Previous version of 2016 November AHPA Newbrief has been recalled
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2017 AHPA Membership Drive
CAPA Pregnancy and Parenting with Arthritis Survey
Upcoming Courses and Conferences
Recent Articles and Online Resources
2017 AHPA Membership Drive is Now Open!
This next year is promising to be an exciting year for AHPA members. Thanks so much for all of your continued commitment and involvement with AHPA. We have developed collaborations with different organizations including the Association of Rheumatology Health Professionals (ARHP), Ontario Rheumatology Association (ORA) and Osteoporosis Canada. With these collaborations there will be additional opportunities for our members.
As you know our focus at AHPA continues to be on education and research with the ultimate goal of providing excellent care for patients with arthritis. Your renewal as a member will continue to provide you with opportunities to stay current, share knowledge and expertise, network, take part in annual conferences, apply for research grants, and more.
For the next year there will be openings on our board and therefore opportunities to become more involved as a board member. We welcome and need new members on our board. If you are interested please watch our website for nomination details.
We hope that you will renew your membership with AHPA.
Please login to www.ahpa.ca to renew your membership.
CAPA Pregnancy and Parenting with Arthritis Survey
Arthritis doesn’t just affect our grandparents but affects people in the prime of their lives like when they are considering having children and in carrying out their role as parents. In the Fall of 2015, the Canadian Arthritis Patient Alliance launched a survey on the important topic of pregnancy and parenting with arthritis. The survey asked people living with arthritis and those in their network of support what they thought were the top issues of concern when considering pregnancy and when parenting. The survey highlighted a number of key concerns from people living with arthritis including:
To take action regarding the issues of medication safety during pregnancy and breastfeeding, CAPA Board Member Laurie Proulx wrote an article in The Mighty about the stress of pregnancy while living with arthritis. CAPA also recently sent a letter to the Federal Minister of Health to emphasize that pregnant and breastfeeding Moms and their children are at high-risk of poor health outcomes because we lack sufficient information on medication safety.
The survey results will be used to guide the development of an educational resource to assist people living with arthritis when considering pregnancy and in carrying out their role as parents. Learn about the survey results and other aspects of the project on the CAPA website.
Upcoming Courses and Conferences
ACR – American College of Rheumatology
Dates: November 11-16, 2016
Location: Washington DC, USA
More information: http://www.rheumatology.org
8th Annual Karin Greaves Memorial Education Seminar
Dates: November 19th, 2-016
Location: Edmonton, University of Alberta, Corbett Hall
Cost: In-person $180, webcast viewing individual $125, webcast viewing group (3+) $300
To register and for more information click Here
Assessment and Management of Rheumatic Diseases is a 4-day skills workshop for physical therapists, occupational therapists and nurses.
Date: April 3 – 6, 2017
Location: Mary Pack Arthritis Centre, Vancouver, British Columbia
Cost: $656.25 ($625 + $31.25 GST)
Key benefits of attending:
* Update your knowledge of evidence-based care for three common forms of arthritis
* Practice hands-on assessment skills with patient models
* Learn from multidisciplinary instructors and case studies
* Registration deadline is March 3, 2017
For more information and a copy of the workshop brochure visit http://mpap.vch.ca/resources-for-professionals/becoming-an-ace-member or contact email@example.com (mailto:firstname.lastname@example.org)
Bone Fit Workshops - Osteoporosis Canada
Date: November 19, 2016
Location: Newmarket, ON, Southlake Regional Health Centre
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
Patient Satisfaction with Pharmacist-Led Collaborative Follow-Up Care in an Ambulatory Rheumatology Clinic
Hall, J. J., Katz, S. J., and Cor, M. K. (2016) Patient Satisfaction with Pharmacist-Led Collaborative Follow-Up Care in an Ambulatory Rheumatology Clinic. Musculoskelet. Care, doi: 10.1002/msc.1160.
Patient satisfaction is known to increase with pharmacist intervention in general outpatient clinics and with nurse-led care in rheumatology clinics. The aim of the present study was to describe and compare patient satisfaction with two different types of care: a pharmacist physician collaborative model and a traditional physician model in a rheumatology clinic setting.
A cross-sectional survey of inflammatory arthritis patients seen during a follow-up visit in Edmonton, Alberta, Canada, was conducted over a ten-week period. Patient satisfaction was measured using a modified version of the validated Leeds Satisfaction Questionnaire, which uses a five-point Likert scale to measure six dimensions of satisfaction, and compared between the collaborative care and traditional physician models.
A total of 62 patients completed the questionnaire (21 collaborative care and 41 traditional physician model). The average age of respondents was 52 years and the majority were female. The mean score for satisfaction across the six dimensions was 4.56 in the collaborative care group and 4.30 in the traditional physician group (p = 0.02). Patient satisfaction in the collaborative care group was consistently higher across all dimensions. No difference was noted between participants seen for the first time compared with those seen two or more times by the pharmacist.
A collaborative care model can exceed the already high expectations for care of patients with inflammatory arthritis. Our findings support the role of pharmacists using a collaborative care approach to care for patients in rheumatology clinics.
Smoking-Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink
Joseph, R. M., Movahedi, M., Dixon, W. G. and Symmons, D. P. M. (2016), Smoking-Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink. Arthritis Care & Research, 68: 1598–1606. doi:10.1002/acr.22882
To investigate the association between smoking status and smoking cessation with mortality in patients with rheumatoid arthritis (RA).
An incident cohort of patients with RA was identified using the Clinical Practice Research Datalink, a database of UK primary care electronic medical records. Time-varying smoking status, years of cessation, and amount smoked were determined from patients’ medical records. The date and underlying cause of death were identified by linkage with Office for National Statistics records. The associations between smoking status and smoking cessation with all-cause and cause-specific mortality (circulatory disease, all cancers, lung cancer, respiratory disease, and respiratory infection) were investigated using adjusted Cox (all-cause mortality) and Fine-Gray (cause-specific mortality) regression.
The cohort comprised 5,677 patients (median age 61.4 years, 68% women), with 40% as never smokers, 34% former smokers, and 26% current smokers at baseline. Compared to never smoking, current smoking was associated with an increased risk of all-cause mortality (hazard ratio 1.98 [95% confidence interval (95% CI) 1.56, 2.53]), and mortality due to circulatory disease (subdistribution hazard ratio [SHR] 1.96 [95% CI 1.33, 2.90]) and lung cancer (SHR 23.2 [95% CI 5.15, 105]). Each year of smoking cessation was associated with a decreased risk of all-cause mortality (former heavy smokers SHR 0.85 [95% CI 0.77, 0.94], former light smokers SHR 0.90 [95% CI 0.84, 0.97]).
Current smoking is associated with an increased risk of all-cause, cardiovascular, and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all-cause mortality. This information may prove helpful in smoking cessation programs for patients with RA.
Interaction Between Low-Dose Methotrexate and Nonsteroidal Anti-inflammatory Drugs, Penicillins, and Proton Pump Inhibitors. A Narrative Review of the Literature
Hall, J., Bolina, M., Chaterly, T., Jamali, F. Ann Pharmacother October 3, 2016 1060028016672035
To review the potential drug interactions between low-dose methotrexate (LD-MTX) and nonsteroidal anti-inflammatory drugs (NSAIDs), penicillins, and proton-pump inhibitors (PPIs) given the disparity between interactions reported for high-dose and low-dose MTX to help guide clinicians.
A literature search was performed in MEDLINE (1946 to September 2016), EMBASE (1974 to September 2016), and International Pharmaceutical Abstracts (1970 to January 2015) to identify reports describing potential drug interactions between LD-MTX and NSAIDS, penicillins, or PPIs. Reference lists of included articles were reviewed to find additional eligible articles.
Study Selection and Data Extraction
All English-language observational, randomized, and pharmacokinetic (PK) studies assessing LD-MTX interactions in humans were analyzed to determine clinical relevance in making recommendations to clinicians. Clinical case reports were assigned a Drug Interaction Probability Scale score.
A total of 32 articles were included (28 with NSAIDs, 3 with penicillins, and 2 with PPIs [1 including both PPI and NSAID]). Although there are some PK data to describe increased LD-MTX concentrations when NSAIDs are used concomitantly, the clinical relevance remains unclear. Based on the limited data on LD-MTX with penicillins and PPIs, no clinically meaningful interaction was identified.
Given the available evidence, the clinical importance of the interaction between LD-MTX and NSAIDs, penicillins, and PPIs cannot be substantiated. Health care providers should assess the benefit and risk of LD-MTX regardless of concomitant drug use, including factors known to predispose patients to MTX toxicity, and continue to monitor clinical and laboratory parameters per guideline recommendations.
Functional Magnetic Resonance Imaging of Working Memory and Executive Dysfunction in Systemic Lupus Erythematosus and Antiphospholipid Antibody–Positive Patients
Kozora, E., Ulu?, A. M., Erkan, D., Vo, A., Filley, C. M., Ramon, G., Burleson, A., Zimmerman, R. and Lockshin, M. D. (2016), Functional Magnetic Resonance Imaging of Working Memory and Executive Dysfunction in Systemic Lupus Erythematosus and Antiphospholipid Antibody–Positive Patients. Arthritis Care Res, 68: 1655–1663. doi: 10.1002/acr.22873
Standardized cognitive tests and functional magnetic resonance imaging (fMRI) studies of systemic lupus erythematosus (SLE) patients demonstrate deficits in working memory and executive function. These neurobehavioral abnormalities are not well studied in antiphospholipid syndrome, which may occur independently of or together with SLE. This study compares an fMRI paradigm involving motor skills, working memory, and executive function in SLE patients without antiphospholipid antibody (aPL) (the SLE group), aPL-positive non-SLE patients (the aPL-positive group), and controls.
Brain MRI, fMRI, and standardized cognitive assessment results were obtained from 20 SLE, 20 aPL-positive, and 10 healthy female subjects with no history of neuropsychiatric abnormality.
Analysis of fMRI data showed no differences in performance across groups on bilateral motor tasks. When analysis of variance was used, significant group differences were found in 2 executive function tasks (word generation and word rhyming) and in a working memory task (N-Back). Patients positive for aPL demonstrated higher activation in bilateral frontal, temporal, and parietal cortices compared to controls during working memory and executive function tasks. SLE patients also demonstrated bilateral frontal and temporal activation during working memory and executive function tasks.
Compared to controls, both aPL-positive and SLE patients had elevated cortical activation, primarily in the frontal lobes, during tasks involving working memory and executive function. These findings are consistent with cortical overactivation as a compensatory mechanism for early white matter neuropathology in these disorders.
Next News Brief Deadline
The deadline for the December newsletter will be November 25th, 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.