Fatima S, Schieir O, Keystone EC, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Tin D, Thorne C, Bykerk VP, Pope JE; and Canadian Early Arthritis Cohort (CATCH) Investigators. Arthritis Rheumatol. 2022;74(1):178-180. doi: 10.1002/art.41918.

Hazlewood GS, Bombardier C, Xiuying Li, Movahedi M,  Choquette D, Coupal L, Bykerk V, Schieir O, Mosher D Marshall DA, Bernatsky S, Spencer N, Richards D,  Proulx L, Barber C, on behalf of OBRI, RHUMADATA, CATCH and The Rheum4U Teams. J Rheumatol. 2021 Aug 1. doi: 10.3899/jrheum.201688. Epub ahead of print. PMID: 34334357.

Fatima S, Schieir O, Bartlett SJ, Valois M, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Thorne C, Tin D, Bykerk V, Pope J, on behalf of CATCH Investigators.  Arthritis Rheumatol. 2021;73(2):197-202. doi: 10.1002/art.41513.

Holdren M, Schieir O, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk VP, Pope J, on behalf of CATCH Investigators. Arthritis Rheumatol. 2021;73(1):53-60. doi: 10.1002/art.41499

Moura CS, Schieir O, Valois MF, Thorne C, Bartlett SJ, Pope JE, Hitchon CA, Boire G, Haraoui B, Hazlewood GS, Keystone EC, Tin D, Bykerk VP, Bernatsky S; Canadian Early Arthritis Cohort (CATCH) Investigators.  Arthritis Care Res. 2020; 72(8):1104-1111. doi: 10.1002/acr.23927.

What was the purpose of the study?

Methotrexate is often used as one of the first treatments of RA. How methotrexate is taken can vary greatly, so this study aimed to see how methotrexate was being used by people who have early RA.

How was this study done?

Participants in the study were taking methotrexate as a first treatment and then had to change either due to safety reasons or because their RA was no longer responding. Study participants were 1,484 early RA patients and most of them started on methotrexate along (in pill or injectable form) or methotrexate plus another medication.

What were the results of the study?

Overall, 911 participants needed to change their medication in some way during the study- which may have included changing the form of methotrexate they took (pill or injectable), adding or stopping a DMARD or biologic, changing dose or frequency of a DMARD or biologic, stopping because their medication was not working for their RA, or stopping because of safety reasons. Compared to patients only taking oral methotrexate only, patients taking methotrexate plus any other combination of DMARDs or biologics stayed on those types of medications longer before needing to make a change to their medication.

Ellingwood L, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone EC, Tin D, Thorne C, Bykerk VP, Pope JE; on behalf of CATCH Investigators. ACR Open Rheumatol. 2019;1(10):614-619. doi: 1002/acr2.11086

Ellingwood L, Kudaeva F, Schieir O, Bartlett SJ, Bessette L, Boire G, Hazlewood GS, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk VP, Pope J; CATCH Investigators. RMD Open. 2019;5(2):e000931. doi:1136/rmdopen-2019-000931

Kudaeva F, Speechley M, Klar N, Schieir O, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon CA, Keystone E, Tin D, Thorne C, Bykerk VP, Pope JE; Canadian Early Arthritis Cohort (CATCH) investigators.  ACR Open Rheumatol. 2019;1(1):63-69. doi: 1002/acr2.1009

Kuriya B, Schieir O, Valois MF, Pope JE, Boire G, Bessette L, Hazlewood G, Thorne JC, Tin D, Hitchon C, Bartlett SJ, Keystone EC, Bykerk VP, Barra L; CATCH investigators.  ACR Open Rheumatol. 2019;1(9):535-541. doi.org/10.1002/acr2.11075

Barber C, Schieir O, Lacaille D, Marshall D, Barnabe C, Hazlewood G, Thorne C, Ahluwalia V, Bartlett SJ, Boire G, Haraoui B, Hitchon C, Keystone E, Tin D, Pope JE, Denning L, Bykerk VP, on behalf of CATCH Investigators.  Arthritis Care Res 2018;70(6):842-850. doi:1002/acr.23439

What was the purpose of the study?

The Arthritis Alliance of Canada developed a set of 6 measures to evaluate timely access to care and treatment for inflammatory arthritis. A national study is underway to test these measures. The objective of this study was to look at 3 of these measures in early rheumatoid arthritis patients receiving care in rheumatology clinics participating in CATCH.

How was this study done?

This study included ERA patients enrolled between January 1, 2007 and January 31, 2015, who met the 1987 or 2010 ACR/EULAR RA criteria and had symptoms for less than one year. Measures included: 1. Percentage of patients with RA seen in a yearly follow-up appointment, 2. Annual percentage of RA patients treated with a disease-modifying drug (DMARD), and, 3. Time from new RA diagnosis to start of DMARD treatment. 

What were the results of the study?

1927 RA patients were in the study. Over 8 years, 72% of patients were seen in a yearly follow-up appointment. The yearly percentage of newly diagnosed RA patients on a DMARD ranged between 92-100%. Between 2007 and 2015 the percentage of RA patients who received DMARD treatment within 14 days of diagnosis increased from 74% to 90%.

Between 2007-2015 the percentage meeting benchmarks for time to DMARD therapy increased in CATCH from 74% to 90%. A drop-off in yearly follow-up is typical of many observational studies, though less in CATCH, maybe because of universal access to care. The decline in percentage on DMARD over time likely represents a number of factors including: DMARD-free remission associated with earlier diagnosis and treatment, patient engagement and not taking medication as prescribed, and a possible care gap. Analysis of medication use over time is an ongoing goal of this study.

This study represents a best-case scenario for capturing measures from data that were systematically collected and shows the feasibility of quick start of DMARD treatment. Our findings may be useful as a benchmark while testing the measures using other settings and data sources.

Nagaraj S, Barnabe C, Schieir O, Pope J, Bartlett SJ, Boire G, Keystone E, Tin D, Haraoui B, Thorne C, Bykerk VP, Hitchon C, on behalf of CATCH Investigators.  Arthritis Care Res 2018; 1245-1250. doi:1002/acr.23470

What was the purpose of the study?

Aboriginal patients who have chronic diseases often experience health inequities. This study compared Aboriginal and Caucasian patients with early inflammatory arthritis in terms of disease presentation, treatment, and outcomes over five years.

How was this study done?

Participants in CATCH who identified as Aboriginal or Caucasian were compared in terms of demographics, clinical characteristics, therapeutic approach and frequency of remission. Measures such as disease activity score (also called DAS28), health assessment questionnaire (HAQ), and patient reported outcomes and tender and  swollen joint counts were examined over five years.

What were the results of the study?

There were 100 Aboriginal and 2,073 Caucasian participants. Socioeconomic and demographic factors such as smoking status, body mass index, education, household income, did not favour Aboriginal patients’ outcomes. The frequency of use of therapeutic approaches and escalation was not different between groups. DAS28 remission occurred less frequently in Aboriginal participants at visits up to 36 months:

• At 3 months 16% of Aboriginal participants were in remission compared to 30% of Caucasian participants;
• At 6 months 17% of Aboriginal participants were in remission compared to 41% of Caucasian participants;
• At 12 months 16% of Aboriginal participants were in remission compared to 50% of Caucasian participants;
• At 18 months 24% of Aboriginal participants were in remission compared to 53% of Caucasian participants;
• At 24 months 29% of Aboriginal participants were in remission compared to 58% of Caucasian participants; and
• At 36 months 40% of Aboriginal participants were in remission compared to 59%, of Caucasian participants.

Aboriginal participants had higher DAS28 scores (which means more active RA) because of slower improvement in swollen joint counts and the lack of improvement in patieent global scores. Although HAQ and pain scores improved in both groups, fatigue did not improve in Aboriginal participants.

The researchers observed differences in disease characteristics in Aboriginal participants and worse disease outcomes. Even when treated with the same treatment approaches as Caucasians, Aboriginals did not have the same frequency of remission. The results may reflect disparities in social and economic status and differences in environmental exposures associated with worse disease outcomes. The results may also show the need to re-evaluate on the use of the same treatment approaches being applied in different population contexts.

Schulman E, Bartlett SJ, Schieir O, Andersen KM, Boire G, Pope J, Hitchon C, Jamal S, Thorne C, Tin D, Keystone E, Haraoui B, Goodman S, Bykerk VP, on behalf of CATCH investigators. Arthritis Care Res 2018;70: 1245-1250. doi:1002/acr.23457

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.

Kuriya B, Schieir O, Lin D, Xiong J, Pope J, Boire G, Haraoui B, Thorne JC, Tin D, Hitchon C, Jamal S, Keystone E, Bykerk VP, on behalf of CATCH Investigators. Clin Exp Rheumatol. 2017;35:799-803.

What was the purpose of the study?
Rheumatologists measure patients’ RA disease activity using a tool called the Disease Activity Score (DAS28). The DAS28 is a number that can be calculated using measures of a patient’s C-reactive protein (CRP) or erythrocyte sedimentation rate (DAS28-ESR). The researchers wanted to see if using these two different values to calculate the DAS28 provided the same score or not.

How was this study done?
The researchers looked at patients’ data at the start of the study and at one year. Patients needed to have complete information to calculate the DAS28 with both CRP and ESR measures. A number of statistical methods were used to make sure that the DAS28 scores calculated using either CRP or ESR were the same or not.

What were the results of the study?
There were 995 early RA patients in the study. Though DAS28 scores calculated using CRP (also called DAS28-CRP) and ESR (called DAS28-ESR) were highly correlated, DAS28-ESR scores were higher than DAS28-CRP scores no matter a patient’s disease activity. Differences between DAS28-CRP and DAS28-ESR were greater at lower ranges of the DAS28 and were most different in women and older patients. This suggests that using ESR or CRP to calculate the DAS28 is a reasonable for research purposes. Overall there was moderate to good agreement between newly calculated DAS28-CRP and DAS28-ESR.

Barra LJ, Pope JE, Hitchon C, Boire G, Schieir O, Lin D, Thorne CJ, Tin D, Keystone EC, Haraoui B, Jamal S, Bykerk VP, and CATCH Investigators. Rheumatol 2017;56:768-776. doi: 10.1093/rheumatology/kew474.

Barra L, Arsenault-Mehta K, Pope J, Hitchon C, Boire G, Schieir O, Lin D, Thorne C, Tin D, Keystone E, Haraoui B, Jamal S, Bartlett SJ, Bykerk VP, on behalf of CATCH Investigators. Rheumatology: Current Research 2017;7:1-4. doi:10.4172/2161-149.1000211.

Bartlett SJ, Barbic SP, Bykerk VP, Choy EH, Alten R, Christensen R, den Broeder A, Fautrel B, Furst DE, Guillemin F, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Pohl C, Scholte Voshaar M, Woodworth TG, Bingham CO 3rd.  J Rheumatol. 2017;44:1536-1543. doi: 10.3899/jrheum.161145.

What was the purpose of the study?

Outcome Measures in Rheumatology (also called OMERACT for short) encourages the development of new measures with robust methods. Measurement tool results should be highly relevant, easy to score and interpret, and meaningful to stakeholders who will use the tool. We did an analysis to explore the psychometric properties of the OMERACT RA Flare Questionnaire (RA-FQ). We reviewed results with RA patient research partners for insight into the interpretability, meaningfulness, and utility of results.

How was this study done?

People with RA in Canada (896 patients), France (138 patients), and the Netherlands (178 patients), completed 5 items representing each of the OMERACT RA flare core domains. We evaluated how the five items worked together as well as reliability, response options, redundancy, local dependence, and response bias among groups (for example, men versus women, age categories, country and language). Ten patient research partners first completed the questionnaire, then reviewed individual and group findings to provide feedback.

What were the results of the study?

Our analysis showed that the 5 items are acceptable to measure RA flare symptoms and impacts by summing each item’s score for a total score ranging from 0-50. The five items and total scores did not differ depending on a respondent’s sex, age, country or language. Items suggest flare symptoms and impacts increased together and showed a consistent story of how individuals experience worsening RA disease activity. There was unanimous agreement from the patients that the story depicted and individual results obtained were easy to understand, meaningful, and very reflective of their current state. Many patients noted that beyond clinical trials, the RA-FQ could also help communication between doctors and patients at routine visits. Several noted that the tool would also be helpful in monitoring their RA’s day-to-day status and with self-management.

Omair MA, Keystone E, Bykerk V, Lin D, Xiong J, Sun Y, Boire G, Carter Thorne J, Tin D, Pope J, Hitchon C, Haraoui B, Akhavan PS, on behalf of CATCH Investigators. Arthritis Care Res 2017;69:737-741. doi:10.1002/acr.22983.

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.

Bykerk VP, Bingham CO, Choy EH, Lin D, Alten R, Christensen R, Furst DE, Hewlett S, Leong A, March L, Woodworth T, Boire G, Haraoui B, Hitchon C, Jamal S, Keystone EC, Pope J, Tin D, Thorne JC, Bartlett SJ, on behalf of the OMERACT RA Flare Group and CATCH Investigators. RMD Open 2016;2:e000225. doi:10.1136/rmdopen-2015-000225.

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.

Hitchon CA, Boire G, Haraoui B, Keystone E, Pope J, Jamal S, Tin D, Thorne C, Bykerk VP, on behalf of CATCH Investigators. Rheumatol 2016;55:1751-1762. doi:10.1093/rheumatology/kew061.

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

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

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

• were older: 54 years old versus 45 years old;
• had higher baseline disease activity mostly because of increased inflammation which was measured in the blood by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

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

Lee JJ, Bykerk VP, Dresser GK, Boire G, Haraoui B, Hitchon C, Thorne C, Tin D, Jamal S, Keystone EC, Pope JE, on behalf of CATCH Investigators. Clin Med Insights Arthritis Musculoskelet Disord 2016;9:37-43. doi:10.4137/CMAMD.S38092.

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.

Barnabe C, Sun Y, Boire G, Hitchon CA, Haraoui B, Thorne JC, Tin D, van der Heijde D, Curtis JR, Jamal S, Pope JE, Keystone EC, Bartlett S, Bykerk VP, and CATCH Investigators. PLoS One 2015;10:e0135327. doi:10.1371/journal.pone.0135327

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

Bartlett SJ, Bykerk VP, Cooksey R, Choy EH, Alten R, Christensen R, Furst DE, Guillemin F, Halls S, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Orbai AM, Pohl C, Voshaar MS, Woodworth TG, Bingham CO.  J Rheumatol 2015;42(11):2185-9. doi:10.3899/jrheum.141169

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.

Curtis JR, Yang S, Chen L, Pope JE, Keystone EC, Haraoui B, Boire G, Thorne JC, Tin D, Hitchon CA, Bingham CO, 3rd, Bykerk VP.  Arthritis Care Res 2015;67(10):1345-53. doi:10.1002/acr.22606.

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.

Hazlewood GS, Thorne JC, Pope JE, Lin D, Tin D, Boire G, Haraoui B, Hitchon CA, Keystone EC, Jamal S, Bykerk VP, and CATCH Investigators. Ann Rheum Dis doi:10.1136/annrheumdis-2014-206504

What is the purpose of the study?
The CATCH researchers wanted to see if it made a difference for early RA patients to take methotrexate by pill (called ‘oral’) versus by injection (called ‘subcutaneous’).

How was the study done?
Patients were treated by their rheumatologist and followed every 3 months over the first year. Patients used methotrexate within 3 months of starting the CATCH study and had either never been on methotrexate before or on a very low dose before that. There were 674 patients, 418 took oral methotrexate and 256 took subcutaneous methotrexate. The researchers compared what is called the survival between subcutaneous and oral methotrexate over the first year. In this case, the researchers defined treatment failure to be a change in how methotrexate was taken or addition or switch of any DMARDs other than glucocorticoids. The researchers also used statistics to ensure that findings were real.

What were the results of the study?
Patients treated with subcutaneous methotrexate were less likely to receive other DMARDs (56% versus 71%), and had a higher starting dose of methotrexate (23 mg versus 17 mg). Other characteristics were similar between groups. Overall patients appeared to do better who were: taking subcutaneous methotrexate, older in age, and being treated with other DMARDs as well (called combination therapy). The starting dose of methotrexate did not matter. Subcutaneous methotrexate improves survival over oral methotrexate for initial treatment in patients with early RA, meaning that the patients who started on subcutaneous methotrexate had fewer medication changes (including a switch from injected to oral methotrexate) than patients who were on oral methotrexate.

Shu J, Bykerk VP, Boire G, Haraoui B, Hitchon C, Thorne JC, Tin D, Keystone EC, Pope JE, and CATCH Investigators. J Rheumatol 2015;42(11):2023-8. doi:10.3899/jrheum.150260.

What is the purpose of the study?
There are 2 markers in a person’s blood that can be measured to show that RA is present. They are called rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). ACPA can be seen earlier in RA patients and is more specific than RF. ACPA testing is not always carried out in new patients and depends on where you live (it often depends on whether or not your provincial health plan covers the cost of the test). The researchers wanted to see if not measuring ACPA in early inflammatory arthritis patients caused any differences in patient care.

How was the study done?
2191 CATCH patients were placed in to 3 groups based on their RF and ACPA results: 1. Seropositive – these patients were RF positive and/or ACPA positive; 2. Seronegative – these patients were RF negative and/or ACPA negative); and, 3. Missing ACPA – these patients were missing ACPA measurements and were also RF negative.

What are the results of the study?
Patients with missing ACPA measures were less likely to be considered to have RA and were treated with fewer medications. For example, at 3 months, the group of patients with missing ACPA measurements who were RF negative were treated with less disease modifying anti-rheumatic drugs (DMARDs), but there were no differences in a number of disease activity and overall function measures (including DAS28, HAQ-DI, corticosteroids being taken, or physician global assessment or patient global assessment). The researchers concluded that more studies are needed to determine if it is worth the cost to have all new inflammatory arthritis patients ACPA-tested.

Wong LE, Huang WT, Pope JE, Haraoui B, Boire G, Thorne JC, Hitchon CA, Tin D, Keystone EC, Bykerk VP, and CATCH Investigators. Arthritis Care Res 2015;67(5):616-23. doi:10.1002/acr.22494

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.

Yang G, Bykerk VP, Boire G, Hitchon CA, Thorne JC, Tin D, Haraoui B, Keystone EC, Pope JE, and CATCH Investigators. J Rheumatol 2015;42(1):46-54. doi:10.3899/jrheum.131382

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 simpliefied disease activity  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.

Arnold MA, Bykerk VP, Boire G, Haraoui B, Hitchon C, Thorne C, Keystone EC, Pope JE, and CATCH Investigators. Rheumatol 2014 Jun;53(6):1075-86. doi:1093/rheumatology/ket449

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.

Barra L, Pope JE, Oray JE, Boire G, Haraoui B, Hitchon C, Keystone EC, Thorne JC, Tin D, Bykerk VP, and CATCH Investigators.  J Rheumatol 2014; 41:2361-2369. doi:10.3899/jrheum.140082

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 DAS 28 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.

Choy T, Bykerk VP, Boire G, Haraoui BP, Hitchon C, Thorne C, Keystone EC, Pope JE, and CATCH Investigators.  Rheumatol 2014;53:482-90. doi:10.1093/rheumatology/ket366

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:

• Simplified Disease Activity Index (SDAI) score less than or equal to 3.3;
• Clinical Disease Activity Index (CDAI) score less than or equal to 2.8;
• 28 joint Disease Activity Score  (DAS28) score less than 0.6;
• ACR/EULAR clinical trial definition based on a number of measures.

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:

• Age;
• Sex;
• Income;
• Education;
• Tender Joint Count;
• Patient Global Assessment;
• Physician Global Assessment;
• Heatlh Assessment Questionnaire (HAQ, a questionnaire where a patient shows their level of physical function); and,
• General pain level.

The only predictor for the DAS 28 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.

Kuriya B, Xiong J, Boire G, Haraoui B, Hitchon C, Pope JE, Thorne C, Tin D, Keystone EC, Bykerk VP, and CATCH Investigators. J Rheumatol 2014;41:2161-6. doi:10.3899/jrheum.140137

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

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

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

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

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

Harris JA, Bykerk VP, Hitchon CA, Keystone EC, Thorne JC, Boire G, Haraoui B, Hazlewood G, Bonner AJ, Pope JE; on behalf of the CATCH Investigators.  J Rheumatol 2013;40;1823-1830. doi:10.3899/jrheum.121316

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

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

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

Kung TN, Dennis J, Ma Y, Xie G, Bykerk V, Pope J, Thorne C, Keystone E, Siminovitch KA, Gagnon F. Arthritis Rheum 2014;66:1111-20. doi:10.1002/art.38331

Barnabe C, Xiong J, Pope JE, Boire G, Hitchon C, Haraoui B, Carter Thorne J, Keystone EC, Bykerk VP, and CATCH Investigators.  Rheumatol Int 2014;34:85-92.doi:10.1007/s00296-013-2846-5

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

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

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

Boyd TA, Bonner A, Thorne C, Boire G, Hitchon C, Haraoui BP, Keystone EC, Bykerk VP, Pope JE, and CATCH Investigators. Results from the CATCH Cohort. Open Rheumatol J 2013;7:58-6. doi:10.2174/1874312901307010058

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

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

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

Barra L, Bykerk V, Pope JE, Haraoui BP, Hitchon CA, Thorne JC, Keystone EC, Boire G, and CATCH Investigators.  J Rheumatol 2013;40:1259-1267. doi:10.3899/jrheum.120736

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

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

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

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

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

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

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

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

Mussen L, Boyd T, Bykerk V, de-Leon F, de Leon F, Li L, Boire G, Hitchon C, Haraoui B, Thorne JC, Pope J. Rheumatol Int 2013;33:457-465. doi:10.1007/s00296-012-2407-3

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

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

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

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

Pyne L, Bykerk VP, Boire G, Haraoui B, Hitchon C, Thorne JC, Keystone EC, Ferland D, Pope JE, and CATCH Investigators. J Rheumatol 2012;39 :2081-2087. doi:10.3899/jrheum.120520.

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

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

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

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

Bykerk VP, Jamal S, Boire G, Hitchon C, Haraoui B, Pope JE, Thorne JC, Sun Y, Keystone EC.  J Rheumatol 2012; 39:2071-80. doi:10. 3899/jrheum.120029. 

Lee YC, Lu B, Boire G, Haraoui BP, Hitchon CA, Pope JE, Thorne JC, Keystone EC, Solomon DH, Bykerk VP. Ann Rheum Dis 2013;72:949-954. doi:10.1136/ahhrheumdis-2012-201501.

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

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

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

Kuriya B, Sun Y, Boire G, Haraoui B, Hitchon C, Pope JE, Thorne JC, Keystone EC, Bykerk VP, and CATCH Investigators.  J Rheumatol 2012;39:1155-1158. doi:103899/jrheum.111341

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

How was the study done?
The CATCH researchers used the following five definitions of remission for patients at 1 year:

• DAS28 less than 2.6 – this is the disease activity score (DAS) value of less than 2.6, calculated by using tender joint count and swollen joint count, patient global assessment, C-reactive protein  measure and erythrocyte sedimentation rate;
• DAS28 less than 2.0 – this is the disease activity score with a value of less than 2.0, and it is calculated the same way as above;
• CDAI less than or equal to 2.8 – this is the clinical disease activity index score value which is calculated using tender joint count and swollen joint count and the patient global assessment and physician global assessment;
• SDAI less than or equal to 3.3 – this is the simple disease activity index value, calculated using tender joint count and swollen joint count, patient global assessment and physician global assessments, and C-reactive protein measure;
• ACR/EULAR criteria – these are standard measures that require a tender joint count of at least 1 plus, swollen joint count of at least 1, plus C-reactive protein less than or equal to 1 mg/dL and patient global assessment less than or equal to 1 on a 0–10 cm visual analog scale (also called the Patient-VAS).

The researchers used statistics to understand agreement between the different definitions of remission.

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

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

McKeown E, Bykerk VP, De Leon F, Bonner A, Thorne C, Hitchon CA, Boire G, Haraoui B, Ferland DS, Keystone EC, Pope JE; CATCH Investigators. Rheumatol 2012;51:1662-1669. doi:10.1093/rheumatology/kes079

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

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

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

Cheng CK, McDonald-Blumer H, Boire G, Pope JE, Haraoui B, Hitchon CA, Thorne C, Sun Y, Bykerk VP. J Rheumatol 2010; 37: 2221-2225. doi:10.3899/jrheum.091368

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

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

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