Rheumatic Disease", and "Surveillance in Rheumatic Disease." In my proposal I describe two objectives relevant to each theme. This research is supported by the Canadian Institutes of Health Research (CIHR) and the National Institutes of Health (NIH).
Theme 1-Cancer in Rheumatic Disease: The rationale for the first theme is that women with SLE are known to have a decreased risk of breast cancer, compared to the age-matched general population. However, the reasons for that decreased risk are unknown. By studying women with SLE, who have such a striking decreased risk of breast cancer, we may learn lessons that can then be used to better understand breast cancer in the general population. Objective 1 is to describe breast cancer cases from a large systemic lupus erythematosus (SLE) cohort, and compare this to the general population (based on Surveillance, Epidemiology and End Result, SEER, data). Data are available the SLE breast cancer cases that have arisen in the very large international multi-centre SLE cohort (16,409 patients, 121,283 person-years). Cancer cases have been determined by linkage of the patients with regional cancer registries. The demographics (age, race/ethnicity, SLE duration) of these SLE patients who developed breast cancer will be compared to the demographics within the over-all SLE cohort. I will also compare SLE cases and the age and race-matched SEER general population breast cancer control sample.
Objective 2 is to examine whether a specific antibody, anti-double stranded DNA antibody, is one of the factors associated with lower breast cancer risk in SLE. Breast cancer cases in SLE will be compared to cancer-free SLE controls from the same cohort. I will calculate the relative risk for breast cancer in the SLE patients, related to anti-ds DNA antibodies, adjusting for drugs, demographics, smoking, calendar year, SLE duration, and other factors.
Theme 2- Surveillance in Rheumatic Disease: Since 2005, I have been funded by the CIHR, the Canadian Arthritis Network, and the Public Health Agency of Canada to study rheumatic disease prevalence, patterns, and co-morbidity, using physician visit and hospitalization records from across Canada. Recently I was funded as through CIHR's Drug Safety and Effectiveness Network (DSEN) to provide new, real-life data regarding different drugs. Objective 3 is to compare rheumatoid arthritis (RA) drugs in terms of later need of patients, for orthopaedic surgery. I will base these analyses on cohorts of new-onset RA patients identified in Canada's provincial physician visit billing databases from 2002-2009. I will compare orthopaedic surgery among patients exposed to anti-Tumor Necrosis Factor drugs versus other drugs, such as methotrexate.
The final objective (Objective 2), also under the theme of Surveillance is to assess whether selective serotonin reuptake inhibitors (SSRIs) are associated with fracture risk. This project will make use of a Canadian cohort linked to physician visit and hospitalization data. The primary outcome is fractures occurring in the femur and/or ulna. I will estimate the relative risk for fractures due to SSRIs, adjusting for other medications (anxiolytics, other antidepressants, glucocorticoids, bisphosphonates, calcium and vitamin D supplements), and for age, sex, and other factors.
A senior FRSQ award will help me pursue these important projects, and fill key knowledge gaps.