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.


Are SDAI50 and DAS28 Response Measures Comparable in Early Rheumatoid Arthritis Patients?

Mohammed Omair1, Edward C. Keystone1, Juan Xiong2, Gilles Boire3, Janet E. Pope4, J. Carter Thorne5, Carol A. Hitchon6, Boulos Haraoui7, Diane Tin5, Deborah Weber2, Vivian P. Bykerk1 and Pooneh Akhavan1. 1Mount Sinai Hospital/University of Toronto, Toronto, ON; 2Mount Sinai Hospital, Toronto, ON; 3Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 4St. Joseph Health Care, London, ON; 5Southlake Regional Health Centre, Newmarket, ON; 6University of Manitoba, Winnipeg, MB; 7Institut de Rhumatologie de Montréal, Montreal, QC.

At the start of the study, patients were treated by their rheumatologists and if they did not respond to their medication within 3 months, their medication was changed. Researchers measured how patients responded to treatment using two different scores:
1. The Disease Activity Score (DAS28), which measures inflammation in the 28 joints usually affected by RA; and,
2. The Simplified Disease Activity Index (SDAI50), which assesses aspects of such as tenderness and swelling of joints, and inflammation.
This study compared results of these scores to see which patients were not responding to treatment and to determine how well each scale actually measured the patient's response. Investigators found that most of the time both scores agreed about whether or not a patient was responding to treatment. However, sometimes the scores did not agree.

Read more

What was the purpose of this study?
The study looked at a strategy of treating patients with early RA called treat to target. This is when the medications that are used to treat an RA patient are changed when the patient does not respond well to therapy at 3 months after its start.

In this study, two different scores were used to measure a patient's response to medication:
1. The Disease Activity Score (DAS28), a measure of disease activity in the 28 joints most usually affected by RA; and,
2. The Simplified Disease Activity Index (SDAI50), which measures tenderness and swelling of joints, physician global assessment, patient global assessment, and C-reactive protein (a protein measured in a person's blood that shows inflammation).
Responses to medication were defined as a 1.2-point change in DAS28 and/or a 50% change in the SDAI50 score. The study's purpose was to determine which patients were not responding to treatment based on either of these scores and also comparing how or if the results of the two scores were different.

How was this study done?
During the first three months of this study, patients were given drugs called DMARDs. Patients in this study had never taken drugs called biologics. Patients who had a DAS28 score change of 1.2 or reached SDAI50 (but not both) were compared in terms of RA characteristics and change in disease activity over the 3 months of the study.

What were the results of this study?
At 3 months, 47% of the 419 patients did not achieve a change in DAS28 of 1.2 and 49% did not achieve SDAI50. Investigators found that patients with a DAS28 change of 1.2 almost always achieved SDAI50 and vice versa. However, of the 206 patients who did not achieve SDAI50, 19% of patients achieved DAS28 change of 1.2. Of the 198 patients who did not achieve a DAS28 change of 1.2, 17% of patients achieved SDAI50. Interestingly, of the patients who achieved only one of the two score benchmarks, RA activity at the start of the study was higher in patients who achieved a DAS28 change of 1.2 than in patients who achieved SDAI50.

In conclusion, while there is correlation between achieving SDAI50 and DAS28 change of 1.2, patients with a higher level of disease activity at the start were more likely to achieve DAS28 change of 1.2 than SDAI50. In patients with a lower level of disease activity at the start, SDAI50 is more likely than a DAS28 change of 1.2.


Are there Differences Between Young and Older Onset Early Rheumatoid Arthritis (RA) and Does this Impact Outcomes? An analysis from the CATCH Cohort

Michael Arnold1, Vivian P. Bykerk2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, J. Carter Thorne6, Edward Keystone7 and Janet E. Pope8. 1University College Dublin, Dublin, Ireland; 2Hospital for Special Surgery, New York, NY; 3Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 4Institut de Rhumatologie de Montréal, Montreal, QC, 5University of Manitoba, Winnipeg, MB; 6Southlake Regional Health Centre, Newmarket, ON; 7University of Toronto, Toronto, ON; 8Schulich School of Medicine and Dentistry, Western University, London, ON.

The CATCH investigators wanted to learn if there were differences between early RA in patients who are diagnosed at an older age versus patients who were diagnosed at a younger age. 1809 patients were sorted into three groups based on age:

  • 24% were in the "young" group (under 42 years old)
  • 50% were in the "middle-aged" group (42 to 64 years old), and
  • 26% were in the "old" group (over 64 years old).

Patients who were diagnosed later in life had worse symptoms at the beginning and end of the study one year later. In general, younger and older patients responded the same to medication, but men were more likely than women to have their RA symptoms improve no matter what age their symptoms began.

Read more

What was the purpose of this study?
The purpose of this study was to learn if there were differences between RA in patients diagnosed at an older age versus patient who were diagnosed at a younger age.

How was this study done?
Patients were split into three groups based on age and were examined using different scores at the start of the study, after six months, and after one year.

What were the results of this study?
Out of 1809 patients involved in this study, the patients were grouped based on age:

  • 24% were in the "young" group (younger than 42 years old),
  • 50% were in the "middle-aged" group (42 to 64 years old), and
  • 26% were in the "old" group (over 64 years of age).

The researchers found a correlation between age and disease activity score (DAS28) and health assessment questionnaire (HAQ) score. Patients diagnosed at when they were older had worse RA activity overall. The required amount of DMARDs increased with age while the required amount of biologics decreased with age. At one year, men were much more likely to be in remission than women.

In conclusion, patients diagnosed with RA later in life had worse symptoms overall- both at the beginning and end of the study (after one year). However, younger and older patients respond the same to treatment. Also, men are more likely to have better outcomes after a year of treatment than women.


Assessing Significant Flares In Rheumatoid Arthritis: Validity Of The Outcome Measures In Rheumatology Preliminary Flare Questions In The Canadian Early Arthritis Cohort

Susan J. Bartlett1, Clifton O. Bingham III1, Ernest Choy2, Juan Xiong3, Gilles Boire4, Boulos Haraoui5, Janet E. Pope6, J. Carter Thorne7, Carol A. Hitchon8, Diane Tin7, Edward C. Keystone9 and Vivian P. Bykerk9. 1Johns Hopkins University, Baltimore, MD; 2Cardiff University, Institute of Infection and Immunity, Cardiff, United Kingdom, 3Mount Sinai Hospital, University of Toronto, Toronto, ON; Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 5Centre Hospitalier de l’Université de Montréal, Montreal, QC; 6St. Joseph Health Care, London, ON; 7Southlake Regional Health Centre, Newmarket, ON; 8University of Manitoba, Winnipeg, MB; 9Mount Sinai Hospital/University of Toronto, Toronto, ON.

During an RA flare, RA activity is higher and more pain is felt. The CATCH investigators wanted to learn more about RA flares by asking patients to fill out a questionnaire called the preliminary flare questionnaire (PFQ) developed by the Outcome Measures in Rheumatology (OMERACT) RA Flare Group. They then compared PFQ answers from patients who were flaring to those who were not. The 1190 patients in this study filled out PFQs at each rheumatology visit for two years. Both patients and physicians recorded whether or not they felt the patient was in a flare each visit. Physicians and patients often, but not always, agreed when patients were flaring. Overall, investigators found that PFQ scores were much higher for patients reporting flares than for patients not reporting flares, showing that the OMERACT PFQs are good at measuring and determining flares.

Read more

What was the purpose of this study?
While flares, times when patients feel more pain and have more RA activity, are very common in patients with RA, there is not a good tool to measure these flares and determine if or how treatment should change. The purpose of this study was to use preliminary flare questionnaires (PFQs) developed by the Outcome Measures in Rheumatology (OMERACT) RA Flare Group, to assess flares in patients with early RA. The PFQ responses of patients who were flaring and not flaring were compared.

How was this study done?
1190 patients in this study filled out PFQs at every rheumatology visit for two years. At each appointment, patients and physicians recorded whether or not they thought the patient was in a flare. One week before each visit, patients filled out PFQs for different categories: pain, physical function, fatigue, stiffness, participation, and coping. Patients also filled out many other disease scores, including a health assessment questionnaire (HAQ).

What were the results of this study?
Overall, 33% of patients and 38% of physicians determined the patients to be flaring. Physicians and patients agreed that patients were flaring 62% of the time and agreed that patients were not flaring 73% of the time. Generally, patients' scores for pain, physical function, fatigue, stiffness, participation, and coping were all higher when patients reported that they were in a flare.

The OMERACT PFQs are effective at measuring and determining flares in patients with RA. However, more studies are needed to show the PFQ can be used across many RA populations (for example, in patients with long-term RA) and are scientifically reliable and valid.

Read the papers on this work here and here.


Changes In Patient-Reported Joint Counts and Composite Indices Can Identify Flare Of Disease Activity In Recent Onset Rheumatoid Arthritis

Karen Visser1, Susan J. Bartlett2, Clifton O. Bingham III3, Ernest Choy4, Daming Lin5, Juan Xiong6, Gilles Boire7, Boulos Haraoui8, Carol A. Hitchon9, Edward Keystone10, Janet E. Pope11, J. Carter Thorne12, Diane Tin12 and Vivian P. Bykerk13. 1Leiden University Medical Center, Leiden, Netherlands; 2Johns Hopkins University, Baltimore, MD; 3Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD; 4Cardiff University, Institute of Infection and Immunity, Cardiff, United Kingdom; 5Mount Sinai Hospital, University of Toronto, Toronto, ON; 6Mount Sinai Hospital, Toronto, ON; 7Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, QC; 8Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC; 9University of Manitoba, Winnipeg, MB; 10University of Toronto, Toronto, ON; 11St. Joseph Health Care, London, ON; 12Southlake Regional Health Centre, Newmarket, ON; 13Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

The CATCH investigators wanted to see if there was a relationship between patient-reported tender joints and swollen joints and flares in RA patients. The 115 patients in this study filled out preliminary flare questions (PFQs) (created by the OMERACT Flare Group) about their RA activity two to three times during a three-month period. Patients and physicians separately determined tenderness and swelling of patient joints, and compared these results to whether or not the patient reported having a flare. Investigators found that patient-reported tenderness and swelling of joints was the biggest indicator and predictor of whether or not a patient was in a flare.

Read more

What was the purpose of this study?
Tenderness and swelling in joints that is reported by patients (also called patient-reported) was used in this study to measure flares in RA. The purpose was to see if there was a relationship between these patient-reported tender joints and swollen joints and an increased level of RA activity.

How was this study done?
The 115 CATCH patients in this study filled out preliminary flare questions (PFQs), created by the OMERACT Flare Group, two to three separate times during a three month period. Patients indicated tenderness and swelling in joints using a homunculus (a human-figure with circles around each joint) and a 16 joint RA disease activity index (RADAI). At the same time, physicians performed swollen joint count, tender joint count, and a global assessment using different tools. A patient was considered to have a flare if they had a change in DAS28 score of greater than 1.2 and if they changed from "no" to "yes" when answering "Are you having a flare at this time?". Patients were also compared based on whether or not they had flares according to these criteria.

What were the results of this study?
At the start of the study, 46% of the 115 patients enrolled were in DAS28 remission and 15% had low RA activity. Three months into the study, only 14% of patients felt they were having a flare but according to the DAS28 definition of a flare, 23% had a flare. The patients determined to be in flare by the DAS28 definition also had higher scores showing worse results in the following assessments:

Many tests showed significantly different outcomes in patients with flares than in patients without flare, especially the following:

  • Patient-reported outcomes;
  • RADAI48;
  • Physician tender joint counts;
  • Erythrocyte Sedimentation Rate;
  • Physician Global Assessment; and,
  • Patient Global Assessment.

Patients who went from having no flare to a flare showed significant increases in patient disease activity score, the patient-reported outcomes of RAPID3 and RAPID4, DAS28, and Erythrocyte Sedimentation Rate. These are all measures of difficulty doing everyday tasks, pain, tenderness and swollen joints, and inflammation. When the scores are higher, this means the symptoms of RA are worse.

In conclusion, a change in a patient's joint count (as reported by the patients themselves) is the biggest indicator of an increasing level of RA activity and predictor of flares. In the future, patient-reported joint count should be used in defining RA flares.


Comparison Of DAS28 Using ESR And CRP In An Early Rheumatoid Arthritis Cohort

V. P. Bykerk1, 2,*, J. E. Pope3, J. Xiong1, G. Boire4, B. Haraoui5, J. C. Thorne6, C. A. Hitchon7, D. Tin8, E. C. Keystone1, *on behalf of CATCH investigators, 1Mount Sinai Hospital, Toronto, ON; 2Hospital for Special Surgery, New York, NY; 3University of Western Ontario, ON; 4Université de Sherbrooke, Sherbrooke QC; 5Institut de Rhumatologie, Montreal QC; 6Southlake Regional Health Centre, Newmarket ON; 7University of Manitoba, Winnipeg, MB; 8Southlake Regional Health Centre, Newmarket, ON.

The CATCH investigators wanted to see if disease activity score (DAS28) for patients with early RA was different if different blood markers were used to determine the score. The DAS provides a number score about how active a patient's RA is and is used to help make decisions about treatment. The DAS can provide information on a person's RA being in remission, low, medium or a high disease activity state. Usually erythrocyte sedimentation rate (ESR, a measure of inflammation) is used to calculate disease activity scores for patients but the CATCH researchers wanted to see if using a different blood marker to calculate the disease activity score could be used called C-reactive protein or CRP. Using the DAS28 based on ESR as a benchmark score, the researchers found that CRP could be used to also provide DAS scores for remission, low, medium and high disease activity states.

Read more

What was the purpose of this study?
Cut-off points for disease activity scores (DAS28) using C-Reactive Protein (CRP) have been reported to be different than for DAS28 using ESR (erythrocyte sedimentation rate) in clinical trials and studies of patients who have had RA for a long time. DAS28 provides a number measure of a patient's RA activity and is helpful for making decisions about treatment. The DAS can provide information on a person's RA being in remission, low, medium or a high disease activity state.

How was this study done?
The researchers looked at medical records of 882 early RA patients in the CATCH study. They used their records to calculate DAS28 with CRP and ESR and used statistics to make sure that the findings were real. They called the DAS28 calculated using the ESR the DAS28-ESR and the DAS28 calculated using the CRP, the DAS28-CRP.

What were the results of this study?
Average DAS28 and DAS28-CRP scores were 3.0 and 2.8, respectively, for all patients. The researchers determined that values for DAS28 were:
• for remission: DAS28-ESR was less than 2.6 and DAS28-CRP was less than 2.4;
• for low disease activity state: DAS28-ESR was less than 3.2 and DAS28-CRP was less than 2.9;
• for medium disease activity state: DAS28-ESR was less than 5.1 and DAS28-CRP was less than 4.8;
• for high disease activity state: DAS28-ESR was greater than or equal to 5.1 and DAS28-CRP was greater than or equal to 4.8.

Just like when the researchers used the ESR to calculate a patient's DAS28, they found out that they could also use the CRP to calculate a DAS28. And also just like the DAS28-ESR, researchers found that the DAS28-CRP could provide values that would classify a patient's RA activity as being in remission, or low, medium or high.


Determining The Absolute Change In The Clinical Disease Activity Index (CDAI) To Define a Minimally Important Difference

Jeffrey R. Curtis1, Shuo Yang1, Lang Chen1, Janet E. Pope2, Edward C. Keystone3, Boulos Haraoui4, Gilles Boire5, J. Carter Thorne6, Diane Tin6, Carol A. Hitchon7, Clifton O. Bingham III8 and Vivian P. Bykerk9. 1University of Alabama at Birmingham, Birmingham, AL; 2St. Joseph Health Care, London, ON, 3Mount Sinai Hospital/University of Toronto, Toronto, ON; 4Centre Hospitalier de l’Université de Montréal, Montreal, QC, 5Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, 6Southlake Regional Health Centre, Newmarket, ON; 7University of Manitoba, Winnipeg, MB, 8Johns Hopkins University, Baltimore, MD; 9Hospital for Special Surgery, New York, NY.

The Clinical Disease Activity Index (CDAI) is a score that measures RA activity in patients by looking at swollen joint count, tender joint count, physician global assessment (in which a physician determines a patient's pain due to arthritis), and patient global assessment (in which patients indicate their pain because of their arthritis). The CATCH investigators wanted to see the smallest change in CDAI score that should be considered an important change in RA disease activity. They called this the absolute minimally important difference or MID. Every three months over one year, rheumatologists looked at patient RA activity using different scores and measures (including the CDAI). They compared the results of these tests to the results of the CDAI to see what amount of CDAI change should be considered important in disease activity for patients with low, moderate, and high disease activity. It was found that these changes in CDAI scores can be used to measure patient improvement in their RA overall.

Read more

What was the purpose of this study?
The Clinical Disease Activity Index (CDAI) uses information from swollen joint count, tender joint count, physician global assessment (where the physician determines a patient's pain due to arthritis) and patient global assessment (where the patient indicates their pain due to arthritis) to determine if or when RA is considered to be in remission, is one of the many tests used to determine disease activity in patients with RA. However, the smallest amount that a CDAI score can change for it to be considered significant, called the absolute minimally important difference or MID, is unknown. The purpose of this study was to determine this value of MID for the CDAI.

How was this study done?
Participants in this study had visits to their rheumatologist every three months over one year. Each visit, physicians recorded patient CDAI scores and calculated the change in this score since the first visit. Patients also told their rheumatologist how they felt their RA improved (better, worse, or the same), filled out Health Assessment Questionnaires (where they rated their abilities to do different physical tasks), and reported their level of pain. DAS28 and Erythrocyte Sedimentation Rate (a blood marker that shows inflammation) were compared to change in CDAI score to find what change should be considered important. This MID was then used to understand what change in CDAI score should be considered a major improvement in a person's RA symptoms.

What were the results of this study?
1191 patients were in this study and CDAI MID was found to be:
• MID is 2 for patients who started with low disease activity;
• MID is 6 for patients who started with moderate disease activity;
• MID is 10 for patients who started with high disease activity.
These values of change of CDAI scores (MID) can be used to show significant patient improvement in their RA, and this finding makes the CDAI test a more helpful tool to understand disease improvement in patients with RA.

Read the paper on this work here.


Do Sustained Clinical Remission and Sustained Low Disease Activity Equally Predict Functional Status in Early Rheumatoid Arthritis?

Bindee Kuriya1, Juan Xiong1, Gilles Boire2, Boulos Haraoui3, Carol A. Hitchon4, Janet E. Pope5, J. Carter Thorne6, Diane Tin6, Edward C. Keystone1, Cheryl Barnabe7, Pooneh Akhavan8 and Vivian P. Bykerk9. 1Mount Sinai Hospital, University of Toronto, Toronto, ON; 2Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 3Institut de Rhumatologie de Montréal, Montreal, QC; 4University of Manitoba, Winnipeg, MB; 5St Joseph Health Centre, London, ON; 6Southlake Regional Health Centre, Newmarket, ON; 7University of Calgary, Calgary, AB; 8Early Rheumatoid Arthritis Program, Mount Sinai Hospital and University of Toronto, Toronto, ON; 9Hospital for Special Surgery, New York, NY.

The CATCH investigators wanted to compare long-term disability in early RA in patients who had a low level of RA activity compared to patients who are in remission (that is when RA symptoms are not seen or decreased greatly). The researchers compared the RA of these two groups of patients using a Health Assessment Questionnaire Disability Index (HAQ-DI), in which patients say how well they can do everyday tasks. By looking at patients over two years, they found there was no difference in patient characteristics (for example, age, sex, etc.) between patients in remission and those with a low level of disease activity. However, researchers found that patients in remission were much more likely to have better long-term function than patients with a low level of disease activity.

Read more

What was the purpose of this study?
The goal of treating RA is to help patients get in to remission (where symptoms aren't seen or decrease greatly) and if remission is not possible, to get patients in to a very low level of disease activity. The purpose of this study was to see if patients with low level RA activity did as well as patients who were in remission by looking at their long-term disability. Investigators looked at patients' abilities to do everyday tasks by using a questionnaire called the Health Assessment Questionnaire Disability Index (HAQ-DI).

How was this study done?
833 patients were in this study. Doctors decided if their patients were in remission or had a low RA activity with tools called the clinical disease activity index (CDAI) and simplified disease activity index (SDAI). Within the first 18 months of the study, remission or low disease activity were called "sustained" if they lasted for at least 6 months.

What were the results of this study?
Only 9% of patients were in sustained remission by both the CDAI and SDAI definitions; 51% had sustained low disease activity by CDAI; and 40% had sustained low disease activity by SDAI. There was no difference in many patient characteristics at the start of the study. After 2 years, the patients in sustained remission had a much easier time doing everyday tasks than patients with sustained low disease activity (this was shown by the HAQ-DI scores). Swelling and tenderness in joints, pain, fatigue, and global health assessment scores were much lower in patients with sustained remission than in patients with sustained low disease activity. This means that patients in sustained remission felt less pain, had less fatigue, had fewer tender joints and swollen joints, and felt better overall.

The lower a patient's RA activity state (for example, remission versus low disease activity) the greater their ability to do everyday physical tasks over time - that means they had better long-term functional abilities. More studies need to be done to determine which factors affect whether a person achieves sustained remission or sustained low RA activity.


Does Socioeconomic Status Affect Outcomes in Early Rheumatoid Arthritis (RA)? Data from a Multi-site Canadian Inception Cohort

Grace Yang1, Vivian P. Bykerk2, J. Carter Thorne3, Gilles Boire4, Diane Tin3, Carol A. Hitchon5, Edward Keystone6, Boulos Haraoui7 and Janet E. Pope8. 1Western University, London, ON; 2Mount Sinai Hospital/University of Toronto, Toronto, ON; 3Southlake Regional Health Centre, Newmarket, ON; 4Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 5University of Manitoba, Winnipeg, MB; 6University of Toronto, Toronto, ON; 7Centre Hospitalier de l’Université de Montréal, Montreal, QC; 8St. Joseph Health Care, London, ON.

The CATCH investigators wanted to find out if socioeconomic status affects the outcome of patients with early inflammatory arthritis. Study participants with RA were split into groups based on their education and income, then evaluated with tests that measure RA activity. The group with high school education or less (called the "low education group") was found to have higher RA activity and lower physical activity than the other groups at the beginning of the study. The group that earned less than $50,000 per year (called the "low income group") was found to have more disability, a higher level of pain, and higher RA activity according to some of the tests. However, while low socioeconomic status is generally associated with higher RA activity, greater pain, etc., only physical function and answers to the Health Assessment Questionnaire were still worse for patients in the low socioeconomic group after one year.

Read more

What was the purpose of this study?
The purpose of this study was to see if a person's socioeconomic status affects the outcomes of people with early RA.

How was this study done?
The 2023 patients in this study were split into groups based on education and income (low versus high socioeconomic status). Patients were assessed for pain and with the Disease Activity Score (DAS28), patient global assessment, Health Assessment Questionnaire Disability Index (HAQ-DI), and SF12-v2 Health Survey.

What were the results of this study?
Of the patients in this study, 44% were in the "low education group" which means they had an education of high school or less; and 38% were in the lowest income group, earning less than $50,000 per year.

At the beginning of the study, the low education group had higher DAS28, which means higher RA activity, than the other groups. The low education group scored lower on SF12-v2 than the other groups at the start of the study and after 12 months which meant they had less physicial abilities. Patients from the low income group had higher HAQ scores meaning they had more issues with everyday tasks, higher levels of pain, higher patient global assessment scores, and higher simplified disease activity index than the other groups at the start of the study. All of these mean that this group had a higher level of RA activity.

In conclusion, at the start of the study, low socioeconomic status is associated with worse physical function, more pain, and higher disease activity, patient global assessment score and Health Assessment Questionnaire score. At one year, only physical function and Health Assessment Questionnaire score were still worse in low socioeconomic status patients than in high socioeconomic status patients.

Read the paper on this work here.


Effect of Age at Menopause in Women with Early Rheumatoid Arthritis

Lauren Wong1, Wei-Ti Huang1, Juan Xiong2, Gilles Boire3, Boulos Haraoui4, Janet E. Pope5, J. Carter Thorne6, Carol A. Hitchon7, Diane Tin6, Edward Keystone8 and Vivian P. Bykerk1. 1Hospital for Special Surgery, New York, NY, 2Mount Sinai Hospital, University of Toronto, Toronto, ON, 3Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, 4Institut de Rhumatologie de Montréal, Montreal, QC, 5St. Joseph’s Health Care, University of Western Ontario, London, ON, 6Southlake Regional Health Centre, Newmarket, ON, 7University of Manitoba, Winnipeg, MB, 8Mount Sinai Hospital, Toronto, ON.

The CATCH investigators wanted to see the effects that age of menopause has on a patient's RA disease activity and the initial RA symptoms. The study participants were split into two groups: early menopause (if a patient had menopause before the age of 45) and usual menopause (if a patient had menopause at age 45 or older). Investigators looked at many types of tests that measure RA activity in patients. Patients in the early menopause group showed different disease characteristics than patients with normal menopause. These patients were more likely to test positive for Rheumatoid Factor (RF) and Anti-Citrullinated Protein Antibodies (ACPA) (proteins often found in the blood of people with RA, but not always) and had more damaged joints (also called joint erosion).

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What was the purpose of this study?
Previous studies have shown that certain hormonal and reproductive factors may affect RA disease activity and the start of RA symptoms. The purpose of this study was to see the effects that age of menopause and hormone use have on the RA disease activity and initial symptoms of RA.

How was this study done?
The 534 patients in this study were post-menopausal women under the age of 65. Patients who had menopause before age 45 were in the "early menopause group" and those who had started menopause at age 45 or older were in the "usual menopause group".

What were the results of this study?
Patients in the early menopause group were more likely to use hormone replacement therapy and have higher Patient Global Assessment and pain scores. This group was more likely to meet the 1987 American College of Rheumatology definition of RA, and test positive for Rheumatoid Factor (RF) and Anti-Citrullinated Protein Antibodies (ACPA) (proteins in the blood that are often but not always found in people with RA). Patients in the early menopause group were slightly more likely to have damaged joints. There was no difference in disease activity (measured by the DAS28) in early versus normal menopause. Patients using hormone replacement therapy were less likely to be RF positive and smokers were more likely to be tested positive for RF and ACPA.

In conclusion, investigators found that patients with early menopause have different disease characteristics than patients with normal menopause—especially in terms of having RF and ACPA in their blood. More studies need to be done to learn more about the effect that hormonal states (including hormone replacement therapy) have on women with RA.

Read the paper on this work here.


Effect of Duration in Menopause on Disease Presentation in Early Rheumatoid Arthritis

L.E. Wong1, J. Xiong2, G. Boire3, B. Haraoui4, J.E. Pope5, J.C. Thorne6, C.A. Hitchon7, D. Tin6, E.C. Keystone2, V.P. Bykerk1,2  * on behalf of CATCH investigators. 1Hospital for Special Surgery, New York, NY; 2Mount Sinai Hospital, Toronto, Canada; 3Universite de Sherbrooke, Sherbrooke, QC; 4Institut de Rhumatologie, Montreal, QC; 5St. Joseph’s Health Care, University of Western, London, ON; 6Southlake Regional Health Centre, Newmarket, ON; 7University of Manitoba, Winnipeg, MB.

The CATCH investigators wanted to see what affect the early onset of menopause (at 45 years of age or less) had on women with RA. Researchers divided patients into two groups—those with early menopause (45 years of age or less) and those with normal menopause (at greater than 45 years of age) - and recorded information on different factors of their disease both at the start and end of the study. Patients in the early menopause group reported having more pain – both overall pain and measured with a score called the Patient Global Assessment (patients show their level of pain due to their RA on a scale). Patients with early menopause tested positive for Rheumatoid Factor (a protein often found in the blood of patients with RA) more often than patients with normal menopause. However, many other RA characteristics were similar between patients with early menopause and patients with normal menopause. While there seems to be different factors associated with normal and early menopause in patients with early RA, more research needs to be done.

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What was the purpose of this study?
The purpose of this study was to find out whether an early age of menopause (under 45 years of age) affects the course of RA differently than a normal age of menopause (45 years of age and older).

How was this study done?
534 women under the age of 65 were involved in this study.

What were the results of this study?
Of the 534 patients in the study, 17% had early-onset menopause and 83% had normal menopause. The average DAS28 was similar between the two groups. Women in the early menopause group were: less likely to have finished high school (33% versus 54%); more likely to be smokers (33% versus 21%): and more likely to use hormone replacement therapy (21% versus 8%). Also women in the early menopause group reported more pain, both in terms of a Patient Global Assessment and greater pain level overall. Early menopause patients were more likely to meet the 1987 American College of Rheumatology criteria for RA and test positive for Rheumatoid Factor (a protein in blood that is often found in people with RA). Many things were similar in patients with early and normal menopause, including the number of tender or swollen joints, amount of inflammation, and scores on the Physician Global assessment.

In conclusion, women with early and normal menopause have different factors associated with their courses of RA. More research needs to be done to determine how much of an influence early menopause has on the course of RA.


Physician Global Assessment at Three Months is Strongly Predictive of Disease Activity at 12 Months in Early Rheumatoid Arthritis. Results from the CATCH Cohort

Tommy Choy1, Vivian P. Bykerk2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, J. Carter Thorne6, Edward C. Keystone7 and Janet E. Pope8. 1University of Western Ontario, London, ON; 2Hospital for Special Surgery, New York, NY; 3Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 4Institut de Rhumatologie de Montréal, Montreal, QC; 5University of Manitoba, Winnipeg, MB; 6Southlake Regional Health Centre, Newmarket, ON; 7Mount Sinai Hospital, University of Toronto, Toronto, ON; 8Schulich School of Medicine and Dentistry, Western University, London, ON.

The CATCH investigators wanted to see if there were any factors that could predict if a patient would be in remission one year after diagnosis by looking back at things they measured at the patient's RA diagnosis and three months after diagnosis. Researchers recorded many patient characteristics at the beginning of the study such as age, the number of tender and swollen joints, etc.. It was found that a low Physician Global Assessment at three months after diagnosis was a good predictor of remission after one year.

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What was the purpose of this study?
The CATCH investigators wanted to see if there were any factors that could predict if a patient would be in remission one year after diagnosis by looking back at things they measured at the patient's RA diagnosis and three months after diagnosis.

How was the study done?

Participants were included in the study if they had medical records at diagnosis, 3 months, and 12 months after diagnosis. There were 579 participants in the study.

What were the results of this study?
Many factors were measured at the start of the study and then compared to the patient's RA activity one year later. Different definitions of remission were used and compared, which included:

The following factors were studied to see if they were related to or predictive of a patient's RA outcome using all four remission definitions:

The only predictor for the DAS28 remission definition was ESR (erythrocyte sedimentation rate which measures inflammation). Swollen joint count at the start of the study was a predictor of CDAI and SDAI remission.

While many of these factors were different at the start of the study and after three months in their ability to predict remission at one year, a low Physician Global Assessment score at three months was a strong predictor of remission after one year.


Prevalence and Impact of Soft Tissue Manifestations in Early Inflammatory Arthritis: Results from the Canadian Early Arthritis Cohort

Mihaela Popescue1, Edith Villeneuve2, Boulos Haraoui3, Gilles Boire4, Carol A. Hitchon5, Edward C. Keystone6, Janet E. Pope7, J. Carter Thorne8, Diane Tin8 and Vivian P. Bykerk6. 1University of Montreal, Montreal, QC; 2Institut de Rhumatologie de Montréal, Montreal, QC; 3Centre Hospitalier de l’Université de Montréal, Montreal, QC, 4Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 5University of Manitoba, Winnipeg, MB; 6Mount Sinai Hospital/University of Toronto, Toronto, ON; 7St. Joseph Health Care, London, ON; 8Southlake Regional Health Centre, Newmarket, ON.

The CATCH investigators wanted to see how the swelling of soft tissues such as muscle, fat and skin is related to early RA. Many patients with early RA also have swelling in soft tissues in at least one part of their body. The investigators compared RA activity, functional ability, and quality of life of RA patients who had soft tissue swelling to patients who did not have soft tissue swelling. Of the 1509 study participants, 222 had soft tissue swelling, and only 59 of these patients had swelling in more than one spot. Patients with soft tissue swelling showed no difference in RA activity score, pain, fatigue, or answers to a Health Assessment Questionnaire (ability to do daily tasks) compared to patients without soft tissue swelling.

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What was the purpose of this study?
Patients with early RA often have swelling and inflammation in soft tissues, which are those that connect, support and surround the body's organs and bones, such as muscle, skin, fat.  However, since RA activity tests do not measure this soft tissue for inflammation, it is often not considered in treatment. The purpose of this study was to see how many patients showed some type of soft tissue inflammation, including tenosynovitis, enthesitis, and bursitis. Investigators looked at RA activity, functional ability, and quality of life of patients who had soft tissue inflammation and compared these to patients without soft tissue inflammation.

How was this study done?
1509 patients were part of this study. Doctors determined whether patients had swelling in soft tissue and their RA characteristics were assessed based on RA activity score, pain, fatigue, a Health Assessment Questionnaire (HAQ), and the Short Form Quality of Health survey (called SF-12 which measures one's ability to do everyday tasks).

What were the results of this study?
Of the 1509 patients in this study, 222 patients had soft tissue inflammation. Only 59 had soft tissue inflammation in more than one place, and just 2 patients had soft tissue inflammation in more than three places. Of the 222 patients, they had soft tissue inflammation in these areas:

  • 57% had it in their hands and wrists;
  • 17% had it in their feet and ankles;
  • 11% had it in their elbows;
  • 10% had it in their shoulders;
  • 3% had it in their hips; and,
  • 2% had it in their knees.

There was no difference in RA activity score, pain, fatigue, Health Assessment Questionnaire score, and SF-12 score between patients with or without soft tissue inflammation.

In conclusion, there were not many patients in this study who had soft tissue inflammation, and there was no difference on any of the tests that were done between patients with and without soft tissue inflammation. Therefore, no further changes in treatment need to be made for patients who have soft tissue inflammation in addition to RA.


Prognosis of Seronegative Patients in a Large Prospective Early Inflammatory Arthritis Cohort

Lillian J. Barra1, Janet E. Pope1, Boulos Haraoui2, Carol A. Hitchon3, J. Carter Thorne4, Edward C. Keystone5, Diane Tin4, Gilles Boire6 and Vivian P. Bykerk7. 1Schulich School of Medicine and Dentistry, Western University, London, ON; 2Centre Hospitalier de l’Université de Montréal, Montreal, QC; 3University of Manitoba, Winnipeg, MB; 4Southlake Regional Health Centre, Newmarket, ON; 5Mount Sinai Hospital, University of Toronto, Toronto, ON; 6Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 7Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

It is thought that early inflammatory arthritis patients who test positive for Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) (proteins that patients with RA often, but not always have in their blood) are likely to have more severe RA symptoms. The CATCH investigators wanted to find out if not having RF and anti-CCP affects how RA progresses over time and the likelihood to be in remission one year after diagnosis. Having RF and anti-CCP is called seropositive and not having them is called seronegative. Physicians used a scale to measure RA activity (called the DAS28) and compared results of seropositive and seronegative patients. There were 841 patients in the study. At the start of the study, the 26% of patients who were seronegative had a higher level of RA activity, and at one year they were just as likely as seropositive patients to achieve remission (when RA symptoms are not seen or decrease greatly) and less likely to have damaged joints.

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What was the purpose of this study?
It is thought that patients who have both Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) (proteins often found, but not always, in the blood of patients with RA) are likely to have more severe RA symptoms. These patients are called RF and anti-CCP positive or seropositive. However, previous studies of early RA patients have found opposite results. The purpose of this study was to determine the outcome of patients who originally tested negative for RF and anti-CCP (called seronegative) after 1 year.

How was this study done?
Disease activity was determined using the DAS28 with remission being a DAS28 of less than 2.6. There were 841 patients in the study.

What were the results of this study?
At the start of the study, 26% of patients were seronegative. These patients were more likely to be male and older than the seropositive patients. While the seronegative patients were less likely to be diagnosed with RA, they tended to have a higher swollen joint count and DAS28 and more damaged joints. Despite having higher DAS28 at the start of this study, the seronegative patients showed more improvement in swollen joint count and DAS28 after 12 months than the seropositive patients. Although the seronegative patients initially showed more joint damage after one year, these patients were likely to have less joint damage than those who originally tested seropositive. However, all patients were equally likely to achieve remission.

In conclusion, although seronegative patients had a higher DAS28 at the start of the study, they ended up responding well to treatment and were more likely to have less joint damage after 1 year than patients who were seropositive.


Reaching the Target of Low Disease Activity at 6 Months Predicts Better Long-term Functional Outcome in Patients with Early Rheumatoid Arthritis

Pooneh Akhavan1, Bindee Kuriya2, Edward C. Keystone2, Juan Xiong3, Janet E. Pope4, Gilles Boire5, Diane Tin6, Boulos Haraoui7, Carol A. Hitchon8 and Vivian P. Bykerk9. 1Early Rheumatoid Arthritis Program, Mount Sinai Hospital and University of Toronto, Toronto, ON, 2Mount Sinai Hospital, University of Toronto, Toronto, ON; 3Mount Sinai Hospital, Toronto, ON; 4St. Joseph Health Care, London, ON; 5Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke; 6Southlake Regional Health Centre, Newmarket, ON; 7Centre Hospitalier de l’Université de Montréal, Montreal, QC; 8University of Manitoba, Winnipeg, MB, 9Mount Sinai Hospital/University of Toronto, Toronto, ON.

The CATCH investigators wanted to see if a patient's low level of RA activity at six months predicted reduced RA progression (that is reduced pain and RA activity in the long term). Two years after the study started, patients filled out Health Assessment Questionnaires where they rated their ability to do different everyday physical tasks. Investigators compared this rating to the patients' RA activity at the start of the study and at the six-month mark. Investigators found that patients with low RA activity at six months were likely to have less disability later. It is important for patients to reach low disease activity soon after being diagnosed with RA to prevent long-term disability.

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What was the purpose of this study?
The goal for RA treatment is either remission or if remission is not possible, a low level of RA activity. From previous studies, investigators have learned that patients who reach a low level of RA activity one year after diagnosis have greater physical ability and have more normal-looking x-ray results in the long term. The purpose of this study was to learn if a low level of RA activity six months after diagnosis could predict a patient's long-term RA activity.

How was this study done?
CATCH patients with medical records spanning at least two years were part of the study. Patients who had a low level of RA activity six months after diagnosis were assessed again at two years using the Health Assessment Questionnaire (HAQ). Original and 6 month RA activities were compared to the HAQ score at two years after diagnosis.

What were the results of this study?
833 patients were in this study. Various patient characteristics were recorded at the start of this study, including age, sex, disease activity scores, and others. Reaching a low level of RA activity six months after diagnosis was predictive of a lower RA activity and lower HAQ scores at two years. Investigators found that both older age and higher RA activity at the start of the study were related to increased RA activity and higher HAQ scores (which means it was harder for the patients to do daily tasks on their own) at the two-year mark. Female patients were also more likely to have higher RA activity after two years. In conclusion, low RA activity at six months after diagnosis is a very good predictor of less disability in the long term. This means that reaching a low level of disease activity soon after diagnosis is important for lower RA activity long term and overall functional and physical abilities.


Relationship between DAS28 1.2 and SDAI50 Responses in Rheumatoid Arthritis

M. Omair1, P. Akhavan1, E. C. Keystone1,2, J. Xiong1, G. Boire3, J. E. Pope4, J. C. Thorne5, C. A. Hitchon6, B. Haraoui7, D. Tin5, D. A. Weber1, V. P. Bykerk8, CATCH Investigators 1Mount Sinai Hospital; 2University of Toronto, Toronto, Ontario; 3Université de Sherbrooke, Sherbrooke; 4University of Western Ontario, St. Josephs Health Centre, London; 5Southlake Regional Health Centre, Newmarket, ON; 6University of Manitoba, Winnipeg; 7Institut de Rhumatologie, Montreal, QC; 8Hospital for Special Surgery, New York, NY.

The CATCH investigators wanted to study the relationship between two different scores used to measure improvement in RA patients. One of these scores called DAS28 measures disease activity by looking at changes in tender joints and swollen joints in the 28 joints commonly affected by RA. A change in disease activity score of 1.2 is considered a significant improvement (called DAS28 1.2). The other score called SDAI50 (Simplified Disease Activity Index) is used to see if a patient's disease activity has improved by 50%. Some of the patients in the study had already received drugs to treat their RA while others had received little or no treatment. Investigators found that DAS28 1.2 and the SDAI50 were very similar, however, patients with a high level of disease activity were more likely to achieve DAS28 1.2, while those with a low level of disease activity were more likely to meet SDAI50.

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What was the purpose of this study?
In patients with RA there are two common scores used to measure their response to treatment:
1. Disease Activity Score (DAS28) - measures the change in tender joints and swollen joints in the 28 joints commonly affected by RA; and,
2. Simplified Disease Activity Index (SDAI) - measures the severity of a patient's RA.
Researchers defined changes in these scores that mean significant disease improvement to be: greater than 1.2 change in DAS28 and/or 50% change in SDAI (SDAI50). The purpose was to measure the number of patients who did not meet either of these targets and see if there was a relationship between the two scores.

How was this study conducted?
1953 patients were in this study. 419 of these patients had never taken biologics, but had been treated with DMARDs such as methotrexate.

What were the results of this test?
Out of 419 patients that were evaluated, at 3 months, 47% did not reach the target DAS28  determined by investigators (a change in DAS28 of 1.2, "DAS28 criteria") and 49% of patients did not reach SDAI50. These two scores yielded very similar results. However, out of the patients who did not meet the DAS28 criteria, 17% did achieve SDAI50. Of the patients who did not meet SDAI50, 19% met DAS28 criteria. Also, there was a greater change in DAS28 if a patient did not meet SDAI50, rather than if they did not have a DAS28 change of 1.2. In comparison, there was a greater change in DAS28 out of patients who at least met DAS28 1.2 than of patients who met SDAI50. Furthermore, patients with a high level of disease activity were more likely to achieve a DAS28 1.2 than SDAI50. Those at a lower level of disease activity, however, had a greater chance of achieving SDAI50 than DAS28 of 1.2. So while DAS28 1.2 and SDAI50 are very similar, results vary at different levels of disease activity.


Reliability and Validity of Patient-Reported Joint Counts and Determinants of Disagreement with the Physician in Recent Onset Rheumatoid Arthritis

Karen Visser1, Janet E. Pope2, Ernest Choy3, Clifton O. Bingham III4, Susan J. Bartlett5, Gilles Boire6, Carol A. Hitchon7, J. Carter Thorne8, Boulos Haraoui9, Diane Tin8, Edward Keystone10 and Vivian P. Bykerk11. 1Leiden University Medical Center, Leiden, Netherlands; 2St. Joseph Health Centre, London, ON; 3Cardiff University, Cardiff, England; 4Johns Hopkins University, Baltimore, MD; 5Johns Hopkins School of Medicine, Baltimore, MD; 6Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, QC; 7University of Manitboa, Winnipeg, MB; 8Southlake Regional Health Centre, Newmarket, ON; 9Institut de Rheumatologie de Montreal, Montreal, QC; 10University of Toronto, Toronto, ON; 11Hospital for Special Surgery, New York, NY.

The researchers wanted to compare a measurement called joint count in terms of what patients saw in themselves (called patient-reported) versus what their doctors saw in patients with recently diagnosed RA. 795 patients reported tender joint counts and swollen joint counts which were compared to what their doctors reported. For tender joints, patients and their doctors agreed 47%-82% of the time (they agreed the most about largest joints) and for swollen joints, there was 33%-60% agreement between patients and their doctors. Differences between patient and physician joint counts were lowest in patients who were in remission or had low disease activity. Disagreement for tender joint counts included patients who were lower age, male, and had higher disease activity, disability and depressed mood. Males with very active disease disagreed the most with their doctors in terms of swollen joint counts. Patient joint counts can be used in studies about remission and treatment changes to see if joint counts can help detect changes in disease activity and also identify flares.

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What was the study purpose?
Patient-reported joint counts might improve the efficiency and consistency of disease monitoring, self-management and early recognition of changes in disease activity in RA. The researchers wanted to see the difference between patient-reported and physician-reported joint counts in recent onset RA and if they could determine what made them disagree on this.

How was the study done?
Data from 795 RA patients from CATCH were used by looking at their patient-reported tender joint counts and swollen joint counts versus those of their doctors. Statistics were used to determine if findings were real.

What were the results of the study?
Agreement about joints counts ranged from 47%-82% for tender joints and from 33%-60% for swollen joints, with agreement being highest for tenderness in large joints. Differences between patient and physician joint counts were lowest in patients in remission or with low disease activity. Disagreement on tender joint count were seen when patients were younger, male, and had higher disease activity, disability and depressed mood. Disagreement on swollen joint count was seen mostly in males with higher disease activity.

Patient joint counts can be used in patient-reported outcomes in studies about remission and treatment withdrawal strategies to see if changes can be detected in disease activity and identify flares.


Responsiveness of the Outcomes Measures In Rheumatology Clinical Trials Initiative’s Preliminary Flare Questions To Detect Flares Within Patients In The Canadian Early Arthritis Cohort

Vivian P. Bykerk1, Karen Visser2, Ernest Choy3, Clifton O. Bingham III4, Daming Lin1, Juan Xiong1, Gilles Boire5, Boulos Haraoui6, Carol A. Hitchon7, Janet E. Pope8, J. Carter Thorne9, Diane Tin9, Edward C. Keystone1, Susan J. Bartlett10, CATCH Investigators11 and OMERACT Flare Working Group12. 1Mount Sinai Hospital, University of Toronto, Toronto, ON; 2Leiden University Medical Center, Leiden, Netherlands, 3Cardiff University, Institute of Infection and Immunity, Cardiff, United Kingdom; 4Johns Hopkins University, Baltimore, MD; 5Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC; 6Institut de Rhumatologie de Montreal, Montreal, QC; 7University of Manitoba, Winnipeg, MB; 8St. Joseph Health Care, London, ON; 9Southlake Regional Health Centre, Newmarket, ON; 10McGill University, Montreal, QC; 11Canadian Collaboration, Toronto, ON; 12International Collaboration, Baltimore, MD.

The CATCH investigators wanted to see if answers to Preliminary Flare Questions (PFQ) are different when patients are in a flare versus when they are not in a flare. PFQs are questions developed by the Outcome Measures in Rheumatology (OMERACT) Flare Group to measure RA patient flares and include questions about how bad the flare is, pain, physical function, stiffness, fatigue, and others. Participants in this study completed the PFQ two times over three months. For each symptom, patients scored each symptom on a scale from 0-10, where 0 was best and 10 was worst. At each visit, patients were asked the question "Are you having a flare at this time?". Investigators found that scores from the PFQs depend on RA activity and scores are higher when patients report that they are flaring. However, the scores also depend on the symptom that is being assessed, for example, fatigue versus stiffness.

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What was the purpose of this study?
In RA, a flare is a time of increased pain and disease activity. Preliminary Flare Questions (PFQ), developed by the OMERACT (Outcome Measures in Rheumatology) Flare Group, was used to measure flares in patients with early RA. Patients were asked questions about their flares, flare severity, pain, physical function, stiffness, fatigue, and others. The purpose of this study was to determine how or if patient responses to the PFQ change when they are experiencing a flare versus when they are not.

How was this study done?
Patients in this study completed the PFQ two times in three months. The PFQ included questions measuring the following:

  • Patient Global Assessment score (rating of joint pain);
  • General pain;
  • Physical function;
  • Stiffness;
  • Fatigue;
  • Coping; and,
  • Participation in daily activities.

Patients scored each of these categories on a scale from 0-10, where 0 was the best and 10 was the worst, and reported the tenderness and swelling in different joints. Investigators determined whether or not a patient was in a flare based on the physician's assessment of disease activity score (DAS28) and the patient's response to the question "Are you having a flare at this time?". Results of the PFQs were compared in patients who initially reported not having a flare and reported feeling they were in a flare by the second visit.

What were the results of this study?
Of the 115 patients enrolled in this study, 23% reported having a flare that lasted more than 8 days. Scores for some of the categories  (Patient Global Assessment, pain, function, fatigue, stiffness, coping, tenderness in joints and swelling in joints) all changed greatly in patients with flares compared to patients without flares.

Overall, scores from the PFQs change significantly when a patient's RA activity increases. However, the degree to which these scores change depends on which category is being measured. Further studies must be done to determine which of these categories is best at indicating an RA flare.

Read the paper about this work here.


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

Glen S. Hazlewood1, J. Carter Thorne2, Janet E. Pope3, Juan Xiong4, Gilles Boire5, Boulos Haraoui6, Carol A. Hitchon7, Edward C. Keystone8, Diane Tin2, and Vivian P. Bykerk9. 1University of Calgary, Calgary, AB; 2Southlake Regional Health Centre, Newmarket, ON; 3St. Joseph Health Care, London, ON; 4Mount Sinai Hospital, Toronto, ON; 5Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, QC; 6Institut de Rhumatologie de Montréal, Montreal, QC; 7University of Manitoba, Winnipeg, MB; 8Mount Sinai Hospital/University of Toronto, Toronto, ON; 9Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

The CATCH investigators wanted to find out whether methotrexate, a drug used to reduce inflammation and slow RA, is better when taken as a pill or when injected. Methotrexate pills are also called the oral form, meaning that you take them by mouth and methotrexate as an injection is also called taken subcutaneously or under the skin. Patients were given one of these two types of methotrexate to take regularly over one year. Patients injecting methotrexate were given a slightly higher starting dose than patients who took pills. Every three months, RA activity was measured and compared between groups. Patients taking injected methotrexate showed a greater decrease in RA activity, which was because of the higher starting dose not because of the form it was taken in.

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What was the purpose of this study?
Methotrexate is a DMARD taken to reduce inflammation and slow RA. Generally methotrexate is the first DMARD given to RA patients. The investigators wanted to find out if methotrexate is more effective when taken by pill or subcutaneously. The pill form is also called the oral form and taking methotrexate by injection under the skin is called subcutaneous methotrexate.

How was this study done?
Patients were divided into two groups: those taking methotrexate pills and those taking it by injection. Study participants took the given form of methotrexate for one year. Every three months, their RA was assessed using the DAS28.

What were the results of this study?
653 patients were in this study, with 442 patients taking methotrexate pills at a dose of 15 mg weekly and 211 patients taking methotrexate by injection at a dose of 25 mg weekly. At the beginning of the study, 35% of subcutaneous methotrexate patients had irreversible joint damage compared to 25% of oral methotrexate patients. Although the subcutaneous methotrexate group received a higher starting amount of the drug, they were less likely to be given other DMARDs at the same time. 38% of patients taking subcutaneous methotrexate also took other DMARDs while that percentage was 58% for patients taking oral methotrexate. After one year, investigators found that the DAS28 decreased for patients taking subcutaneous methotrexate. However, it was determined that the higher starting dose caused the decrease in disease activity, not the form of methotrexate that was taken. In conclusion, there may not be a significant difference in RA outcomes in patients taking subcutaneous versus oral methotrexate.

Read the paper on this work here.