Gilles Boire

Objective: To evaluate the relationship between major life stressors in the year prior to diagnosis and rheumatoid arthritis (RA) symptoms and function at diagnosis and at 1 year. Methods: Data were from adults with RA in the Canadian Early Arthritis Cohort, a multicenter inception cohort from January 2007 to March 2017 with ≥ 12 months of follow-up. Patients completed questionnaires about stressful life events in the prior year: Health Assessment Questionnaire–Disability Index (HAQ-DI); 12-item Short Form Health Survey; and 11-point rating scales of sleep, fatigue, pain, and patient global assessment (PtGA). Group characteristics were compared with ANOVA or chi-square test, and adjusted multivariable regression models examined the effect of stressors on symptoms and function at 1 year. Results: The 1933 participants were mostly White (87%) women (72%) with a mean age of 55 years; 52% reported ≥ 1 stressors in the year prior to diagnosis. Around diagnosis, patients reporting major stressors had significantly worse mean HAQ-DI, depression, sleep, fatigue, pain, and PtGA, which generally worsened with the type and number of stressors. At 1 year, the odds of depression and disability, and ratings of pain, fatigue, poor sleep, and PtGA generally increased with an increasing number of stressors, though Simplified Disease Activity Index (SDAI) improved similarly among groups. Conclusion: Fifty-two percent of patients with newly diagnosed RA reported stressful life events in the year prior to diagnosis that were associated with worse disability, depression, pain, fatigue, sleep, and well-being, but not SDAI, at diagnosis. Poorer patient-reported outcomes persisted at 1 year despite similar improvements in SDAI. Results highlight the potential independent contributions of environmental and psychological factors in the onset and course of RA.

Objective: We investigated whether gradual clinical changes in RA patients diagnosed over two decades contributed to their improving outcomes during follow-up. Methods: A total of 840 consecutive early RA patients were recruited in the Early Undifferentiated PolyArthritis (EUPA) cohort and assessed up to 5 years. Recruitment was categorized into three periods: (1) preBIO (1998–2004), (2) INNOV (2005–2010) and (3) T2Tp (2011–2022). Inverse probability of treatment weighting (IPTW) was used to account for baseline variations over time periods. Multivariate generalized estimating equations (GEEs) with repeated measures identified predictors of outcomes. Results: The recruitment periods comprised 245, 266 and 329 recruited patients, respectively. After IPTW, baseline characteristics became largely similar across periods. Use of high-dose MTX and biologics markedly increased after 2005, remaining similar (MTX) or increasing slightly (biologics) in T2Tp relative to INNOV periods. Corticosteroid tapering accelerated and became more complete in the T2Tp period. In multivariable analyses, after balancing baseline characteristics and accounting for changes in diagnostic and therapeutic strategies over time, recruitment after 2011 remained strongly associated with faster and more prevalent ACR/EULAR remission but not with erosive status over follow-up. Despite improved clinical outcomes, improvement curves over 5 years for functional status and other patient-reported outcomes (PROs) remained unchanged across the three periods. Conclusions: Compared with the INNOV period, patients recruited after 2011 presented with milder baseline characteristics and showed evidence for an amplified response to treatment during follow-up, contributing to higher remission rates. Nonetheless, improvements of function and other PROs remained similar across recruitment periods.

Objective: We aimed to understand the association of nonarticular pain (NAP), regional and widespread, with patient‐reported outcomes in early rheumatoid arthritis (RA). Methods: This real‐world, multicenter study observed participants with newly diagnosed active early RA (symptoms 2.8) over the first year. Participants were examined by rheumatologists and synchronously completed body pain diagrams and Patient‐Reported Outcomes Measurement Information System 29 (PROMIS‐29) measures at regular intervals. Participants were classified as follows: (1) no NAP, (2) regional NAP, or (3) widespread NAP. Associations between repeated measures of NAP and PROMIS‐29 over the first year were estimated in separate mixed models, adjusting for sociodemographic and RA characteristics and time‐varying CDAI. Results: These 472 participants with early RA were mostly women (66%), had a mean age of 57 (SD 14) years, and had active disease (mean CDAI 27.0 [SD 14.1]). Over one‐half (n = 246, 52%) reported NAP at baseline; of these, 72% (176 of 246) had regional NAP, and 28% (70 of 246) had widespread NAP. Adjusted mean change in PROMIS‐29 domains were significantly worse in patients with regional versus no NAP: physical function ‐1.4 (95% confidence interval [CI] ‐2.1 to ‐0.7), pain interference 2.7 (95% CI 1.9–3.5), sleep disturbance 1.2 (95% CI 0.4–2.0), fatigue 2.1 (95% CI 1.2–3.1), anxiety 1.5 (95% CI 0.7–2.4), depression 1.4 (95% CI 0.5–2.2), and social participation ‐2.4 (95% CI ‐3.3 to ‐1.5). Associations between widespread and no NAP were larger for pain interference (5.0 [95% CI 3.7–6.4]), fatigue (3.2 [95% CI 1.7–4.8]), and social participation (‐5.6 [95% CI ‐7.2 to ‐4.0]). Mean physical function, pain interference, and social participation scores were well outside the normal range. Conclusion: NAP interferes with key aspects of well‐being in early RA. Individuals with NAP experience greater pain interference and impairments in physical and social function, supporting a need for earlier identification of and interventions targeting NAP. image

Objective: We assessed changes in health-related quality of life (HRQOL) in Canadian patients with juvenile idiopathic arthritis (JIA), comparing inception cohorts from 2017 to 2023 and 2005 to 2010. Methods: We included newly diagnosed patients who completed the Juvenile Arthritis Quality of Life Questionnaire (JAQQ) at both enrollment and 1 year later. Mean changes in JAQQ domain scores from baseline to 1 year were compared between cohorts using Mann-Whitney U tests. Multivariable linear regression was used to adjust for baseline imbalances between the cohorts. We also compared changes in treatments, the Quality of My Life scale, arthritis pain, Childhood Health Assessment Questionnaire disability index, and physician and parent global assessments. Results: We included 478 and 663 patients from the 2017-2023 and 2005-2010 cohorts, respectively. By 1 year, a greater proportion of patients in the 2017-2023 cohort had used conventional synthetic and biologic disease-modifying antirheumatic drugs compared to the 2005-2010 cohort (57.9% vs 46.2% and 27.2% vs 6.3%, respectively). Improvements in total JAQQ score from baseline to 1 year were similar between the 2017-2023 (0.97; 95% CI 0.85-1.09) and 2005-2010 (0.92; 95% CI 0.82-1.02) cohorts, with no significant difference observed across JAQQ domains. Pain scores, however, improved significantly (−2.07 vs −1.62, P = 0.03). After adjusting for baseline imbalances, greater improvements were observed in the 2017-2023 cohort for all JAQQ domains in patients with ≥ 5 active joints (β 0.28 for psychosocial to β 0.62 for gross motor). Conclusion: First-year improvements in HRQOL measured by JAQQ were similar in the 2017-2023 and 2005-2010 cohorts, but adjustment for baseline imbalances suggests greater HRQOL improvements in those with more severe disease in the later cohort.

Objectives: Growing evidence points to mental health impacts of coronavirus disease 2019 (COVID-19). We explored trajectories of depressive symptoms in the year pre- and 2 years post-pandemic onset in adults with RA. Methods: Data are from the Canadian Early Arthritis Cohort (CATCH), a prospective, multicentre, early RA cohort of Canadian adults treated by rheumatologists. Pre-pandemic, participants completed patient-reported outcome measures and rheumatology exams in person. After March 2020, patient-reported outcomes were collected at in-person and virtual visits. We used group-based trajectory modelling to explore longitudinal patterns of depressive symptoms prior to and throughout the COVID-19 pandemic and multinomial regression to identify factors associated with depression trajectory group. Results: A total of 989 participants had a mean age of 60 years (s.d. 14), RA for 6 years (s.d. 4) and were mostly white (84%) and female (73%) with some college education (60%). Most (77%) were in Clinical Disease Activity Index remission/low disease activity prior to the pandemic. We identified four trajectories: resilient (no symptoms throughout: 60%), worsening (none–mild: 22%), improving (mild–minimal: 8%) and persistent (moderate–severe throughout: 9%). Age, sex, race, education, pain, physical and social functioning, fibromyalgia and history of anxiety/depression were associated with different trajectories. Conclusion: Although 60% had a consistent affect during the first 2 years of the pandemic, mood worsened in greater than one in five, suggesting a cumulative impact over time. Biological, psychological and social factors and worse pre-pandemic symptoms and function were associated with a greater risk of depression during the pandemic. Identifying at-risk groups impacted by major stressors like the pandemic may offer new opportunities to personalize treatment, allocate resources, reduce disease flares and improve outcomes.

Objective: This study investigated whether sleep disturbance can predict the extent to which pain interferes with daily functioning in patients with early rheumatoid arthritis (RA).Methods: Data were from adults with early RA (joint symptoms ≤12 months) enrolled in the Canadian Early Arthritis Cohort between 2016 and 2023. Participants underwent standardized clinical assessments and completed Patient‐Reported Outcomes Measurement Information System measures at 0, 6, 12, 18, and 24 months to assess sleep disturbance (primary predictor) and pain interference (primary outcome). Linear mixed‐effects models were used to estimate crude and adjusted (age, sex, body mass index, education, income, smoking status, comorbidities, disease activity, treatment, and depression) effects of sleep disturbance on pain interference over the 24‐month study period. The analysis was lagged so that repeat measures of sleep disturbance at 0, 6, 12, and 18 months were evaluated as predictors of pain interference 6 months later at 6, 12, 18, and 24 months’ follow‐up.Results: The analysis included 502 patients with early RA. At baseline, the sample was 68% female and 81% White; the mean age was 56 (SD 14) years, and the mean disease duration was 5.4 (SD 2.9) months. The unadjusted and adjusted linear mixed‐effects models revealed a significant association between sleep disturbance and subsequent pain interference scores, indicating that worse sleep six months prior was associated with greater pain interference at the following six‐month evaluation.Conclusion: These findings underscore the importance of addressing sleep disturbances as part of pain management strategies soon after RA diagnosis. Identifying and targeting problematic sleep disturbances early on may help improve long‐term pain outcomes.

Objective: To validate the Coping with Health Injuries and Problems (CHIP) questionnaire in a prospective cohort of early RA patients. Methods: Between 2006 and 2022, newly diagnosed RA patients self-administered CHIP at baseline and at follow-up visits. The original CHIP comprises four subscales (Distraction, Palliative, Instrumental, Emotional preoccupation), each containing eight items (scores 8 to 40). At inclusion and again after more than 2 years of follow-up, internal consistency was assessed with Cronbach’s alpha, factor structure with exploratory and confirmatory factor analyses (EFA, CFA), and sensitivity to change with mixed linear models with repeated measures. Results: In 381 early RA patients, the means (SD) were 23.75 (6.52) for Distraction, 23.55 (6.11) for Palliative, 31.38 (5.41) for Instrumental and 25.11 (7.89) for Emotional preoccupation, values comparable to the literature only available in back pain patients. In 253 of the 381 patients followed up into established RA, all subscales except Distraction had decreased significantly between inclusion and follow-up. Internal consistency was similar in established and early RA (Cronbach’s alphas: 0.77 to 0.89 vs 0.75 to 0.86, respectively). EFA in early and established RA suggested that three items linked to treatment adherence consistently segregated from other Instrumental items as a subscale, although this did not improve internal consistency and CFA significantly. Conclusion: The original CHIP possesses good psychometric properties to describe individual coping styles in both early and established RA. Coping in RA might be better characterized using five rather than four subscales, with the additional subscale addressing treatment adherence.