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 (also called manuscripts) that have resulted from CATCH research, you can click here and you will be redirected to a page that lists all papers that have been published according to year.

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


Comorbidity is Commonly Reported in Early Inflammatory Arthritis

Carol Hitchon1, Jillian Dooley1, Gilles Boire2, Boulos Haraoui3, Janet Pope4, Carter Thorne5, Diane Ferland6, Vivian Bykerk7, Network of Early Arthritis Researchers8. 1University of Manitoba, Winnipeg; 2Université de Sherbrooke, Sherbrooke; 3University of Montreal, Montreal, 4University of Western Ontario, London; 5Southlake Regional Health Care, The Arthritis Program, Newmarket; 6 Hospital Maisonneuve, Montreal; 7Mount Sinai Hospital, Toronto; 8Toronto, Canada.

The CATCH investigators wanted to find out if patients with early inflammatory arthritis (EIA) also have other medical conditions called comorbidities. They compared patients from all across Canada and also patients who lived in just one city. In the group of patients from all across Canada, 67% of patients had at least one comorbidity while for patients in one city, 82% of patients had at least one comorbidity. Some examples of comorbidities included high blood pressure, high cholesterol level, diabetes, heart disease, cancer, and others. In these patients the researchers also saw RA that was more active and they had less functional abilities compared to patients without comorbidities. The researchers concluded that comorbidities are common in EIA and may also be associated with more active RA.

Read more

What was the purpose of the study?
The CATCH investigators wanted to find out if patients with early inflammatory arthritis (EIA) also have other medical conditions called comorbidities.

How was the study done?
Medical records were reviewed for comorbidities, RA activity and physical scores in patients from all across Canada compared to patients who lived in one city. Comorbidities were reported by patients at their baseline visit and new ones were identified at each subsequent visit.

What were the results of the study?
Of 803 patients from all across Canada, 67% of them reported at least 1 comorbidity, with the number of comorbidities ranging from none to 8. Some examples of comorbidities at the patients' first visits were:

  • high blood pressure in 27% of patients;
  • high cholesterol in 14% of patients;
  • diabetes needing insulin in 8% of patients;
  • cardiovascular disease in 11% of patients;
  • cancer in 6% of patients.

These results were similar to those from patients who lived in one city. In this group, 82% of patients reported one comorbidity at the start of the study including 19% of patients with high blood pressure, 8% of patients with diabetes needing insulin, 9% of patients with heart disease, and 3% of patients with cancer.

In both groups, new diagnoses of comorbities were made over a year that also included high blood pressure, heart disease, diabetes, cancer, respiratory issues (those are issues that affect the lungs), and gastrointestinal issues.

Patients with comorbidities also had higher RA activity measured by the disease activity score (also called DAS28) and more functional issues measured by the health assessment questionnaire (also called HAQ). The researchers concluded that comorbities are common in EIA and may be associated with more active RA.


Disease Activity State At 3 Months Is A Better Predictor Of Outcome At 6 Months Than Response To Treatment (DAS28 Change) In A Cohort Of Early Rheumatoid

P. Akhavan1, V. Bykerk2, Y. Sun3, G. Boire4, B. Haraoui5, J. Pope6, C. Thorne7, D. Ferland8, C. Hitchon9, D. Weber10, E. Keystone1, CATCH Investigators. 1Rheumatology, University of Toronto, Canada; 2Rheumatology, Brigham and Women's Hospital, Boston, United States; 3Mount Sinai Hospital, Toronto; 4Rheumatology, University of Sherbrook; 5Rheumatology, Institut de Rhumatologie, Montreal; 6Rheumatology, University of Western Ontario, London; 7Rheumatology, Southlake Regional Health Centre, Newmarket; 8Hospital Maisonneuve Rosemont, Montreal; 9Rheumatology, University of Manitoba, Winnipeg; 10Rheumatology, Mount Sinai Hospital, Toronto, Canada

The researchers wanted to see if RA disease activity score measured by the DAS28 or change in the DAS28 at 3 months predicts remission or a state of low disease activity (LDAS) at 6 months. Patients with early rheumatoid arthritis (ERA) who were on stable disease modifying anti-rheumatic drug (DMARD) therapy for 6 months were studied. Stable DMARD therapy means that there were no changes in dose one month after starting and the patients were not taking any steroids. RA activity was measured at the start, 3 months and 6 months. Of 108 patients, the researchers found that while patients were on stable therapy for 6 months, a large number of patients who had not achieved LDAS or remission by 3 months did achieve these by 6 months. Disease activity status and DAS28 response both predict remission or LDAS at 6 months however disease activity appears to be a better predictor.

Read more

What was the purpose of the study?
The goal of treating RA is to help patients get to remission or low disease activity (LDAS) if remission is not possible. With RA patients, doctors often measure disease activity score and its change and adjust medication until the treatment target is met. The researchers wanted to know whether disease activity score measured by the DAS28 or DAS28 change at 3 months predict remission or low disease activity status (LDAS) at 6 months.

How was the study done?
Patients with early RA (ERA) on stable disease modifying anti-rheumatic drug (DMARD) therapy for 6 months were evaluated. Stable DMARD therapy means that there were no changes in dose one month after starting and the patients were not taking steroids. RA activity was measured at the start of the study, 3 months and 6 months. The researchers wanted to determine if DAS28 score and DAS28 change could predict which patients would achieve a LDAS at 6 months. LDAS is measured by a DAS28 of less than 3.2.

What were the results of the study?
There were 108 patients in the study who were mostly female, an average age of 50 years and who had RA for an average of 6.3 months and DAS28 score at the study start of 5.3. At 3 months:

  • 46 patients achieved LDAS and 31% were in remission;
  • 58 patients were not in LDAS, but 45% of these achieved LDAS by 6 months; and,
  • 74 patients were not in remission, but 40% of these were in remission by 6 months.

By 6 months:

  • 65% of patients achieved LDAS; and
  • 52% of patients were in remission.

The researchers found that a lower DAS28 score and larger DAS28 change at 3 months were both associated with a higher chance of remission or LDAS at 6 months. They also found that DAS28 score was a better predictor of remission or LDAS at 6 months than DAS change.


Factors Affecting Glucocorticoid Use in Early Rheumatoid Arthritis. Results from an Early Arthritis Cohort

Pooneh S. Akhavan1, Glen S. Hazlewood1, Ye Sun2, Edward C. Keystone3, Gilles Boire4, Janet E. Pope5, Carol A. Hitchon6, Boulos Haraoui7, Diane S. Ferland8, V. Bykerk9 and CATCH Investigators10. 1University of Toronto, Toronto, ON; 2Mount Sinai Hospital, Toronto, ON; 3Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON; 4CHUS – Sherbrooke University, Sherbrooke, QC; 5St. Joseph’s Health Care, University of Western Ontario, London, ON; 6University of Manitoba, Winnipeg, MB; 7Institut de Rhumatologie, Montreal, QC; 8LaSalle, QC; 9Brigham & Women’s Hospital, Boston, MA; 10Toronto, ON

The researchers wanted to know how much drugs called glucocorticoids (GC) are used to treat patients with early RA. They also wanted to learn about the patients' characteristics at the start of the study and the clinics using GCs. The CATCH investigators reviewed the medical records of 455 patients who were not treated before they started CATCH and looked at their records at the start of the study and 3 months follow-up. They found that 20% of patients received GC therapy during the first 3 months and this was not because of their starting RA activity or functional abilities since these were the same in patients who did not receive GC therapy. The researchers found that patients who received GC therapy were older and often certain clinics where patients were treated preferred to use GC therapy.

Read more

What was the purpose of the study?
The researchers wanted to know how much drugs called glucocorticoids (GC) are used in treating patients with early RA. They also wanted to learn more about the patients' characteristics at the start of the study and to understand which clinics are using GCs. Even though there are recommendations for early, short-term use of GC in patients with early RA, their use seems to be limited, maybe because of concerns about side effects.

How was the study done?
The CATCH investigators reviewed the medical records of 455 patients, at the start of the study and 3 months, who were not treated before they started CATCH. The patients were mostly women (74%) of an average age of 52 years, with active RA, mostly Rheumatoid Factor positive (61%), and who had RA for an average of 6 months. They found that 20% of patients received GC therapy during the first 3 months but this was not because of their RA activity or functional abilities since these were the same in patients who did not receive GC therapy.

What were the results of the study?
The researchers found that patients who received GC therapy were older and often certain clinics preferred to treat patients with GC therapy. Since there were large differences in how patients were treated between different clinics, the researchers feel there is an opportunity around the education on use of GCs in patients with early RA.


Function (HAQ) and Disease Activity (DAS) Varies by Rheumatoid Factor (RF) Status in Early Inflammatory Arthritis (EIA) with Stronger Associations in RF Positive Patients: Results From the CATCH Cohort

Tristan Boyd1, Vivian Bykerk2, Gilles Boire3, Carol A. Hitchon4, J. Carter Thorne5, Edward Keystone6, Boulos Haraoui7, Diane S. Ferland8, Janet E. Pope9 and CATCH Investigators10. 1University of Western Ontario, London, ON; 2Brigham & Women’s Hospital, Boston, MA; 3CHUS - Sherbrooke University, Sherbrooke, QC; 4University of Manitoba, Winnipeg, MB; 5Southlake Regional Health Centre, Newmarket, ON; 6Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON; 7Institut de Rhumatologie, Montreal, QC; 8LaSalle, QC, 9St. Joseph’s Health Care, University of Western Ontario, London, ON; 10Toronto, ON.

The researchers wanted to see if there was a relationship between early inflammatory arthritis (EIA) patients' functional abilities and RA activity and to see if it changed over time. The researchers looked at medical records for 1,145 EIA patients where their functional ability and RA activity were measured with tools called the HAQ (health assessment questionnaire) and DAS28 (disease activity score) at visits over 2 years. They also looked to see if results were different in older and younger patients or in those who tested differently for a blood marker called Rheumatoid Factor (RF). The researchers found that patients' functional ability and RA activity improved after treatment started and were most strongly related in the first year. A patient's age did not affect the link between function and RA activity but being tested positive for RF was related to function and RA activity.

Read more

What was the purpose of the study?
The researchers wanted to see if there was a relationship between early inflammatory arthritis (EIA) patients' functional ability and disease activity and to see if this changed over time.

How was the study done?
The researchers looked at medical records for 1,145 EIA patients where their functional ability and disease activity were measured with the HAQ (health assessment questionnaire) and DAS28 (disease activity score) at each visit (every 3 months for year 1, then at 18 and 24 months). The researchers also looked to see if the relationship was different in older versus younger patients, or in those who tested positive for a blood marker called Rheumatoid Factor (RF) versus those who did not.

What were the results of the study?
The researchers found that both function and disease activity improved after treatment started and were related, with the largest improvement seen after the first visit. A patient's age did not affect the link between function and disease activity while being RF positive did. Patients who were RF positive also had larger improvements in function and disease activity.


Improving Clinical Trial Recruitment in a Real World Practice. Results From the Canadian Early Arthritis Cohort

Pooneh S. Akhavan1, Vivian Bykerk2, Ye Sun3, Boulos Haraoui4, J. Carter Thorne5, Janet E. Pope6, Carol A. Hitchon7, Diane S. Ferland8, Gilles Boire9, Edward C. Keystone10 and CATCH Investigators11. 1University of Toronto, Toronto, ON; 2Brigham & Women’s Hospital, Boston, MA; 3Mount Sinai Hospital, Toronto, ON; 4Institut de Rhumatologie, Montreal, QC; 5Southlake Regional Health Centre, Newmarket, ON; 6St. Joseph’s Health Care, University of Western Ontario, London, ON; 7University of Manitoba, Winnipeg, MB; 8LaSalle, QC, 9CHUS - Sherbrooke University, Sherbrooke, QC; 10Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON; 11Toronto, ON.

Few RA patients can be in clinical trials because of the strict entry criteria for a clinical trial. The CATCH investigators wondered if changing or relaxing these 'entry requirements' would allow more patients to be in clinical trials and also to see if they achieve the same RA outcomes as patients who do meet the strict trial entry requirements. The researchers outlined 2 sets of clinical trial participation criteria and five new relaxed definitions for trials, then compared the numbers of CATCH patients eligible to be in trials, their baseline disease characteristics, and their ACR and EULAR responses. ACR and EULAR responses are standard measurements used to determine how patients are responding to treatment. The researchers found that more relaxed clinical trial criteria may allow more patients to be able to participate in clinical trials, and suggest that these criteria be considered for future clinical trials.

Read more

What was the purpose of the study?
Few RA patients can be in clinical trials because of the strict entry criteria to these clinical trials. The CATCH investigators wondered if relaxing clinical trials' 'entry requirements' would increase how many patients could be in clinical trials and also if patients achieve the same RA outcomes as patients who do meet the trial entry requirements.

How was the study done?
Patients from CATCH were included in this study if they were: over 18, diagnosed with RA, on methotrexate at baseline but not on a biologic, and in CATCH for more than 6 months. Their RA activity was assessed at baseline and 24 weeks. The two "standard" clinical trial enrolment criteria were having more than 6 tender and swollen joints and certain values of erythrocyte sedimentation rate and C-reactive protein (these are two measurements done on blood also called ESR and CRP that show inflammation). The investigators also proposed five "liberal" criteria requiring fewer tender and swollen joints and different ESR and CRP values.

What were the results of the study?
Of 312 patients, 28-33% of patients met the standard criteria to participate in a clinical trial. When the researchers loosened the criteria for clinical trials, 32-90% of patients could be in a clinical trial. The researchers found that patients in two of the liberal groups had the lowest proportion of elevated ESR/CRP (41% and 42% compared to more than 70% in other groups). The ACR50 response rate (that is a measurement of 50% improvement in RA symptoms) was 56–57% in the standard clinical trials' criteria groups and 53–55% in the liberal groups (except for one group), and another measure of response of patients to treatment called the EULAR response rate was also similar among all groups.

The CATCH investigators concluded that more liberal clinical trial entry criteria may increase the number of patients who can be in clinical trials, for example by allowing patients with fewer tender and swollen joints to participate. Although patients who qualified to be in a clinical trial using liberal criteria may have less active RA (because they have fewer tender and swollen joints), they had similar RA disease outcomes measured by standard tools.


Incidence and Predictors of Fibromyalgia in An Early Arthritis Cohort

Yvonne C. Lee1, Daniel H. Solomon1, Bing Lu1, Gilles Boire2, Boulos Haraoui3, Carol A. Hitchon4, Janet E. Pope5, J. Carter Thorne6, Edward Keystone7, Diane S. Ferland8 and Vivian Bykerk9. 1Brigham and Women’s Hospital, Boston, MA; 2CHUS-Sherbrooke University, Sherbrooke, QC; 3Institut de Rhumatologie, Montreal, QC; 4University of Manitoba, Winnipeg, MB; 5St. Joseph’s Health Care, University of Western Ontario, London, ON; 6Newmarket, ON, 7Mount Sinai Hospital, Toronto, ON; 8LaSalle, QC; 9Brigham & Women’s Hospital, Boston, MA

The CATCH researchers wanted to understand why people with RA have fibromyalgia (FM) more than the general population (20% compared to 3%), how FM in RA develops over time, and if arthritis affects the risk of having FM. Of 1,198 patients in CATCH, the number of patients with FM rose from 0% at the study start (also called baseline) to 5.9% at 1 year and 11.8% at 5 years. Being female, tender joint count, depressed mood and poor memory were related to an increased risk for FM while swollen joint count and erythrocyte sedimentation rate were related to a decreased risk of FM. No clear cause of this could be found and the researchers feel that more studies are needed.

Read more

What was the purpose of the study?
The CATCH researchers wanted to know why more people with RA also have fibromyalgia (FM) more than the general population (20% compared to 3%), how FM in RA develops over time, and if long-term pain and inflammation from arthritis affect the risk of FM.

How was the study done?
Researchers studied the medical records of 1,198 CATCH patients to see if they could find any link between RA and FM.

What were the results of the study?
Over time, the numbers of people with RA and FM increased from 0% at baseline to 5.9% at 1 year, to 11.8% at 5 years. Being female, tender joint count, depressed mood, and poor memory all predicted being diagnosed with FM. Measures of inflammation like swollen joint count and erythrocyte sedimentation rate were related to decreased risk of FM. The researchers concluded that the results might be because of how doctors consider a diagnosis of FM in RA patients, however more studies are needed.


Patient Sex Does Not Influence Pain Levels in Early Inflammatory Arthritis

Cheryl Barnabe, Louis Bessette, Cathy Flanagan, Sharon Leclercq, Vivian Bykerk.

The CATCH researchers wanted to see if there was a difference between the pain felt by women and men who had early inflammatory arthritis (EIA) and who were treated to remission. Some research on patients who have had RA for many years showed women feel more RA pain than men. The researchers looked at pain measurements from 819 females and 307 males in CATCH. The patients all had similar levels of RA activity and a similar number had achieved remission (so the two groups could be compared). The CATCH researchers concluded that in this group of patients with EIA, sex does not influence how they feel pain. Since this finding was different than in patients who have had RA for many years, the researchers thought the differences could be due to the length of time people have had RA or other factors.

Read more

What was the purpose of the study?
In patients who have had RA for many years, research shows that women feel more pain than men, so the CATCH researchers wanted to see if the same was true in patients with early inflammatory arthritis (EIA) and who were treated to remission.

How was the study done?
Patients were over age 16, had more than 2 swollen joints or 1 swollen finger joint, with symptoms for 6 weeks to 1 year, and one or more of: positive Rheumatoid Factor (RF), anti-cyclic citrullinated peptide (anti-CCP), morning stiffness, and response to non-steroidal anti-inflammatory medications (NSAIDs) or painful hand squeeze test. The researchers looked at pain measurements from 819 females and 307 males in CATCH that included:
• Visual Analogue Scale (VAS) – a 10 cm long scale where a person shows their pain level on a scale of no pain (0 cm) to pain as bad as it can possibly be (10 cm);
Patient Global Assessment (PGA); and,
Rheumatoid Arthritis Disease Activity Index (RADAI) pain components.

What were the results of the study?
The patients all had RA for an average of 6 months and females and males had similar levels of disease activity, disease activity score (DAS28) at baseline, and numbers that achieved remission. No differences were found in pain measurements between females and males at their baseline, year 1 or year 2 visits. The CATCH researchers concluded that sex does not influence how these EIA patients feel pain. Since this is different than in patients who have had RA for many years, the researchers thought this could be due to how long patients have had RA and other factors.


Patients with a Severe Clinical Disease Course Can Be Identified Using Cluster Analysis – Results From a Canadian National Early Arthritis Cohort

Ye Sun1, Cindy Lim2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, Edward C. Keystone6, Janet E. Pope7, J. Carter Thorne8, Diane S. Ferland9, Vivian P. Bykerk10 and CATCH Investigators11. 1Mount Sinai Hospital, Toronto, ON; 2Mount Sinai Hospital, Toronto, ON; 3CHUS - Sherbrooke University, Sherbrooke, QC; 4Institut de Rhumatologie, Montreal, QC; 5University of Manitoba, Winnipeg, MB; 6Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON; 7St. Joseph’s Health Care, University of Western Ontario, London, ON; 8Southlake Regional Health Centre, Newmarket, ON; 9LaSalle, QC, 10Brigham & Women’s Hospital, Boston, MA; 11Canada

The researchers wanted to find patterns (also called clusters or trajectories) of RA over time based on how patients' RA first appeared or what medication they used. The researchers looked at medical records of 185 people with early RA to see if they could find clusters of disease. The researchers found five disease trajectories and patients with worse RA needed stronger medications over time.

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What was the purpose of the study?
The researchers wanted to find patterns of RA over time (also called a trajectory of disease) based on how patients' RA first appeared or what medications they used. Researchers believe patterns of RA will help doctors treat patients and give them a better idea of how a patient's RA will change over time.

How was the study done?
The researchers looked at medical records from 185 early RA patients with 2 years of data, to see if they could find patterns or clusters of disease.

What are the results of the study?
The researchers found five disease trajectories. The following were different between clusters: age, employment status, rheumatoid factor, and erythrocyte sedimentation rate (a sign of inflammation). The disease trajectories were:
1. patients had low levels of disease activity and went into remission;
2. patients had moderate disease activity and stayed there;
3. patients first had high disease activity, improved, and went in to remission;
4. patients started in a high disease activity, received stronger treatment than the patients in group 3, but stayed with high-moderate disease activity;
5. patients had very high levels of disease activity at the start and over time.


Overall the researchers concluded that patients with worse RA (that is, RA that had high activity) needed stronger therapy over time.


Patients with Early Rheumatoid Arthritis Determined to Be Inadequate Responders After 12 Weeks May Still Have Substantial Improvement in Core Set Measures. Results from an Early Arthritis Cohort

Pooneh S.Akhavan1, Vivian Bykerk2, Ye Sun3, Gilles Boire4, J. Carter Thorne5, Janet Pope6, Carol A. Hitchon7, Boulos Haraoui8, Diane S. Ferland9, Edward Keystone1 and CATCH Investigators10. 1University of Toronto, Toronto, ON; 2Brigham & Women’s Hospital, Boston, MA; 3Mount Sinai Hospital, Toronto, ON; 4CHUS - Sherbrooke University, Sherbrooke, QC; 5Southlake Regional Health Centre, Newmarket, ON; 6University of Western Ontario, London, ON; 7University of Manitoba, 8Institut de Rhumatologie, Montreal, QC; 9LaSalle, QC; 10Toronto, ON.

Doctors use standard tools to measure their RA patients' response to treatment and to help them decide whether or not to change treatments. These tools are the same ones used in clinical trials to see if patients are responding to treatment. The CATCH researchers wanted to see if the RA symptoms of patients who were not considered 'responders' to treatment still improved from when they were first diagnosed. The researchers studied 416 patients who were 'inadequate responders' to treatment based on high RA activity (measured by tender joint count, swollen joint count, and disease activity score). The researchers found a large number of patients who did not show improvement in measures of disease activity used in clinical trials can still show large improvement in their own disease measures. These findings should be considered when making treatment decisions in real world settings.

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What was the purpose of the study?
Doctors use certain standard tools to measure their RA patients' response to treatment and to help them decide whether or not to change treatments. These standard tools are called ACR criteria and EULAR criteria after the organizations that created them). These are the same measures used in clinical trials to see if patients are responding to treatment. The CATCH researchers wanted to see if the RA symptoms of patients who were not considered 'responders' according to these standard measures (that is, achieved DAS28 greater than 1.2 or ACR20) still improved from when they were first diagnosed.

How was the study done?
Patients were part of the study if they had been on DMARD therapy for 3 months and did not meet DAS28 greater than 0.6 or DAS28 greater than 1.2 or ACR20 (that means a 20% improvement in their RA symptoms), and they were checked for 20% or 30% improvement in disease activity (that is tender joint count, swollen joint count, Patient Global Assessment and Physician Global Assessment). These patients were an average age of 52.5 years old with RA for about 6 months.

What were the results of the study?
416 patients were in the study. The researchers used measures called the ACR20, 50, and 70 (which correspond to an improvement of 20%, 50% and 70% in RA symptoms, respectively) and the DAS28 (where a change of more than 1.2 is considered a significant improvement) to determine major improvements in RA. At 3 months, 47% of patients had not achieved ACR20 (a 20% improvement in their RA symptoms), 73% had not achieved ACR50 (a 50% improvement in their RA symptoms), and 84% had not achieved ACR70 (that is a 70% improvement in their RA symptoms). For the DAS28 scores, 50% of patients had DAS28 improvement less than 1.2 and 34% of patients' DAS28 improvement was less than 0.6 at 3 months. Of the patients with:
• DAS28 less than 0.6: about 30% still had 30% improvement in their tender joint count, swollen joint count, and patient global assessment and physician global assessment;
• DAS28 less than 1.2:  about 30-50% had about 30% improvement in their RA disease activity compared to where they began.


Of patients who did not achieve ACR20 (that is a 20% improvement in their RA symptoms), 20–41% of patients still had about 30% improvement of their RA. Due to many factors, the researchers concluded that even though many patients don't see a significant improvement in disease activity measures used for clinical trials, they many still see major improvement in their own disease activity. These findings should be considered when making treatment decisions in real world settings and to identify patients with an inadequate response so that their treatments can be changed.


Prevalence of Remission in Early RA—A Comparison of New Remission Criteria to Established Criteria

Bindee Kuriya1, Ye Sun2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, Janet E. Pope6, J. Carter Thorne7, Edward Keystone2, Diane S. Ferland8 and Vivian Bykerk9. 1University of Toronto, Toronto, ON; 2Mount Sinai Hospital, Toronto, ON; 3CHUS - Sherbrooke University, Sherbrooke, QC; 4Institut de Rhumatologie, Montreal, QC; 5University of Manitoba, Winnipeg, MB; 6St. Joseph’s Health Care, University of Western Ontario, London, ON; 7Newmarket, ON; 8LaSalle, QC; 9Brigham & Women’s Hospital, Boston, MA

The CATCH researchers wanted to see how using different definitions of remission for RA changed how many of the same patients were considered to be in remission. They looked at the medical records of 331 patients to see how many of them were in remission at 1 year based on 5 different remission definitions. The researchers found that at baseline, patients had moderate-to-high disease activity according to all scores, and by 1 year, 22-53% of patients were in remission by at least one or more definition. Since remission depends on the definition used, this could affect long-term outcomes, treatment choices and quality of care standards.

Read more

What is the purpose of the study?
The CATCH researchers wanted to see how using different definitions for RA remission changed how many of the same patients were considered to be in remission, and how the definitions agreed with each other.

How was the study done?
The CATCH researchers used the following five definitions of remission for patients at 1 year:
• DAS28 less than 2.6 - this is the disease activity score (DAS) value of less than 2.6, calculated by using tender joint count and swollen joint count, patient global assessment, C-reactive protein measure and erythrocyte sedimentation rate;
• DAS28 less than 2.0 - this is the disease activity score with a value of less than 2.0, and it is calculated the same way as above;
CDAI less than or equal to 2.8 - this is the clinical disease activity index score value which is calculated using tender joint count and swollen joint count and the patient global assessment and physician global assessment;
SDAI less than or equal to 3.3 - this is the simple disease activity index value, calculated using tender joint count and swollen joint count, patient global assessment and physician global assessments, and C-reactive protein measure;
• ACR/EULAR criteria - these are standard measures that require a tender joint count of at least 1 plus, swollen joint count of at least 1, plus C-reactive protein less than or equal to 1 mg/dL and patient global assessment less than or equal to 1 on a 0–10 cm visual analog scale (also called the Patient-VAS).
The researchers used statistics to understand agreement between the different definitions of remission.

What were the results of the study?
245 patients were in the study. At baseline, the patients all had moderate-to-high disease activity according to all scores, most were positive for 2 markers in their blood that often indicate RA (there were 63% positive for Rheumatoid Factor and 83% were positive for anti-cyclic citrullinated peptide) and most were on three DMARDs (also called triple therapy). By 1 year, 22-53% of patients were considered to be in remission by one or more definition. For the DAS28-based definitions, patients had higher tender joint counts, swollen joint counts, Patient-Visual Analogue Scale and Physician-Visual Analogue Scale. For all definitions, about the same number of patients was on biologic (6–10%).

In conclusion, remission was measured less frequently by using the strict ACR/EULAR criteria and there was poor agreement between these and the other definitions that used the disease activity score (DAS). Depending on the remission definition used, patients may or may not be considered to be in remission. This affects long-term outcomes, choice of therapy and quality of care standards.


Response to Second-Line DMARDs and TNFi in Seropositive and Seronegative Patients in Early and Late Rheumatoid Arthritis Are Not the Same: Results From the CATCH Cohort and a Large, Established Rheumatoid Arthritis Database

Yang Cao1, Ashley Bonner2, Lillian J. Barra3, J. Carter Thorne4, Boulos Haraoui5, Gilles Boire6, Carol A. Hitchon7, Nicole G. H. Le Riche8, Andrew E. Thompson9, Edward Keystone10, Vivian Bykerk11, Janet E. Pope12 and CATCH Investigators13. 1University of Western Ontario, London, ON; 2McMaster University, Hamilton, ON; 3Schulich School of Medicine and Dentistry, London, ON; 4Southlake Regional Health Centre, Newmarket, ON; 5Institut de Rhumatologie, Montreal, QC; 6CHUS - Sherbrooke University, Sherbrooke, QC; 7University of Manitoba, Winnipeg, MB; 8St. Joseph’s Hospital, London, ON; 9St. Josephs Health Centre, London, ON; 10University of Toronto, Toronto, ON; 11Brigham & Women’s Hospital, Boston, MA; 12St. Joseph’s Health Care, University of Western Ontario, London, ON; 13Toronto, ON

The CATCH investigators wanted to see why seropositive and seronegative patients with early or long-term (also called established) RA have differences in how they respond to medications called second-line disease-modifying anti-rheumatic drugs (DMARDs) and biologics (called Tumour Necrosis Factor inhibitor or TNFi). Second line DMARDs are DMARDs that patients try after they have already tried others and not responded to them. Seropositive patients have 2 blood markers that seronegative patients do not called Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP)) Patients with established RA who were RF positive may be more responsive to TNFi therapy shown by improvements in health assessment questionnaire-disability index (HAQ-DI) and pain scores. Initial results show that for patients with established RA who have failed DMARDs, biologics may not work well in patients who are RF negative, and TNFi therapy may work better for anti-CCP negative patients. These results need to be confirmed.

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What was the purpose of the study?
The CATCH investigators wanted to see why seropositive and seronegative patients with early or long-term (also called established) RA have differences in how they respond to medications called second-line disease-modifying anti-rheumatic drugs (DMARDs) and biologics (called Tumour Necrosis Factor inhibitor or TNFi). Second line DMARDs are DMARDs that patients go on after they have already tried others and not responded to them. Seropositive patients have 2 blood markers that seronegative patients do not called Rheumatoid Factor (RF) and anti-CItrullinated Cyclic Peptide (anti-CCP).

How was the study done?
Patients with early RA who did not respond to a DMARD and were put on another DMARD were included in the study while those on DMARDs before starting CATCH were excluded. The number of patients who responded to DMARD or biologic therapy (measured by disease activity score of less than 2.6) was compared to RF status and anti-CCP status. For patients with established RA who were on a TNFi, their response to medication was also compared to RF status and health assessment questionnaire-disability index (HAQ-DI) and pain score change.

What were the results of the study?
For the patients with early RA:
• No difference was found in second-line DMARD response between RF positive and RF negatives patients or anti-CCP positive and anti-CCP negative patients;
• After starting a biologic, anti-CCP negative patients responded well as shown by the DAS score being less than 2.6 (64% versus 34%);
• Changes in health assessment questionnaire (HAQ) scores were not different after DMARD or TNFi therapy when looking at RF and CCP status.


For the patients with established RA:
• Their average HAQ-DI change in a year was greater in RF positive patients compared to RF negative patients;
• Their average pain score change was greater in RF positive patients compared to RF negative patients.

The researchers found that RF positive patients with established disease may be more responsive to TNFi therapy because they had greater changes in their HAQ and pain scores. In patients with established RA who failed DMARDs, those who are RF negative do not respond well to any biologic medication. Patients with early RA and who were anti-CCP negative seem to respond better to TNFi therapy. More studies are needed to confirm these findings.


Trajectory of Anti-Cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor Over Time Does Not Predict Disease Activity in the Canadian Early Arthritis Cohort

Lillian J. Barra1, V. Bykerk2, Janet Pope3, Ye Sun4, Boulos Haraoui5, Carol A. Hitchon6, Diane S. Ferland7, J. Carter Thorne8, Edward Keystone4 and Gilles Boire9. 1University of Western Ontario, London, ON; 2Brigham & Women’s Hospital, Boston, MA; 3University of Western Ontario, London, ON; 4Mount Sinai Hospital, Toronto, ON; 5Institut de Rhumatologie, Montreal, QC; 6University of Manitoba, Winnipeg, MB; 7LaSalle, QC; 8Southlake Regional Health Centre, Newmarket, ON; 9CHUS - Sherbrooke University, Sherbrooke, QC.

The researchers wanted to see if two markers that are measured in blood of people with rheumatoid arthritis (RA) stayed the same over time and could be used to predict RA outcomes such as RA activity, swollen joints, and others. The two markers are called Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP). The researchers looked at the levels of anti-CCP in 361 people and RF in 340 people when they were diagnosed and about 21 months later. Like other studies showed, the researchers found that RF changed more than anti-CCP did and neither predicted a person's RA over time.

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What was the purpose of the study?
The researchers wanted to see if two markers that are measured in blood of people with rheumatoid arthritis (RA) stayed the same over time and could be used to predict RA outcomes such as RA activity, swollen joints, etc.. The two markers measured in blood are called Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP). Other researchers have found that RA tends to be worse for people who test positive for both RF and anti-CCP.

How was the study done?
From the CATCH study, medical records were looked at if patients:

  • Were over 16 years of age with symptoms lasting from 6 weeks up to 12 months;
  • Had more than 2 swollen joints or more than 1 swollen small joint of the hand; and,
  • Had more than 1 of: positive RF, positive anti-CCP, morning stiffness that lasted more than 45 minutes, good response to anti-inflammatory medications that were not steroids or positive hand squeeze test.

Patients had measurements of anti-CCP and RF values taken at baseline (that is when they were diagnosed) and at least one other appointment.

What were the results of the study?
There were 361 patients who had anti-CCP values at baseline and at least one follow up visit (average 21 months later) and 340 patients with RF values. The researchers found that, at the beginning of the study:

  • 55% of patients were anti-CCP positive and 9% became anti-CCP negative by their next visit
  • 24% of anti-CCP negative patients became anti-CCP positive by their next visit
  • 58% of patients were RF positive at the beginning of the study and 20% became RF negative by their next visit
  • 13% of RF negative patients became RF positive after about 15.6 months.

Patients who were RF and/or anti-CCP positive at the beginning did not have worse RA outcomes at their next visit and changes in anti-CCP or RF over time did not predict their RA disease course, which was measured by joint damage, disease activity score or remission.

The researchers found that patients with early RA who were anti-CCP positive at the start tended to stay that way. A large number of patients who were first anti-CCP negative became anti-CCP positive later. The researchers also found that RF changes more over time and can change from positive to negative and vice versa. Patterns of anti-CCP and RF over time do not seem to be able to predict a patient's RA outcomes. The results found here are the same as those from other studies.


Validation of the 2010 Criteria to Diagnose RA in a Canadian Multicenter Cohort Of Patients with New Onset Inflammatory Arthritis

Vivian Bykerk1, Boulos Haraoui2, Gilles Boire3, Carol Hitchon4, Edward Keystone5, Carter Thorne6, Diane Ferland7, Janet Pope8, CATCH Investigators of Canada9. 1Mount Sinai Hospital, Jamaica Plain; 2University of Montreal, Montreal; 3Université de Sherbrooke, Sherbrooke; 4University of Manitoba, Winnipeg; 5Mount Sinai Hospital, Toronto; 6Southlake Regional Health Care, The Arthritis Program, Newmarket; 7Hôpital Maissonneuve Rosemont, Montreal; 8University of Western Ontario, London; 9Multiple sites across Canada.

The CATCH investigators wanted to see how many patients with early inflammatory arthritis (EIA) would be considered to have rheumatoid arthritis (RA) using special criteria to define a diagnosis of RA called the new criteria and if they would meet qualifications to be in clinical trials. These clinical trial criteria have not been used before in a study of EIA or to identify EIA patients for clinical trials. 648 patients were included in this study because they had either received no medications yet for their EIA or only a few weeks of disease-modifying anti-rheumatic drug (DMARD) treatment. Of these patients, 68% were diagnosed with RA by using the old criteria while 31% of patients had what was considered to be undifferentiated inflammatory arthritis (UIA). 87% of those considered to have RA by the old criteria were also considered to have RA by the new criteria, and of the 31% with UIA, 66% of these were now considered to have RA based on the new criteria. Using RA activity scores and the new RA criteria, many patients who had UIA by the old criteria were now considered to have RA, and most of these patients could participate in clinical trials. Most patients who met the old criteria for having RA fulfilled the new criteria for RA.

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What was the purpose of the study?
The CATCH investigators wanted to see how many patients with early inflammatory arthritis (EIA) were considered to have RA with special criteria to classify RA called the 2010 ACR/EULAR criteria or 2010 criteria and if they would meet qualifications to be in clinical trials. These clinical trial criteria have not been used before in a study of EIA or to identify EIA patients for clinical trials.

How was the study done?
648 CATCH patients were included in the study because they received no treatment or only a few weeks of disease modifying anti-rheumatic drugs (DMARDs) for their EIA. RA activity was measured and patients with a disease activity score (DAS28) greater than or equal to 3.2 made patients eligible for a clinical trial for early RA patients.

What were the results of the study?
At baseline, patients were average 52 years old, 73% female, with symptoms for 5.5 months. Of the 648 patients in the study, 68% met the old criteria also called the 1987 ACR criteria for being considered to have RA and 31% were considered to have undifferentiated inflammatory arthritis (UIA). Of those patients who had RA based on the old criteria, 87% also had RA based on the new criteria also called the 2010 ACR/EULAR critieria. Of the patients with UIA based on the old criteria, 66% of these patients were now considered to have RA using the new criteria.

The researchers concluded that using the new RA criteria to define whether or not a patient has RA, many patients who had UIA by the old criteria were now considered to have RA and most of these patients would be eligible for clinical trials based on RA activity scores. Most patients who met the 1987 ACR criteria for having RA were also considered to have RA by using the 2010 criteria.