2016 June AHPA Newsbrief
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AHPA Clinical Innovation Award
ACPAC Program 2016-2017
Upcoming Courses and Conferences
Recent Articles and Online Resources
AHPA Clinical Innovation Award
The AHPA Clinical Innovation Award was created to recognize AHPA members who have designed and implemented an innovative clinical project or related initiative that benefits the lives of Canadians living with arthritis. The award showcases clinical initiatives including those that assess, treat, educate or otherwise support people living with arthritis in new and innovative ways. The 2016 recipient of the AHPA Clinical Innovation Award was Marie Westby for her work related to the Total Joint Arthroplasty Outcome Measure (TJAOM) Toolkit. The purpose of the toolkit is to provide clinicians with outcome measures appropriate for use along the continuum of care for patients before and after total joint arthroplasty.
Dr. Westby completed her BSc. in physiotherapy in 1988 and her PhD in rehabilitation sciences at UBC in 2010. She has worked as a physiotherapist at the Mary Pack Arthritis Centre in Vancouver her entire career and published several articles, authored chapters and presented internationally on rehabilitation and exercise therapy for varied forms of arthritis and joint arthroplasty. Building on her doctoral research, she is currently undertaking a CIHR-funded postdoctoral fellowship in the School of Public Health, University of Alberta to develop quality indicators for hip and knee arthroplasty rehabilitation.
ACPAC Program 2016-2017
The Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program is pleased to announce that applications for the 2016-2017 program are now open.
Offered through the Office of Continuing Professional Development at the University of Toronto, ACPAC is an award-winning clinical-academic program that prepares experienced Physiotherapists, Occupational Therapists, and Nurses from across Canada for extended practice roles, including the diagnosis and management of patients with arthritis.
ACPAC graduates have been recognized at the local, provincial, national, and international level for providing:
The program runs from October 2016 to June 2017.
For more information contact firstname.lastname@example.org or visit http://acpacprogram.ca/about-the-program/register/
Upcoming Courses and Conferences
CBT Immersion - Cognitive Behaviour Therapy
All health care professionals address behaviour change in their clinical practice. This course is a unique, condensed course on the principles of CBT training to be used within the scope of non-mental health practitioners to help facilitate behaviour change in their patients. This course is offered in partnership between Wilfrid Laurier University Faculty of Social Work Professional Development and Qualia Counselling Services Inc.
Dates: Jan. 29, 30, 31 2016 & Nov. 4, 5, 6, 2016 (Course duration is over 2 weekends)
Hours: 9:30 a.m. to 5 p.m.
Location: Wilfrid Laurier University 130 King St. West, Toronto
Cost: $1,599 after December 1, 2015
(textbooks, parking, lunch and accommodations not included)
TO REGISTER: call 519-884-0710 ext. 5265 or online at www.wlu.ca/fswpd
Chronic Pain Management
There are many ways to fight arthritis pain. The Chronic Pain Management Workshop is a two-hour course that gives you the tools to help control the pain of your disease. You will learn about the sources of arthritis pain and how to handle it. From helpful tips to an overview of the different medications used to treat arthritis, our trained instructors discuss your options for managing pain.
Bone Fit Workshops - Osteoporosis Canada
June 11, 2016
North York, ON
This evidence-informed exercise training workshop is designed for healthcare professionals & exercise practitioners to provide training on the most appropriate, safe & effective methods to prescribe & progress exercise for people with osteoporosis.
Recent Articles and Online Resources
Efficacy and Safety of Subcutaneous Golimumab in Methotrexate-Naive Patients With Rheumatoid Arthritis: Five-Year Results of a Randomized Clinical Trial
Emery, P., Fleischmann, R. M., Strusberg, I., Durez, P., Nash, P., Amante, E. J. B., Churchill, M., Park, W., Pons-Estel, B., Han, C., Gathany, T. A., Xu, S., Zhou, Y., Leu, J. H. and Hsia, E. C. (2016), Efficacy and Safety of Subcutaneous Golimumab in Methotrexate-Naive Patients With Rheumatoid Arthritis: Five-Year Results of a Randomized Clinical Trial. Arthritis Care Res, 68: 744–752. doi: 10.1002/acr.22759
To evaluate the safety and efficacy of golimumab through 5 years in adults with active rheumatoid arthritis (RA) who had not previously received methotrexate (MTX).
In the GO-BEFORE study, 637 MTX-naive adult patients with active RA were randomized (1:1:1:1) to placebo + MTX (group 1), golimumab 100 mg + placebo (group 2), golimumab 50 mg + MTX (group 3), or golimumab 100 mg + MTX (group 4). Inadequate responders in groups 1, 2, and 3 entered early escape at week 28 to golimumab 50 mg + MTX, golimumab 100 mg + MTX, or golimumab 100 mg + MTX, respectively; remaining patients in group 1 could cross over to golimumab 50 mg + MTX at week 52. Assessments included the American College of Rheumatology 20%/50%/70% improvement criteria (ACR20/50/70) response, the Disease Activity Score in 28 joints (DAS28) using C-reactive protein (CRP) level, and the modified Sharp/van der Heijde score (SHS). Efficacy was analyzed using an intent-to-treat (ITT) analysis. Pharmacokinetics and immunogenicity were evaluated at selected visits.
A total of 422 patients completed golimumab treatment through week 256. At week 256, 72.8%, 54.6%, and 38.0% of all patients in the full ITT population (n = 637) had an ACR20/50/70 response, respectively; 84.1% had a good or moderate DAS28-CRP response; and 72.7% had a clinically meaningful improvement in physical function. Radiographic progression was minimal in all treatment groups through week 256, and the overall mean change from baseline in SHS was 1.36. Serum trough golimumab concentrations were approximately dose proportional and maintained through week 256. Antibodies to golimumab occurred in 9.6% of patients through week 256. Infections were the most common type of adverse event (AE); 204 of 616 patients (33.1%) had ≥1 serious AE.
Clinical efficacy with golimumab treatment was maintained through week 256 of the GO-BEFORE trial of MTX-naive RA patients. No unexpected AEs occurred; safety results through 5 years are consistent with earlier reports.
Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow-Up: Results From the Nurses’ Health Study
Sparks, J. A., Chang, S.-C., Liao, K. P., Lu, B., Fine, A. R., Solomon, D. H., Costenbader, K. H. and Karlson, E. W. (2016), Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow-Up: Results From the Nurses’ Health Study. Arthritis Care Res, 68: 753–762. doi: 10.1002/acr.22752
To evaluate rheumatoid arthritis (RA) and mortality risk among women followed prospectively in the Nurses’ Health Study (NHS).
We analyzed 119,209 women in the NHS who reported no connective tissue disease at enrollment in 1976. Comorbidity and lifestyle data were collected through biennial questionnaires. Incident RA cases were validated by medical records review. Cause of death was determined by death certificate and medical records review. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality for women with RA compared to those without RA.
We validated 964 incident RA cases and identified 28,808 deaths during 36 years of prospective follow-up. Of 307 deaths among women with RA, 80 (26%) were from cancer, 70 (23%) were from CVD, and 44 (14%) were from respiratory causes. Women with RA had increased total mortality (HR 1.40, 95% CI 1.25–1.57) compared to those without RA, independent of mortality risk factors, including smoking. RA was associated with significantly increased respiratory disease mortality (HR 2.06, 95% CI 1.51–2.80) and cardiovascular disease mortality (HR 1.45, 95% CI 1.14–1.83), but not cancer mortality (HR 0.93, 95% CI 0.74–1.15). For women with seropositive RA, respiratory disease mortality was nearly 3-fold higher than among non-RA women (HR 2.67, 95% CI 1.89–3.77).
Women with RA had significantly increased mortality compared to those without RA. Respiratory disease and cardiovascular disease mortality were both significantly elevated for women with RA. The nearly 3-fold increased relative risk of respiratory disease mortality was observed only for those with seropositive RA.
Walking Speed As a Potential Indicator of Cartilage Breakdown Following Anterior Cruciate Ligament Reconstruction
Pietrosimone, B., Troy Blackburn, J., Harkey, M. S., Luc, B. A., Hackney, A. C., Padua, D. A., Driban, J. B., Spang, J. T. and Jordan, J. M. (2016), Walking Speed As a Potential Indicator of Cartilage Breakdown Following Anterior Cruciate Ligament Reconstruction. Arthritis Care Res, 68: 793–800. doi: 10.1002/acr.22773
To determine whether or not self-selected walking speed associates with serum biomarkers of cartilage (collagen and proteoglycan) breakdown in anterior cruciate ligament reconstructed (ACLR) individuals.
Twenty individuals with a history of a primary unilateral ACLR participated in this cross-sectional study. Resting blood was collected from each participant prior to completing 5 walking gait trials at a self-selected comfortable speed. Walking speed was evaluated in a 3-dimensional motion capture laboratory and determined from the velocity of the pelvic center of mass. Sera were assessed for collagen type II cleavage product (C2C) and proteoglycan (aggrecan) concentrations using commercially available specific enzyme-linked immunosorbent assays. Pearson’s product-moment (r) and Spearman’s (ρ) correlations were used to evaluate associations between walking speed and biomarkers of cartilage breakdown metabolism. Partial correlations were used to determine whether covariates influenced associations between walking speed and biomarkers of cartilage breakdown.
ACLR individuals with a slower walking speed demonstrated higher concentrations of serum C2C (r = −0.52, P = 0.02), while there was no significant association between walking speed and aggrecan concentrations (ρ = −0.29, P = 0.31). After accounting for the variance associated with stance phase duration, ACLR individuals with a slower walking speed still demonstrated greater serum C2C concentrations (partial r = −0.53, P = 0.02).
ACLR individuals who habitually walk slower may experience a greater degree of collagen breakdown, suggesting that walking speed may be a future useful clinical indicator for identifying individuals with higher levels of cartilage breakdown and preradiographic osteoarthritic joint changes.
Suppressive Effects of Insulin on Tumor Necrosis Factor–Dependent Early Osteoarthritic Changes Associated With Obesity and Type 2 Diabetes Mellitus
Hamada, D., Maynard, R., Schott, E., Drinkwater, C. J., Ketz, J. P., Kates, S. L., Jonason, J. H., Hilton, M. J., Zuscik, M. J. and Mooney, R. A. (2016), Suppressive Effects of Insulin on Tumor Necrosis Factor–Dependent Early Osteoarthritic Changes Associated With Obesity and Type 2 Diabetes Mellitus. Arthritis & Rheumatology, 68: 1392–1402. doi: 10.1002/art.39561
Obesity is a state of chronic inflammation that is associated with insulin resistance and type 2 diabetes mellitus (DM), as well as an increased risk of osteoarthritis (OA). This study was undertaken to define the links between obesity-associated inflammation, insulin resistance, and OA, by testing the hypotheses that 1) tumor necrosis factor (TNF) is critical in mediating these pathologic changes in OA, and 2) insulin has direct effects on the synovial joint that are compromised by insulin resistance.
The effects of TNF and insulin on catabolic gene expression were determined in fibroblast-like synoviocytes (FLS) isolated from human OA synovium. Synovial TNF expression and OA progression were examined in 2 mouse models, high-fat (HF) diet–fed obese mice with type 2 DM and TNF-knockout mice. Insulin resistance was investigated in synovium from patients with type 2 DM.
Insulin receptors (IRs) were abundant in both mouse and human synovial membranes. Human OA FLS were insulin responsive, as indicated by the dose-dependent phosphorylation of IRs and Akt. In cultures of human OA FLS with exogenous TNF, the expression and release of MMP1, MMP13, and ADAMTS4 by FLS were markedly increased, whereas after treatment with insulin, these effects were selectively inhibited by >50%. The expression of TNF and its abundance in the synovium were elevated in samples from obese mice with type 2 DM. In TNF-knockout mice, increases in osteophyte formation and synovial hyperplasia associated with the HF diet were blunted. The synovium from OA patients with type 2 DM contained markedly more macrophages and showed elevated TNF levels as compared to the synovium from OA patients without diabetes. Moreover, insulin-dependent phosphorylation of IRs and Akt was blunted in cultures of OA FLS from patients with type 2 DM.
TNF appears to be involved in mediating the advanced progression of OA seen in type 2 DM. While insulin plays a protective, antiinflammatory role in the synovium, insulin resistance in patients with type 2 DM may impair this protective effect and promote the progression of OA.
Next News Brief Deadline
The deadline for the June newsletter will be May 27th 2016. Please send any contributions to Julia Farquharson at Julia.email@example.com. We are particularly interested in notices of conferences or workshops, new resources for patients or health professionals and summaries of recent research/publications. We welcome contributions from members from all parts of the country.