Efficacy of Allogeneic Hematopoietic Cell Transplantation for Autoimmune Diseases.

Allogeneic hematopoietic cell transplantation (HCT) may be efficacious for autoimmune diseases (AIDs), but its efficacy for individual AIDs is unknown. Factors influencing the likelihood of relapse for each AID are also unknown. This study aimed to determine the likelihood of relapse for each common AID and to generate hypotheses about factors influencing the likelihood of relapse.

The global burden of SLE: prevalence, health disparities and socioeconomic impact.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification.

Improving Appropriate Access to Care With Central Referral and Triage in Rheumatology.

Objective: To evaluate the short-term and long-term impact of a centralized system for the intake and triage of rheumatology referrals on access to care and referral quality.

Methods: An innovative central referral process, the Central Referral and Triage in Rheumatology (CReATe Rheum) program, was implemented in 2006, serving a referral base of 2 million people. Referrals are received in a central office, triaged by trained nurses, and assigned to the next available appointment on a prioritized basis.

Effect of remission definition on healthcare cost savings estimates for patients with rheumatoid arthritis treated with biologic therapies.

Objective: Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.

The effect of different remission definitions on identification of predictors of both point and sustained remission in rheumatoid arthritis treated with anti-TNF therapy.

Objective: Predictors of remission in rheumatoid arthritis (RA) have been defined in cross-sectional analyses using the 28-joint Disease Activity Score (DAS28), but not with newer composite disease activity measures or using the more clinically relevant state of sustained remission. We have evaluated predictors of remission using cross-sectional and longitudinal durations of disease state, and by applying additional definitions of remission [American College of Rheumatology/European League Against Rheumatism Boolean, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI)].

Methods: Individuals in the Alberta Biologics Pharmacosurveillance Program were classified for the presence of remission (point and/or sustained > 1 yr) by each of the 4 definitions.

Clinical and serological features of patients referred through a rheumatology triage system because of positive antinuclear antibodies.

Background: The referral of patients with positive anti-nuclear antibody (ANA) tests has been criticized as an inappropriate use of medical resources. The utility of a positive ANA test in a central triage (CT) system was studied by determining the autoantibody profiles and clinical diagnoses of patients referred to rheumatologists through a CT system because of a positive ANA test.

Methods: Patients that met three criteria were included: (1) referred to Rheumatology CT over a three year interval; (2) reason for referral was a "positive ANA"; (3) were evaluated by a certified rheumatologist.

Canadian estimates of health care utilization costs for rheumatoid arthritis patients with and without therapy with biologic agents.

Objective: To provide Canadian estimates of health care utilization costs associated with rheumatoid arthritis (RA)-related and non-RA-related care within 4 treatment strategies and in different physical functioning categories.

Methods: In the Alberta Rheumatoid Arthritis Biologics Pharmacosurveillance Program, clinical data were linked with provincial health care administrative databases to estimate health care costs. A propensity score matching technique was used to evaluate annual costs across 4 treatment strategies: 1) remaining on disease-modifying antirheumatic drugs and not progressing to therapy with a biologic agent (n = 75), 2) progressing to biologic agents (n = 68), 3) initiation and stabilization on a first anti-tumor necrosis factor agent (n = 731), or 4) requiring a switch to another biologic agent (n = 212).

Reproducible metacarpal joint space width measurements using 3D analysis of images acquired with high-resolution peripheral quantitative computed tomography.

Objective: Joint space narrowing is an important feature of progressive joint damage and functional impairment in rheumatoid arthritis (RA). Methods to provide a continuous measurement of joint space width have not been adopted in research or clinical settings. High-resolution peripheral quantitative computed tomography (HR-pQCT) (Scanco Medical AG, Brüttisellen, Switzerland) accurately and reproducibly images bone microstructure at a nominal isotropic voxel dimension of 82 μm.

Quantification of small joint space width, periarticular bone microstructure and erosions using high-resolution peripheral quantitative computed tomography in rheumatoid arthritis.

Objectives: This paper aims to investigate the ability of a novel imaging technique, high-resolution peripheral quantitative computed tomography (HR-pQCT), to quantify joint space width at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and provide periarticular bone microstructure measurements (including volumetric density and morphometric indices). We also compared the sensitivity and specificity of HR-pQCT to detect erosions relative to plain radiography.

Methods: HR-pQCT imaging of the MCP and PIP joints of the dominant hand was performed in 30 rheumatoid arthritis (RA) and control subjects matched for age, sex and dominant hand use.

Lymphoma risk in systemic lupus: effects of disease activity versus treatment.

Objective: To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE).

Methods: We performed case-cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages.

Healthcare service utilisation costs are reduced when rheumatoid arthritis patients achieve sustained remission.

Objective: Determine healthcare service utilisation costs among patients using biological therapies for rheumatoid arthritis (RA), considering the magnitude and duration of patient response achieved.

Methods: Clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm) was linked with provincial physician billing claims, outpatient visits and hospitalisations. The annual mean healthcare service utilisation costs (total, RA-attributable, non-RA attributable) were estimated for patients during the best disease activity level reached during treatment.

Prevalence of autoimmune inflammatory myopathy in the first nations population of Alberta, Canada.

Objective: To estimate the population-based prevalence of autoimmune inflammatory myopathy (AIM) in Alberta, Canada, with a specific focus on rates in the First Nations population.

Methods: Physician billing claims and hospitalization data for the province of Alberta (1994-2007) were used to estimate the probability of having AIM (i.e.

Prevalence of systemic lupus erythematosus and systemic sclerosis in the First Nations population of Alberta, Canada.

Objective: To estimate the population-based prevalence of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in Alberta, Canada, stratified by First Nations status.

Methods: Physician billing claims and hospitalization data for the province of Alberta (1994-2007) were used to ascertain cases of SLE and SSc using 3 case definitions. A latent class Bayesian hierarchical regression model was employed to account for the imperfect sensitivity and specificity of billing and hospitalization data in case ascertainment.

Infliximab therapy efficacy and persistence at a Canadian academic centre despite a change in access procedure.

Patients treated with infliximab at our centre through a special access programme (initiation group) had long-standing, treatment-resistant rheumatoid arthritis. The clinical experience for these patients may be different than that of patients initiating treatment after provincial government approval and cost coverage for all anti-tumour necrosis factor (anti-TNF) therapies became effective (contemporary group). We compared adverse events, drug survival and reasons for discontinuation in these two groups.

Autoantibodies to tissue transglutaminase in Sjögren's syndrome and related rheumatic diseases.

Objective: Sjögren's syndrome (SS) has been reported in up to 15% of patients with biopsy proven celiac disease (CD). The diagnosis of CD in the setting of SS and other systemic rheumatic diseases can be difficult because they are often associated with a number of gastrointestinal symptoms and diseases. Although the diagnosis of CD is often confirmed by a small bowel biopsy, marker autoantibodies directed against the endomysium of transitional epithelium (EMA) and tissue transglutaminase (tTG) are highly correlated with biopsy-proven disease and serve as a valuable screening test.

The use and abuse of commercial kits used to detect autoantibodies.

The detection of autoantibodies in human sera is an important approach to the diagnosis and management of patients with autoimmune conditions. To meet market demands, manufacturers have developed a wide variety of easy to use and cost-effective diagnostic kits that are designed to detect a variety of human serum autoantibodies. A number of studies over the past two decades have suggested that there are limitations and concerns in the use and clinical application of test results derived from commercial kits.