Cervical And Vaginal/Vulvar Malignancies Risk In Women With Rheumatoid Arthritis (RA)

Objective: Given recent concerns about cervical dysplasia with RA medications, we performed a literature review and a pooled analysis to examine the relative risk of cervical and vaginal cancers in RA.Methods: We conducted a literature search covering 2007- 2014. A pooled analysis was conducted: the total numbers of cancers expected and observed across all studies were respectively summed for different cancer types (cervical and vaginal/vulvar cancers). As some studies pooled vaginal and vulvar cancers together, we did not discern between the two for the purpose of this study. Using these pooled estimates, standardized incidence ratios (SIRs) were calculated, demonstrating the relative risk of the cancers in RA, versus the general population.Results: Our search strategy retrieved 13 papers. Our pooled SIR estimates were 0.82, 95% confidence interval, CI, 0.73-0.92 for cervical cancer in RA and 1.04, 95% CI 0.80-1.34 for vaginal/vulvar cancer in RA.Conclusion: Our simple pooled analysis was consistent with a relatively lower cervical cancer risk in RA versus the general population, while the data did not establish if the risk of vaginal/vulvar cancer was different from the general population. Cervical cancer screening in RA will continue to be important, particularly as evolving treatment strategies may affect future risk

The incidence of juvenile rheumatoid arthritis in Quebec: a population data-based study

<p>Abstract</p> <p>Objective</p> <p>To determine the population incidence of juvenile rheumatoid arthritis (JRA) in Quebec.</p> <p>Methods</p> <p>We obtained data from Quebec's physician claims database. Incident cases were defined as having a visit for JRA in 2000, no visit in the previous 3 years, a confirmed diagnosis by an arthritis specialist, or having ≥ 2 visits to any physician for JRA, ≥ 2 months apart but within 2 years.</p> <p>Results</p> <p>Cumulative incidence of JRA was 17.8/100,000. Mean age at diagnosis was 9.8 ± 4.6 years, 68% were female and more persons were diagnosed in winter. Subjects had a median of 10 medical visits over the first year.</p> <p>Conclusion</p> <p>Our population based incidence estimate was similar to others. Children and adolescents with JRA are heavy users of medical care. Additional study of environmental or climate- related triggers may be warranted.</p

Effect of menopause on the modified Rodnan skin score in systemic sclerosis

INTRODUCTION: We aimed to evaluate the effect of menopause on skin thickening, as measured by the modified Rodnan skin score (mRSS), in women with systemic sclerosis (SSc). METHODS: We identified women with either limited or diffuse SSc, aged ≥ 18 years, enrolled within the Canadian Scleroderma Research Group (CSRG) cohort, between 2004 and 2011. As part of the CSRG cohort, subjects undergo annual assessments with standardized questionnaires and physical examinations. We performed multivariate regression analyses using generalized estimating equation (GEE) to determine the effect of menopause on the mRSS, adjusting for relevant covariates including notably age, follow-up time, and disease duration. RESULTS: We identified 1070 women with SSc, contributing a total of 3546 observations over the study period. Of these women, at baseline, 65% had limited disease and 35% diffuse disease. In multivariate analyses, we observed a substantial effect of postmenopausal status on the mean mRSS in women with diffuse disease subtype [−2.62 units, 95% confidence interval (CI) -4.44, −0.80] and significant interaction between menopausal status and disease subtype (2.04 units, 95% CI 0.20, 3.88). The effect of postmenopausal status on the mean mRSS was smaller in women with limited SSc (−0.58, 95% CI −1.50, 0.34). CONCLUSIONS: Our results suggest that menopause has a substantial effect on skin thickening in diffuse SSc, with postmenopausal status being associated with a lower mean mRSS compared to premenopausal status

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ABSTRACT. Objective. Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada. Methods. We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting. Results. Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic. Conclusion. Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences

An iceberg I can’t handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya

Background: Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to nonspecialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. Purpose: We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. Methods: We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. Results: A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31–40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. Conclusion: There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients

When does the increased mortality risk appear in rheumatoid arthritis? A distributed data analysis comparing mortality in two Canadian provinces

Introduction Rheumatoid arthritis (RA) is chronic inflammatory arthritis. For decades studies showed that RA patients died earlier than their general population counterparts. Some inception cohorts have failed to detect an increased mortality risk, possibly due to limited follow-up or to improvement in mortality risk in cohorts of more recent onset. Objectives and Approach We evaluated mortality risk in RA patients and estimated when the increased risk appears. Using a common protocol, we conducted distributed analyses using administrative data, of incident RA patients in British Columbia (BC) and Ontario (ON) over 2000-2015. We identified all RA patients (using validated criteria), and identified non-RA comparators, matched 1:2 on age, sex and index years. Adjusted hazard ratios (HRs) were estimated using multivariable Cox regression, controlling for comorbidities and other factors. To estimate when the increased risk appeared we included an interaction with follow-up time, to detect if and how the HR varied by RA duration. Results Among 13834 RA patients in BC (27668 comparators), 66% were female with a mean age of 58 years at cohort entry. Among 27405 RA patients in ON (54810 comparators), 70% were female with a mean age of 56 years. The prevalence of individual comorbidities was comparable across RA cohorts. During follow-up, 23% of RA patients in each province died, with corresponding crude mortality rates of 2.3 deaths per 100 person-years in both provinces. Multivariable analyses detected an increased mortality risk in RA by 6 years of follow-up, with a linear relationship suggesting further increase over time. By 10 years, the adjusted HR was 1.14 (95% CI 1.07,1.22) in BC and 1.13 (95% CI 1.08,1.18) in ON. Conclusion/Implications In 2 large Canadian RA inception cohorts, a small increased mortality risk appeared after 6 years of RA duration and increased to a 14% (in BC) and 13% (in ON) increased mortality risk after 10 years, suggesting increased efforts to prevent disease progression and optimizing comorbidity management are needed

Development of Myasthenia Gravis in Systemic Lupus Erythematosus

Objectives: To perform a literature review and estimate MG incidence in an SLE cohort. Materials and methods: We searched MEDLINE and PubMed for case reports of SLE and MG. We also calculated MG incidence within our clinical SLE cohort (females only). Results: Eleven articles met our criteria, providing 13 SLE patients who developed MG. The majority were female (84.6%), with the average ages of 25.6 and 33.5 years at diagnoses of SLE and MG, respectively. In 380 SLE female patients followed for 2,850 person-years, one MG case occurred. Conclusion: MG in SLE is a rare event

An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on algorithm performance

BACKGROUND: We have previously validated administrative data algorithms to identify patients with rheumatoid arthritis (RA) using rheumatology clinic records as the reference standard. Here we reassessed the accuracy of the algorithms using primary care records as the reference standard. METHODS: We performed a retrospective chart abstraction study using a random sample of 7500 adult patients under the care of 83 family physicians contributing to the Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Using physician-reported diagnoses as the reference standard, we computed and compared the sensitivity, specificity, and predictive values for over 100 administrative data algorithms for RA case ascertainment. RESULTS: We identified 69 patients with RA for a lifetime RA prevalence of 0.9%. All algorithms had excellent specificity (>97%). However, sensitivity varied (75-90%) among physician billing algorithms. Despite the low prevalence of RA, most algorithms had adequate positive predictive value (PPV; 51-83%). The algorithm of “[1 hospitalization RA diagnosis code] or [3 physician RA diagnosis codes with ≥1 by a specialist over 2 years]” had a sensitivity of 78% (95% CI 69–88), specificity of 100% (95% CI 100–100), PPV of 78% (95% CI 69–88) and NPV of 100% (95% CI 100–100). CONCLUSIONS: Administrative data algorithms for detecting RA patients achieved a high degree of accuracy amongst the general population. However, results varied slightly from our previous report, which can be attributed to differences in the reference standards with respect to disease prevalence, spectrum of disease, and type of comparator group