Canadian Rheumatology Association Meeting Fairmont Empress Victoria, British Columbia, Canada February 26 – 29, 2020
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J Rheumatol First Release June 1 2020; doi:10.3899/jrheum.200419 Canadian Rheumatology Association Meeting Fairmont Empress Victoria, British Columbia, Canada February 26 – 29, 2020 The 74th Annual Meeting of The Canadian Rheumatology Association was held at the Fairmont Empress, Victoria, British Columbia, Canada, February 26–29, 2020. The program consisted of presentations covering original research, symposia, awards, and lectures. Highlights of the meeting include the following 2020 Award Winners: Distinguished Rheumatologist, Jamie Henderson; Distinguished Investigator, Paul Fortin; Distinguished Teacher-Educator, Rayfel Schneider; Emerging Investigator, Claire Barber; Emerging Teacher-Educator, Dharini Mahendira; Ian Watson Award for the Best Abstract on SLE Research by a Trainee, Kimberley Yuen; Phil Rosen Award for the Best Abstract on Clinical or Epidemiology Research by a Trainee, Kristina Roche and Eugene Krustev; Best Abstract on Research by a Rheumatology Resident, Julie Mongeau; Best Abstract on Basic Science Research by a Trainee, Sonya Kim; Best Abstract by a Post-Graduate Research Trainee, Carolina Munoz-Grajales; Best Abstract on Quality Care Initiatives in Rheumatology, Arielle Mendel; Best Abstract by a Medical Student, Declan Webber; Best Abstract by an Undergraduate Student, Chloe Lee; Best Abstract by a Rheumatology Post- Graduate Research Trainee, Nancy Maltez; Best Abstract on Research by Young Faculty, Lily Lim; Best Abstract on Spondyloarthritis Research, Anas Samman; Practice Reflection Award, Gold, Steven Katz; Practice Reflection Award, Silver, Bailey Dyck. Lectures and other events included Keynote Lecture by Tim Spector: Inflammatory Diets — The Microbiome; Keynote Address by Paul Fortin, Distinguished Investigator Awardee: The Power of Many in Lupus Research; State of the Art Lecture by Dinesh Khanna: Systemic Sclerosis-related Lung Fibrosis: Management in 2020; Dunlop-Dottridge Lecture by Betty Diamond: Neuropsychiatric Lupus from Mechanisms to Treatment; and the Great Debate: To Diagnose or Not to Diagnose: Be It Resolved That It Is Better to Underdiagnose than Overdiagnose in Rheumatology Practice. Arguing for: Kam Shojania and Andrea Knight, and against: Amanda Steiman and Corrie Baldwin. Topics including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, psoriatic arthritis, spondyloarthritis, vasculitis, osteoarthritis, fibromyalgia, and their respective diagnoses, treatments, and outcomes are reflected in the abstracts, which we are pleased to publish in this issue of The Journal. 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CRA meeting abstracts 1033 Downloaded on September 24, 2021 from www.jrheum.org Podium 2 A Serum Proteomic Signature Defines Transition From the Preclinical 1 State to Rheumatoid Arthritis A Canadian Evaluation Framework for Quality Improvement in Liam O’Neil (University of Manitoba, Winnipeg); Victor Spicer (University Childhood Arthritis: Key Performance Indicators of the Process of of Manitoba, Winnipeg); Irene Smolik (University of Manitoba, Winnipeg); Care Xiaobo Meng (University of Manitoba, Winnipeg); John Wilkins Claire Barber (University of Calgary, Calgary); Marinka Twilt (Alberta (University of Manitoba, Winnipeg); Hani El-Gabalawy (University of Children’s Hospital, Calgary); Tram Pham (University of Calgary, Calgary); Manitoba, Winnipeg) Gillian Currie (University of Calgary, Calgary); Susanne Benseler (Section Objectives: Anti-citrullinated protein antibodies (ACPA) are the primary of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital/ biomarker for identifying individuals at increased risk for future RA devel- University of Calgary, Calgary); Rae Yeung (The Hospital for Sick Children, opment. However, we have recently shown in a prospective study that Toronto); Michelle Batthish (McMaster University, Hamilton); Nicholas most unaffected ACPA+ individuals do not develop RA. We hypothesized Blanchette (Trillium Health Partners, Toronto); Jaime Guzman (Division that abnormalities in the serum may serve as additional biomarkers in the of Rheumatology, Department of Pediatrics, BC Children’s Hospital & prediction risk for future disease. The aim of our study was to mine the University of British Columbia, Vancouver); Bianca Lang (IWK Health serum proteome of individuals who ultimately developed RA to detect Centre, Halifax); Claire LeBlanc (Montreal Children’s Hospital, Montreal); biomarkers that predict disease onset. Deborah Levy (Division of Rheumatology, SickKids Hospital; Faculty of Methods: Using the SOMAscan (slow off-rate modified aptamer) array, we Medicine, University of Toronto, Toronto); Christine O’Brien (Hospital for generated quantitative levels of 1307 proteins in serum samples from seven- Sick Children, Toronto); Heinrike Schmeling (Section of Rheumatology, teen first-degree relatives (FDR) of Indigenous North American (INA) RA patients who developed inflammatory arthritis (IA) synovitis after having Department of Paediatrics, Alberta Children’s Hospital/University of been followed prospectively for a mean of 3.2 years. All were ACPA+ at Calgary, Calgary); Gordon Soon (North York General Hospital, Toronto); time of IA diagnosis. Each individual had two preclinical samples, one at Lynn Spiegel (The Hospital for Sick Children, Toronto); Kristi Whitney the time of IA onset, and one at an earlier time point. We also analyzed (Hospital for Sick Children, Toronto); Deborah Marshall (University of samples from ACPA+ FDR (n = 63) and ACPA- FDR (n = 47) who did not Calgary, Calgary) develop inflammatory arthritis. We applied a machine learning lasso regres- Objectives: To develop a set of key performance indicators (KPIs) of sion model to identify a minimum set of proteins that classified patients the process of care for Juvenile Idiopathic Arthritis (JIA) as part of a who transition into clinical arthritis. standardized evaluation framework for the Understanding Childhood Results: Differential expression of 669 proteins were identified between Arthritis Network (UCAN) CURE Precision Decisions for Childhood pre-Transition samples (TR-pre) and ACPA negative FDR. ITGA2B and Arthritis project and help build upon quality improvement efforts in HIST1H3A were the highest upregulated proteins in TR-pre samples, while Canada. protease inhibitors SERPINA5 and ITIH4 were highly downregulated in Methods: An initial list of 37 candidate KPIs identified from a systematic the TR-pre samples. Compared with ACPA- FDR, overlap between TR-pre review were reviewed for inclusion by a working group of 3 pediatric rheu- baseline and non-baseline samples of highly upregulated proteins was 60%, matologists. The final list of 14 KPIs were then assessed using a 3 round suggesting alterations in the serum proteome occur years before the develop- modified Delphi process based on the RAND/UCLA Appropriateness ment of RA. A lasso regression model identified a 23-marker panel that clas- Method. Ten panelists across Canada were invited to participate based on sified TR-pre samples from the larger pool of FDR (ACPA±) serum samples. their expertise in JIA, quality measurement or lived experience as a parent In a validation cohort (n = 34), the model correctly classified 31/34 samples of a child with JIA. During Round 1 and 3, panelists rated each KPI on a (sensitivity = 95.6%, specificity = 85.7%, AUC = 0.931). Transition scores 1-9 Likert scale on themes of importance, feasibility and priority. In Round extracted from the model were higher in ACPA+ FDR compared to ACPA- 2, panelists participated in a moderated in-person discussion that resulted FDR (p < 0.001). There were no differences in Transition score comparing in minor modifications to some KPIs. In Round 3, panelists were asked to TR-pre samples that were remote or close to IA onset. re-rate the KPIs. KPIs with median scores of ≥ 7 on all 3 questions without Conclusion: Compared to at-risk individuals who did not develop IA, clear disagreement were included in the framework. and reproducible differences in the serum proteome are demonstrable in the Results: All panelists completed Rounds 1 and 3. Ten KPIs met criteria serum samples of individuals who ultimately developed IA, even several for inclusion after Round 3. Five KPIs addressed routinely measuring years before the onset of clinically evident disease. Our findings suggest important patient outcomes including pain assessment, joint counts, func- that a small serum biomarker panel can serve to accurately classify at-risk tional status, global assessment of disease activity, and measurement of the individuals who have a high likelihood of progressing to develop IA. clinical Juvenile Arthritis Disease Activity Score. One KPI addressed wait times for consultation and another captured the proportion of JIA patients 3 in the population seen by a pediatric rheumatologist within 1 year of diag- Axial Spondyloarthritis: Knowledge, Screening and Referral Practices Amongst Primary Care Providers nosis. Safety was addressed through KPIs on TB screening, laboratory Laura Passalent (Toronto Western Hospital, Toronto); Christopher Hawke monitoring, and clinical follow-up. While assessment of functional status (Toronto Western Hospital, Toronto); Jeff Bloom (Toronto Western Hospital, using the Childhood Health Assessment Questionnaire and quality of life Toronto); Andrew