rheumatholiday - sta healthcare communications...10.it’s 1:30 a.m. and you are writing “10...

Summer 2010, Volume 20, Number 2

RheumatHolidayFocus on

Editorial10 Reasons I Need a Vacation

RheumatHoliday• Those Long, Hot Days of Summer

• Relaxing in Manitoba

Northern (High)lights• Passing the Torch: A Message from the Past President

• Hail to the Chief

Joint Communiqué• The Journal of Rheumatology

• Pediatric Section Committee

• Education Committee

• Therapeutics Committee

• Website Committee

• Access to Care Committee

• Cancun Congress, February 2011

• Canadians Honored with International Prize for Medicinein Saudi Arabia

• The 9th ORA Annual Meeting

• Rheumatology and Pediatrics: Update

• My Paralympics Experience

Joint CountNo Vacation Goes Unpunished

Hallway ConsultDiagnosing Arthritis in Children: JIA

The CRAJ is online! You can find us at: www.stacommunications.com/craj.html

Mission Statement. The mission of the CRAJ is to encourage discourse among the Canadian rheumatologycommunity for the exchange of opinions and information.

CRA EDITORIAL BOARD

Copyright©2010 STA HealthCare Communications Inc. All rights reserved. THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION is published by STA Communications Inc. in Pointe Claire, Quebec. None of the contents of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, mechanical,photocopying, recording or otherwise) without the prior written permission of the publisher. Published every three months. Publication Mail Registration No. 40063348. Postage paid atSaint-Laurent, Quebec. Date of Publication: July 2010. THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION selects authors who are knowledgeable in their fields.THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION does not guarantee the expertise of any author in a particular field, nor is it responsible for any statements by such authors. The opinions expressed herein are those of the authors and do not necessarily reflect the views of STA Communications or the Canadian Rheumatology Association. Physicians should takeinto account the patient’s individual condition and consult officially approved product monographs before making any diagnosis or treatment, or following any procedure based onsuggestions made in this document. Please address requests for subscriptions and correspondence to: THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION, 955 Boul. St. Jean, Suite 306, Pointe-Claire, Quebec, H9R 5K3.

The editorial board has complete independence in reviewing the articles appearing in this publication and isresponsible for their accuracy. The advertisers exert no influence on the selection or the content of materialpublished.

PUBLISHING STAFF

Paul F. BrandExecutive Editor

Russell KrackovitchEditorial Director, Custom Division

Katherine EllisEditor

Catherine de GrandmontEditor-proofreader, French

Donna GrahamProduction Manager

Dan OldfieldDesign Director

Jennifer BrennanFinancial Services

Robert E. PassarettiPublisher

EDITOR-IN-CHIEFGlen Thomson, MD, FRCPCFormer President, CanadianRheumatology AssociationRheumatologistWinnipeg, Manitoba

MEMBERS:Michel Gagné, MD, FRCPCPolyclinique St-EustacheSt-Eustache, Quebec

James Henderson, MD, FRCPCPresident, CanadianRheumatology AssociationChief, Internal Medicine,Dr. Everett Chalmers HospitalTeacher, Dalhousie UniversityFredericton, New Brunswick

Joanne Homik, MD, MSc,FRCPCAssociate Professor ofMedicine,Director, Division ofRheumatologyUniversity of AlbertaEdmonton, Alberta

Sindhu Johnson, MD, FRCPCClinical Associate,Division of Rheumatology University Health Network-Toronto Western Hospital SiteInstructor,University of TorontoToronto, Ontario

Majed M. Khraishi, MD, FRCPCMedical Director,Nexus Clinical ResearchClinical Professor ofRheumatology,Memorial UniversitySt. John’s, Newfoundland

Gunnar R. Kraag, MD, FRCPCChief CaptioneerProfessor, Faculty of Medicine,University of OttawaDivision of Rheumatology, The Ottawa HospitalPast President, CanadianRheumatology AssociationOttawa, Ontario

Diane Lacaille, MD, FRCPCAssociate Professor ofRheumatology,Division of RheumatologyUniversity of British ColumbiaVancouver, British Columbia

Janet Markland, MD, FRCPCClinical Professor, Rheumatic Diseases Unit Royal University HospitalVisiting Consultant, Saskatoon City HospitalMedical Staff, St. Paul’s HospitalClinical Professor, University of SaskatchewanSaskatoon, Saskatchewan

Éric Rich, MD, FRCPCAssistant Professor,Director, RheumatologyProgramUniversité de MontréalRheumatologist,Hôpital Notre-Dame du CHUMMontreal, Quebec

John Thomson, MD, FRCPCPast President, CanadianRheumatology AssociationAssistant Professor,Department of Medicine, Division of Rheumatology, University of OttawaStaff, The Ottawa HospitalOttawa, Ontario

Lori Tucker, MDClinical Associate Professor inPediatrics,University of British ColumbiaVancouver, British Columbia

Barbara A. E. Walz, MD, DABIM, FRCPCHead, Division of Rheumatology,Credit Valley HospitalMississauga, Ontario

Michel Zummer, MD, FRCPCAssociate Professor,Université de MontréalChief, Division ofRheumatology,Hôpital Maisonneuve-RosemontMontreal, Quebec

Click here to comment on this article CRAJ 2010 • Volume 20, Number 2 3

The wait is almost over. The summer is here and it’sonly days to the beginning of your summer holiday.But the pangs of guilt are already appearing, and

doubt as to the wisdom of the vacation is growing. How willthe world survive without your daily labor and uncelebrat-ed insights? The bills keep rolling in, but there will be no"fee-for-service" income for the duration of the break.(Note to self: get a generously salaried position). You keepasking yourself if you can really pack 12 months of The

Journal of Rheumatology and Arthritis and Rheumatism intoyour carry-on luggage so that you can catch up on yourneglected reading, and get your much needed Maintenanceof Competence (MOCOMP) hours.

If you are having these second thoughts, please readthe 10 reasons you need to take a vacation:1. The coffee at work is starting to taste good.2. Your patients sound healthier than you feel.3. The "to do list” of household projects is now in its

third volume and is covered by a layer of dust datingback to last summer.

4. You have 12 of the 18 tender points.5. There’s a rumor that you have a cottage, but you can't

remember at which lake or when you were last there.6. The patients who missed their last appointments with-

out giving notice all want to be seen immediatelybefore you take time off because their prescriptionsneed to be refilled before they can go on vacation.

7. You are tired of your old luggage and need Air Canadato mangle it or make it disappear so you can justifypurchasing a new suitcase.

8. Your office staff keep telling you that “the office func-tions are so much better when you are away.”

9. You don't have time for a yearly physical so the bodyscan and pat down at the airport security will have tosuffice.

10. It’s 1:30 a.m. and you are writing “10 reasons why youneed to take a vacation.”

Have a safe holiday.

Glen Thomson, MD, FRCPCEditor, CRAJ Winnipeg, Manitoba

EDITORIAL

10 Reasons I Need a VacationBy Glen Thomson, MD, FRCPC

CRA never takes a holiday—busy at work as usual. Whichever way the wind blows on Lake Winnipeg.

Editor “editing” some trees on vacation.

mailto:[email protected]?Subject=Comment on CRAJ Summer 2010

Click here to comment on this article4

When I stop to think of my favorite summer getaway,it occurs to me that living in Kelowna, BritishColumbia, means I don’t really have to get away. If

I can steal myself from the office by the early afternoon(instead of the usual dreaded 7 pm), there is a wide choiceof warm weather activities to enjoy in the summer months.Riding my road bike up into the orchards and vineyards sur-rounding our city is a delight. However, the perfect summerevening competes with either finishing the ride with dinnerand a local vintage on a patio overlooking the city andOkanagan Lake, or a short drive to a local river for an earlyevening whitewater run in a canoe or kayak.

Of course, for the absolute in rest and relaxation afterwork, we simply head to a nearby neighborhood beach. TheOkanagan Lake water is pleasantly warm by midsummer, anda swim followed by a nap on the beach is its own reward. Ifonly I didn’t have to return to the office the next day...

Favorite Summer VacationYears ago (BBC [before British Columbia]), I had the won-derful opportunity to rent a private island in LakeTemagami, about an hour north of North Bay, Ontario.Beyond the reach for a rheumatologist to own, the islandcame complete with cottage, docks and a rock ledge forswimming, with more than enough room to share with theextended family.

The island was almost like returning to summer camp,but much better, with the hot summer days spent floatingin the water, exploring the surrounding area in a canoe

and lounging on the deck. I’ve rented other cottages since, but never again have

we had our own island!

Stuart Seigel, BSc, MD, FRCPCRheumatologist, Kelowna General Hospital Kelowna, British Columbia

Those Long, Hot Days of SummerBy Stuart Seigel, BSc, MD, FRCPC

EDITORIAL

CRAJ 2010 • Volume 20, Number 2

RHEUMATHOLIDAY

“Bike’n’wine.” Dr. Seigel enjoying a glass of wine in Kelowna’s wine country.

My favorite places during the summer... Every summer, my family and I visit the Eastern Townships and its many charming Bed and Breakfasts that cut acrossthe magnificent landscape of the region, traveling for a weekend or sometimes longer. The friendly locals are welcom-ing and will give you plenty of advice on the best places to visit in their little corner of Quebec.

There are very good restaurants, vineyards and bike routes, and the whole only an hour to an hour and a half out-side of Montreal! We sometimes take advantage when friends tag along to squeeze in one or two games of golf. Did youknow the Estrie region in Quebec has many golf clubs? A nice locally brewed beer after the game at the local pub ora stop at a vineyard for a taste of their latest creation finishes the afternoon off well. For those who like the tourist cir-cuit, the area has many historical cities, including Granby, Cowansville, Bromont, Magog and Sherbrooke (the Queenof the Eastern Townships.) You’ll be able to get all your souvenirs and gift shopping done at one of these. You mighteven cross paths with a Quebec rheumatologist while doing his shopping!

—Michel Gagné, MD, FRCPC


Click here to comment on this article 5CRAJ 2010 • Volume 20, Number 2

Having grown up in Winnipeg, I spent everysummer holiday at West Hawk Lake in White -shell Provincial Park, located in eastern

Manitoba. The water was clear and cold, the sunnydays went on forever and we reveled in the small treatsthat only happened at the lake, including canned popand sunflower seeds. We even watched the first lunarlanding gathered around our small 13 inch TV with allour neighbors!

It is perhaps not surprising that after 12 years inEdmonton, with yearly trips to Grandma’s house inWinnipeg, we decided to take the plunge and becomecottage owners ourselves. We now take three to fourweeks in the summer to spend at our cottage on FalconLake in Whiteshell Park. It is pure heaven.

We always find it takes almost a week to let go of ourstress, but pretty soon, we are spending the early morn-ings drinking coffee on the dock staring at the calmwaters, interrupted only by the occasional loon or canoe.Afternoons mean swimming and boating, and in theevenings we are often hosting an impromptu barbecuefor old friends and family. Not even the bugs or a rainyday can bring us down. A bad day at the lake is alwaysbetter than a good day in the office!

Eventually, we hope to spend several months out thereas part of the retirement plan. Come visit us sometime!

Joanne Homik, MD, MSc, FRCPCAssociate Professor of Medicine,Director, Division of Rheumatology,University of AlbertaEdmonton, Alberta

Relaxing in ManitobaBy Joanne Homik, MD, MSc, FRCPC

Dr. Homik and her daughter Allie take many leisurely boat rides during the summer.

My favorite summer vacation...My wife, two children and I have discovered manyplaces during our summer holidays. Our teenagers(now 16 and 17) still want to come along, although itwould be tough to say no to this year’s destination:Kauai and Maui.

But we always like to go back where I spent my sum-mer vacations as a kid, in Provence. My grandparentshave lived there since the 1960s, and now my parents.Family lunches in the shade of a grapevine refreshedby rosé; strolls in the garrigue with the smells of wildthyme and rosemary; the beauty of lavender fields; thebustling open-air market; a classical music concert inan abbaye romane; and the quiet but hilly countryroads where I love to bike make for a great summervacation.

—Éric Rich, MD, FRCPC

My favorite summer vacation...Europe is wonderful to see by bike and easier thanyou think. I have had some great cycling vacations inSpain, Provence, Loire Valley, Burgundy and Tuscanyover the years, and there are many online groups thatwill arrange everything for you.

My favorite vacation spot, however, will always beour camp in Thunder Bay, Ontario. It’s a gathering offamily and friends everyone looks forward to. There isno place like it with days filled with sailing, windsurf-ing or having a sauna, a barbecue, a campfire, bugs ornot—anyone who has a cottage, camp or cabin knowswhat I mean. The kids have life long memories andcontinue to return as adults.

The next best are trips abroad. This year, it was afamily trip to Australia. A fascinating place where thelanguage is the same and that is about it. The weath-er, food, things to see and people are fantastic. A def-inite must on your bucket list!

—Alfred Cividino, MD, FRCPC


Click here to comment on this articleCRAJ 2010 • Volume 20, Number 26

EDITORIALNORTHERN HIGHLIGHTS

It has been almost four months since our extremelysuccessful 65th Canadian Rheumatology Association(CRA) Annual Meeting in beautiful Quebec City. What

a wonderful way to finish off my two-year tenure as CRAPresident!

Things began somewhat inauspiciously two years agowith the infamous snowfest that was the 2008 MontTremblant meeting. Fortunately, this was not a harbingerof things to come. The storm passed and relative calmensued over the next 24 months, and it has been a won-derful two years.

When I first began my tenure on the CRA Board sever-al years ago, I never imagined that I would end up aspresident. Take this as a warning—if you stick aroundlong enough on any board, watch out, they might just askyou to become president!

The real strength of our organization, however, lies inthe Executive Board whose seats are filled by a very tal-ented group of individuals that give their time and ener-gy generously for the good of the CRA. There is a truesense of collegiality and spirit of cooperation that is everevident amongst this group. Problems and challenges aretaken on and dealt with intelligently while always keepingin mind the CRA’s mission statement “[...] to representCanadian rheumatologists and promote their pursuit ofexcellence in arthritis care, education and research.”

My heartfelt thanks to my fellow board members fortheir support over the past two years. I would especiallylike to thank my fellow officers Drs. Gunnar Kraag, JamieHenderson and Cory Baillie. I would also like to extend mythanks to our executive coordinator Christine Charnockwho is the real strength behind the real strength. Thankyou Christine for all your support and wisdom.

Finally, thank you to the membership for entrusting mewith this position. It has been a pleasure and an honor.

Now it is almost time to get on with the business ofsummer. I am looking forward to time with family at ourcottage enjoying warm weather, cool breezes, busy barbe-cues and quiet sleepy afternoons. I wish you all a safe andrelaxing summer season.

Sincerely, John Thomson

John Thomson, MD, FRCPCPast President, Canadian Rheumatology Association Assistant Professor, Department of Medicine,Division of Rheumatology, University of Ottawa Staff, The Ottawa Hospital Ottawa, Ontario

Passing the Torch: A Message from thePast President By John Thomson, MD, FRCPC

And away we go! A scene from Dr. Thomson’s dock at his cottage in Quebec.


Click here to comment on this article

Greetings to everyone! As I was set-tling into my new role as presidentof the Canadian Rheumatology

Association (CRA), the CRA ExecutiveBoard completed our annual retreat. I wasable to host the members in Fredericton,New Brunswick, this past April, and spent16 hours reviewing the activities of theCRA from one end to the other.

I am happy to report that Dr. GlenThomson and his Scientific Committeehave completed 95% of the organization forthe 2011 annual meeting taking place inCancun, Mexico. It looks to be an excitingmeeting, balanced with a daily opportunityto get out and enjoy the surroundings.

Dr. Andy Thompson regaled about hiscommittee’s plans for the website, whichhas seen a steady increase in traffic as more and morefeatures have been added. Dr. Thompson also shared hisideas to further improve the website’s quantity and qual-ity of offerings, which include enhancing the continuingmedical education (CME) features and provide memberswith more opportunities to qualify for Royal CollegeCME credits.

We also reexamined the many liaisons the CRA has withother organizations and have prioritized the areas intowhich we wish to put our energies and resources, includ-ing assisting the Arthritis Health Professions Association(AHPA) to establish a certification curriculum allowingtheir members (i.e., nurses, physiotherapists and occupa-tional therapists) to complete a program to develop anexpertise in treating arthritis patients and be recognitionfor their expertise. The CRA will also continue to supportthe Alliance for the Canadian Arthritis Program (ACAP) intheir (our) quest for the federal government to recognizearthritis as a chronic disease, and provide funding to helporganize necessary programs to treat this properly. We willproceed to integrate Canadian Initiative for Outcomes inRheumatology Care (CIORA) into the CRA committeestructure. Finally, members will see the fruition of our sup-port of the international lupus meeting, which will takeplace in Vancouver, British Columbia, from June 24 to 27.

As you can see, the CRA’s plate is full and the breadth ofour undertakings is large. The board is engaged, enthusi-astic and active, and I left the retreat with the feeling thebusiness of the CRA is being well looked after.

As for the holidays this year, during the summer I willbe seeking some rest and relaxation to recharge the bat-teries. One of my favorite methods is to retreat into theless traveled parts of New Brunswick and seek out Atlanticsalmon on some of our pristine rivers. I always find thatstanding in the middle of the river with nothing but thesound of flowing water around you helps soothe the souland drive other cares and tribulations away. I know manyof you achieve the same effect in other ways and I wishyou success in your pursuit of that goal as summerapproaches.

Sincerely, Jamie Henderson

James Henderson, MD, FRCPC President, Canadian Rheumatology AssociationChief, Internal Medicine,Dr. Everett Chalmers HospitalTeacher, Dalhousie UniversityFredericton, New Brunswick

Hail to the ChiefBy James Henderson, MD, FRCPC

CRAJ 2010 • Volume 20, Number 2 7

Dr. Henderson fishing in New Brunswick.


Click here to comment on this article8

EDITORIAL


JOINT COMMUNIQUÉ

The Pediatric Section Committee has a strong mem-bership, consisting of pediatric rheumatologists fromnearly all pediatric rheumatology programs across

Canada. Our section is structured in subcommittees: scien-tific, human resources, education and advocacy. Represen -tatives of these subcommittees have become members ofthe corresponding Canadian Rheumatology Association(CRA) subcommittees, thereby providing input and interac-tion from our section through the CRA structure.

The Scientific Subcommittee, which includes Drs.Bianca Lang, Susanne Benseler, Paivi Miettunen, EarlSilverman and Rae Yeung, has been providing input intothe planning of the CRA/Mexican meeting slated to takeplace in Cancun, Mexico, with the hope of having a strongand interesting pediatric program that will be of interestto all rheumatologists.

The Education Subcommittee, which includes Drs. RayfelSchneider, Shirley Tse, Kristin Houghton, Karen Duffy andRoss Petty, have an extensive mandate, and members havebeen working on developing shared pediatric rheumatol-ogy training resources among other projects, including par-ticipating on the Canadian Council of AcademicRheumatologists (CCAR), as well as providing pediatriccontent for the annual national residents meeting. Also,concerns have been raised about the change to theCanadian Resident Matching Service (CaRMS) match sys-tem, fearing that it may not be advantageous for pediatricrheumatology training programs. We will have to wait to seehow the site works out.

The Advocacy Subcommittee, whose members includemyself, Drs. Claire LeBlanc, Sarah Campillo, Bianca Lang andBrian Feldman, have been working on addressing the issue

The Journal of Rheumatology has continued to show aprofit, mainly due to advertising revenues and spe-cial requests for article reprints, and the budget is

on target for the fiscal year of 2010 so far. As for the members of the Canadian Rheumatology

Association (CRA), they play an important role in the suc-cess of the Journal. Through their readership and support,advertisers know that this is a respected vehicle to com-municate with Canadian rheumatologists, and as such, ourCanadian advertising revenues have continued to grow.

Also, the Journal is being developed for higher impact.The Editorial Board is refusing more articles in anattempt to become selective for the highest quality, and areview article is now a component of each edition. The

Journal’s staff is our most valuable asset, and they are keep-ing article turn-around time to less than three monthsfrom submission.

The Journal is also looking to hire a new advertising agentin the United States, and interviews are currently underway.Finally, the website and multi-user access is the mainsource of growth in access to the Journal, and they are mak-ing every effort to develop these resources maximally.

Arthur A. M. Bookman, MD, FRCPCPresident, The Journal of RheumatologyAssociate Professor, University of TorontoSenior Staff, Toronto Western HospitalToronto, Ontario

The Canadian RheumatologyAssociation’s 2010 Committee ReportsFrom the CRA Executive Board meeting, April 23 to 25, 2010 in Fredericton, New Brunswick

Pediatric Section CommitteeBy Lori Tucker, MD

The Journal of RheumatologyBy Arthur A. M. Bookman, MD, FRCPC



of access to biologic treatment for children with arthritis andrheumatic diseases. As part of this process, we conducted asurvey of our pediatric rheumatology members from 2008 to2009, asking them to report which biologic drugs were reim-bursable for children with juvenile idiopathic arthritis (JIA)and other rheumatic conditions, as well as under what con-ditions (i.e., special authority application and case-by-casereview). This data was summarized and presented as anabstract at the CRA meeting in Quebec City in February thisyear. The results demonstrated that the overall access to bio-logic medications for children with arthritis in Canada ispoor and highly variable between provinces. Etanercept isthe only biologic drug reimbursable across Canada for thetreatment of polyarticular JIA.

A comparison with data collected by the ArthritisConsumer Experts (January 2010), which focused on bio-logic medications reimbursed on provincial formulariesfor adults with rheumatoid arthritis (RA), ankylosingspondylitis and psoriatic arthritis, clearly shows the limit-ed availability of drugs for children with similar diseases.We plan to update our survey information to reflect cur-rent 2010 provincial formulary policy, and move forward to

publish this data. Further efforts to use this informationon a provincial and federal level to advocate for improvedtreatment for children with JIA in Canada are planned.

Lori Tucker, MDChair, Pediatric Section Committee Clinical Associate Professor in Pediatrics,University of British ColumbiaVancouver, British Columbia

The brainstorming session for the CanadianRheumatology Association’s (CRA) EducationCommittee was extremely productive. Presently, the

focus of the committee includes all levels of education fromundergraduate and postgraduate trainees to the practicingrheumatologist (i.e., continuing medical education [CME]).This scope was felt to be too broad by some members, asother existing committees in Canada (e.g., the CanadianCouncil of Academic Rheumatologists [CCAR]) have a piv-otal role in defining and implementing the educationalfocus of our trainees.

However, discussion from the board retreat and subse-quent conference call determined that the EducationCommittee is indeed pivotal in guiding the education notonly of rheumatology residents, but also the medical stu-dents and other postgraduate rotating residents, areas notadequately addressed in any other committee. CME was iden-tified as the other primary focus of the Committee to ensurethat practicing rheumatologists in the community and aca-demic centers were meeting their educational needs.

Several important action items were discussed for thecommittee. These included: 1) expanding membership ofthe committee to include rheumatologists from less popu-lated locations and those with a community type practice;2) putting a six-month moratorium on educational productendorsement while a fair and equitable process is devel-oped and implemented to review any proposed productseeking CRA endorsement that is not beyond the resourcesof the CRA Board and Education Committee; and 3) reviewthe current educational portal and create a similar portalfor CME for the membership. The optimization of CME byutilizing the CRA website was discussed, and further dis-cussions will be held between the Website Committee andEducation Committee.

Stephanie Keeling, MD, FRCPC Assistant Professor of Rheumatology, University of Alberta HospitalEdmonton, Alberta

Five awfully good looking guys. And Michel Zummer.

Education CommitteeBy Stephanie Keeling, MD, FRCPC



EDITORIALJOINT COMMUNIQUÉ

It has been another productive year for the CanadianRheumatology Association’s (CRA) website. We have atotal of five sponsors (Abbott, Amgen, Astra-Zeneca,

Roche and Schering, now part of Merck) who have kindlysupported our continued success. Elisia Teixeira continues towork diligently behind the scenes ensuring the site contin-ues to run and function well.

Last year also brought two new additions to our website.The first is a career centre where CRA members can post jobopenings. Dr. Carter Thorne was our first poster and he tellsme he has since had three calls about the job. We encour-age all of our members to post their opportunities. To placea job posting, log on to the CRA website, click on “CareerCentre” and then “Job Opportunities.” The second addition

is a program director’s portal. The addition, initiated by Dr.Heather McDonald-Blumer, provides a valuable place forprogram directors to share information.

In April 2010, the CRA executive and committee chairsmet for a weekend-long retreat. Based on this meeting, thewebsite will be exploring its next step of transformation toa new content management system, which will improve itsflexibility and functionality.

I would be remiss if I didn’t mention our sponsors greatprograms posted in the “grey pages” on the right hand side ofthe home page. Please take some time to visit these programsas they are worthwhile. The newest edition to the slate is anaccredited program called “Rheum to Grow” where Dr. CarlLaskin provides important information about reproduction

The Canadian Rheumatology Association’s (CRA)Therapeutics Committee continued to be very activein 2009.

Giving advice to Canadian rheumatologists on how todeal with the H1N1 flu pandemic was a major focus thisyear, and an article was published in The Journal of the

Canadian Rheumatology Association (CRAJ) before theautumn 2009 influenza season, covering best practicesamid therapeutic uncertainty. Recommendations fromother national rheumatology societies facing the H1N1 fluwere reviewed as well.

Progress on the formulation of new Canadian guidelineson the management of rheumatoid arthritis (RA), fundedby a Canadian Institute Health Research (CIHR) grant, con-tinues. We hope to have these guidelines ready for presen-tation later in 2010 and published in The Journal of

Rheumatology. The article would be followed by a knowledgetranslation plan to ensure dissemination and uptake ofthese guidelines.

Also, for the first time, the CRA has been asked to provideinput to the Canadian Agency for Drugs and Technologiesin Health (CADTH), an agency which advises the differentCanadian public formularies on the listing of new drugs atthe federal, provincial and territorial government level.

CADTH is currently conducting a therapeutic review ofbiologic therapies in RA. The CRA’s TherapeuticsCommittee hopes to achieve some degree of harmonybetween its RA therapeutic guidelines and the CADTHreview. The development of the guidelines on systemiclupus and other rheumatic diseases is under consideration.We would also like to welcome our newest member, Dr.Stephanie Ensworth from Vancouver. Finally, we welcomenew members and proposals for future initiatives of theCRA’s Therapeutics Committee.

Philip Baer, MDCM, FRCPC, FACRRheumatologist Co-Chair, Therapeutics Committee, CRAVice-President, Ontario Rheumatology Association (ORA)Chair, OMA Section of RheumatologyToronto, Ontario

Vivian Bykerk, MD, FRCPCRheumatologist Co-chair, Therapeutics Committee, CRAAssistant Professor of Medicine, University of TorontoDirector, Early Arthritis Program, Mount Sinai HospitalToronto, Ontario

Therapeutics Committee By Philip Baer, MDCM, FRCPC, FACR; and Vivian Bykerk, MD, FRCPC

Website Committee By Andrew E. Thompson, MD, FRCPC



and rheumatoid arthritis; Dr. Stepanie Keeling has organizedan excellent module on malignancy; Drs. Paul Haraoui, CarterThorne and Niall Jones have put together a standardizedassessment module; and Drs. Janet Pope, Carl Laskin andAndy Thompson have created a module on patient commu-nication. Finally, we’ve been trying to send out a websitehighlights newsletter to let you know what is going on andwhat is new with our site. These are being sent every two tothree months, with our most recent sent in April. Thanks toall the CRA membership for supporting our site!

Andrew E. Thompson, MD, FRCPC Chair, Website Committee, CRADirector of Post Graduate Education,Assistant Professor of Medicine,Division of Rheumatology, Department of Medicine,Schulich School of Medicine,University of Western Ontario London, Ontario

Access to Care Committee By Michel Zummer, MD, FRCPC

The main focus of the Access to Care Committee forthe past two years has been as an active participatingmember, including my participation, on the execu-

tive board of the Alliance for the Canadian ArthritisProgram (ACAP).

ACAP activities have been invested in evaluating the pro-jected burden of arthritis between 2010 and 2040, and thevalue that would be brought by timely interventions. Theimportant provincial breakdowns of this endeavor will beavailable and at that point, the committee will be activated inorder to discuss investment into care and research of muscu-loskeletal (MSK) diseases with the appropriate provincialauthorities in each provincial context. It is clear that we proj-ect a significant increase in the needs of individuals withMSK problems, and we would like to explore different modelsof care relevant to each jurisdiction and type of practice.

In the near future, we will be reconstituting the commit-tee and will be looking for representation from eachprovince. If you are interested in joining the committee tobring these issues to your provincial government, pleasecontact me by email at [email protected].

We are also collaborating with the Arthritis HealthProfessions Association (AHPA) to help in the developmentof a process of certification for allied health professionals. Itis very clear that care of patients require an interdisciplinary

approach and that certification will ensure the quality ofservices, as well as the ability to attract these qualified indi-viduals to our clinical practices. If you would like to partici-pate in this process, please send me an email.

Michel Zummer, MD, FRCPCAssociate Professor, Université de MontréalChief, Division of Rheumatology,Hôpital Maisonneuve-RosemontMontreal, Quebec

Future, past and present presidents in the back, and the CRA’s legendary ladies man.

Looks like the Grey Cup curse is not over for Rob as the guyfrom Winnipeg wins the "dating game"!



JOINT COMMUNIQUÉ

Join us in Cancun, Mexico for the 66th Meeting of theCanadian Rheumatology Association (CRA) and the 2nd

Joint Congress with the Mexican College of Rheumatology(MCR), from February 10 to 15, 2011.

Rheumatologists from the CRA and MCR associations havebeen planning this congress for more than two years. Thegreat success of the Acapulco meeting in 2006 has motivatedthis year’s committee to attain and surpass the excellence inthe scientific and social events. The Organizing Committee,with Drs. Michel Zummer, Jamie Henderson, John Thomsonand Ms. Christine Charnock, have negotiated and confirmedgreat accommodations in Cancun with easy access to theCancun Convention Centre.

The format of the meeting will be similar to that inAcapulco, but with several differences from the Canadianannual meeting. As usual, CRA members will be asked to sub-mit their best scientific research abstracts. However, a plena-ry session will be held to present the best abstracts, as well astwo poster days with discussion groups led by eminentCanadian and Mexican rheumatologists. The Trainee Abstract

Podium Session will be held during the Trainee Pre-Course andadjudicated for the annual prizes.

Furthermore, community rheumatologists will have a chanceto present interesting case reports in the Pearls in Rheumatology

sessions, as seen in Dr. Ricardo Cartagena’s insert.Four days of concurrent sessions will allow attendees to

choose one of three topics ranging from clinic to basic scienceon any given day. The Scientific Program Committee, com-prised of Drs. Diane Lacaille, Éric Rich, Arthur Bookman,Ricardo Cartagena, Alfred Cividino, Steve Edworthy, JoanneHomik, Lori Tucker, Michel Zummer and Glen Thomson, hascreated a program in concert with the MCR. The Canadiancontent will emphasize excellence in Canadian rheumatologicachievement from coast-to-coast. The keynote speakers, chosenby the Canadian and Mexican associations, are sure to impressthe audiences. Simultaneous translation of all sessions willallow Canadian and Mexican rheumatologists to share experi-ence and expertise. Stay tuned for the full program announce-ments in the autumn issue of the Journal of the Canadian

Rheumatology Association (CRAJ) and on the CRA website.Scientific learning is just the start of this action-packed

congress. In addition to memorable joint opening and clos-ing ceremonies, one of the evening events will take delegates

off-site for an informal evening of Mexican culture. Athletesfrom the CRA and MCR will again face off in the much antic-ipated soccer game (bring your own oxygen). Of course, therewill be the CRA Annual Awards Dinner to meet and greetyour colleagues from across Canada once again.

The Congress will provide CRA members the opportunity toexchange ideas with their MCR counterparts. It is an excellentopportunity to learn about the state-of-the-art of rheumatol-ogy not only in Mexico, but in Canada. Also, the social eventsand setting will provide the backdrop for a pleasant winter get-away for CRA members and their families. Plan now to attendand be sure to book your accommodations early as the hotelblock will be given up in early December.


Pearls in RheumatologyThe Scientific Program Committee will embracedozens of rheumatologists from across Canada andMexico, dedicating one hour on Sunday, February 13and Tuesday, February 15, from 12:45 to 1:45 pm todiscuss interesting clinical cases in the Pearls in

Rheumatology Session. Four individuals (two from the CRA and two from the

MCR) will have 10 minutes to present and five minutesto discuss. There will also be a competition for the bestfour Canadian cases selected by a jury of rheumatolo-gists. Some consideration will be given to areas not cov-ered during the other activities of the Congress. Youwill receive an email from the CRA, inviting communityrheumatologists to submit a clinical case before theend of September 2010, so stay tuned!

—Ricardo A. Cartagena, MD, FRCPC

Cancun Congress, February 2011By Glen Thomson, MD, FRCPC

Scientific Abstract Deadline Date: Tuesday October 12, 2010, 1700 Central Standard Time



Canadian rheumatology was recognized on theinternational stage this past March, as Drs. Jean-Pierre Pelletier and Johanne Martel-Pelletier

accepted this year’s prestigious King Faisal InternationalPrize for Medicine.

Dr. Martel-Pelletier, a Montreal researcher and Dr.Pelletier, a researcher/rheumatologist, along with Dr.Reinhold Ganz, a German professor who dedicated hiscareer to the study and treatment of diseases of the hipjoint including conservative hip surgery, were recognizedfor their research in non-arthroplasty management ofdegenerative disease. Over their nearly 30 year career,the work of these two Canadians has helped in theresearch of osteoarthritis—a debilitating articular jointdisease that affects more than 15% of the Canadian pop-ulation.

“We have been the fortunate recipients of a number ofdistinguished awards [in this field],” said Dr. Pelletier.“[We received] the Carol-Nachman Award for Rheuma -tology, a prize given in Germany by the Chancellor in1996, the Roussel EULAR Award for Scientific Researchin 1991, and the Novartis-ILAR Rheumatology Prize in2001.” Dr. Pelletier was also awarded the CanadianRheumatology Association’s Distinguished InvestigatorAward in 2000.

Since its inception in 1976, 55 scholars from 11 coun-tries have won the King Faisal International Prize forMedicine, including two other Canadians—ProfessorTak W. Mak and Professor Fernand Labrie.

The award ceremony took place in Riyadh, SaudiArabia, under the auspices of the Custodian of the TwoHoly Mosques King Abdullah bin Abdulaziz and the KingFaisal Foundation. “It was truly a unique experience withroyal treatment,” said Dr. Pelletier. Drs. Pelletier andMartel-Pelletier accepted their award in the presence of

1,200 high ranking guests, including the reigning Kingand his family, and fellow awardees. (Six others receivedawards for their service to Islam, Arabic language and lit-erature or science.) The award included a certificatedescribing the winner’s work written in Arabic and acommemorative medallion. After the ceremony, theguests were treated to a Saudi Arabian feast.

While in Saudi Arabia, Drs. Pelletier and Martel-Pelletier also guest lectured at a few local universities.

Jean-Pierre Pelletier, MD, FRCPCProfessor of Medicine, University of MontrealMontreal, Quebec

Johanne Martel-Pelletier, PhDProfessor of Medicine, University of MontrealMontreal, Quebec

Canadians Honored with InternationalPrize for Medicine in Saudi Arabia

Drs. Pelletier and Martel-Pelletier have won many awards together over their30 year career.



In early 2009, an online survey of Canadian adult andpediatric rheumatologists was conducted to ascertainthe involvement of rheumatologists across the country

in general medical and pediatric oncall coverage. Of the377 members of the Canadian Rheumatology Association

(CRA), 190 responded (82 men and 65 women). Pleasenote, the subtotals will frequently not match the numberof respondents since not all respondents answered allquestions. No effort was made to differentiate betweenthe responses from male and female rheumatologists, but

Rheumatology and Pediatrics: UpdateBy Barry Koehler, MD, FRCPC; and Sangeeta Bajaj, MD, FRCPC

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The Ontario Rheumatology Association (ORA) held its9th Annual General Meeting from May 28 to 30 atthe Taboo Conference Centre in Gravenhurst,

Ontario, this year. There were over 200 registrants, includ-ing 20 allied health professionals and 16 industry sponsorsmaking this one of our more successful meetings. Thisyear’s meeting objective was to provide a venue to learnthrough information and interaction.

The ORA, closely aligned with the RheumatologySection of the Ontario Medical Association (OMA),endeavors to ensure that the voice of rheumatologists res-onates at the OMA—no small task with 160 rheumatolo-gists vs. 26,000 physicians in Ontario. The mission of theOMA’s Rheumatology Section is to represent rheumatolo-gists when negotiations with government focus on fiscalmatters. This aligns well with the ORA, whose mission is“…to represent Ontario rheumatologists and promotetheir pursuit of excellence in arthritis care in Ontariothrough leadership, education and communications.”

The ORA also meets regularly with the Ministry ofHealth (MoH) to ensure expeditious access to therapeuticsappropriate for our patients, while minimizing the paper-work required to provide the same. We have also beeninvited by the MoH to respond to specific questionsregarding the utilization of biologics in clinical practiceand orphan indications. The development of a standard-ized form for application for biologics in rheumatoidarthritis (RA) has reduced the approval time by nearly two-thirds. Though it is a significant change, it is not as goodas we would wish for our patients. The ORA has also been

invited to present similar forms for ankylosing spondylitisand psoriatic arthritis. On a similar note, the associationhas begun discussions with the Canadian Life and HealthInsurance Association (CLHIA) to develop a common formfor third-party payers.

The Ontario Biologics Research Initiative (OBRI) contin-ues to provide a means to demonstrate the commitment ofmembers to improved outcomes. Other initiatives of ourmembers, including the METRIX project headed by Drs.Alfred Cividino, Janet Pope and myself, will ensure that weare prepared to provide leadership in arthritis care.

As the ORA moves into its second decade and new chal-lenges and opportunities present themselves, they will beaddressed by a committed membership and Executive Board.

Carter Thorne, MD, FRCP, FACPVice President, Canadian Rheumatology Association Past President, Ontario Rheumatology AssociationMedical Director, The Arthritis Program (TAP),Southlake Regional Health Centre Newmarket, ON

The 9th ORA Annual Meeting By Carter Thorne, MD, FRCP, FACP



age ranges were as follows:• 31 to 50 years of age: 72 respondents;• 51 to 70 years of age: 69 respondents; and• > 70 years of age: 1 respondent.Of the 190 respondents, 142 stated that they had priv-

ileges at a general hospital (including an adult or pedi-atric service), and 104 of the hospitals were academicinstitutions. However, 48 members stated they did nothold privileges at any general hospital.

Of those responding to the question whether they par-ticipated in general medical or pediatric rotations, 31stated they did so because it was mandatory and nine stat-ed it was by preference. Forty members responded they nolonger did general call but had done so in the past, and62 reported never having participated in such a call. Thenumber of years for which members participated in thesecalls ranged from one to 22. Forty-seven of the 102respondents stated they had completed these calls formore than 10 years. However, the answers varied as to howlong members anticipated continuing to do general callfrom “a few years” to “many more years” to “forever.”

Whether or not general call coverage was mandatory,the positive aspects of doing these calls included thefinancial reward, keeping up with general medicine, moreinteraction with other colleagues in the departments ofmedicine and pediatrics, and more interaction withtrainees. Negative aspects were listed as taking away fromthe members’ rheumatology practice time, as well as con-cerns with the member’s as he/she dealt with less familiarproblems and fatigue.

When members who had previously done general callstopped doing so, they cited the main reason was thedemands of their rheumatology practice. In addition, afew stated they felt that their skills in general medicine orpediatrics were waning, and several stated that there weresufficient members in the department of medicine orpediatrics that their continued participation was nolonger necessary. It was noted that the rheumatologists’withdrawal from call sometimes was a cause of rancorfrom their colleagues.

Most of the members, regardless of whether or not theywere participating in general call, provided a rheumatol-ogy consultation service at their hospital, as evidenced by125 positive responses (of a total of 129). Eighty-nine hada formal call schedule with a rheumatologist always avail-able. The remainder made themselves available when they

were not away. Many of these stated that they received astipend or an augmented fee when they provided a hospi-tal consultation. However, a significant number did notand some commented that their hospital or health regiondid not deem rheumatology an important part of the hos-pital’s service.

Results: Comments While holding no brief as to whether an individual rheuma-tologist should participate in general medical or pediatriccall, it is concerning that, in the opinion of many of themembers who do or have done such calls, this results in lesstime for their rheumatology practices. While it is apparentfrom the numbers (102) that most members were presentlynot involved in general call schedules, a large number ofthese (40) had done so in the past and 40 others were stilldoing so. Given the significant problem with the lack ofrheumatologists and the reality that patients with signifi-cant rheumatic diseases who do not see a rheumatologistreceive substandard care, patient health needs may oftenbe jeopardized by such participation.

It is also discouraging and aggravating that the value ofhaving a rheumatologist available, as a rheumatologist,for oncall consultation is not recognized by institutions.It is clear to those of us who are called that our colleaguesrecognize our importance. “When no one else can figureit out, better call the rheumatologist!”

One wonders whether the undue influence of proce-dural subspecialties, coupled with the usual refrain ofbudgetary constraints, has resulted in this uneven divi-sion of funding.

Barry Koehler, MD, FRCPC Chair, Human Resources Committee, CRA Clinical Professor Emeritus, Department of Medicine, University of British ColumbiaRichmond, British Columbia

Sangeeta Bajaj, MD, FRCPC Staff, Department of Medicine,William Osler Health CentreBrampton, OntarioStaff, Department of Medicine, Headwaters Health Care CentreOrangeville, Ontario

Acknowledgements: We would like to especially thank Christine Charnock, the Canadian RheumatologyAssociation’s (CRA) Executive Coordinator, for her invaluable help with this survey.



A. I prefer taking a longer vacation atanother time of year.

B. I prefer to work than go on vacation.

C. I have visited every province inCanada.

CRA Members’ Vacation: Overview

36%64%

8%92%

20%80%

No Vacation Goes Unpunishedby Glen Thomson, MD, FRCPC

Throughout the long arduous months of winter,Canadians eagerly anticipate that warm, sunny sea-son known as “construction.” Instead of blizzards,

uncooperative engines, Raynaud’s inducing numbinglycold car seats and puddles (for our thermally challengedB.C. readers) interrupting our daily commute, we mustnow negotiate a myriad of detours, confusing roadworksigns and the hot yoga traffic jams of summer. Once in theglacially air-conditioned office, we too often find that thepatients have less patience with these months, and oftenfail to arrive or cancel so that they may spend more qual-ity time in the more natural clime of the beach. It is timeto take a vacation.

The majority of our respondents in this issue’s JointCount survey feel that three to four weeks is the ideallength for a summer vacation, but the majority take onlyone or two weeks off. A third have taken a month or moreoff in a summer, but 40% have only ever had a week off.There is a lot of delayed gratification out there. Or not.

A third of those surveyed prefer a winter vacation toone in the summer, and another small group prefer workto vacation. Perhaps the latter are aware of the saying byKarl Hakkarainen, “No vacation goes unpunished.”Certainly, the most common sentiment expressed is thefear of the daunting amount of work bending the desk

after the vacation is over. Perhaps this is why half of us(including the author) obsessively carry the “guilt brief-case” with the other vacation luggage.

Where do we go to get far from the crowd? The state ofrestful repose is often shattered by the utterance, “I knowyou—could I tell you about my knee?” So, it is not sur-prising that 85% of the respondents will travel duringpart of their vacation. The ever popular cabin is a greatescape for a third of the respondents. Travelling withinone’s province or Canada is most popular, although it issurprising how few have been to all the provinces (20%),and even less to the Canadian Arctic (14%). Crossing the49th Parallel seems to require more inquisition than themultiple borders overseas. Consequently, travel to Europe(51%) is more popular than a visit to our disquietedneighbors to the south (40%).

In the end, the time away no matter where or how longis refreshing. Or as stated by an unknown writer, “A vaca-tion is like love—anticipated with pleasure, experiencedwith discomfort, and remembered with nostalgia.”


Congratulations to this issue’s Joint Count survey winnerDr. Peter Leefrom Toronto, ON.

D. I have visited Canada’s Artic. 14%86%

E. I take medical reading or work-related material with me on vacation.

49%51%

F. I dread the amount of work on mydesk when I return from a vacation.

89%11%

YesNo

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HALLWAY CONSULT

Diagnosing Arthritis in Children: JIA By Lori Tucker, MD

A recent Ipsos-Reid poll issued by The Arthritis Societyconfirmed that only 19% of Canadians are aware thatarthritis can present in children. As demonstrated by theseresults, it is no wonder it remains difficult to change thegeneral opinion that arthritis in children is not a seriousdisease or that children will grow out of their arthritis.

Children and ArthritisJuvenile idiopathic arthritis (JIA) is the most commonrheumatic disease of childhood, and is one of the mostcommon chronic disabling diseases in children and ado-lescents. To ensure the best outcome for children with JIA,early disease recognition and diagnosis is critically impor-tant since we know that, similar to rheumatoid arthritis(RA), disease damage begins in the disease’s early stages.

The diagnostic nomenclature of chronic arthritis inchildhood is now based on an accepted international clas-sification: JIA. Of note, children under the age of 16 years

presenting with chronic arthritis should most appropri-ately be given the diagnosis of JIA. There are eight cate-gories of JIA, which are differentiated based on their clin-ical presentation within the first six months of disease,listed below:

• systemic;• oligoarthritis persistent;• oligoarthritis extended;• polyarthritis rheumatoid factor (RF) negative;• polyarthritis RF positive;• enthesitis-related arthritis (ERA);• psoriatic arthritis (PsA); and • other/unclassified. Each category has distinct clinical presentations,

immunogenetic associations and outcomes. Proper diag-nostic classification is very helpful in discussing thepotential disease course with children and parents, andwhen deciding on an appropriate treatment.

Not all clinically significant questions have been definitively answered by randomized double-blind placebo-controlled trials. The Hallway Consult department in The Journal of the Canadian RheumatologyAssociation will seek a consensus answer from rheumatologic experts for your difficult questions. Please forward questions for future issues to: [email protected].

Case History: Jane, a 14-year-old girl, first complained of pain and swelling of several knuckles in June 2009. She was initiallyseen by her family doctor and given naproxen for a brief course of treatment. By September, she had persistentpain and swelling of the proximal interphalangeal (PIP) joints in both hands, and developed pain and stiffnessof both ankles and most of the metatarsophalangeal joints (MTPs). The patient became increasingly fatigued,had trouble walking around school, difficulty writing (especially test taking), and gave up gym and playingsoccer. Her family doctor referred her to an adult rheumatologist where she was diagnosed with seronegativerheumatoid arthritis. The patient was prescribed hydroxychloroquine and indomethacin.

Also, her ANA, HLA-B27 and rheumatoid factor (RF) tests were negative. However, Jane’s mother discontin-ued the indomethacin after one month due to stomach pain, and noted that Jane had no improvement in hersymptoms after three months of hydroxychloroquine treatment. Jane was then referred to the pediatricrheumatology clinic. On examination, she was found to have an active joint count of 16, primarily involvingthe small joints in the hands, feet and ankles. Jane was diagnosed with juvenile idiopathic arthritis (JIA)-pol-yarticular RF negative subtype. Jane began taking methotrexate and naproxen, was seen by the pediatricrheumatology nurse for education, as well as the pediatric rheumatology physiotherapist and occupationaltherapist. She received orthotics, which improved her gait, and was assisted in obtaining a laptop for use inher school work. After six months of methotrexate treatment, her active joint count was two, and she wasback to full school and sports participation.


HALLWAY CONSULT

Treatment Options and Follow-up The treatment options for JIA have changed in the past 10years due to the recognition that earlier aggressive treat-ment improves arthritis patients’ outcomes. However, themultidisciplinary approach to the treatment of a child witharthritis and their family remains of critical importance.For the patient described in the case presented, recogni-tion and treatment of her school function issues, as well asadolescent and parent issues were as important as provid-ing a prescription.

Although Jane had been diagnosed with arthritis, sheand her family did not know what the diagnosis meant anddid not receive information about juvenile arthritis. In apediatric rheumatology clinic, the pediatric rheumatologynurse plays a very important role educating the family, pro-viding reading material about JIA and treatments, as well asadditional reliable website resources. The nurse also workswith the patient and their parents over time when dis-cussing adolescent development issues related to the dis-ease and its treatment.

In addition to assessment and exercise prescription, thepediatric rheumatology physiotherapist and occupationaltherapist will often communicate directly with the schoolteachers and counselor so that problematic issues, such asthe number of stairs a child with arthritis must climb in theschool or providing extra time for test completion, can bedealt with quickly and efficiently.

Children and teenagers with arthritis involving their feetand ankles require special attention to footwear and prop-er orthotics. For teenagers, the goal of being able to fullyparticipate in sports and physical education is often moreappealing than a daily home exercise plan. It is also impor-tant to include the local family doctor as a member of themultidisciplinary team, with appropriate communicationabout diagnosis and treatment plans so that they may par-ticipate as needed in their patient’s ongoing generalhealthcare.

Early institution of a disease-modifying anti-rheumaticdrug (DMARD) has become routine in pediatric rheuma-tology clinics, with many patients receiving a DMARD at

time of diagnosis or within the first few months if they donot respond quickly to non-steroidal anti-inflammatorydrugs (NSAIDs). The most common DMARD used in chil-dren with JIA is methotrexate, with approximately 70% ofchildren demonstrating favorable response in clinical tri-als and clinic settings. However, children with systemiconset JIA may have less frequent response to methotrexate,and newer research supports early institution of anti-IL1therapy in some of these patients. Furthermore, some chil-dren with ERA may have a better response to sulfasalazineas a first DMARD choice. Older DMARDs, such as hydrox-ychloroquine or gold, are rarely used in the pediatricrheumatology clinic in the treatment of JIA, as previousstudies did not demonstrate efficacy greater than placebo.Biologic treatments are used for children with JIA whohave persistent active disease despite an optimal trial oftreatment of methotrexate, but restricted availability tobiologics is often a factor in their use.

Conclusions Outcomes for children and adolescents with JIA haveimproved with early aggressive treatment. The CanadianJIA research project, Research on Arthritis in CanadianChildren Emphasizing Outcomes (ReACCh-Out) hasshown that in a large inception cohort of children withJIA (354 patients), 33% of patients had inactive diseasesix months after diagnosis. JIA subtype is an importantpredictor of persistent active disease, and children withpolyarticular RF negative disease were more likely to haveongoing disease activity. Long-term follow-up of thiscohort will provide information about outcomes of chil-dren with JIA receiving current treatments.

Further readings:1. Oen K, Tucker L, Huber A, et al. Predictors of early inactive disease in a juve-

nile idiopathic arthritis cohort: The Research in Arthritis in Canadian ChildrenOutcomes Studies. Arthritis Rheum 2009; 61(8):1077-86.

2. Oen K, Duffy CM, Tse SM, et al. Early outcomes and improvement of patientswith juvenile idiopathic arthritis enrolled in a Canadian multicenter inceptioncohort. Arthritis Care Res (Hoboken) 2010; 62(4):527-36.

3. Petty RE, Southwood TR, Manners P, et al. International League of Associationsfor Rheumatology Classification of Juvenile Idiopathic Arthritis: second revision,Edmonton, 2001. J Rheumatol 2004; 31:390-2.

Dr. Lori Tucker is a Clinical Associate Professor of Pediatrics at the University of British Columbia in Vancouver, British

Columbia.

Sponsored by an unrestricted educational grant from Pfizer Canada.

Working together for a healthier worldTM


Publication of The Journal of the Canadian Rheumatology Association is madepossible through an unrestricted educational grant from Pfizer Canada.

Working together for a healthier worldTM

Ihave been involved with internationalelite sports since 2005, primarily work-ing as team physician with the Canadian

women’s youth and senior national soccerteams. However, my time at the 2010Vancouver Paralympic Games was my firstexperience with paralympians and with win-ter sports event coverage. I was excitedabout the opportunity to be a part of theParalympics movement and the experiencefar exceeded my expectations.

As part of the athlete medical team at thesledge hockey event, I provided medical cov-erage at practices and games. However, pro-viding medical services at a hockey rink andattending to athletes on sledges posed someunique medical challenges. Our team of ther-apists, paramedics and doctors prepared by practising med-ical scenarios on ice. Providing medical services during majorgames also had unique opportunities: during competitions,the medical team had the privilege of prime ice level seats!

Sledge hockey is a fast, physical and skilled sport.Essentially, all of the rules of ice hockey apply. The athletes’sledges have two skate blades on a metal frame that allows thepuck to pass underneath. They use two sticks with a curvedblade at one end to handle the puck, and metal picks at theother for maneuvering and propulsion, and sometimes hit-ting their opponents! Fortunately, there were few acuteinjuries despite the intense physical nature of the game.

The paralympians I met were amazing athletes andinspiring individuals. The Paralympics was a wonderfulopportunity to enhance my sports medicine skills, be partof a dedicated and energetic medical team and to learnsome basic greetings in many languages.

"To enable paralympic athletes to achieve sporting excel-

lence and inspire and excite the world" is the goal of theInternational Paralympic Committee, and the 2010Paralympics lived up to this vision with the outstanding indi-vidual and team athletic performances, record spectatorcrowds, and the energetic vibe in Vancouver that was feltacross Canada and countries around the world.

My Paralympics experience was very rewarding. It furtherimpressed upon me the tremendous value of physical activ-ity and sport. The Paralympics values—courage, determina-tion, inspiration and equality—transcend elite sports, andare worthy ideals for all to aspire to.

Kristin Houghton, MD, MSc, FRCPC, Dip Sports MedClinical Assistant Professor,Division of Rheumatology,Department of Pediatrics, University of British Columbia Vancouver, British Columbia

My Paralympics Experience By Kristin Houghton, MD, MSc, FRCPC, Dip Sports Med

The Canadian sledge hockey team celebrating a win during a preliminary game.

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