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.


An Evaluation Of Flare In Patients With Early Rheumatoid Arthritis Using The OMERACT Preliminary Flare Questionnaire

V.P. Bykerk1, S.J. Bartlett2, E. Choy3, G. Boire4, C. Hitchon5, J. Pope6, C. Thorne7, B. Haraoui8, E. Keystone1, C.O. Bingham III9, on behalf of Omeract RA Flare Group and CATCH. 1University of Toronto, Toronto; 2McGill Univeristy, Montreal; 3Cardiff University, Cardiff, United Kingdom; 4University of Sherbrooke, Sherbrooke; 5Univeristy of Manitoba, Winnipeg; 6University of Western Ontario, London; 7Southlake Regional Health Center, Newmarket; 8Institute de Rheumatologie, Montreal; 9Johns Hopkins University, Baltimore, United States

The CATCH researchers wanted to learn more about flares in patients with early rheumatoid arthritis (ERA) and what terms are important to patients to describe their flares. Patients answered flare questionnaires at their rheumatology visits and rheumatologists were also asked if their patients were in a flare. Overall, patients in a flare mostly tried to manage the flare themselves before asking their rheumatologist for help. Rheumatologists and patients did not often agree that patients were having a flare, but did agree most when patients were not doing well with their RA by reporting high levels of pain, stiffness, and fatigue, and difficulty with daily functions, coping and participation in activities.

Read more

What was the purpose of the study?
The CATCH researchers wanted to learn more about flares in patients with early rheumatoid arthritis (ERA) and what terms are important to patients to describe their flares.

How was the study done?
Patients answered the Preliminary Flare Questionnaire (PFQ) at rheumatology visits that asks patients: if they are in a flare or not; flare severity; to answer the patient global assessment (also called the PGA); about levels of function, fatigue, pain, stiffness, coping, participation; and, to describe self-management strategies. Self-management strategies are things that patients do on their own to deal with the flare. At each visit rheumatologists rated if they felt their patient was in a flare.

What were the results of the study?
Of 263 patients answering the PFQ, 30% reported being in a flare and 70% not in a flare. Patients who reported a flare were:

  • on average, 52 years old;
  • 77% female;
  • 68% rheumatoid factor positive (this is a blood marker that is often present in people with RA, but not always); and,
  • having RA symptoms for between 4 to 48 months.

The percentages of patients that had flares ranging over many days, could be broken down in to the following:

  • 15% had flares lasting 1-3 days;
  • 20% had flares lasting 4-7 days;
  • 12% had flares lasting 8-14 days; and,
  • 53% had flares lasting more than 14 days.

Generally, doctors and patients did not agree when patients were in a flare, but were more likely to agree when patients weren't doing well with their RA and said they had more pain, stiffness and fatigue; and, more difficulty coping, participating in activities, and with daily functions. Only 5% of flare patients asked their rheumatologist for help, while 3% of patients increased the steroid doses they were taking, 58% of patients used painkillers, and 48% of patients reduced activities. Most patients did more than one of these things to try to help them cope with their flare.

The researchers concluded that flares are common in ERA and overall agreement on flares between patients and rheumatologists was low. These results are similar to other studies that have seen large differences in symptoms reported by patients when defining a flare. The findings show that patients try many approaches to treat flares before they ask their doctor for help.

Read the papers on this work here and here.


Can We Improve Outcomes in Early Rheumatoid Arthritis by Determining Best Practices? An Analysis of the Canadian Early Rheumatoid Arthritis Cohort (CATCH)

Jamie Harris1, Vivian P. Bykerk2, Carol A. Hitchon3, Edward Keystone4, J. Carter Thorne5, Gilles Boire6, Boulos Haraoui7, Glen S. Hazlewood4, Ashley Bonner8, Janet E. Pope9 and CATCH Investigators10. 1Western University, London, ON; 2Hospital for Special Surgery, New York, NY; 3University of Manitoba, Winnipeg, MB; 4University of Toronto, Toronto, ON; 5Southlake Regional Health Centre, Newmarket, ON; 6CHUS - Sherbrooke University, Sherbrooke, QC; 7Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 8McMaster University, Hamilton, ON; 9Western University of Canada, St. Joseph’ s Health Care, London, ON; 10Toronto, ON.

The CATCH researchers wanted to see if there were differences in where patients are treated, and if this affects early rheumatoid arthritis (ERA) outcomes. They compared the sites of where patients were treated by clinic size and differences in how doctors treat their patients. Sites from the CATCH database that had more than 40 patients at 6 months were part of the study. Patient data was used to calculate remission (very low disease activity) with different definitions and to see treatment and treatment changes. Most of the patients in the study were female of average age of 52, about half smoked (currently or in the past), they had RA for an average of 6 months, and in terms of blood markers that many RA patients have, 33% were anti-cyclic citrillunated peptide positive and 51% were rheumatoid factor positive. The size of the clinic where patients were treated was a factor in their disease outcome, and the fastest and best indicator for low disease activity score or remission was when patients started their treatment with a combination of disease modifying anti-rheumatic drugs (DMARDs).

Read more

What was the purpose of the study?
The goal of early rheumatoid arthritis (ERA) treatment is remission (when RA activity is very low) but many patients do not achieve this for many reasons, which may include how physicians have different styles in how they treat patients. The CATCH researchers wanted to see if differences in where patients are treated (also called a site) affect patient outcomes. They compared clinics by size and any differences in how doctors treat patients.

How was the study done?
Sites in the CATCH study that had more than 40 patients at 6 months were included. Patient data was used to calculate remission and to determine treatment and treatment changes. Statistics were used to make sure results were real.

What were the results of the study?
Of the 1138 patients at the start of the study (also called baseline), 798 patients had data at 6 months and 640 patients had data at 12 months. At baseline, patients were mostly female, an average age of 52 years, and 54% were current or smokers in the past. Additionally 33% were anti-cyclic citrullinated peptide positive (anti-CCP) and 51% were rheumatoid factor positive (RF), 23% had joint damage, and 6 months was the average RA duration. The site where patients are treated is an important predictor for changes in disease activity score (DAS28), increase in DAS28, and remission. The two largest sites had the biggest changes in disease activity score at 6 and 12 months. The fastest and best indicator for low disease activity score or remission was when patients started treatment with a combination of disease modifying anti-rheumatic drugs (DMARDs). At 1 year the best indicator of low disease activity score of remission was if patients were treated with a combination of DMARDs at the beginning or started on methotrexate by injection with a weekly dose of 20 – 25 mg.


DAS Does Not Predict Increasing Treatment in Early Rheumatoid Arthritis: Results From the CATCH Study

Lonnie Pyne1, Vivian P. Bykerk2, Carol A. Hitchon3, Edward Keystone4, J. Carter Thorne5, Boulos Haraoui6, Ashley Bonner7, Janet E. Pope8 and CATCH Investigators9. 1Western University, London, ON; 2Hospital for Special Surgery, New York, NY; 3University of Manitoba, Winnipeg, MB; 4University of Toronto, Toronto, ON; 5Southlake Regional Health Centre, Newmarket, ON; 6Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 7McMaster University, Hamilton, ON; 8Western University of Canada, St. Joseph’s Health Care, London, ON; 9Toronto, ON.

The CATCH investigators wanted to see which factors are related to increased treatment of early rheumatoid arthritis (ERA) at 3 months and 6 months after diagnosis. A tool called the disease activity score (DAS) gives doctors a number score that can help guide RA treatment and the researchers wanted to see how it was used in treating ERA patients. Patients were in the study if they had medical record data at their baseline and at least 2 other visits. Of the 790 patients in the study, most of them were female, around 53 years old, and had RA for about 6 months. Overall the researchers found that the Physician Global Assessment (a scale where the doctor determines the patient's level of pain due to RA) was most closely related to increasing patient therapy in the first 6 months of ERA, while few doctors said that the DAS was the main reason for intensifying ERA treatment.

Read more

What was the purpose of the study?
The CATCH investigators wanted to see which factors are most related to increased therapy in early rheumatoid arthritis (ERA) at 3 months and 6 months after diagnosis. A tool called the disease activity score (DAS28) provides doctors with a number score that helps guide RA therapy and the researchers were interested to see how it was used in treating ERA patients.

How was the study done?
Patients were included in the study if they had medical record data at their baseline and at least 2 other visits (between baseline and 6 months), and statistics were used to make sure that findings were real.

What were the results of the study?
Of the 790 patients who were in the study, they were an average age of 53.4 years; had RA for an average of about 6 months; were 75% female; and, their baseline DAS28 was 4.7 while at 6 months it was 2.9. The decrease in the average DAS28 score over 6 months shows that these patients' RA disease activity decreased considerably over that time.

The MD Global (a tool where the doctor determines a patient's level of pain due to their RA) and swollen joint counts were most related to doctors increasing treatment at 3 months and 6 months, while the DAS was not strongly associated with increasing treatment. Doctors said the DAS was not a big factor for them making treatment changes, while they used swollen joint count, tender joint count, and MD Global more in their decisions. If large joints were more active in patients, doctors were also more likely to increase treatments.


Discrepancy Between Patient and Physician Global Assessments Over Time in Early Rheumatoid Arthritis

Pooneh Akhavan1, Vivian P. Bykerk2, Juan Xiong3, Janet Pope4, Boulos Haraoui5, J. Carter Thorne6, Gilles Boire7, Carol A. Hitchon8, Diane Tin6, E. Keystone3 and CATCH9. 1University of Toronto, Toronto, ON; 2Hospital for Special Surgery, New York, NY; 3Mount Sinai Hospital, Toronto, ON; 4Schulich School of Medicine and Dentistry, Western University, London, ON; 5Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 6Southlake Regional Health Centre, Newmarket, ON; 7CHUS - Sherbrooke University, Sherbrooke, QC; 8University of Manitoba, Winnipeg, MB; 9Toronto, ON.

The researchers wanted to see if the differences seen in patient self-assessment and physician assessment at the beginning of the study change after one year in patients with early rheumatoid arthritis (ERA). Patients answered standard questionnaires called the Patient Global Assessment (PGA) and the physician standard questionnaire was called the Physician Global Assessment (MDGA). These questionnaires measure physical ability and pain and each have a total score of 100 points. To be in this study, patients had to be on disease modifying anti-rheumatic drugs (DMARDs) at baseline but not biologics, and have information in their medical records available at their 1 year visit (of their diagnosis). The PGA and MDGA difference was found by subtracting the score of the MDGA from PGA at baseline, and was found to decrease over time but the pattern in how they these scores disagreed remained the same. This means that with time, patients and doctors agreed more about how well a patient was doing overall, but they still disagreed overall about what factors affected patients the most. Pain and swollen joint count greatly influence PGA-MDGA difference at baseline and at one year even when RA is better controlled. Though other studies have emphasized the pain score as a major factor affecting the PGA-MDGA difference, this study also showed that swollen joint count plays a big role.

Read more

What is the purpose of the study?
The purpose of this study is to see if the differences in patient self-assessment and physician assessment at the beginning of the study change after one year in patients with early rheumatoid arthritis (ERA). These differences can affect treatment decisions. Patients answered standard questionnaires called the Patient Global Assessment (PGA) and the physicians answered standard questionnaires called the Physician Global Assessment (MDGA). These questionnaires measure items like physical ability and pain, and each has a total score of 100 points.

How was the study done?
Patients had to be on disease modifying anti-rheumatic drugs (DMARDs) at baseline, never taken a biologic and have data in their medical records at their 1 year visit. MDGA was subtracted from PGA to get the difference score.

What were the results of the study?
There were 480 RA patients in the study who at were: 74% female, average age 54, and had RA for about 6 months. At baseline, they had an average of:

At baseline the biggest predictors of PGA-MDGA differences were: pain, swollen joint count; tender joint count, ESR, and, clinic where patients were treated. At one year the biggest differences in PGA and MGDA scores were due to: pain, swollen joint count, tender joint count, age, and, clinic. At baseline PGA was very related to pain, the health assessment questionnaire (also called HAQ), swollen joint count, age, and, site. However at 1 year, PGA scores were only very influenced by pain and site. Baseline factors associated with MDGA were swollen joint count, tender joint count, pain, ESR, HAQ, and, site. At 1 year ESR and HAQ were not longer significant factors in the MDGA score.

In ERA, PGA-MDGA differences decrease with time but the pattern remains the same. This means that with time, patients and doctors agreed more about how well a patient was doing overall, but they still disagreed on factors that contributed to these scores. Pain and swollen joint count affect PGA-MDGA difference that continued at 1 year when RA is better controlled. This study showed that along with pain score, swollen joint count also plays a big role in affecting the PGA-MDGA difference.


Disease Activity and Anti-CCP Status, but Not Sociodemographic Factors or Patient Comorbidities, Affect Time to Diagnosis in Early Rheumatoid Arthritis

Cheryl Barnabe1, Juan Xiong2, Gilles Boire3, Carol A. Hitchon4, Boulos Haraoui5, Janet E. Pope6, J. Carter Thorne7, Edward Keystone8, Diane Tin7, Vivian P. Bykerk9 and Canadian ArThritis CoHort10. 1University of Calgary, Calgary, AB; 2University of Toronto, Toronto, ON; 3CHUS-Sherbrooke University, Sherbrooke, QC; 4University of Manitoba, Winnipeg, MB; 5Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 6St. Joseph’s Health Care London, London, ON; 7Southlake Regional Health Centre, Newmarket, ON; 8University of Toronto, Toronto, ON; 9Hospital for Special Surgery, New York, NY; 10Toronto.

The CATCH researchers wondered if getting an RA diagnosis is affected by the severity of person's RA, having a family history of RA, sociodemographic factors (for example, age, sex, socioeconomic status, education, ethnicity), or other illnesses that can influence physical exams. Other illnesses are called comorbidities and can be obesity, mental health, and other musculoskeletal pain conditions. On average, patients had symptoms for about 6 months before they saw a rheumatologist. The researchers found out that patients saw a rheumatologist sooner if they had a higher number of swollen joint counts, higher erythrocyte sedimentation rates (which means more inflammation), worse patient global scores (more difficulty with everyday activities and more pain), and were negative for anti-cyclic citrullinated peptide (anti-CCP). More studies should be done on why it takes some patients longer to be diagnosed with RA since it was found that those who did had fewer swollen joints and normal blood test results.

Read more

What was the purpose of the study?
The CATCH researchers wondered if getting a diagnosis of RA is affected by a person's RA severity, having a family history of RA, sociodemographic factors (for example, age, sex, socioeconomic status, education, ethnicity), or other illnesses that may influence physical exams. These other illnesses are called comorbidities, and can be obesity, mental health, and other musculoskeletal pain conditions. Getting a diagnosis quickly is extremely important because the sooner treatment starts the odds of joint damage and entering remission are affected.

How was the study done?
The researchers looked at the medical records of 1,151 patients in the CATCH study. The researchers looked to see if factors affected time to diagnosis such as sex, age, ethnicity, body mass index, disease activity score (DAS28), swollen joint count, tender joint count, health assessment questionnaire (HAQ) score, patient global score (pain due to RA), inflammation markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)), blood markers (rheumatoid factor (RF), anti-cyclic citrillunated peptide (anti-CCP)), education, income, mental health, family history of RA, and other illnesses such as fibromyalgia or osteoarthritis.

What were the results of the study?
On average, at the baseline rheumatology visit patients had RA symptoms for 6 months. Patients who had a shorter time to RA diagnosis had a higher number of swollen joints, higher ESR (that is, more inflammation), worse patient global scores, and were often negative for anti-CCP. Patients who took longer to get an RA diagnosis had fewer swollen joints and normal laboratory blood test results. More studies are required to understand these factors and why they affect time to get a diagnosis.


Effects of Stress On Clinical Presentation of Patients with Early Rheumatoid Arthritis

Yun A. Kim1, Jane E. Salmon2, Juan Xiong3, Boulos Haraoui4, Carol A. Hitchon5, Edward Keystone6, Janet Pope7, Diane Tin8, J. Carter Thorne8, Gilles Boire9, Vivian P. Bykerk2 and CATCH10. 1Hospital for Special Surgery (and Kwangju Christian Hospital, Gwangju, Korea), New York, NY; 2Hospital for Special Surgery, New York, NY; 3Mount Sinai Hospital, Toronto, ON; 4Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 5University of Manitoba, Winnipeg, MB; 6University of Toronto, Toronto, ON; 7Schulich School of Medicine and Dentistry, Western University, London, ON; 8Southlake Regional Health Centre, Newmarket, ON; 9CHUS - Sherbrooke University, Sherbrooke, QC; 10Toronto.

The CATCH researchers wanted to study early rheumatoid arthritis (ERA) patient-reported outcomes (PROs) within a year of the patients' first rheumatology visit. A patient-reported outcome is one that a patient answers about their RA and could be something like how much stress they feel. The researchers looked at psychological and physical stress of 951 patients who answered a stress and life events survey. More patients who said they had psychological stress were female, living alone, employed and felt fatigue. Patients who said they had physical stress were female, older, and had a higher health assessment questionnaire (HAQ) score and other illnesses. Factors like how long symptoms have been experienced, morning stiffness, smoking, race, education, income and marital status were not associated with stress. Patients who said they were feeling stressed also felt they had more pain, fatigue and difficulty with everyday tasks at baseline, 6 and 12 months. Stress may be important to consider when looking at PROs in long-term studies of RA.

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What was the purpose of the study?
Stress is related to the development and course of RA. The CATCH researchers wanted to see the role of early RA (ERA) patient-reported outcomes (PROs) within a year of the patients' first rheumatology visit. PROs are ones that a patient answers about their RA and could include the level of stress they feel.

How was the study done?
The study looked at psychological and physical stress of 951 patients who answered a stress and life events survey. Psychological stress included death of family member, divorce, separation, and family and financial stress. Physical stress could be a car accident, surgery, major illness and infection. Differences in baseline characteristics and PROs in patients at 6 months and 1 year reporting stress or no stress were compared.

What were the results of the study?
Patients were mostly Caucasian (83%) and female (73%), average age of 54 years, had RA symptoms for about 6 months, and 18% were smokers. More patients who said they had psychological stress were female, living alone, employed and felt fatigue. Patients saying they had physical stress were female, older, and had a higher health assessment questionnaire (HAQ) score and more other illnesses. Factors like how long someone was experiencing symptoms, morning stiffness, smoking, race, education, income and marital status were not associated with stress. Patients who said they had stress also said they felt more pain, fatigue and and had more difficulty with everyday tasks at 0, 6 and 12 months. In patients who said they had stress, these items all improved at about the same level in both stress and non-stress groups.

Both physical and psychological stress in ERA patients negatively affects PROs. Stress may be important to consider when assessing PROs in long-term RA studies, and further studies should also be done since patients' self-reporting of stress may be affected by their ability to remember accurately.


Evaluation of Parenteral Methotrexate as a First-line Treatment in Early RA: A Nested Case Control Study from a Nationwide Cohort

David Rowe1, Carter Thorne2, Janet Pope3, Vivian Bykerk4, CATCH Scientific Advisory Committee5. 1University of Toronto, Newmarket; 2Southlake Regional Health Care, The Arthritis Program, Newmarket; 3University of Western Ontario, London; 4Mount Sinai Hospital, Toronto; 5Canadian Arthritis Cohort, Toronto.

The CATCH researchers wanted to see if patients with early rheumatoid arthritis (ERA) who took methotrexate by injection (also called parenteral methotrexate) did better than patients who took methotrexate in pills. The CATCH researchers looked at how many patients were in remission or had low RA activity. They also looked to see how many patients were taking 1 drug only, a combination of disease modifying anti-rheumatic drugs (DMARDs), or a biologic. The researchers found at:

  • 6 months, 55% of the patients injecting methotrexate were in remission and 71% were in a low disease activity state; and,
  • 12 months, 77% of the patients injecting methotrexate were in remission and 84% were in a low disease activity state.

The researchers found that injecting methotrexate by patients with ERA is an effective first treatment.

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What was the purpose of the study?
It is thought that in the first year after diagnosis, patients with early rheumatoid arthritis (ERA) who take methotrexate by injection are more likely to reach remission than those who take methotrexate in a pill. So the CATCH researchers wanted to compare these two groups of patients.

How was the study done?
At one clinic, the researchers looked at ERA patients who were taking more than 20 mg of methotrexate per week within 3 months of starting it and compared patients who were taking methotrexate by injection and pills. At 6 months and 12 months, the two groups of patients were compared to see how many were in remission or had low disease activity, and whether they were only taking 1 drug (called monotherapy), a combination of disease modifying anti-rheumatic drugs (DMARDs), or a biologic.

What were the results of the study?
There were 69 patients taking methotrexate by injection and of these, 62 had data available at 6 months and 56 had data at 1 year, and these were compared against 138 patients taking methotrexate pills. At 6 months, 55% of the patients taking methotrexate by injection were in remission and 71% were in a low disease activity state, while at 12 months, 77% were in remission and 84% were in a low disease activity state. In ERA patients, the researchers found that methotrexate taken by injection is an effective first treatment.


Flare Self-Management Strategies Used by Patients with Rheumatoid Arthritis

Susan J. Bartlett1, Clifton O. Bingham III2, Juan Xiong3, Ernest Choy4, Gilles Boire5, Carol A. Hitchon6, Janet E. Pope7, J. Carter Thorne8, Diane Tin8, Boulos Haraoui9, E. Keystone10, Vivian P. Bykerk11, OMERACT Flare Working Group12 and CATCH13. 1McGill University, Montreal, QC; 2Johns Hopkins University, Baltimore, MD; 3Mount Sinai Hospital, Toronto, ON; 4Cardiff University School of Medicine, Cardiff, United Kingdom; 5CHUS – Sherbrooke University, Sherbrooke, QC; 6University of Manitoba, Winnipeg, MB; 7Western University of Canada, St. Joseph’s Health Care, London, ON; 8Southlake Regional Health Centre, Newmarket, ON; 9Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 10University of Toronto, Toronto, ON; 11Hospital for Special Surgery, New York, NY; 12Ottawa, 13Toronto, ON

The CATCH researchers wanted to learn more about how patients find ways to cope when they have an RA flare. A flare is a time when a person's RA is very active. Most patients know when they are flaring and their rheumatologists agree. Patients reported many ways to manage their flares by themselves including taking more pain killers and decreasing activities. Patient and doctor agreement about being in a flare, being female and having greater disability were predictors of patients trying to manage their flares by themselves. Few patients experiencing a flare in this group asked healthcare providers for help before their next rheumatology visit.

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What was the purpose of the study?
The CATCH researchers wanted to learn more about how patients find their own ways to cope when they have an RA flare. Flares are times when a person's RA is very active. They also wanted to see if they could find predictors of ways patients manage their flares by themselves.

How was the study done?
512 early arthritis patients were eligible for the study and answered the OMERACT preliminary flare questionnaire (PFQ). The PFQ is a standard survey to measure flares that was created by a group called OMERACT, an acronym which stands for Outcome Measures in Rheumatology. Patients in a flare provided ratings of flare severity, pain, disability by answering a questionnaire called the HAQ, and shared how they were managing their flares. Rheumatologists were also asked whether their patient was in a flare and took joint counts to see if these joints were swollen or painful to the touch. Patient and rheumatologist answers were compared.

What were the results of the study?
Participants were mostly female, an average age of 53 years old, Caucasian, had more than a high school education, 18% smoked, 65% were rheumatoid factor positive, 53% were anti-cyclic citrillunated peptide positive, and about 25% of them had joint damage. 149 patients said they were flaring while doctors said 169 of their patients were flaring, and they agreed about flare status 72% of the time. Women smokers who were rheumatoid factor and anti-cyclic citrullinated peptide positive, of a minority, lived alone and completed less than a high school education were more likely to be considered in a flare.

Just over half the patients took more painkillers to manage their flares (51%), only about 5% took more steroids, and about one third of them tried to manage without medication. When patients and doctors agreed on flare, most patients (87%) tried to manage their flare, decreased their activities, and ask their healthcare team for help (though overall few did ask for help at all). When patients but not doctors identified flare, 65% used their own coping strategies. Overall, predictors of patients trying to manage their flares on their own included patient and doctor agreement about a flare, being female, and having more disability.


Patient Self-Assessments and Selected Patient Reported Outcomes May Reliably Identify Rheumatoid Disease Flare in Early Rheumatoid Arthritis Patients

Vivian P. Bykerk1, CO Bingham III2, Ernest Choy3, Juan Xiong4, Gilles Boire5, Carol A. Hitchon6, Janet E. Pope7, J. Carter Thorne8, Boulos Haraoui9, Edward Keystone10 and Susan J. Bartlett11. 1Hospital for Special Surgery, New York, NY; 2Johns Hopkins University, Baltimore, MD; 3Cardiff University School of Medicine, Cardiff, United Kingdom; 4Mount Sinai Hospital, Toronto, ON; 5CHUS-Sherbrooke University, Sherbrooke, QC; 6University of Manitoba, Winnipeg, MB; 7Western University of Canada, St. Joseph’s Health Care, London, ON; 8Southlake Regional Health Centre, Newmarket, ON; 9Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 10University of Toronto, Toronto, ON; 11McGill University, Montreal, QC.

The CATCH researchers wanted to see how much patients and their rheumatologists agree about flares. Patients answered a standard flare questionnaire, including if they were in a flare and rated things such as pain, stiffness, function, and tender joints and swollen joints. On the other hand, rheumatologists rated if they felt their patients were in a flare and measured tender and swollen joints. 149 out of 512 patients said they were in a flare and physicians agreed with 72% of these 149 patients. Some measures like tender and swollen joints were higher in patients who said they were flaring compared to those who were not, and highest when patients and physicians agreed about a flare. As you might expect, patients in a flare did have worse measures of disease activity (that means that their RA was more active). More research is needed to see if the researchers can figure out why patients and physicians agree and disagree in flare assessment, and if researchers can predict what those factors are.

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What was the purpose of the study?
RA symptoms getting worse or being in a flare may predict worse outcomes or the need to change a patient's treatment, however there is little agreement on how to identify a flare. The CATCH researchers wanted to look at how much agreement there is between patients and their rheumatologists about flares.

How was the study done?
Patients answered a standard flare questionnaire called the preliminary flare questionnaire (PFQ) created by a group called OMERACT. They answered questions about if they were in a flare and rated items such as pain, stiffness, function, tender joints and swollen joints. Rheumatologists were asked if patients were in a flare and measured tender and swollen joints.

What were the results of the study?
149 out of 512 patients said they were in a flare, and physicians agreed with 72% of those 149 patients. Certain measures of RA activity such as disease activity score (also called DAS28) and clinical disease activity index (also called CDAI) provided scores that were higher in patients who were flaring compared to patients who were not. Patient-reported outcomes (PROs) such as pain, function, stiffness, coping, participation, and fatigue were very different between patients reporting flare compared to those not reporting flare. These PROs were the same the most when patients and physicians agreed about a flare. Patients in a flare also reported more RA activity and higher numbers of tender and swollen joints than physicians. More research is needed to understand what factors cause patients and physicians to disagree and agree on flares.


Patterns of Use and Predictors of Initial Disease-Modifying Anti-Rheumatic Drug Therapy in Early Rheumatoid Arthritis: Results From a Multicenter Canadian Early Arthritis Cohort

Glen Hazlewood1, Pooneh Akhavan1, Ye Sun2, Gilles Boire3, Boulos Haraoui4, Carol Hitchon5, Edward Keystone1, Carter Thorne6, Diane Ferland7, Janet Pope8, Vivian Bykerk9. 1University of Toronto, Toronto; 2University Health Network, Toronto; 3Université de Sherbrooke, Sherbrooke; 4University of Montreal, Montreal; 5University of Manitoba, Winnipeg; 6Southlake Regional Health Centre, Newmarket; 7Hospital Maisonneuve, Montreal; 8University of Western Ontario, London; 9Mount Sinai Hospital, Toronto.

The CATCH researchers wanted to find out what the first disease modifying anti-rheumatic drugs (DMARDs) are that patients with early RA (ERA) take and how their doctors decided on these. Patients were part of the study if they had  swelling in their joints (called synovitis) and were not taking medication for their arthritis or who were treated for only a short time with DMARDs. At the first visit, 57% of patients received methotrexate only and 27% received more than one DMARD (called combination therapy). At both the first and 3-month visits, the strongest predictors of methotrexate use and combination DMARD use were the treatment centre and having a higher disease activity score. Since these findings showed that patients were treated differently depending on where they were treated and what symptoms they had, the researchers think there is an opportunity to use these findings to help standardize care for ERA patients.

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What was the purpose of the study?
The CATCH researchers wanted to find out what the first disease modifying anti-rheumatic drugs (DMARDs) are that patients with early RA (ERA) take and how their doctors decided on these. The Canadian Rheumatology Association (CRA) provides guidelines to help doctors treat ERA patients that recommend starting patients on DMARDs when they are diagnosed.

How was the study done?
Patients with newly diagnosed RA were in the study that had swollen joints (called synovitis) and had not been taking medication for their RA or been taking DMARDs only within a month of their first rheumatology visit. The researchers looked to see if treatment patterns were linked to treatment centre or patient characteristics like age, gender, blood markers, disease activity score (DAS28) or the health assessment questionnaire disability index (HAQ-DI).

What were the results of the study?
565 RA patients were in the study who were mostly female (74% were), an average age of 52 years, and had RA for an average of 6 months. At the first visit, 57% of patients received methotrexate and 27% received combination therapy. At the first and 3-month visits, the strongest predictors of both methotrexate use and combination DMARD use were the treatment centre and higher DAS28. Since these findings showed that patients were treated differently depending on where they were treated and what symptoms they had, the researchers think there is an opportunity to standardize care for ERA patients.


Predictors of Sustained Clinical Remission in Early Rheumatoid Arthritis - Results From the Canadian Early Arthritis Cohort

Bindee Kuriya1, Juan Xiong2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, Janet E. Pope6, J. Carter Thorne7, Diane Tin7, Edward Keystone1, Vivian P. Bykerk8 and CATCH9. 1University of Toronto, Toronto, ON; 2Mount Sinai Hospital, Toronto, ON; 3CHUS - Sherbrooke University, Sherbrooke, QC; 4Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 5University of Manitoba, Winnipeg, MB; 6St. Joseph’s Health Care London, London, ON; 7Southlake Regional Health Centre, Newmarket, ON; 8Hospital for Special Surgery, New York, NY; 9Toronto, ON.

Some people with early rheumatoid arthritis (ERA) go in to remission which is when RA activity so low that it can't be measured or seen, and the CATCH researchers wanted to see if they could find what these patients all have in common. They looked at ERA patient records with a standard definition of remission in patients who were in remission for more than 6 months or 2 consecutive visits to their rheumatologist (which they called sustained remission). The only factors related with increased chances of sustained remission were younger age, low baseline pain scores and earlier time-to-first remission. Since getting to remission faster also related to sustained remission, this finding supports treatment that aims for early remission in ERA patients, but the exact treatment approach for this could not be determined.

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What was the purpose of the study?
Some people with early rheumatoid arthritis (ERA) go in to remission and the CATCH researchers wanted to see if they could determine what all these patients have in common.

How was the study done?
The CATCH researchers looked at ERA patient records with standard definitions of remission either from the American College of Rheumatology/European League Against Rheumatology (ACR/EULAR) or with the Simple Disease Activity Index (SDAI). Patients were in the study if they were in remission for more than 6 months or 2 consecutive visits to their rheumatologist (which they called sustained remission). Statistics were used to make sure findings were real.

What were the results of the study?
1244 patients were included in the study. Within the first 3 months of diagnosis, patients were on a variety of treatments, including: 32% were on methotrexate only, 44% were on a combination of more than one disease modifying anti-rheumatic drug (DMARD), and 2% were on biologics. Overall, 42% achieved ACR/EULAR remission and 40% achieved SDAI remission in just under 2 years. 59% of patients achieved sustained ACR/EULAR remission and 56% of patients achieved sustained SDAI remission.

Factors related to increased chance of sustained remission were younger age, low baseline pain scores and earlier time-to-first remission. These factors had no effect on sustained remission: various blood marker measurements, responses to patient questionnaires, smoking status, symptom duration, fatigue, morning stiffness, and joint damage. No one specific initial treatment approach or biologics use within the first 6 months predicted sustained remission.

The researchers concluded that sustained remission is possible within two years for ERA patients treated with DMARDs, gender influenced the chance of remission only in when it was defined as ACR/EULAR remission, and demographics and pain are predictors of sustained remission. Since getting to remission faster also related to sustained remission, this study supports treatment aimed at achieving early remission in ERA patients, but the exact treatment for this could not be determined.


Self Reported Comorbidity Is Common in Early Inflammatory Arthritis and Associated with Poorer Function and Quality of Life and Greater Disease Activity: Results From the Canadian Early Arthritis Cohort

Carol A. Hitchon1, Gilles Boire2, Boulos Haraoui3, Edward Keystone4, Janet E. Pope5, Vivian P. Bykerk6 and Canadian Early Arthritis Cohort (CATCH) Investigators7. 1University of Manitoba, Winnipeg, MB; 2CHUS-Sherbrooke University, Sherbrooke, QC, 3Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 4University of Toronto, Toronto, ON; 5University of Western Ontario, London, ON; 6Hospital for Special Surgery, New York, NY; 7Toronto.

The CATCH researchers wanted to see if patients with RA who also had other illnesses, called comorbidities, saw affects on RA activity, functional ability and quality of life in early inflammatory arthritis (EIA). Of 779 patients, 538 had comorbidities. Comorbidities included cardiovascular disease, diabetes, liver or renal disease, migraines, and others. All patients with comorbidities had poorer physical abilities and lower mental health scores.  Overall the researchers found that patients with comorbidities have greater disease activity, poorer functional abilities and lower quality of life over the first year of EIA and this finding may affect their treatment.

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What was the purpose of the study?
The CATCH researchers wanted to see if patients with RA who also had other illnesses, called comorbidities, saw affects on RA activity, functional ability and quality of life in early inflammatory arthritis (EIA). Long-term comorbidities may also affect how a person's RA is treated initially.

How was the study done?
779 patients with EIA were in the study, whose rheumatologists were all treating them to decrease disease activity as much as possible. Statistics were used to ensure findings were real.

What were the results of the study?
538 patients reported comorbidities that they had, and they ranged from having none to a total of 8 comorbidities. Compared to patients without comorbidities patients with comorbidities:

At the study start (also called baseline), patients with any comorbidity had worse functional abilities measured by the health assessment questionnaire (HAQ) and more pain than those without any comorbidity. For all patients, baseline overall health survey scores were below average and related to the number of comorbidities. All physical and mental health scores were much worse in patients with any comorbidity compared to patients who did not have any comorbities. For example, poorer physical scores were seen in patients with cardiovascular disease, endocrine disease (such as diabetes and thyroid issues), gastro-intestinal or kidney disease (such as stomach, bowel, or liver disease, hepatitis or kidney problems); and respiratory disease (such as asthma, bronchitis); while lower mental scores were seen in patients with neurologic disease (for example, migraines, Parkinson's, seizures), and mental health (such as depression), gastro-intestinal or kidney diseases. Patients with comorbidities have greater RA activity, poorer functional status and lower quality of life over the first year, which also affects their EIA treatment.


The Comparative Effectiveness of Oral Methotrexate Versus Subcutaneous Methotrexate for the Treatment of Early Rheumatoid Arthritis

Glen S. Hazlewood1, J. Carter Thorne2, Janet Pope3, Gilles Boire4, Boulos Haraoui5, Carol A. Hitchon6, Edward Keystone1, Diane Tin2, CATCH Investigators7 and Vivian P. Bykerk8. 1University of Toronto, Toronto, ON; 2Southlake Regional Health Centre, Newmarket, ON; 3Schulich School of Medicine and Dentistry, Western University, London, ON; 4CHUS –  Sherbrooke University, Sherbrooke, QC; 5Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 6University of Manitoba, Winnipeg, MB; 7Toronto, ON; 8Hospital for Special Surgery, New York, NY.

The CATCH researchers wanted to see if there were differences in how patients with rheumatoid arthritis (RA) did if they took methotrexate by pill or by injection. Taking methotrexate as a pill is also called oral methotrexate and taking methotrexate by injection is called subcutaneous methotrexate. 653 patients were in the study who had RA for less than a year and had not taken methotrexate or had only taken it for 3 months. Most patients were female and about 52 years old. At the study start, patients who took methotrexate by injection were more likely to have joint damage, more active RA, and were started on a higher dose of methotrexate. The researchers initially thought that patients who were on methotrexate by injection had better RA outcomes, but when they did further studies, they found that there was no difference in RA outcomes between patients who took methotrexate by injection or by pill.

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What was the purpose of the study?
The CATCH researchers wanted to see if there were any differences in how patients with rheumatoid arthritis (RA) did if they took methotrexate by pill or injection. They called this looking at the patients' RA outcomes.

How was the study done?
For this study, patients were older than 16, had RA for less than a 1 year, and had either not taken methotrexate before or only for 3 months. The researchers used the patients' RA disease activity score (DAS28) to measure how well methotrexate was working. They also used statistics on the results to make sure they were real.

What were the results of the study?
Of 653 patients, 442 took methotrexate by pill and 211 by injection; and they were an average age of 54, 72% female, had RA symptoms for an average of 5.3 months, and average baseline DAS28 of 4.6. At baseline the patients taking methotrexate in either form were similar except that patients taking methotrexate by injection were more likely to have joint damage (35% compared to 25%), less likely to receive other disease modifying anti-rheumatic drugs (38% versus 58%), and had a higher starting dose of methotrexate (25 mg compared to 15 mg). After using statistics to look at results, neither way of taking methotrexate or starting dose was associated with disease activity score.

Read the paper on this work here.