JointHealth™ express   November 12, 2023

ACE Reporting on American College of Rheumatology’s annual scientific meeting – Important research news for Canadians living with arthritis

The American College of Rheumatology’s annual meeting - ACR Convergence – is taking place November 10–15 in San Diego, California. The annual meeting offers arthritis patients, clinicians, and researchers from around the world the opportunity to learn about the latest research, advancements, and breakthroughs in arthritis. Presentations and abstracts from Canadian arthritis experts were some of the presentations highlighted during the opening day. Here is a look at some of those studies.

Rheumatic Disease in Indigenous Populations: North American Perspective

Dr. Cheryl Barnabe is a Métis rheumatologist and a Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. She is a Professor in the Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary. She is a Vice-Chair in the Department of Medicine (Indigenous Health), and the Deputy Director for the McCaig Institute for Bone and Joint Health.

In a special session on Rheumatic Disease in Indigenous Populations, Dr. Barnabe was one of three panelists who looked at the higher prevalence of arthritis with Indigenous populations and spoke about the reasons for this disproportionate rate of arthritis and identified ways to deal with the gaps in models of care.

In her presentation, Dr. Barnabe focussed on the impact of arthritis on Indigenous Peoples in North America, including First Nations, Métis, Inuit, American Indian, Alaska Native, and Native Hawaiian communities. These groups, constituting about 5% of Canada's population and 2% in the United States, are shown to have a higher prevalence of rheumatic diseases compared to the general population.

Dr. Barnabe’s research described the significant challenges faced by Indigenous Peoples, such as lower chances of recovering from these diseases, increased reliance on health services, and unique circumstances where social relationships and community roles play a crucial role. She also spoke about the various factors affecting healthcare access, such as racism, economic status, geographical distance, and difficulties in navigating the healthcare system. Additionally, Dr. Barnabe’s research raised issues surrounding medication access including trust concerns, stigma related to medication use, challenges in the supply chain, and financial burdens associated with reimbursement coverage for arthritis medications.

In her study, Dr. Barnabe proposes practical solutions to address these health disparities. First, she suggests improving the relationship between patients and health care providers by adopting trauma-informed care. This approach aims to create a safer and more supportive environment for individuals who have experienced trauma. Another key recommendation is enhancing access and coordination through navigation models, making it easier for Indigenous individuals living with arthritis to navigate the complex healthcare systems in North America. Dr. Barnabe also emphasizes the importance of expanding treatment options to reduce the burden on patients and support informed decision-making.

Dr. Barnabe concluded her presentation by describing the significance of collaboration among family, community, primary care, and other support systems. By fostering a holistic approach to healthcare, Indigenous communities can better address the challenges posed by arthritis. She called for policy changes, emphasizing the need for better medication access and restructuring health systems to ensure fair and effective care for Indigenous Peoples living with arthritis.

Recommendations for musculoskeletal ultrasound education in Canada

At a November 11 Plenary session, Maria Powell, MD, Fellow in Training at the University of Calgary Cumming School of Medicine, Calgary, Canada presented ground-breaking consensus recommendations for musculoskeletal ultrasound (MSUS) education in Canada. This is a significant development, as Canada lacked standardized levels of essential skills and abilities (also referred to as “competencies”) for students studying rheumatology, particularly in MSUS.

The Royal College of Physicians and Surgeons in Canada recently incorporated MSUS training into core competencies for rheumatology residents. However, a lack of standardization meant residents were receiving varied education. At a Plenary session at ACR Convergence, Dr. Powell outlined 42 mandatory and 39 optional MSUS competencies agreed upon by experts in Canada and the United States.

The recommendations aim to standardize MSUS residency training across Canada. A Residency program is a training environment where newly graduated MD physicians go to begin specialized training to become a certain type or specialty of a doctor, such as a rheumatologist.

The new recommendations call for mandatory basic ultrasound skills training for all rheumatology students, covering focused MSUS exams for hands, wrists, and feet to identify features of inflammatory arthritis. This includes recognizing effusion, synovitis, bone erosion, osteophyte, and tenosynovitis. Additionally, limited MSUS exams for the knee and ankle to identify joint effusion are emphasized. Dr. Powell highlighted the clinical and educational benefits of MSUS in rheumatology: “Musculoskeletal ultrasound in rheumatology has multiple clinical benefits as well as educational advantages and is an exciting area of ongoing research. Residency is an ideal time to learn this skill.”

What role does poor sleep play in pain experienced by RA patients

ACE Convergence Abstract: Sleep Disturbance Predicts Pain Interference in Patients with Early Rheumatoid Arthritis in a Prospective Real-World Cohort

A study led by a large number of leading Canadian experts focused on patients with early rheumatoid arthritis (RA) who, despite taking strong medications, often experience persistent pain that is not easily explained by clinical measures or experience. Sleep disturbances are common in RA patients and may impact how they perceive pain. While previous research showed a link between one night of poor sleep and increased pain the next day, this study aimed to understand if early sleep disturbances influence long-term pain outcomes.

The study used data from the Canadian Early Arthritis Cohort, involving 502 patients with early RA. Participants reported their sleep quality and pain interference using PROMIS measures over 24 months. The results showed a significant association between sleep disturbances and pain interference. Better sleep six months prior was linked to less pain interference at the subsequent evaluation.

These findings highlight the importance of addressing sleep issues in managing pain for early RA patients. Early identification and intervention for sleep disturbances could potentially improve long-term pain outcomes. The study underscores the need for further research to explore underlying mechanisms and potential interventions targeting sleep to alleviate pain in RA.