Rheumatoid Arthritis in a North American Native Population: Longitudinal Followup and Comparison with a White Population

Peschken, Christine A.; Hitchon, Carol; Robinson, David; Smolik, Irene; Barnabe, Cheryl; Prematilake, Suraj; El-Gabalawy, Hani

doi:10.3899/jrheum.091452

Cited by 60 publications

(67 citation statements)

References 21 publications

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“…We have previously demonstrated that the Cree/Ojibway North American Native population, like several other North American Native populations, has a high prevalence of RA and multicase families and a high background frequency of predisposing HLA-DRB1 shared epitope alleles (6,9,20,(22)(23)(24). In the present study, our multiplex analyses of 42 proinflammatory and antiinflammatory cytokines, chemokines, and growth factors indicated that, as a group, the serum cytokine profile of the disease-free first-degree relatives more closely resembled that of the RA patients than did the cytokine profiles of North American Native and Caucasian controls.…”

Section: Discussionmentioning

confidence: 99%

Familial clustering of the serum cytokine profile in the relatives of rheumatoid arthritis patients

El-Gabalawy¹,

Robinson²,

Smolik³

et al. 2012

Arthritis & Rheumatism

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Objective. Rheumatoid arthritis (RA) is prevalent in North American Native populations, with a high frequency of multicase families and seropositivity in first-degree relatives. This study was undertaken to determine whether the serum cytokine profile of firstdegree relatives of North American Native patients with RA differed from that of individuals with no family history of autoimmunity and whether there was an association with RA autoantibodies.Methods. North American Native patients with RA (n ‫؍‬ 105), their first-degree relatives (n ‫؍‬ 273), healthy North American Native controls (n ‫؍‬ 200), and Caucasian controls (n ‫؍‬ 150) were studied. Serum levels of 42 cytokines were tested using a multiplex laser bead assay. Rheumatoid factor (RF), anti-cyclic citrullinated peptide 2 (anti-CCP-2), monocyte chemotactic protein 1 (MCP-l), and high-sensitivity C-reactive protein (hsCRP) were tested by enzyme-linked immunosorbent assay, and HLA-DRB1 alleles by specific primers. Discriminant analysis and logistic regression classified individuals based on their cytokine profile.Results. The prevalence of RF (cutoff level predetermined to include 5% of Caucasian controls) and anti-CCP (cutoff level of >40 units) was, respectively, 88% and 81% in the RA patients, 34% and 9% in first-degree relatives, and 9% and 4% in North American Native controls; the prevalence of anti-CCP was 0% in Caucasian controls. Levels of most cytokines were highest in RA patients; 17 of 40 cytokines (43%) were significantly higher in first-degree relatives than in controls, including multiple proinflammatory cytokines. Discriminant analysis showed a notable distinction between the groups, with 85% classification accuracy. First-degree relatives had markedly higher MCP-1 and hsCRP levels than North American Native controls, but there was no consistent association with RA autoantibodies.Conclusion. Our findings indicate that levels of multiple cytokines and hsCRP are higher in first-degree relatives of North American Native patients with RA compared to individuals from a nonautoimmune background. These data suggest that elevated baseline cytokine levels may be part of the risk profile for developing RA.

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Section: Discussionmentioning

confidence: 99%

Familial clustering of the serum cytokine profile in the relatives of rheumatoid arthritis patients

El-Gabalawy¹,

Robinson²,

Smolik³

et al. 2012

Arthritis & Rheumatism

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“…Methotrexate is the first-line therapy indicated for rheumatoid arthritis, and was used by 72 % of patients in a recently reported Canadian cross-sectional study [21]; estimates of rates of use of biologics for rheumatoid arthritis from population-based administrative datasets in Ontario was 23.5 % [22], similar to that in the Netherlands (22 %) [23], or the United States (26 %) [24]. Thus, our findings are counterintuitive given findings of worse arthritis severity in First Nations people [12]. A reassuring trend was the increased use of combination therapies in recent years.…”

Section: Discussionmentioning

confidence: 48%

“…By 2012, approximately 20 % of DMARDs were used in combination, and the majority of patients with claims for biologic therapies concomitantly have claims for at least one DMARD, which improves efficacy and survival of biologic agents. Prior to our study, the only publication discussing therapeutic exposures for DMARDs was for Aboriginal patients with rheumatoid arthritis in Manitoba, who had more DMARD, combination therapy and corticosteroid exposures [12]. As the dataset used in our study does not allow exploration of reasons for our observations at the individual level, we cannot identify specifically what factors influence this perceived under-utilization of evidence-based therapies.…”

Section: Discussionmentioning

confidence: 99%

“…To date, no published studies have characterized psoriasis or psoriatic arthritis prevalence or phenotype in any Indigenous groups. Inflammatory arthritis among First Nations People is also more severe [12] and is associated with worse disability [13] compared to non-First Nations. Timely diagnosis and effective use of disease-modifying therapy are proven strategies to reduce the impact of disease, as summarized in Solomon et al [14].…”

Section: Introductionmentioning

confidence: 99%

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Claims for disease-modifying therapy by Alberta non-insured health benefits clients

Barnabé

Healy

Portolesi

et al. 2016

BMC Health Serv Res

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BackgroundUncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. Disease-modifying therapies are widely used to suppress this disease activity, but cost-coverage is variable. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Our objective was to describe the prevalence and patterns of treatment with disease-modifying therapy for the NIHB claimant population, and also examine adjuvant therapy (analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids) use.MethodsCases (n = 2512) were defined by ≥1 claim for a disease-modifying anti-rheumatic drug (DMARD) or biologic between 1999 and 2012 in the NIHB pharmacy claim database. The proportion of the population with claims for individual agents and drug classes annually was calculated to estimate annual incidence and prevalence rates for use of disease-modifying therapy, and the prevalence of use of individual DMARDs, biologics and adjuvants. Differences in the proportion accessing adjuvant therapies and median doses in the 6 months following initiation of disease-modifying therapies was estimated.ResultsThe incidence rate of treatment was calculated at an average of 127.5 cases per 100,000 population between 2001 and 2012, and the cumulative prevalence, accounting for patients lost to the database, increased and then stabilized at 1.3 % in the last three years of the study. Annual dispensation of methotrexate, combination DMARD therapy and biologic therapy approached 35 %, 19 %, and 10 % of the cohort respectively. A declining prevalence of claims for acetaminophen (28 % to 15 %) and anti-inflammatories (73 % to 63 %) occurred from 2000 to 2012, however corticosteroid (32 %) and opioid (65 %) dispensation remained stable. The proportion of patients with claims for NSAIDs (69.9 % to 61.1 %, p = 0.002), oral corticosteroids (45.4 % to 33.6 %, p < 0.001) and parenteral corticosteroids (16.2 % to 8.3 %, p = 0.002) decreased in the 6 months following biologic initiation.ConclusionsThe proportion of NIHB clients with active claims for disease-modifying therapy is lower than expected based on existing epidemiologic knowledge of the prevalence of inflammatory conditions in the First Nations and Inuit populations. These findings should be further explored in order to optimize treatment outcomes for NIHB claimants with inflammatory disease.

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“…Arthritis is the most common chronic disease experienced by Indigenous populations in Canada, and population-based studies estimate that the prevalence of many arthritis conditions is at least 1.3-1.6 times more frequent than that of the non-Indigenous population [2] with high rates of disability observed [3] including rates in the 25–44 year age group [4]. A significant rise in the prevalence of arthritis conditions in the general population is anticipated over the next 30 years [5] and given that approximately half of the Indigenous population is currently under the age of 25 years [1], there will be a great increase in need for arthritis care.…”

Section: Introductionmentioning

confidence: 99%

Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory

Thurston

Coupal

Jones

et al. 2014

Int J Equity Health

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IntroductionAccess to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals.MethodsUsing constructivist grounded theory methodology we investigated Indigenous peoples’ experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary.ResultsIn the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out’ and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in’. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers.ConclusionLow specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and racism and reinforce rejection of healthcare by patients. Examples of 'working around’ the system were revealed and showed potential for improved utilization of specialist services. This framework has significant implications for health policy and indicates that culturally safe services are a priority in addressing chronic disease management.

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Rheumatoid Arthritis in a North American Native Population: Longitudinal Followup and Comparison with a White Population

Cited by 60 publications

References 21 publications

Familial clustering of the serum cytokine profile in the relatives of rheumatoid arthritis patients

Familial clustering of the serum cytokine profile in the relatives of rheumatoid arthritis patients

Claims for disease-modifying therapy by Alberta non-insured health benefits clients

Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory

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