeg, MB, 5Hopital Maisonneuve Rosemont, Montreal, QC, 6South Lake Regional Health Center, Newmarket, ON, Newmarket, ON, 7Mt. Sinai Hospital, University of Toronto, Toronto, ON, 8St Joseph Health Care London, London, ON

Treatment of patients with early RA aims for remission within 6 months of diagnosis, by quickly increasing the methotrexate dose in combination with other disease modifying anti-rheumatic drugs (DMARDs) or a biologic if required. Since biologics are expensive and affect a person's immune system differently than DMARDs, their use in new RA patients is still controversial. The CATCH investigators wanted to see if they could predict which patients need biologic therapies one year after diagnosis. The researchers looked at many factors such as age, sex, disease activity score (DAS28) at the study start and 3 months, use of methotrexate in doses of higher than 20 mg per week by 3 months, joint damage at the start of the study, socioeconomic status, smoking status, blood markers, swollen joint count, tender joint count, and how long they have experienced their symptoms. Of all of these factors, the only one that predicted the use of biologics at one year was the score of how active a person's RA was (DAS28) at the study start.

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What is the study purpose?
Treatment of patients with early RA aims to put patients in to remission within 6 months of diagnosis, by quickly increasing methotrexate dose in combination with other disease modifying anti-rheumatic drugs (DMARDs) or a biologic if required. Since biologics are expensive and affect a person's immune system differently than DMARDs, their use in new RA patients is still controversial. The CATCH investigators wanted to see if they could predict which patients need biologic therapies at one year after their diagnosis.

How was the study done?
The researchers looked at the medical records of CATCH patients to see which factors predict which patients will require biologic therapies at one year. They looked at the following factors: age, sex, disease activity score (DAS28) at the start of the study, DAS28 at 3 months, use of methotrexate at doses higher than 20 mg per week by 3 months, joint damage at the start of the study, socioeconomic status, smoking status, anti-cyclic citrillunated peptide (anti-CCP), rheumatoid factor (RF), higher than normal C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), swollen joint count, tender joint count, and how long they have experienced their symptoms. Patients were treated with more than 2 DMARDs before being able to go on a biologic drug.

What were the study results?
The researchers found that 25% of patients had joint damage at the start of the study, and at one year, 27% of patients were treated with glucocorticoid pills, 50% with methotrexate, 35% with more than one DMARD, and 8% with biologics. Of all the factors, the only one predicting the use of biologics at one year was the score of a person's RA activity (DAS28) at the start of the study.


Disease Activity in Patients with Early Rheumatoid Arthritis Receiving Stable Conventional DMARDs Significantly Influences the Timing of Achieving a Low Disease State and Remission at 3 Versus 6 Months

Pooneh Akhavan1, Vivian P Bykerk1, Ye Sun1, J Hochman2, Janet E Pope3, Carol A Hitchon4, Gilles Boire5, Boulos Haraoui6, Diane S Ferland7, J Carter Thorne8, Deborah A Weber9, Ed C Keystone10, CATCH investigators. 1Mt. Sinai Hospital, Toronto, ON; 2University of Toronto, Toronto, ON; 3St Joseph Health Care London, London, ON; 4University of Manitoba, Winnipeg, MB; 5Sherbrooke University, Sherbrooke, QC; 6Institut de Rhumatologie, Montreal, QC; 7Hopital Maisonneuve, LaSalle, QC; 8South Lake Regional Health Center, Newmarket, ON; 9Advanced Therapeutics, Mt Sinai Hospital, Toronto, ON; 10Mt. Sinai Hospital, Toronto, ON.

The researchers wanted to see if disease activity in patients with early rheumatoid arthritis (ERA) has any affect on the time it takes them to get to a Low Disease Activity State (LDAS) and remission (REM) for those who are on stable disease modifying anti-rheumatic drugs (DMARDs). They also wanted to see if disease activity at the start of the study had any effect on how a person responds to treatment. Patients who started with moderate disease activity (MDA) or high disease activity (HDA) who had not achieved LDAS or REM at 3 months were followed to see if they reached LDAS or REM at 6 months. There were 108 patients in the study. These patients' disease activity scores (DAS28) were compared at 3 and 6 months. Of patients who started with MDA, 58% of them reached LDAS at 3 months while 63% reached LDAS at 6 months. At 3 months 47% of MDA patients achieved REM versus 50% at 6 months. Of 20 patients not in REM at 3 months, 25% of them were in REM at 6 months. For patients who started in with a HDA, 34% achieved LDAS at 3 months versus 62% at 6 months. Disease activity at the start of the study has a significant effect on the time needed to achieve a good response to medications. Patients with HDA should be continuing therapy for at least 6 months if LDAS or REM is not achieved quickly at 3 months since many of them achieved LDAS or REM by 6 months.

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What was the study purpose?
The researchers wanted to see if disease activity in patients with early rheumatoid arthritis (ERA) has an affect on the time it takes them to get to a Low Disease Activity State (LDAS) and remission (REM) in those who are on stable DMARD treatment and not taking steroids. They also wanted to see if disease activity at the start of the study had any effect on a person's response to treatment.

How was the study done?
Patients were included in the study who were receiving stable DMARDs for 6 months which means they had no changes in medication doses after one month of starting therapy and not taking any steroids. Most patients were on a combination of methotrexate, sulphasalazine, and hydroxychloroquine. Patients with baseline moderate disease activity (MDA) or high disease activity (HDA) who had not achieved LDAS or REM at 3 months were looked at again at 6 months to see if they had reached LDAS or REM. At this time, disease activity score (DAS28) responses were also compared: a poor response was a change in DAS28 less than 0.6 and a good response was a change in DAS28 of less than 1.2.

What were the study results?
In total 108 patients were in the study. The majority of MDA patients achieved LDAS or REM by 3 months with a slightly greater proportion requiring 6 months to achieve a good response. At 3 months 58% of MDA patients reached LDAS versus 63% at 6 months. Of 16 patients not in LDAS, 31% achieved it by 6 months. At 3 months 47% of MDA patients achieved REM versus 50% at 6 months. Of 20 patients not in REM at 3 months, 25% of them achieved it by 6 months.

In patients with HDA, many needed 6 months to achieve LDAS or REM: 34% achieved LDAS at 3 months versus 62% at 6 months. Of 40 patients not achieving LDAS at 3 months, 48% achieved it by 6 months. Of 51 patients not achieving REM at 3 months, 43% achieved it by 6 months.

93% of HDA patients achieved a change in DAS28 of more than 0.6  and 84% achieved a change in DAS28 of more than 1.2 at 3 months, while 37% of MDA patients had a poor response and 53% did not achieve a change in DAS28 of greater than 1.2 at 3 months. Of MDA patients with a poor response at 3 months, 36% achieved LDAS and 29% achieved REM at 6 months and similar results were seen in terms of a good response at 3 months. Disease activity at the study start has a significant effect on the time required to achieve a good response. Patients with HDA should be continuing therapy for at least 6 months if LDAS or REM is not achieved at 3 months because many of them have been shown to take longer to achieve a good response to their medications.


Parenteral MTX as an Initial Treatment Strategy for Early Rheumatoid Arthritis: Results from a Nationwide Cohort

Vivian P Bykerk1, David S Rowe2, Janet E Pope3, CATCH Scientific Advisory Committee, Ashley Bonner3, J Carter Thorne4.  1Mt Sinai Hospital, Toronto, ON; 2University of Toronto School of Medicine, Stouffville, ON; 3St Joseph Health Care London, London, ON; 4South Lake Regional Health Center, Newmarket, ON.

Studies have shown it is important to quickly diagnose and treat patients with Early Rheumatoid Arthritis (ERA). Although rheumatologists think that more than 20 mg of methotrexate injected weekly is the best starting treatment, there is not a guideline for the best dose or type of methotrexate (pill or injected). Methotrexate taken by injection is also called parenteral methotrexate. The researchers looked at 593 patients in this study who were taking more than 20 mg of methotrexate by injection per week and those receiving all other treatments. They then compared those patients in terms of RA outcomes and demographics in their first year after diagnosis. Patients receiving more than 20 mg of methotrexate by injection weekly were more likely to achieve a low disease state and remission within the first year, and were also more likely to be on a combination treatment which means they were taking more than one type of disease-modifying anti-rheumatic drug. The results show that more than 20 mg of methotrexate injected weekly may be an optimal therapy and should be considered as the first treatment for ERA.

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What was the study purpose?
Studies have shown it is important to quickly diagnose and treat patients with Early Rheumatoid Arthritis (ERA). Although rheumatologists think that more than 20 mg methotrexate injected weekly is the best starting treatment (also called the optimal treatment), there is no clear recommendation for a standard dose or type of methotrexate (pill or injected form). Methotrexate taken by injection is also called parenteral methotrexate. The researchers wanted to compare this "optimal treatment" with other therapies and to also see how many patients reached remission.

How was the study done?
The researchers looked at 593 patients in this study who were taking more than 20 mg of methotrexate by injection per week and those receiving all other treatments. They then compared these patients in terms of RA outcomes and demographics in their first year of diagnosis.

What were the study results?
Within the first year, patients receiving the optimal treatment were more likely to achieve a low disease state (67% compared to 52%) and remission (53% compared to 40%) and were more likely to be on a combination therapy. Combination therapy is when someone is being treated with more than one type of disease-modifying anti-rheumatic drug. Overall, patients who were put on early optimal treatment were more likely to have predictors of poor outcomes from the start of the study. The results show that this optimal methotrexate therapy should be considered as the first treatment for ERA.


Patient Self Reported Health Related Quality of Life Improves with Effective Treatment in Early Inflammatory Arthritis (EIA)

Carol Hitchon1, Gilles Boire2, Boulos Haraoui3, Shahin Jamal4, Janet Pope5, Carter Thorne6, Dianne Mosher7, William Bensen8, Michel Zummer9, Majed Khraishi10, Bindu Nair11, Alice Klinkhoff12, Alfred Cividino8, Vivian Bykerk13. 1University of Manitoba, Winnipeg, MB; 2Sherbrooke University, Sherbrooke, QC; 3University of Montreal, Montreal, QC; 4St Michael’s Hospital, Toronto, ON; 5University of Western Ontario, London, ON; 6South Lake Regional Health Center, Newmarket, ON; 7University of Calgary, Calgary, AB; 8McMaster University, Hamilton, ON; 9CH Maisonneuve-Rosemont, Montreal, QC; 10St. John’s, NFLD; 11University of Saskatchewan, Saskatoon, SK; 12Mary Pack Arthritis Program, Vancouver, BC; 13Mount Sinai Hospital, Toronto, ON.

The researchers wanted to study how treating patients with early inflammatory arthritis (EIA) with the goal to get them in to remission improves their long-term RA outcomes as well as how those patients report their quality of life (also called health related quality of life). At one year after their diagnosis, 116 EIA patients were mostly being treated with DMARDs and about half were in remission. They also found that patients' reports of their health related quality of life improved with good DMARD treatment and that disease activity also affects how they answer their health related quality of life survey.

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What was the purpose of the study?
The researchers wanted to study how treating patients with early inflammatory arthritis (EIA) with the goal to get them in to remission improves their long-term RA outcomes and how they report their quality of life (health related quality of life or HRQOL).

How was the study done?
For patients in the CATCH study, besides regular medical chart information that is collected at their regular rheumatology visits, their functional abilities (measured by a questionnaire called the modified Health Assessment Questionnaire or mHAQ) and health related quality of life (HRQOL or short form 12 health survey (SF12)) were recorded at the start of the study and one year. Clinical outcomes measured at one year were treatment response, remission (REM or when the disease activity score (DAS28) is less than 2.6) and sustained remission (sREM which is REM for 6 consecutive months).

What were the study results?
There were 116 patients in the study and at the start of the study (also called baseline) 82% of patients were taking DMARDs. At 1 year DMARDs were increased in 31 patients and reduced in 33 patients, 70% were doing well on their treatments, and 54% were in REM. Baseline SF12 scores were below normal for patients in remission meaning that they were doing well physically and mentally, and at one year, their SF12 scores improved more than patients who were not in remission. At one year, the patients in remission were doing better physically and about the same mentally (according to their SF12 scores) than patients not in remission. Patients in sustained remission also did better physically than patients not in sustained remission, but mentally were similar. At one year, disease activity scores correlated with how patients were doing physically and with their responses on the mHAQ, and mHAQ scores also correlated to how patients were doing physically.

The researchers concluded that HRQOL improves when DMARDs are working well for EIA patients and the patients' HRQOL responses are affected by their RA activity.


Prognostic Value of Patient History, Radiography and Serology on Poor Outcomes in Undifferentiated Inflammatory Arthritis Patients

Maria Petre1, Carly Cheng2, Gilles Boire3, Janet Pope4, Boulos Haraoui5, Carol Hitchon6, Shahin Jamal7, Carter Thorne8, Vivian Bykerk9. 1University of Toronto, Hamilton, ON; 2University of Toronto, Toronto, ON; 3Sherbrooke University, Sherbrooke, QC; 4University of Western Ontario, London, ON; 5University of Montreal, Montreal, QC; 6University of Manitoba, Winnipeg, MB; 7St Michael’s Hospital, Toronto, ON; 8Southlake Regional Health Center, Newmarket, ON; 9Mount Sinai Hospital, Toronto, ON.

The researchers wanted to understand the outcomes for patients who have undifferentiated inflammatory arthritis (UIA). They also wanted to see if patient history, physical exam, blood work, and x-rays give any indication or prediction that could be used to treat patients with UIA. UIA patients do not meet the special criteria that rheumatologists use to diagnosis patients with RA but will sometimes later be diagnosed with RA and then also treated for RA. Early tenderness and damage in the small foot joints predicted which UIA patients would develop RA. The researchers recommend that a thorough foot exam should be done on UIA patients to predict prognosis and guide their medications and treatment.

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What was the study purpose?
The researchers wanted to understand the outcomes for patients who have undifferentiated inflammatory arthritis (UIA). They also wanted to see if patient history, physical exam, blood work, and x-rays give any indication or prediction that could be used to treat patients with UIA. UIA patients do not meet the special criteria that rheumatologists use to diagnosis patients with RA but will sometimes later be diagnosed with RA and then also treated for RA.

How was the study done?
Records from 642 patients in the CATCH study were reviewed. UIA was defined as not meeting 1987 ACR classification criteria for RA or criteria for other types of arthritis. The researchers wanted to see how many patients developed a diagnosis of RA over time and what factors predicted this. They looked at factors such as age, gender, smoking status, initial use of DMARDs, rheumatoid factor status, metatarsophalangeal joint (MTP joints - these are in your feet) involvement and including damage). The MTP foot joints were studied closely because they are currently not used to diagnose RA.

What are the study results?
At the start of the study, 25% of patients had UIA and at 12 months, 64% of those still had UIA, while the rest had developed RA or other rheumatological diseases. The researchers found that the early presence of MTP tenderness and joint damage predicted which patients would develop RA. They propose that a thorough foot exam should be performed on UIA patients to predict prognosis and help with making decisions on how these patients are treated.


Quality Assurance Study of the Use of Preventative Therapies in Glucocorticoid Induced Osteoporosis (GIOP) in Early Inflammatory Arthritis (EIA): Results from the CATCH Cohort

Emily McKeown1, Vivian P. Bykerk2, Faye Deleon3, J. Carter Thorne4, Carol A. Hitchon5, Gilles Boire6, Boulos Haraoui7, Diane S. Ferland8, Ed C. Keystone9, Janet E. Pope10. 1University of Western Ontario, London, ON; 2Mt Sinai Hospital, Toronto, ON; 3McMaster University, Hamilton, ON; 4South Lake Regional Health Centre, Newmarket, ON; 5University of Manitoba, Winnipeg, MB; 6CHUS - Sherbrooke University, Sherbrooke, QC; 7Institut de Rhumatologie, Montreal, QC; 8Hopital Maisonneuve, LaSalle, QC; 9Mt. Sinai Hospital, University of Toronto, Toronto, ON; 10St Joseph Health Care London, London, ON.

Glucocorticoids are drugs used to treat inflammatory arthritis (IA) that may also cause osteoporosis. Because of this, physicians use guidelines that help them to treat patients with glucocorticoids. The CATCH researchers wanted to learn about use of glucocorticoids in patients with early IA and how closely doctors were following guidelines. Patients with postmenopausal osteoporosis could not be in the study, so there were 311 patients on glucocorticoids in the study in total. Of these patients on glucocorticoids, 50% were on oral prednisone, 41% received muscular or joint injections of steroids, and 9% received both. Long-term users were older compared to non-users and the number of women and number of patients positive for rheumatoid factor and disease activity scores were similar. In long-term users of glucocorticoids, the researchers looked at the number of patients receiving calcium, vitamin D and a bisphosphonate (all which help strengthen bones and protect against osteoporosis), as well as what kinds of other preventative steps these patients took against osteoporosis. In conclusion, glucocorticoids are frequently used in early IA and the use of calcium, vitamin D or a bisphosphonate was low in longtime glucocorticoid users. This shows that physicians are not using the guidelines that have been created to help them treat patients who are on glucocorticoids since these patients should also be taking supplements to help prevent osteoporosis by strengthening their bones.

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What was the study purpose?
Glucocorticoids are drugs used to treat inflammatory arthritis (IA) that may also cause osteoporosis. Because of this, physicians use guidelines to help them when they choose to treat patients with glucocorticoids. The CATCH researchers wanted to learn about glucocorticoid use in patients with early IA and how closely doctors were following guidelines.

How was the study done?
Patients with postmenopausal osteoporosis could not be in the study. In long-term users of glucocorticoids, the researchers looked at the number of patients receiving calcium, vitamin D and a bisphosphonate (these all help strengthen bones and protect against osteoporosis) as well as what kinds of preventative steps these patients took against developing osteoporosis.

What were the study results?
311 of 655 patients in the CATCH study were on glucocorticoids: 50% on oral prednisone, 41% received muscular or joint injections of steroids, and 9% received both.
Long-term glucocorticoid users compared to non-users were older (56 versus 50 years), a similar number were females (68% versus 73%), and the two groups had similar rheumatoid factor positivity (55% and 57%) and disease activity scores. Of these long-term glucocorticoid users, 45% were treated with calcium, 41% with vitamin D, 38% with both, and 18% were taking a bisphosphonate. Rates of taking these medications to prevent osteoporosis were only slightly higher for people who took oral steroids for a long time; 54% were taking calcium, 48% were taking vitamin D, 45% were taking both and 23% were on a bisphosphonate. There were no significant differences in use of calcium, vitamin D or bisphosphonate between men and women or post-menopausal or pre-menopausal women. Women who had taken hormone treatment and who were smokers had no increase in being treated. In conclusion, glucocorticoid therapy is frequently used to treat early IA and the use of calcium, vitamin D or a bisphosphonate was low among longtime glucocorticoid users. This shows that physicians are not using the guidelines that have been created to help them treat patients who are on glucocorticoids since these patients should also be taking supplements to help prevent osteoporosis by strengthening their bones.


Self-Reported Comorbidity is Common in Early Inflammatory Arthritis

C. Hitchon1, J. Dooley1, G. Boire2, B. Haraoui3, J. Pope4, C. Thorne5, D. Ferland6, V. Bykerk7, Network of Early Arthritis Researchers. 1University of Manitoba, Winnipeg, MB, 2Universite de Sherbrooke, Sherbrooke, QC, 3Institut de Rhumatologie, Montreal, QC, 4University of Western Ontario, London, ON, 5South Lake Regional Health Center, Newmarket, ON, 6Hospital Maisonneuve, Montreal, QC, 7Harvard University, Boston, MA.

The researchers wanted to see how many patients with early inflammatory arthritis also had other illnesses called comorbidities, by studying patients in one city compared to patients across Canada. Patients told their rheumatologist what their comorbidities were at their first visit and any new comorbidities were identified by their doctor at other visits. At the start of the study 67% of patients from all across Canada reported at least one comorbidity while 82% of patients in one city in reported at least one comorbidity. These comorbidities could be high blood pressure, high cholesterol, diabetes, thyroid disease, cardiovascular disease, cancer, neurological disorders, gastrointestinal disorders, and others. At the start of the study, these patients with comorbidities tended to have higher RA activity and more issues doing daily activities. More studies need to be done to better understand this.

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What was the study purpose?
The researchers wanted to see how many patients with early inflammatory arthritis also had other illnesses called comorbidities by studying patients in one city compared to patients from all across Canada. An example of a comorbidity is heart disease, which could be because of inflammation from RA or its treatments.

How was the study done?
CATCH patients told their rheumatologist what their comorbidities were at their first visit which was called 'self-report' and any new comorbidities were identified by their doctor at other visits. There were 803 patients in the study from all across Canada, and these were compared to 291 patients in one city.

What were the study results?
At the start of the study, 67% of patients from all across Canada reported at least one comorbidity, while 82% of patients in one city indicated they had at least one comorbidity. In the patients from all across Canada, comorbidities were high blood pressure (in 27% of patients), diabetes (in 8% of patients), cardiovascular disease (in 11% of patients), cancer (in 6% of patients), neurological disorders (in 9% of patients), gastrointestinal disorders (in 12% of patients), and others. At the start of the study, these patients with comorbidities had higher RA activity and more issues doing daily activities. For patients in one city, 82% of patients reported at least one comorbidity, including: high blood pressure (in 19% of patients), diabetes (in 8% of patients), cardiovascular disease (in 9% of patients), cancer (in 3% of patients), neurological disorders (in 42% of patients ), and gastrointestinal disorders (in 26% of patients). At one year comorbidities which patients and their doctors reported included: high blood pressure, heart disease, diabetes, cancer, respiratory illnesses, and gastrointestinal issues. In conclusion, comorbidities are common in early arthritis and may be associated with more active disease, and overall more studies are needed to better understand this.


The Proportion of Patients with Work Disability (WD) in Early Inflammatory Arthritis: Results from the Canadian Early Arthritis Cohort (CATCH) Cohort

Lauren Mussen1, Vivian Bykerk2, Faye De Leon3, Janet Pope1. 1University of Western Ontario, London, ON; 2Mount Sinai Hospital, Toronto, ON; 3McMaster University, Hamilton, ON.

The researchers wanted to see how many patients with early inflammatory arthritis (EIA) and rheumatoid arthritis (RA) experience work disability such as being on sick leave, unable to work, and others. Patients answered questionnaires about their job when they entered the CATCH study. They answered if they were employed, retired, unemployed, on sick leave, work disabled, maternity leave, in school, or homemaker and the physical demands of different jobs were determined. Of 655 patients in the study, it was found that work disability is low when patients are first diagnosed with RA and there is a chance then to prevent work disability. In patients with established RA, work disability was related to things such as being able to do daily functions, joint damage, and RA activity.

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What was the study purpose?
The researchers wanted to see how many patients with early inflammatory arthritis (EIA) and rheumatoid arthritis (RA) experience work disability such as being on sick leave, unable to work, and others.

How was the study done?
Data from 655 CATCH patients were collected, and when they entered the CATCH study, patients were asked about their work. Possible answers to the question about work could include being employed, retired, unemployed, on sick leave (SL), work disabled (WD), on maternity leave, in school or a homemaker. The physical demands of each kind of job were determined.

What were the study results?
The researchers found that 54% of patients in the CATCH study were employed, 22% were retired, and 6% reported WD or SL, and the remaining 18% were homemakers, students or on maternity leave. Of the 351 patients who were working, they were an average age of 47 years, 74% were female, 57% were rheumatoid factor positive, 68% were diagnosed with RA, and their RA activity was high. 86% of those who were employed had jobs sitting most of the day or without many physical demands. In the WD group, the average age was also 47 years, 68% were female, 58% were rheumatoid factor positive, 80% were diagnosed with RA, and their RA activity was much higher than those who were working.

Factors associated with WD/SL included tender joint count, disease activity score, and SF-12 (this is an overall measure of health status). Between the WD/SL and employed groups the swollen joint count and numbers who were positive for rheumatoid factor and anti-cyclic citrullinated peptide were not different. WD is low when patients are first diagnosed with RA and there is a chance then to prevent work disability, knowing that it relates to certain patient factors, the health assessment questionnaire, joint damage and disease activity. In patients with established RA, WD was related to things such as being able to do daily functions, joint damage, and RA activity.


The Revised 2010 ACR/EULAR Diagnostic Criteria for Rheumatoid Arthritis Identify Many More Patients Who Are Eligible for Treatment and for Clinical Trials

Vivian P Bykerk1, Gilles Boire2, Boulos Haraoui3, Carol A. Hitchon4, Ed C. Keystone5, J. Carter Thorne6, Diane S. Ferland7, Janet E. Pope8, CATCH Investigators across Canada. 1Mt Sinai Hospital, University of Toronto, Toronto, ON; 2CHUS – Sherbrooke University, Sherbrooke, QC; 3Institut de Rhumatologie, Montreal, QC; 4University of Manitoba, Winnipeg, MB; 5Mt. Sinai Hospital, University of Toronto, Toronto, ON; 6South Lake Regional Health Center, Newmarket, ON; 7Hopital Maisonneuve Rosemont, LaSalle, QC, 8St Joseph Health Care London, London, ON.

Physicians use special new criteria to diagnose patients with RA, which are called 2010 revised ACR/EULAR criteria. The CATCH researchers wanted to see how many patients who had early inflammatory arthritis (IA) (that is for less than one year) met these new criteria. They also wanted to see how many of these patients could be in a clinical trial based on their disease activity score (DAS). To be in the study, patients had received no treatment or little treatment for their arthritis with disease modifying anti-rheumatic drugs (DMARDs). Of 648 patients, 74% met the new criteria to be considered to have RA which was an increase of 115 patients from those who met the old criteria. That means that with the 'old criteria' these 115 patients would have been diagnosed with undifferentiated inflammatory arthritis, not RA. The revised ACR/EULAR 2010 criteria can identify many more patients with RA than the old criteria and most of these patients would be eligible for clinical trials.

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What was the study purpose?
Physicians use special new criteria to diagnose patients with RA, which are called 2010 revised ACR/EULAR criteria. The CATCH researchers wanted to see how many patients who had early inflammatory arthritis (IA) (less than one year) met these new criteria. They also wanted to see how many of these patients could be in a clinical trial according to their disease activity score (DAS28).

How was the study done?
To be in the study, patients had received no treatment or little treatment for their RA with DMARDs. Patients with a DAS28 greater than or equal to 3.2 were potentially eligible to be in an early RA clinical trial.

What were the study results?
Most of the patients who fulfilled the old criteria to be considered to have RA also fulfilled the new 2010 criteria. Of 648 patients, 74% met the new criteria for a diagnosis of RA, an increase of 115 patients from those diagnosed with RA using the old criteria. Previously these 115 patients would have been considered to have undifferentiated inflammatory arthritis, not RA, and would have been treated differently by their physician. The revised ACR/EULAR 2010 criteria can identify many more RA patients than the old criteria and most of these patients would be eligible for clinical trials based on their DAS28.


Three Months of Therapy with DMARDs Is an Inadequate Period of Time To Alter the Treatment in Patients with Early Rheumatoid Arthritis When Treating to a Target of Low Disease State or Remission. Results from Canadian Early ArThritis CoHort (CATCH)

Pooneh Akhavan1, Vivian P. Bykerk1, Ye Sun1, J. Hochman2, Janet E. Pope3, Carol A. Hitchon4, Gilles Boire5, Boulos Haraoui6, Diane S. Ferland7, J. Carter Thorne8, Deborah A. Weber9, Ed C. Keystone10, CATCH Investigators. 1Mount Sinai Hospital, University of Toronto, Toronto, ON; 2University of Toronto, Toronto, ON; 3St Joseph Health Care London, London, ON; 4University of Manitoba, Winnipeg, MB; 5Université de Sherbrooke, Sherbrooke, QC; 6Institut de Rhumatologie, Montreal, QC; 7Rheumatology, Hopital Maisonneuve, Rosemont LaSalle, QC; 8South Lake Regional Health Center, Newmarket, ON; 9Advanced Therapeutics, Mt. Sinai Hospital, Toronto, ON; 10Mt. Sinai Hospital, University of Toronto, Toronto, ON.

The CATCH researchers wanted to see if giving their early RA patients 3 months to respond to therapy before making a change to their medications was long enough. They defined response to medication as when the person was either experiencing low RA activity or in remission. Patients in the study were not taking any steroids and were on disease modifying anti-rheumatic drugs (DMARDs) for 6 months without any changes to medications one month after starting in the study. Patients not getting to a low RA activity state or remission by 3 months and 6 months were compared. 180 patients were studied, and of the patients who had not responded well enough to therapy by 3 months, many had by 6 months. Patients who took longer to respond also often said they felt more pain and had more difficulty with everyday tasks at the start of the study. The researchers concluded that 3 months was not enough time to decide on changing therapy, and that 6 months should be used before deciding on how to adjust medications.

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What was the study purpose?
The CATCH researchers wanted to see if giving their early RA (ERA) patients 3 months to respond to medication before making a change was long enough. They defined response to medication as being low RA activity (LDAS for low disease activity state) or being in remission (REM).

How was the study done?
Patients in the study were not taking any steroids and were on DMARDs for 6 months without any changes to medications one month after starting the study. Patients not getting in to a low RA activity state or remission by 3 months and 6 months were compared. The researchers looked at the average patient global assessment of disease activity, pain score and health assessment questionnaire disability index (HAQ-DI) at the start of the study (baseline), 3 months, and 6 months.

What were the study results?
From the CATCH study, 108 patients participated. At 3 months, 46% and 31% of patients achieved LDAS or REM respectively, while by 6 months, 65% and 52% achieved LDAS or REM respectively. Of 58 patients not in LDAS at 3 months, 45% achieved LDAS by 6 months. Of 74 patients not in REM by 3 months, 40% achieved REM by 6 months, and of 56 patients who achieved REM by 6 months, only 48% achieved it by 3 months. At baseline, swollen joint count, tender joint count and C-reactive protein levels were not different, and patients who achieved LDAS at 6 months versus those who did at 3 months had higher pain and patient global assessment scores at baseline. In patients with REM at 6 months compared to those in REM at 3 months, HAQ-DI was higher at baseline which means that these patients had more difficulty doing everyday tasks.

Overall, even though patients were on stable therapy for 6 months, many patients who had not achieved a good response by being in a LDAS or REM by 3 months achieved these by 6 months. The researchers think that physicians need to consider more closely the outcomes that patients report themselves including pain and ability to do daily activities when deciding how well their patients with ERA are doing. The researchers concluded that 3 months was not enough time to decide on changing medications, and that 6 months should be used before deciding on how to adjust treatment.