Newsbrief

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Message from the President:

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Remember to Renew Your Membership!

Meet and Greet in Montreal

AHPA Precourse Feb 27, 2019 Montreal

Notice of Annual General Meeting - Agenda now available

Year End Report

Call for Nominations

Volunteer Opportunity - Camp Cambria

Interprofessional Arthritis Fellowship Opportunity at University Health Network

Recent Articles and Online Resources

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Remember to Renew Your Membership!

Don’t miss out on all the benefits of AHPA membership. Renew your membership now! Along with opportunities for research grants and other awards, we will be collaborating with our American counterparts in providing exciting webinars in 2019, but this is a member-only offer!

Please login to www.ahpa.ca to renew your membership. Note that you will now see a membership number under your name when you log in. Please take note of this as you may need this number to register for various educational opportunities.

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Meet and Greet in Montreal

Going to Montreal for the Pre-Course and CRA ASM? Join us for our annual AHPA Meet and Greet in Montreal on Tuesday February 26, 2019 7:30 – 10 pm: Fairmont The Queen Elizabeth room: Av Duluth. Join us for a drink and some nibbles and catch up with your colleagues from across Canada!

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AHPA Precourse Feb 27, 2019 Montreal

The AHPA Pre-course will be taking place at Fairmont, The Queen Elizabeth, in Montreal on Wednesday, Feb 27, 2019 in the Centre-Ville room. There will be a great lineup of speakers. Dr. Paul Fortin will lead off the day by providing an update on Connective Tissue Diseases.  Other speakers include Dr. Ophir Vinik: Dermatomyositis (adults and paediatrics); Dr. Christian Veillette: Shoulder arthroplasty; Mandy McGlynn: Pain management; Dr. Tom Appleton:  Osteoarthritis; and Dr. Medha Soowamber: Vaccinations.  We are very pleased once again to include patients in our curriculum! Laurie Proulx, representing the Canadian Arthritis Patient Alliance (CAPA), will provide information about CAPA’s “Pregnancy and Parenting with Arthritis” resource. There will also be an interactive component to the day where participants will exercise not only their muscles (lead by Karen Gordon), but their brains as well!

Please find the agenda for the day here: https://www.ahpa.ca/events/2019-ahpa-cra-annual-meeting/ 

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Notice of Annual General Meeting

The Annual General Meeting of the Arthritis Health Professions Association will be held on Friday March 1, 2019 at 12:30 pm EST at Fairmont The Queen Elizabeth, 900 boulevard Rene Levesque Ouest, Montreal, QC H3B 4A5. Room Av Duluth. All members of AHPA are encouraged to participate in this meeting. If members are unable to attend and wish to participate in the election of the Board of Directors, they must complete the proxy voting form.  Minutes of the 2018 AGM can be found here, and the agenda for the 2019 AGM are available for your review on the website. Please take time to review these documents prior to the AGM.

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Call for Nominations 

There’s still time to consider running for one of our available positions for 2019-2021: President-Elect, Communications Chair, Membership Chair, and Member-at-Large Western Canada. Elections will be held at the AHPA Annual General Meeting in Montreal, Quebec on 01 March, 2019 during the 2019 Annual CRA Scientific Meeting and AHPA Annual Meeting. Fill out a nomination form and bring it with you to Montreal. Forms should be submitted to Lynne Broderick before the AGM. For more details about the available positions, please click here for position descriptions or refer to the AHPA Website for further details.

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Year End Report

The 2018 Year End Report is now posted on the website (homepage). Please sign in to the website to review of AHPA activities in 2018.

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Interprofessional Arthritis Fellowship Opportunity at University Health Network

BACKGROUND

The Arthritis Program, at University Health Network (UHN), is focused on leading the way in innovative Inter-professional models of care. The ‘Inter-Professional Arthritis Fellowship’, is a position, that was created in response to the expanding and changing roles of healthcare professionals within the current healthcare landscape in Ontario.

The fellowship is designed to develop the skills of experienced clinicians under the guidance of specialist orthopaedic surgeons, current extended scope physiotherapists (ESPs) and arthritis researchers over a 1-year period. At the end of the year, the ESP will have advanced knowledge and skills in the diagnosis and management of patients with various musculoskeletal conditions. The fellowship will provide resources and knowledge such that the fellow will be equipped to act as a first point of care within an inter-professional team. Expected competencies at the end of the fellowship include; ordering and interpretation of laboratory tests pertinent to the care of patients with arthritis/musculoskeletal conditions, ordering and interpretation of imaging (radiographs, magnetic resonance imaging, bone density, ultrasound), and detailed knowledge of surgical procedures for each clinical area completed within the fellowship. 

The overarching goal of the fellowship is to provide early access to excellent care within an inter-professional team by developing ESPs who are skilled clinicians and leaders. As such, the fellowship is specifically designed to meet the growing demand for registered physiotherapists or advanced practice clinicians looking to advance their training and become an ESP, or for existing ESPs wishing to further their expertise in inter-professional musculoskeletal/arthritis care.

The fellowship will draw from existing and newly developed internal and external resources to explore the theoretical and practical skills essential to develop the level of practice required for ESPs to work safely, effectively & legally within the scope of their practice.

Eligibility for Application

The innovative fellowship program has been designed to attract high calibre physiotherapists or advanced practice clinicians to deliver specialist care for joint and spine patients using an upstream, shared-care model of care.

The preferred candidate would be a senior physiotherapist or advanced practice clinician with interest in inter-professional models of care, wishing to work in an Extended Scope Practitioner role, or an ACPAC Program-trained clinician seeking to join an inter-professional team and further develop their knowledge and skills in musculoskeletal/arthritis care.

Fellowship Components

The fellowship will include four components; clinical, education, leadership and research. Each component will run concurrently with the fellowship time divided 60:40 between clinical and research/educational time. 

CLINICAL

a)      Three sets of four-month clinical rotations with co-supervisors consisting of an orthopaedic surgeon and an ESP in a preceptorship model in the clinical areas of: shoulder/elbow; hip/knee; foot/ankle; or spine. Depending on the learning needs of the fellow, the time in each clinical area can be variable; and may not need to be three areas.

At the end of each clinical rotation, there will be an evaluation to ensure the fellow has met the learning needs and has all the skills, experience and confidence to work an ESP.

Clinical supervision will be as follows:

Shoulder/Elbow – Dr. Christian Veillette/Dr. Tim Leroux /Christopher Hawke (ESP)

Hip/Knee – Dr. Nizar Mahomed/Dr. Rod Davey/Emily May (ESP)

Foot/Ankle – Dr. Johnny Lau  

Spine – Dr. Raj Rampersaud/Dr. Stephen Lewis/Angela Sarro (Nurse Practitioner)

EDUCATIONAL

a)      Preferred that the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program will completed in conjunction to the fellowship (if not already completed)

b)      Participation in City Wide IPAC Rounds conducted 6 times/year on clinical topics and presented by ESPs and Faculty across the Greater Toronto Area and academic hospitals, available by webcast to disseminate the rounds to the community of practice

c)       Participation in UHN ESP Journal Club 4 times/year

d)      Completion of self-directed learning log related to each of the clinical areas

e)      Attendance at relevant weekly rounds, e.g., Spine Rounds Monday and Tuesday 7-8 a.m.

f)       Completion of radiology update for each clinical area.

g)      Completion of physiatry clinic observation related to pain management

LEADERSHIP

a) Acquisition of skills related to leadership and management to support the Arthritis Program, align with UHN strategy, develop leadership within the ESP community, and be proactive in health system-level needs of patients with arthritis, through enrolment in a Michener Institute Leadership course; or equivalent.

RESEARCH

a) Completion of research modules on Good Clinical Research (UHN Elearning modules)

b) Participation in Journal Club evaluating current evidence in orthopaedic care

c) Completion of a research project in population health and value-based healthcare delivery with the support of the Health Services Research Program and Data Management Team within the Arthritis Program, with suitability for publication in a peer-reviewed journal, such as:

a. Analysis of existing dataset

b. Case report

Potential interested candidates are encouraged to submit a letter of interest and copy of curriculum vitae to Leslie Soever at leslie.soever@uhn.ca by March 4, 2019.

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Recent Articles and Online Resources

Cost-effectiveness of combination disease-modifying antirheumatics vs. tumour necrosis factor inhibitors in active rheumatoid arthritis: TACIT trial

Patel, A., Heslin, M., Scott, D. L., Stringer, D., Birrell, F., & Ibrahim, F. (2019). Cost-effectiveness of combination disease-modifying antirheumatics vs. tumour necrosis factor inhibitors in active rheumatoid arthritis: TACIT trial. Arthritis Care & Research. doi:10.1002/acr.23830

Objective

To determine whether intensive combinations of synthetic disease modifying drugs (cDMARDS) achieve similar clinical benefits more cheaply than high-cost biologics such as tumour necrosis factor inhibitors (TNFis) in patients with active rheumatoid arthritis (RA) who have failed to respond to methotrexate and another DMARD.

Methods

Within-trial, cost-effectiveness and cost-utility analyses from health and social care (H&SC) and two societal perspectives. Participants were recruited into an open-label, 12-month, pragmatic, randomised, multicentre, two-arm, non-inferiority trial in 24 rheumatology clinics in England. Costs were linked with the Heath Assessment Questionnaire (HAQ; primary outcome) and quality-adjusted life years (QALYs) derived from two measures (SF-36, EQ-5D-3L).

Results

205 participants were recruited, 104 in the cDMARDs arm, 101 in the TNFis arm. cDMARD arm participants with poor response at 6 months were offered TNFis; 46 (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6 month follow-up and 91-92% at 12 month follow-up. The cDMARDs arm had significantly lower total costs from all perspectives (6 month H&SC adjusted mean difference -£3615 (95% confidence interval -£4104 to -£3182); 12 month H&SC adjusted mean difference -£1930 (95% confidence interval -£2599 to -£1301)). The HAQ showed benefit to the cDMARDs arm at 12 months (-0.16; 95% CI-0.32 to -0.01); other outcomes/follow-ups showed no differences.

Conclusion

Starting treatment with cDMARDs, rather than TNFis, achieves similar outcomes at significantly lower costs. Patients with active rheumatoid arthritis and meeting NICE criteria for expensive biologics can cost-effectively be treated with combinations of intensive synthetic disease modifying drugs.

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The Association of Short-term Ultraviolet Radiation Exposure and Disease Severity in Juvenile Dermatomyositis

Neely, J., Long, C. S., Sturrock, H., & Kim, S. (2019). The Association of Short-term Ultraviolet Radiation Exposure and Disease Severity in Juvenile Dermatomyositis. Arthritis Care & Research. doi:10.1002/acr.23840

Objective

Ultraviolet radiation (UVR) is considered to be an important environmental factor in the clinical course of children with JDM. We aimed to evaluate the association between UVR and severe disease outcomes in JDM.

Methods

This is a cross-sectional study of JDM subjects enrolled in the U.S. multi-center Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry from 2010-15. Mean UV index (mUVI) in the calendar month prior to symptom onset in each subject’s zip code was calculated from daily satellite solar noon measurements. Multivariable logistic regression was used to model the relationship between mUVI and calcinosis as well as other outcomes of severe disease. Covariates included sex, race, age, time to diagnosis, disease duration, and latitude.

Results

In a multivariable model, there was no association between mUVI and calcinosis. Black race was associated with a 3-fold greater odds of calcinosis. However, there was a significant statistical interaction between race and UVI. Accounting for this interaction, the odds of calcinosis markedly decreased in black subjects and steadily increased in non-black subjects over a range of increasing mUVI. Higher mUVI was associated with decreased odds of using biologics or non-methotrexate DMARDs and skin ulceration.

Conclusions

We describe a novel association between UVR, calcinosis, and race in a large cohort of patients with JDM. This study furthers our knowledge of the role of UVR in the clinical course of JDM and highlights the complex interplay between genes and environment in the clinical phenotypes and development of calcinosis in children with JDM.

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Next Newsbrief Deadline

The deadline for the March newsletter will be February 28, 2019. Please send any contributions to communications@ahpa.ca. 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.