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.


A Reduction in Serum Uric Acid Levels May be Related to Methotrexate Efficacy in Early Rheumatoid Arthritis: Data from a Canadian Arthritis Cohort

Jason Lee1, VP Bykerk2, George Dresser3, Gilles Boire4, Boulos Haraoui5, Carol Hitchon6, J Carter Thorne2, Diane Tin7, Shahin Jamal8, Edward C. Keystone9, Janet E. Pope10 and CATCH Investigators. 1Rheumatology, Western University, St. Joseph's Hospital, London, ON; 2University of Toronto, Toronto, ON; 3Clinical Pharmacology and Toxicology, Western University, London, ON; 4Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 5Institut de Rhumatologie, Montreal, QC; 6University of Manitoba, Winnipeg, MB; 7The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 8Vancouver Coastal Health, Vancouver, BC; 9Mount Sinai Hospital, University of Toronto, Toronto, ON; 10Monsignor Roney Bldg/Rheum, University of Western Ontario, St Joseph Health Care, London, ON.

It is not known how methotrexate works in the treatment of rheumatoid arthritis (RA). It is thought that methotrexate may lower uric acid levels in a person, so the researchers looked at uric acid levels in RA patients who were on methotrexate and those who were not on methotrexate. They found that patients who took methotrexate and who responded well to it had lower uric acid levels compared to patients who did not take methotrexate or who did not respond well to methotrexate as a treatment for their RA. Patients who responded well to methotrexate treatment had uric acid levels that decreased over time and fewer swollen joints compared to patients who did not respond well to methotrexate as a therapy. The study shows that for patients who responded well to methotrexate, they did in fact have lower uric acid levels as the researchers predicted.

Read more

What was the purpose of the study?
It is not known how methotrexate works in the treatment of rheumatoid arthritis (RA). Methotrexate may result in an increase in adenosine levels in the body and a decrease in uric acid levels. This study was done to see if methotrexate lowers uric acid in early RA (ERA).

How was this study done?
All CATCH patients with uric acid measurements were included, and those who were using methotrexate were compared to those who were not using methotrexate.

What were the results of the study?
Forty-nine ERA patients were included in the study. For patients who were put on methotrexate, their uric acid levels before they started methotrexate were measured to be 300 μmol/L and after methotrexate use, their uric acid levels had decreased to 273 μmol/L. This is a decrease in uric acid level of 26.8 μmol/L. The group not taking methotrexate was not expected to show a difference in their uric acid levels between the study start and end, which was shown: their uric acid level was 280 μmol/L at the start of the study and 282 μmol/L at the end of the study (a change of 2.3 μmol/L, which is negligible). At 18 months in to the study, patients on methotrexate with a decrease in uric acid had a lower DAS28 score of 2.37 than the group who did not take methotrexate who had a DAS28 score of 3.26. Methotrexate users who showed a decrease in uric acid levels also had a lower swollen joint count of 0.9 at 18 months compared to methotrexate users who did not have a decrease in uric acid and who had a swollen joint count of 4.5. Lower DAS28 and swollen joint counts mean that a person is experiencing less RA disease activity.

Methotrexate response is associated with lowering of uric acid in ERA compared to non-methotrexate users, and may be due to changes in adenosine levels. Patients who responded well to methotrexate treatment had uric acid levels that decreased over time as well as fewer swollen joints compared to patients who did not respond well to methotrexate as a therapy.

Read the paper about this work here.


Cardiovascular Disease in a Large Incident Cohort of Early Inflammatory Arthritis

Lillian Barra1, Janet E. Pope2, Carol Hitchon3, Gilles Boire4, Daming Lin5, J Carter Thorne6, Diane Tin7, Edward C. Keystone8, Boulos Haraoui9, VP Bykerk6 and CATCH. 1Medicine, Division of Rheumatology, Western University, London, ON; 2University of Western Ontario, London, ON; 3University of Manitoba, Winnipeg, MB; 4Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 5Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON; 6University of Toronto, Toronto, ON; 7The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 8Mount Sinai Hospital, University of Toronto, Toronto, ON; 9Institut de Rhumatologie de Montréal and University of Montreal, Montreal, QC.

Rheumatoid Arthritis (RA) is linked to a greater risk of cardiovascular disease (CVD). This study wanted to understand the rate of CVD and its predictors in people with early inflammatory arthritis. When participants enrolled in CATCH their physicians collected information on any pre-existing diagnosis of CVD, and risk factors and medications for CVD. After their enrollment in CATCH, patients informed their doctor of any CVD issues and cardiac medications they started taking. At the beginning of the study, 7% of patients had CVD already and after the start of CATCH, there were another 62 new CVD events in 57 participants. The rate of CVD events in patients with early inflammatory arthritis was higher later in the disease course. CVD seems to be under-treated and is associated with usual CVD risk factors (such as being male, high levels of fat or cholesterol in blood and high blood pressure) and the use of NSAIDs.

Read more

What was the purpose of this study?
Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). This study set out to determine the rate of CVD and its predictors in people with early inflammatory arthritis from the CATCH study.

How was this study done?
CVD was defined as a number of different things, such as coronary artery disease, stroke, death secondary to CVD, and others. Patients' already-existing diagnoses of CVD, risk factors and medications for CVD were collected when they enrolled in CATCH by their physician. After enrollment in CATCH, patients were asked to report any additional CVD events and cardiac medications. Predictors for CVD were determined using statistical methods.

What were the results of the study?
2652 patients were enrolled in the study and at the beginning, 180 of them (or 7%) had pre-existing CVD. After enrollment in CATCH, there were 62 new CVD events in 57 participants with a total of 6 deaths, including one that was not caused by CVD. Patients with new CVD events were older, more often male and had higher rates of usual CVD risk factors such as higher fat or cholesterol levels in the blood, high blood pressure, or used NSAIDs. Arthritis-related factors were not significantly associated with the risk of CVD. Less than 25% of participants with a CVD diagnosis reported taking aspirin or cholesterol-lowering drugs during their enrollment in CATCH.

Overall the researchers found that the rate of CVD events in patients with EIA was higher later in the course of them having inflammatory arthritis. CVD appears to be under-treated and is associated with traditional CVD risk factors and the use of NSAIDs.


Characteristics and Outcomes Associated with Early Corticosteroid Use in a Large Multicenter Canadian RA Cohort

Kathleen Andersen1, Daming Lin2, Susan J. Bartlett3,4, Gilles Boire5, Boulos Haraoui6, Carol Hitchon7, Shahin Jamal8, Edward C. Keystone9, Janet E. Pope10, Diane Tin11, J Carter Thorne12, VP Bykerk13,14 and CATCH Investigators. 1Hospital for Special Surgery, New York, NY; 2Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Division of Rheumatology; 3Johns Hopkins School of Medicine, Baltimore, MD; 4Medicine, Divisions of Clinical Epidemiology, Rheumatology, Respirology, McGill University, Montreal, QC; 5Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 6Institut de Rhumatologie, Montreal, QC; 7Department of Rheumatology, University of Manitoba, Winnipeg, MB; 8Vancouver Coastal Health, Vancouver, BC; 9Mount Sinai Hospital, University of Toronto, Toronto, ON; 10University of Western Ontario, London, ON; 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 12University of Toronto, Toronto, ON, Canada, Rheumatology, 13Hospital for Special Surgery, New York, NY; 14Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON.

The CATCH researchers wanted to see if patients with RA who were prescribed corticosteroids (also called steroids) had any characteristics or arthritis outcomes in common. The researchers compared socio-demographic characteristics such as age, employment status, income, and others including how patients 'scored' on different clinical tools that rheumatologists use to measure RA. Patients taking steroids within the first 3 months after their RA diagnosis tended to be older, had RA for less time and had higher disease activity. This study suggests that steroids are used to treat patients who have more active RA and who might not do as well in the long term.

Read more

What was the purpose of the study?
Corticosteroids, also just called steroids, are often used to treat RA to quickly decrease disease activity. This gives people some relief from their RA symptoms until their slower-acting DMARDs start to work. Early steroid use is variable so the purpose of this study was to compare patient characteristics and outcomes over time of people who were given steroids shortly after their RA diagnosis versus those who were not.

How was this study done?
In CATCH, patients were included within the first 18 months of being in CATCH and who had symptoms for less than one year, were diagnosed with RA because they met either the ACR 1987 and/or 2010 RA criteria, and who used steroids within the first 3 months of being in CATCH. Socio-demographic and RA characteristics between groups at baseline and selected outcomes (CDAI, DAS28, MD global, RAPID 3 and starting a biologic) at 3, 6, 12, and 18 months were compared. Outcomes for patients receiving no steroids, intra-articular steroids (that means an injection in to the joint, also called IA), intra-muscular steroids (that means an injection of steroids in to the muscle, also called IM) only, oral steroids only, or both forms of steroids were evaluated at each time point.

What were the results of the study?
At the beginning of the study, patients who received steroids were older and less likely to have a job but otherwise the same in terms of race, weight, or socio-economic status. Patients who used steroids had symptoms for a shorter amount of time, higher levels of inflammation markers in their blood, and said they felt more pain and fatigue. Many patient-reported outcomes such as patient global, HAQ, RAPID 3, and RADAI pain, as well as clinical outcome measurements, such as MD global, joint counts, and DAS28, were much worse in those who received steroids. Steroid use was more frequent in participants enrolled at study sites with more than 100 participants and in those who were also taking methotrexate. Measures were worse over time in patients receiving both injections and oral forms of steroids at months 3 to 12, and these patients also tended to go on to using a biologic later.

Patients receiving steroids within the first 3 months of their RA diagnosis tended to be: older, have RA for a shorter period of time, and have higher RA activity. This suggests steroids are being used to help treatment in patients with poor prognostic factors to control more active RA. Despite early use of both injected and oral steroids, biologic use in the long term is still required in patients with more active RA at diagnosis.


Characteristics of Patients with Early Rheumatoid Arthritis (ERA) over Time: Data from the CATCH Cohort Demonstrate that more Patients Achieve Remission in Recent Years

J.E. Pope1, B.P. Haraoui2, G. Boire3, C. Hitchon4, C. Thorne5, D. Tin5, E. Keystone6, V.P. Bykerk7. 1Medicine, Rheumatology, University of Western Ontario, London; 2Rheumatology, Institut de Rhumatologie, Montreal; 3Medicine, Rheumatology, Universite de Sherbrooke, Sherbrooke; 4Medicine, Rheumatology, University of Manitoba, Winnipeg; 5Rheumatology, Southlake Regional Health Centre, Newmarket; 6Medicine, Rheumatology, University of Toronto, Toronto; 7Medicine, Rheumatology, Hospital for Special Surgery, New York.

The CATCH researchers wanted to see if the baseline and one year characteristics of early RA (ERA) patients are changing over time in the CATCH study, including numbers of participants going in to remission. The CATCH study started in 2003 and has 23 research sites, and many data points are collected from participants about their arthritis. The researchers compared these data points in patients enrolled before 2010 in CATCH to patients enrolled after 2010 to see if the outcomes of their ERA are different. They found that their baseline characteristics were mostly similar but more patients were in remission in the group enrolled after 2010 despite slightly less methotrexate and biologic use by one year. The researchers thought that there could many reasons for this that are related to how treatment practices have changed with respect to ERA patients since the CATCH study started.

Read more

What was the purpose of the study?
It seems that outcomes in early rheumatoid arthritis (ERA) are improving due to how RA treatment is changing, resulting in earlier identification of patients due to the ACR/EULAR 2010 RA criteria, treating toward remission, and/or early introduction of DMARDs. The CATCH researchers wanted to see if the baseline and one year characteristics of ERA patients are really changing over time by looking at data from the CATCH study.

How was this study done?
CATCH started in 2003 and has 23 sites that enroll participants within one year of symptom onset who are thought to have ERA or are diagnosed with ERA. Data are collected on participants at the study start and at one year, including: percent of patients who are diagnosed with RA, disease activity score (DAS28), rheumatoid factor, anti-cyclic citrullinated peptide, x-rays, DMARD and biologic treatment. Participants enrolled before 2010 (before RA diagnosis criteria and aggressively treating to remission were practiced) were called the 'early cohort' and were compared to participants enrolled from 2010 to 2014 and called the 'later cohort.' There were 701 patients in the early cohort and 862 in the later cohort. Their data at study start and at one year were compared to see if they had differences in outcomes.

What were the results of the study?
In both groups, the characteristics of participants were similar at the start of the study, except there were less participants who were anti-CCP positive in later cohort. Also at one year more patients were in remission in the later cohort based on a disease activity score of less than 2.6, even though they used less methotrexate and biologics. There could be many reasons for why the later cohort had more patients in remission, including: slightly earlier time to first rheumatology visit, less anti-CCP positive patients, and larger percentage of participants diagnosed with RA in the later cohort. Site differences could also be a reason, since more CATCH sites were added over time and may vary in their initial treatment of patients with ERA, including starting patients on an optimized subcutaneous dose of methotrexate and/or initial treatment with combination DMARDs. Others have shown that effective early DMARD treatment strategies in ERA have decreased biologics use.


Clinically Important Worsening (CIW) of RA Disease Activity Requiring an Increase in Therapy Can be Identified Using a Combined Patient and Physician Report of Flare

VP Bykerk1,2, Clifton O. Bingham III3, Ernest H. Choy4, Daming Lin2, Rieke Alten5, Robin Christensen6, Daniel E. Furst7, Francis Guillemin8, Sarah Hewlett9, Amye L. Leong10, Lyn March11, Thasia Woodworth12, Gilles Boire13, Carol Hitchon14, Shahin Jamal15, Edward C. Keystone16, Janet E. Pope17, J Carter Thorne18, Diane Tin19, Susan J. Bartlett20,21,22 and CATCH Investigators and OMERACT Flare Group. 1Rheumatology, Hospital for Special Surgery, New York, NY, Rheumatology; 2Mount Sinai Hospital, University of Toronto, Toronto, ON; 3Rheumatology, Johns Hopkins University, Baltimore, MD; 4Cardiff University, Institute of Infection and Immunity, Tenovus Building, University Hospital of Wales, Cardiff, United Kingdom; 5Internal Medicine, Rheumatology & Clinical Immunology, Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; 6The Parker Institute, RC, Copenhagen, Denmark; 7Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA; 8University of Lorraine, Nancy, France; 9Academic Rheumatology, University of West of England, Bristol, United Kingdom; 10Spokesperson; Strategic Relations, BONE AND JOINT DECADE, Santa Barbara, CA; 11Department of Rheumatology, Northern Clinical School, Institute of Bone and Joint Research, Kolling Institute, University of Sydney & Department of Rheumatology, Royal North Shore Hospital, St Leonards, Sydney, Australia; 12Medicine, Division of Rheumatology, David Geffen School of Medicine, Los Angeles, CA, 13Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 14Department of Rheumatology, University of Manitoba, Winnipeg, MB; 15Vancouver Coastal Health, Vancouver, BC; 16Mount Sinai Hospital, University of Toronto, Toronto, ON; 17Monsignor Roney Bldg/Rheum, University of Western Ontario, St Joseph Health Care, London, ON; 18University of Toronto, Toronto, ON; 19The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 20Medicine, Divisions of Clinical Epidemiology, Rheumatology, Respirology, McGill University, Montreal, QC; 21Division of Rheumatology, Johns Hopkins University, Baltimore, MD; 22Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD

It is important to identify a point where a patient's RA disease activity is getting worse and requires a change in treatment such as a change in medication or increasing a treatment. This point can be called the clinically important worsening (CIW) of RA disease activity and this has not been well defined yet. The CATCH researchers looked for how to define this point by looking at patients who were in remission or had low disease activity at two rheumatology visits in a row. They found that when patients and physicians agreed on a patient being in a flare was a good point to call clinically important worsening. Knowing this point will help determine when changes to treatment are needed.

Read more

What was the purpose of the study?
A reference point for clinically important worsening (CIW) of RA disease activity requiring a change in treatment is needed for randomized trials where treatment is stopped. These studies are usually with patients in states of low disease activity or remission. Restarting RA therapy needs a point of agreement where the patient and physician both agree that the patient is worsening, in this case flaring, to try to maximize taking the treatment when it should be taken and at the right dose.

How was this study done?
CATCH patients were in the study if they were in remission (defined by DAS28) or low disease activity at the first visit of two rheumatology visits in a row that were 3 or 6 months apart. RA flare was assessed at the second visit where patients reported if their RA was flaring or not, and if they were in a flare, they indicated how bad and how long the flare was. At the same time, physicians also answered whether or not they felt the patient was in a flare. Changes in disease activity and treatment, OMERACT flare domains, physician measures, inflammatory markers, and DAS28 were assessed in patients reporting flare, physicians classifying flare, and when patients and physicians agreed in terms of flare.

What were the results of the study?
360 patients were in the study. They most often reported that flare lasted more than 14 days when they were in agreement with their physician about a flare. DAS28 worsening was less in physician reported flare (DAS28 of 0.9) compared to when patients and physicians agreed about flare (DAS28 of 1.8). Prior treatment decrease or withdrawal was observed in 36% of flares where patients and their physician agreed on flare with subsequent treatment addition in 61% at or after the second flare. Average differences in measures of RA activity such as patient-reported outcomes, physician measures, and blood test measurements were significant in patient-reported flare, and worse when patients and physicians agreed about flare.

The researchers concluded that when patients and physicians agree about flare, this can provide a measure that can assess the CIW of RA activity associated with worsening in RA activity measures and items measured in the OMERACT Flare core set. This CIW is often related to stopping or reducing treatment and with increases in therapy. This study provides a rationale for using when patients and physicians agree on flare to identify CIW for existing and new RA activity measures.


Early Rheumatoid Arthritis Patients in the Worse Disease Trajectory Group Fail to Achieve Improvement in Physical Function

Cheryl Barnabe1, Ye Sun2, Susan J. Bartlett3,4, Gilles Boire5, Carol Hitchon6, Edward C. Keystone7, Boulos Haraoui8, J Carter Thorne2, Diane Tin9, Janet E. Pope10, VP Bykerk11 and CATCH Investigators. 1Cumming School of Medicine, University of Calgary, Calgary, AB; 2University of Toronto, Toronto, ON; 3Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, 4Medicine, Divisions of Clinical Epidemiology, Rheumatology, Respirology, McGill University, Montreal, QC; 5Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 6Department of Rheumatology, University of Manitoba, Winnipeg, MB; 7Mount Sinai Hospital, University of Toronto, Toronto, ON; 8Institut de Rhumatologie, Montreal, QC; 9The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 10University of Western Ontario, London, ON; 11Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON.

In a large group of people with early RA, clear differences in disease courses (also called trajectories) are seen. These are separated by differences in disease activity and improvement in their RA symptoms. Patients in the worse disease trajectories have poorer quality of life and constant fatigue. This study set out to see if the improvements in physical function measured by the Health Assessment Questionnaire (HAQ) were different between the disease trajectories. The researchers found that there were five different disease trajectories in RA. The study also helped show that strategies are needed to identify patients at risk for the worst outcomes so that the best care plans can be taken to help them maintain their abilities to function.

Read more

What was the purpose of the study?
In a large group of people with early RA, disease courses (also called trajectories) are seen which are defined by differences in disease activity and rates of RA improvement. Patients in the worse disease trajectories have poorer quality of life and feel constant fatigue. This study wanted to see if the improvements in physical function measured by the Health Assessment Questionnaire (HAQ) were different between the different disease trajectories.

How was this study done?
Five early RA disease activity trajectories defined by DAS28 over 24 months were identified. Starting HAQ scores as well as changes with time were studied for differences by trajectory group.

What were the results of the study?
There were 1586 patients in the study, and they were identified to be part of 5 different disease trajectories:

  • Group 1 – This group began in high disease activity state (DAS) (this was 50% of patients) and from here 20% of patients rapidly reached remission
  • Group 2 – This group began in moderate DAS and ended in remission at 24 months
  • Group 3 – These patients started in moderate DAS and ended in low DAS at 24 months
  • Group 4 – This group started in a high DAS and ended in ow DAS at 24 months
  • Group 5 – This group started in high DAS and was in moderate DAS by 24 months, despite more frequent of use of steroids and biologics.

At the start of the study, HAQ scores were similar between Groups 1, 4 and 5. Group 1's HAQ scores improved by 1.08 by 12 months whereas Group 5's HAQ scores did not reach the minimal clinically important difference for improvement and got worse between months 12 to 24.

The study helped show that strategies are needed to identify which patients are at risk for the worst outcomes so that the best care plans can be undertaken for those patients and to help preserve their abilities to function.


Read the paper on this work here.


Effect of Age at Menopause on Disease Presentation in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort

Janet Pope1, Lauren Wong2, Wei-Ti Huang3, Gilles Boire4, Boulos Haraoui5, Carol Hitchon6, Carter Thorne7, Diane Tin8, Ed Keystone9, Vivian Bykerk10. 1St. Joseph’s Health Care, London; 2Hospital for Special Surgery, New York; 3Hospital for Special Surgery, New York; 4Université de Sherbrooke, Sherbrooke; 5Université de Montréal, Montréal; 6University of Manitoba, Winnipeg; 7Southlake Regional Hospital, Newmarket; 8Southlake Regional Health Centre, Newmarket; 9Mount Sinai Hospital, University of Toronto, Toronto; 10Hospital for Special Surgery, New York.

The CATCH researchers wanted to see how a woman's age of menopause affects her RA by looking at women who started menopause early ("early menopause" and who were less than 45 years old) versus those who started at a normal age (and who were 45 years old or older). Of 534 women in CATCH, 93 started menopause early, and the age when all the women were diagnosed with RA was about the same. The researchers looked at many variables in the normal and early menopause groups, such as their RA disease activity and certain blood markers. They found that the women who had menopause early also tested positive for two RA-related blood markers (called rheumatoid factor and anti-citrillunated protein antibody).

Read more

What was the study purpose?
Research suggests that a woman's hormones affect her RA. The CATCH researchers looked at how age at menopause affects RA in women with early RA by looking at women who started menopause early (were less than 45 years old) versus women who started it at normal age (were 45 years old or greater).

How was the study done?
Women with early RA who were in menopause and under 65 years old at time they were enrolled in CATCH were part of this study. RA-related disease characteristics in women who had early age at menopause were compared to those who had usual age at menopause.

What were the study results?
Of 534 women, 93 were in the early menopause group, and the age at RA-onset was about the same in all women. The early menopause group was more likely to be rheumatoid factor (RF) positive, more likely to be anti-citrillunated protein antibody (ACPA) positive, and seropositive (RF or ACPA positive). Symptom duration, joint counts, disease activity score (DAS28), health assessment questionnaire (HAQ) and blood markers of inflammation were not different between groups.

Overall the researchers found that women with early RA who start menopause earlier than usual are more likely seropositive.

Read the paper on this work here.


Enhancing Comparative Effectiveness Research By Combining Observational and Randomized Trial Data to Personalize the Choice Between Methotrexate and Triple Therapy for Methotrexate-Naïve Patients with Early Rheumatoid Arthritis

Glen S. Hazlewood1,2, Cheryl Barnabe3, Gilles Boire4, Carol Hitchon5, Edward C. Keystone6, Boulos Haraoui7, J Carter Thorne8, Diane Tin9, Janet E. Pope10, Daming Lin11, VP Bykerk12 and CATCH investigators. 1Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON; 2Medicine, University of Calgary, Calgary, AB; 3Cumming School of Medicine, University of Calgary, Calgary, AB; 4Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 5University of Manitoba, Winnipeg, MB; 6Mount Sinai Hospital, University of Toronto, Toronto, ON; 7Institut de Rhumatologie, Montreal, QC; 8Southlake Regional Health Centre, Newmarket, ON; 9The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 10University of Western Ontario, London, ON; 11Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON; 12Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

The CATCH researchers wanted to see if they could use patient characteristics from CATCH and those from clinical trials to develop better ways to treat patients individually. The CATCH researchers developed a model to predict the probability of patients reaching ACR50 based on characteristics such as swollen joint count, DAS28, and HAQ, for patients on methotrexate only and for patients taking triple therapy, which is when a person takes three types of DMARDs for their RA. ACR50 is when a patient's symptoms are 50% improved based on a number of variables and measures. Rheumatologists can use this information to create the best treatment plans right from diagnosis to determine what therapy they should go on (methotrexate or triple therapy).

Read more

What was the purpose of the study?
Randomized controlled trials (also called RCTs) are considered the best method to compare how well treatments work, but the environment and patient requirements often do not represent real life. The CATCH researchers recently completed a literature analysis of all RCTs and found a significant increase in the chances of patients having an ACR50 response for those taking triple therapy compared to methotrexate alone, in patients who had never taken methotrexate before. ACR50 is when a patient's symptoms are 50% improved based on a number of variables and measures. The objective of this study was to take the findings from the literature analysis and apply them to a set of real-life patients from CATCH to help rheumatologists put their patient on the best medication right from their diagnosis.

How was this study done?
For patients in CATCH, the researchers estimated the probability of an ACR50 response at 6 months for patients with early RA (diagnosed using the 2010 ACR criteria and who had symptoms for less than 1 year). A model was used to estimate the probability of ACR50 response for patients taking methotrexate and who had different disease characteristics at the start of the study. They did the same for patients on triple therapy (where patients take three types of DMARDs for their RA) with information from the clinical trials literature analysis.

What were the results of the study?
There were 666 patients from CATCH in the study who were an average age of 53 years old and 74% female, had an average DAS28 of 5.5, had an average HAQ of 1.1, and an average swollen joint count of 9.4. A younger age, lower HAQ-DI and higher swollen joint counts were each associated with a higher likelihood of an ACR50 response. The expected probability of an ACR50 response for different patient characteristics was determined for patients on methotrexate alone versus patients on triple therapy. As the baseline chance of an ACR50 response increased, the difference between methotrexate and triple therapy also increased.

By combining information on patient characteristics and outcomes from CATCH and those from a literature analysis of clinical trials, the researchers were able to estimate probabilities of treatment response to methotrexate and triple therapy. This can be used to guide individual patient treatment based on a person's own disease characteristics.


High Body Mass Index Negatively Impacts Time to Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from a Multicenter Early Arthritis Cohort Study

Elizabeth Schulman1, Kathleen Andersen2, Meng Zhang3, Susan M. Goodman4, Daming Lin5, Gilles Boire6, Boulos Haraoui7, Carol Hitchon8, Shahin Jamal9, Edward C. Keystone10, Janet E. Pope11, Diane Tin12, Carter Thorne13, VP Bykerk2 and CATCH Investigators. 1Rheumatology, Hospital for Special Surgery, New York, NY; 2Hospital for Special Surgery, New York, NY; 3Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY; 4Rheumatology, Hospital for Special Surgery, New York, NY; 5Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON; 6Department of Medicine/Division of Rheumatology, University of Sherbrooke, Sherbrooke, QC; 7Institut de Rhumatologie de Montréal, Montréal, QC; 8University of Manitoba, Winnipeg, MB; 9Vancouver Coastal Health, Vancouver, BC; 10Mount Sinai Hospital, University of Toronto, Toronto, ON; 11University of Western Ontario, London, ON; 12The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 13Southlake Regional Health Centre, Newmarket, ON.

The CATCH researchers wanted to understand if a person's weight (measured by their body mass index) could affect their chances of being in sustained remission when they have early RA. Although very few factors in RA can be controlled, the researchers found that a person's weight could have an affect their RA outcomes. Patients who are overweight or obese take more time to reach sustained remission, if this is even possible for them. Early methotrexate use is associated with shortened time to sustained remission and early steroid use is associated with a longer time to reach sustained remission, regardless of a person's body mass index. These findings support other studies that include weight management as part of early RA treatment plans.

Read more

What was the purpose of the study?
High body mass index (BMI) has been associated with worse RA and lower rates of sustained remission in early rheumatoid arthritis (ERA). This study examined the relationship of higher BMI on time to sustained remission in patients with ERA.

How was this study done?
CATCH patients with ERA who had information on BMI and at least 2 consecutive DAS28 measurements were in the study. There were very few underweight patients (BMI less than or equal to 18.5) so they were excluded from the study. The other patients were put into 3 BMI groups: normal (BMI of 18.5-24.9), overweight (BMI of 25-29.9), and obese (BMI of greater than or equal to 30), and time to sustained remission (time from one visit to DAS28 less than or equal to 2.6 at two consecutive visits) was assessed. The time to sustained remission was compared among the three BMI groups.

What were the results of the study?
Of 1066 patients with available BMI information:

  • 348 patients or 33% had a normal BMI
  • 369 patients or 35% were overweight, and
  • 348 patients or 33% were obese.

Obese and overweight patients were less likely to reach sustained remission quickly compared to those with normal BMI. Other factors that positively affected the likelihood of reaching sustained remission included achieving DAS28 of less than or equal to 3.2 by 6 months, having a higher education, and using methotrexate in the 3 months. Factors such as higher BMI, more comorbidities and use of steroids in the first three months, pointed towards patients being less likely to achieve sustained remission.

Patients who are overweight or obese take more time to reach sustained remission, if this is even possible for them. Early use of methotrexate is associated with shortened time to sustained remission and early steroid use is associated with prolonged time to sustained remission, independent of a person's BMI. These findings support other studies that include weight management as part of ERA treatment plans.


No Sex Bias in the Escalation of Therapy in the Treatment of Early Inflammatory Arthritis

Stephanie Garner1, Cheryl Barnabe2, Gilles Boire3, Carol Hitchon4, Edward C. Keystone5, Boulos Haraoui6, J Carter Thorne7, Diane Tin8, Janet E. Pope9, VP Bykerk10 and CATCH Investigators. 1University of Calgary, Calgary, AB; 2Cumming School of Medicine, University of Calgary, Calgary, AB; 3Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 4Department of Rheumatology, University of Manitoba, Winnipeg, MB; 5Mount Sinai Hospital, University of Toronto, Toronto, ON; 6Institut de Rhumatologie, Montreal, QC; 7University of Toronto, Toronto, ON; 8The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 9University of Western Ontario, London, ON; 10Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON.

Studies have shown that women with early inflammatory arthritis have higher disease activity, more issues with functioning and report worse outcomes, but do not have more radiographic damage compared to men. It is thought that the current tools that measure disease activity are biased against women (so show higher scores than for men). The Hospital Universitario La Princesa Index (HUPI) is a tool used in early RA that the researchers thought would be more objective than other tools currently used. However overall, the researchers did not find any sex differences in treatment of RA or increase in therapy by disease activity.

Read more

What was the purpose of the study?
Several studies have shown that women with early inflammatory arthritis have higher disease activity, more issues with functioning and worse patient-reported outcomes, but do not have more radiographic damage. It is thought that the current tools for measuring disease activity are biased against females. The Hospital Universitario La Princesa Index (HUPI) is a validated tool in early RA and has been proposed to account for this sex bias by adjusting for both the tender joint count and erythrocyte sedimentation rate for males and females. The purpose of this study was to assess if there are really differences in disease activity between males and females measured by the DAS28 and the HUPI, and whether there are differences in therapy between the men and women.

How was this study done?
Data from CATCH were used for an analysis of men and women looking at disease activity and treatment increase at 3, 6, 12, 24 and 60-month follow-up. Patients were included if they met the ACR 1987 or 2010 classification criteria for RA and their sex was documented. Patients were classified into remission, low disease activity and moderate/high disease activity using the DAS28 and the HUPI. An increase in treatment was defined as: 1) increased dose of methotrexate; 2) addition of a new DMARD; 3) addition of a biologic; or 4) switching a biologic.

What were the results of the study?
2228 patients (1619 females, 609 males) were in the study. Females were younger than men (52 versus 58 years old) and more often seropositive (72% versus 64%) and males had more joint damage at the study start (14% of men versus 9% of women) and higher swollen joint count (9 for men and 7 for women). The DAS28 was similar in both men and women at the start of the study (5.1 for men versus 5.0 for women) but HUPI scores were higher in men (8.9 for men and 8.3 for women). Initially more women than men were taking NSAIDs (60% women versus 52% men) and steroids (81% women versus 59% men) at the start but by twelve months, these numbers were similar between men and women. The proportion of patients on DMARDs and biologics were the same for both men and women at any time point. There were no differences between men and women in their increases in therapy when disease activity was measured with either DAS28 or HUPI. At 60 months, more males were in remission according to the DAS28 defintion (67% of men versus 52% of women) but the same proportion of men and women were in remission according to the HUPI definition (53% of men and 50% of women). There were no sex differences in the proportion of patients with joint damage at 24 and 60 months.

There were no sex differences in treatment or increase of therapy by disease activity state. Increased efforts to treat all patients with the goal of remission is required.


Patient Reported “Negative” Life Events that Cause Stress can Impact Patient Reported Outcomes in Early Rheumatoid Arthritis; An Analysis of the CATCH Study

V.P. Bykerk1,2, Y.A. Kim2, D. Lin1, S.J. Bartlett3, G. Boire4, C.A. Hitchon5, B. Haraoui6, E. Keystone1, D. Tin7, J.C. Thorne7, J. Pope8, J. Salmon2. 1Mount Sinai Hospital, Toronto; 2Hospital for Special Surgery, New York; 3McGill University, Montreal; 4University of Sherbrooke, Sherbrooke; 5University of Manitoba, Winnipeg; 6University of Montreal, Montreal; 7Southlake Regional Health Centre, Newmarket; 8Western University, London.

The researchers wanted to see how stressful physical and psychological life events were reported by patients with early rheumatoid arthritis (ERA) when they were first diagnosed and one year later. Patients filled in surveys called patient-reported outcomes or PROs about major life events. Of 1596 patients, 51% reported stress. Patients reporting stress were younger, more often female, lived alone, and fewer completed high school. These patients also said they had more pain, fatigue, and issues with physical function, and were also less likely to achieve remission. Rheumatologists should use stress to help them assess a patient's response to therapies and to help them decide on treatment plans.

Read more

What was the purpose of the study?
It is known that stress plays a role in RA onset, activity, and worsening of symptoms. However the effect of stress on patient-reported outcomes (PROs) has not been studied in early RA (ERA). The CATCH researchers wanted to measure the effect of stressful physical and psychological major life events on PROs at symptom start and over one year in patients with ERA.

How was this study done?
1596 participants in CATCH were asked about major life events that occurred in the year prior to starting CATCH. Changes in PROs and in the RAPID 3 score over time were evaluated for participants who reported psychological or physical stress.

What were the results of the study?
Of 1596 patients, 51% reported stress. Patients reporting prior stress were:

  • Younger: 53 compared to 55 years old,
  • More often female: 77% compared to 69%,
  • Living alone: 17% compared to 12%, and
  • Less likely to have completed high school: 41% compared to 48%.

These participants also reported higher levels of pain, fatigue, worse physical function, and global disease assessment. A significant, independent negative effect of psychological but not physical stress was associated with RAPID 3 scores at the start of the study, 6 months, and 12 months. Fewer patients reporting prior psychological stress achieved a RAPID 3 remission. Rheumatologists should use stress to help them assess a patient's response to therapies and to help them decide on treatment plans.


SDAI50 Is More Stringent Than the EULAR Response Measure and a Better Predictor of Low Disease State/Remission in Early Rheumatoid Arthritis: Results from an Early Arthritis Cohort

Mohammed Omair1, Edward C. Keystone2, VP Bykerk3, Boulos Haraoui4, Gilles Boire5, J Carter Thorne3, Janet E. Pope6, Daming Lin7, Carol Hitchon8 and Pooneh S. Akhavan9. 1Rheumatology, Mount Sinai Hospital, Toronto, ON; 2University of Toronto/Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Toronto, ON; 3University of Toronto, Toronto, ON; 4Institut de Rhumatologie de Montréal and University of Montreal, Montreal, QC; 5Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 6St. Joseph's Health Care, London, ON; 7Mount Sinai Hospital, Toronto, ON; 8University of Manitoba, Winnipeg, MB; 9Mount Sinai Hospital, Toronto, ON.

The CATCH researchers wanted to compare two measures of RA disease activity called the EULAR response measure and the SDAI50 response measure. Both of these use different patient variables to measure of a patient's RA disease activity. Overall the researchers found that the two measures were usually in agreement when measuring a patient's RA disease activity, however at the start of the study, some patients with very low disease activity or very high disease activity had measures that were not in agreement. They also found out that the SDAI50 response measure was a better predictor of low disease activity or remission at 6 months than the EULAR response measure.

Read more

What was the purpose of the study?
The study compared the sensitivity of the EULAR and SDAI50 response measures and how or if they were related to predicting future response to treatment in patients with early rheumatoid arthritis (RA). These two types of measures take various patient variables to measure RA disease activity.

How was this study done?
Patients who had not taken a biologic and who had baseline, 3 and 6 months data were part of the study. Statistics were used to determine the relationship between the EULAR and SDAI50 response measures. The response measures at 3 months were also compared to see if they could predict low disease state or remission at 6 months.

What were the results of the study?
A total of 419 participants were in the study. Of those participants, 198 (or 47%) did not meet the EULAR response measures and 206 (49%) patients did not meet the SDAI50 response measures. A strong correlation was seen between the EULAR and SDAI50 response measures which means that they were mostly in agreement in terms of what they each said about a person's RA activity. Throughout from low to high disease activity, the SDAI50 response was shown to be more stringent than the EULAR response. The SDAI50 response measure at 3 months better predicted a patient having low disease state or being in remission at 6 months compared to the EULAR response measure.

The results show there is a strong correlation between the EULAR and SDAI50 response measures. However at the start of the study, a small number of patients' EULAR and SDAI response measures were not in agreement – and these patients either had very low or very high disease activity. It was also found that the SDAI50 response at 3 months was a better predictor of outcomes at 6 months than the EULAR response.


Sociodemographic and Health Status Characteristics Explain Five Clinical Outcome and Radiographic Trajectories in Early Rheumatoid Arthritis: Data from the CATCH Cohort

Cheryl Barnabe1, Ye Sun2, Gilles Boire3, Carol Hitchon4, Boulos Haraoui5, Carter Thorne6, Diane Tin7, Desiree van der Heijde8, Jeffrey Curtis9, Janet Pope10, Ed Keystone11, Vivian Bykerk12. 1University of Calgary, Calgary; 2University of Toronto, Toronto; 3Université de Sherbrooke, Sherbrooke; 4University of Manitoba, Winnipeg; 5Université de Montréal, Montréal; 6Southlake Regional Hospital, Newmarket; 7Southlake Regional Health Centre, Newmarket; 8Leiden University, Leiden; 9University of Alabama at Birmingham, Birmingham; 10St. Joseph’s Health Care, London; 11Mount Sinai Hospital, University of Toronto, Toronto; 12Hospital for Special Surgery, New York.

The CATCH researchers wanted to see what patients have in common when they’re diagnosed with RA, and if that can be used to predict how well they will do over time, including any joint damage they may have. The researchers split the patients in to groups based on their RA disease activity at the start of the study and their RA disease activity one year later. They found 5 distinct groups based on socio-demographic and health factors, and each of these groups had different amounts of joint damage (also called x-ray or radiographic damage). They concluded that treating each patient very individually, being able to predict the course of a person’s RA, and dealing with social determinants of health could lead to the best results for patients.

Read more

What was the study purpose?
The CATCH researchers wanted to see what patients have in common when they’re diagnosed with RA and if that can be used to predict how well they will do over time, including predicting any joint damage they may have.

How was the study done?
Patients in CATCH were split in to groups based their RA disease activity scores (DAS28) over 2 years. This formed a trajectory – or a path of how their RA changed over time. Variables in each patient group were looked at including socio-demographic, disease and treatment variables, and joint damage (measured by x-ray or radiography).

What were the study results?
In 1586 patients, five trajectory groups were created based on the patients’ DAS28 scores at the start of the study and 1 year later:

  • Group 1 - 20% of patients. They started in a high disease activity state (HDAS) and improved to remission (REM);
  • Group 2 - 21% of patients. They started in a moderate disease activity state (MDAS) and improved to REM;
  • Group 3 - 30% of patients. They started in a MDAS and improved to a low disease activity state (LDAS);
  • Group 4 - 19% of patients. They started in a HDAS and improved to a LDAS; and,
  • Group 5 - 10% of patients. They started in a HDAS and improved to a MDAS only.

Patients in Groups 4 and 5 were older, had more other illnesses (called comorbidities), lower levels of education and were not working as much. Also, Group 5 patients were more often from an ethnic minority, had lower income, and had the lowest use of methotrexate and combination therapy (which is using more than one disease modifying anti-rheumatic drug) but higher steroid and biologic use. Not all patients had many x-rays over time, but for those that did, patients in Group 2 had lower odds of joint damage (also called radiographic progression) compared to Group 1, while more radiographic progression was observed in Groups 4 and 5.

A person’s RA and the course it takes over time are affected by socio-demographic and health factors and may result in unpredictable joint damage. The researchers concluded that treating each patient very individually, being able to predict a person’s RA course and dealing with social determinants of health could lead to best outcomes for patients.


Working Harder to Stay in Control: Patient Reports of Flare in Early RA Are Associated with Higher Disease Activity and More Intensive Self Management

Susan J. Bartlett1,2, Clifton O. Bingham III3, Daming Lin4, Kathleen Andersen5, Gilles Boire6, Carol Hitchon7, Boulos Haraoui8, Edward C. Keystone9, Diane Tin10, J Carter Thorne11, Janet E. Pope12, VP Bykerk4 and CATCH Investigators and OMERACT Flare Group. 1Clinical Epidemiology, McGill University, Montreal, QC; 2Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD; 3Rheumatology, Johns Hopkins University, Baltimore, MD; 4Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON; 5Hospital for Special Surgery, New York, NY; 6Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC; 7Department of Rheumatology, University of Manitoba, Winnipeg, MB; 8Institut de Rhumatologie, Montreal, QC; 9Mount Sinai Hospital, University of Toronto, Toronto, ON; 10The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON; 11University of Toronto, Toronto, ON; 12University of Western Ontario, London, ON.

The researchers wanted to learn more about patients with early RA who are in a flare, if their flares are related to their RA activity and how they try to manage their flares on their own. At each appointment, patients were asked to rate how bad their flare was on a scale, how long they had been having their flare, flare symptoms, how it affected how they functioned, and what they tried to manage their flare. Overall the researchers found that patients who were flaring had higher disease activity and said they had much more pain, fatigue, stiffness, and disability; decreased participation in activities; and, had difficulty coping. Self-management of flares is common and increases when a flare is worse and lasts for a longer time. Self-management appears to be started early into flares which shows their large affect on a person's quality of life.

Read more

What was the purpose of the study?
At their appointments, patients with early rheumatoid arthritis (ERA) patients often say they are in a flare. The CATCH researchers looked at patient reports of flare in relation to RA activity and how these patients tried to manage flares themselves.

How was this study done?
At each rheumatology appointment, patients provided ratings of how bad their flare was on a 10 point scale and information about how long the flare was, symptoms, how their flare affected how they could function and what they tried to manage their flare. RA activity was measured using joint counts and CDAI scores. A checklist of self-management strategies was developed based on international studies by the OMERACT RA Flare Group.

What were the results of the study?
474 out of 1983 patients, which is equal to 24% of patients, reported being in a flare. On a scale of 0-10, with 0 being the lowest score and 10 being the highest score, the average flare score was 5.4 and 67% of patients reported flares lasting for more than 7 days. Patients who were flaring also said they had much more pain, fatigue, stiffness, and disability; decreased participation in activities; and had difficulty coping. Self-management did not differ between males and females and included:

  • using drugs such as analgesics and steroids;
  • reducing and avoiding activities;
  • using massage or heat/cold;
  • exercising; and,
  • calling the rheumatologist for help.

As flares got worse, people generally tried more ways to manage their activities. Patterns were seen with flare duration and use of analgesics, avoiding activities, and calling the rheumatologist. Patients who were within one year of their diagnosis were much more likely to self-manage compared to those who had RA for more than one year (79% versus 66% of patients), and mostly using massage, heat and exercise. Compared to patients who were not on biologics, patients on biologics were more likely to reduce or avoid activities. Among those with flare severity with a score of greater than or equal to 4 and which lasted more than 7 days, 80% reported using self-management including analgesics (57% of patients), reducing activities (46% of patients), behaviors (40% of patients), avoiding activities (34% of patients), or calling a physician (19% of patients).

Patient reports of RA flare are associated with higher disease activity. Self-management of flares is common and increases when a flare is worse and lasts for a long time. Self-management of flares may include limiting participation in activities and using other medications and behaviors to try to decrease the flare. Self-management appears to be started early into flares which demonstrates their huge impact on a person's quality of life.


Working Status and Improvements in Work Productivity Over Time in an Early Rheumatoid Arthritis (ERA) Cohort

Bindee Kuriya1, Daming Lin2, Cheryl Barnabe3, Gilles Boire4, Carol Hitchon5, Shahin Jamal6, Boulos Haraoui7, Diane Tin8, Carter Thorne9, Janet Pope10, Ed Keystone11, Vivian Bykerk12. 1University of Toronto, Toronto; 2Mount Sinai Hospital, Toronto; 3University of Calgary, Calgary; 4Université de Sherbrooke, Sherbrooke; 5University of Manitoba, Winnipeg; 6University of British Columbia, Vancouver; 7Université de Montréal, Montréal; 8Southlake Regional Health Centre, Newmarket; 9Southlake Regional Hospital, Newmarket; 10St. Joseph’s Health Care, London; 11Mount Sinai Hospital, University of Toronto, Toronto; 12Hospital for Special Surgery, New York.

The CATCH researchers wanted to see how work was affected in people who were diagnosed with early rheumatoid arthritis (ERA). Patients filled out a survey about work at the start of the study and 1 year later. At the beginning of the study, 110 patients were working out of 190 patients. The researchers found many differences in demographics (such as age, education, salary) and RA-related variables between ERA patients who are working and those patients who are not. For patients who were working, with time they generally missed less work due to their RA, were more productive, and had less issues with doing activities than when they were first diagnosed.

Read more

What was the study purpose?
The CATCH researchers wanted to see how work was affected in people who were diagnosed with early rheumatoid arthritis (ERA).

How was the study done?
Patients in CATCH filled out a survey about work (called the Work Productivity and Activity Impairment or WPAI-RA questionnaire) at the beginning of the study and one year later. The responses of the survey were compared between patients who were working and those who were not working. For patients who didn't work, the researchers looked at change in work status (for example, from not working to working) and overall issues doing activities. For patients who were working, the researchers calculated work hours missed (called absenteeism) and how RA affected their productivity at work (called presenteeism). The researchers looked at many different characteristics of patients to see which ones were related to work.

What were the study results?
Of 190 patients, 110 were working at the beginning of the study. Patients who were not working generally had less education and a lower salary, were older, and had more active RA and more disability. At one year, in patients who were working, 78% missed fewer work hours because of their RA (on average, 9.6 fewer hours missed), 67% said they were more productive at work and 72% had fewer issues with doing different activities.

Patients who started working over the year of the study were generally younger, in remission or had less physical activity issues at 6 months. A higher HAQ-DI was associated with less issues in doing activities and DMARD or biologic use at month 6 was not associated with change in work survey answers, and use of drugs called corticosteroids was negatively associated with presenteeism.

There are differences in demographic and disease-related variables between ERA patients who are working and those who are not. Over time most working patients show improvements in the factors that are measured by work surveys. It would also be helpful to understand how age, remission, disability and corticosteroid use improve work productivity.


Worse Disease Trajectory in Early RA Patients is Associated With Lower Improvements in Health Related Quality of Life; Results from a Multicenter Early RA Cohort

C. Barnabe1, S.J. Bartlett2, Y. Sun3, G. Boire4, C.A. Hitchon5, E. Keystone3, B. Haraoui6, J.C. Thorne7, D. Tin7, J. Pope8, V.P. Bykerk3,9. 1University of Calgary, Calgary; 2McGill University, Montreal; 3Mount Sinai Hospital, Toronto; 4University of Sherbrooke, Sherbrooke; 5University of Manitoba, Winnipeg; 6University of Montreal, Montreal; 7Southlake Regional Health Centre, Newmarket; 8Western University, London; 9Hospital for Special Surgery, New York.

The CATCH researchers wanted to see if there was a relationship between a person's RA disease activity and how they felt about their quality of life. The researchers identified five sets of early RA patients based on their RA activity over time. How a person's RA activity changed over time is called the disease trajectory. Within each of these groups the researchers compared how the patients felt they were doing emotionally and physically, and also if they had joint damage from their RA. The group of patients who reached remission quickly had the most improved emotional and physical well-being scores. However, having joint damage or not did not have a direct relation to emotional or physical well-being scores.

Read more

What was the purpose of the study?
Patients with early RA go through periods of different RA activity over time. Because of these changes in RA activity, many patients will experience a long delay or may not even achieve low disease activity or remission, even though their rheumatologists treat them with the hopes of getting them there. The CATCH researchers wanted to see if there was a relationship between a person's RA disease activity and how they felt about their quality of life.

How was this study done?
The researchers identified five RA activity trajectories in patients based on their scores measured by the disease activity score, called the DAS28. Patients completed the Veteran's RAND 12 Forms (VF12) every year, which has 12 questions about emotional and physical well-being, and a scale about fatigue intensity every 3 to 6 months. The researchers wanted to see if these scores were different for the different groups of patients. These survey responses were also compared to patients' x-rays over time to see if there was a relationship to joint damage.

What were the results of the study?
There were 1586 patients in this study, and the 5 groups based on RA disease activity were:

  • Group 1 – this group was about half of the patients and they started in a high disease activity state and 20% rapidly reached remission,
  • Group 2 – this group of patients started in a medium disease activity state and ended in remission at 24 months,
  • Group 3 – this group of patients started in a medium disease activity state and ended in a low disease activity state at 24 months,
  • Group 4 – this group of patients started in a high disease activity state and achieved low disease activity state by 24 months,
  • Group 5 – this group of patients started in high disease activity state and achieved moderate disease activity state by 24 months.

Scores for physical and emotional well-being and fatigue started in different places for all groups of patients and steadied between years 1 and 2. Groups 1, 4 and 5 had the worst physical scores at the start. Group 1's physical scores improved the most, followed by Group 4 and Group 5 in the first year.

Group 1 also has the greatest improvement in emotional health, followed by Group 4, and then Groups 2, 3, and 5 all had similar changes to each other. Group 1 also had the greatest improvement in fatigue over 1 year. No significant differences in rates of improvement of these scores were seen when comparing patients with and without joint damage.

Read the paper on this work here.