Lyn M March

• The University of Sydney

Background People with rheumatoid arthritis (RA) are at increased risk of osteoporosis. The Australian Rheumatology Association RA Clinical Care Standard recommends fracture risk assessment at RA diagnosis and as clinically indicated. Aims The aim of this study was to evaluate the use of dual‐energy X‐ray absorptiometry (DEXA) for osteoporosis scr...

Objectives: To describe the associations between OA-related biochemical markers and knee symptoms in middle-aged adults followed up over 10-13 years. Methods: Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year: 2004-06) and 10-13 year follow-up at CDAH-3. Serum samples from baseline (n=156) and follo...

Objective Individuals with inflammatory arthritis require long‐term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out‐of‐pocket (OOP) visit costs. Methods We linked data from Australian Rheumatology Association Databas...

OBJECTIVES Evaluate reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis (RA)-RA-Patient Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort. METHODS Individual patient interviews were performed to check the language and completion time of the...

Objectives To investigate whether circulating endothelial protein C receptor (EPCR) is associated with disease activity and inflammatory markers in rheumatoid arthritis (RA). Methods 38 RA patients and 21 healthy controls (HC) were recruited via the A3BC biobank. Peripheral blood mononuclear cells and plasma were isolated from the blood of these p...

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. Low back pain is the leading cause of disability in terms of years lived with disability (YLDs). Due to sparse data, a current limitation of GDB is that a uniform severity distribution is presumed based on 12-Item Short Form Health Survey scor...

Although paracetamol (acetaminophen) combined with other analgesics can reduce pain intensity in some pain conditions, its effectiveness in managing low back pain and osteoarthritis is unclear. This systematic review investigated whether paracetamol combination therapy is more effective and safer than monotherapy or placebo in low back pain and ost...

Importance Knee osteoarthritis is disabling, with few effective treatments. Preliminary evidence suggested that krill oil supplementation improved knee pain, but effects on knee osteoarthritis remain unclear. Objective To evaluate efficacy of krill oil supplementation, compared with placebo, on knee pain in people with knee osteoarthritis who have...

Objective Dyadic coping, the process of coping that transpires between couples challenged by one partner's illness, is an important predictor of disease adjustment and patient wellbeing. However, dyadic coping in rheumatoid arthritis remains unclear. This study examines the effect of dyadic coping on psychological distress and relationship quality...

Endothelial Protein C Receptor (EPCR) is a key regulator of the activated protein C anti-coagulation pathway due to its role in the binding and activation of this protein. EPCR also binds to other ligands such as Factor VII and X, γδ T-cells, plasmodium falciparum erythrocyte membrane protein 1, and Secretory group V Phospholipases A2, facilitating...

Objective To determine the effect of zoledronic acid (ZA) on the risk of total knee replacement (TKR) in patients with symptomatic knee osteoarthritis and without severe joint space narrowing (JSN). Methods We included 222 participants (mean age 62 years, 52% female) from the two‐year Zoledronic Acid for Osteoarthritis Knee Pain trial (113 receive...

Endothelial protein C receptor (EPCR) is a receptor for the natural anti-coagulant activated protein C (aPC). It mediates the anti-inflammatory and barrier-protective functions of aPC through the cleavage of protease-activated receptor (PAR)1/2. Allergic contact dermatitis is a common skin disease characterized by inflammation and defective skin ba...

Importance The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated. Objective To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture. Design, Setting, and Participants This prospective cohort study compared indiv...

Actions towards the health-related Sustainable Development Goal 3.4 typically focus on non-communicable diseases (NCDs) associated with premature mortality, with less emphasis on NCDs associated with disability, such as musculoskeletal conditions—the leading contributor to the global burden of disability. Can systems strengthening priorities for an...

Objective To determine distinct trajectories of self-reported pain-related health status in rheumatoid arthritis (RA), their relationship with sociodemographic factors and medication use. Methods 988 Australian Rheumatology Association Database participants with RA (71% female, mean age 54 years, mean disease duration 2.3 years) were included. Dis...

Objectives: Endothelial protein C receptor (EPCR) is highly expressed in synovial tissues of patients with rheumatoid arthritis (RA), but the function of this receptor remains unknown in RA. This study investigated the effect of EPCR on the onset and development of inflammatory arthritis and its underlying mechanisms. Methods: Collagen-induced a...

Objectives Describe associations between MRI markers with knee symptoms in young adults. Methods Knee symptoms assessed using WOMAC scale during Childhood Determinants of Adult Health (CDAH)-knee study (year : 2008–10) and 6–9 year follow-up (CDAH-3; year : 2014–2019). Knee MRI scans, obtained at baseline, assessed for morphological markers (carti...

Introduction Un score de fréquence et de gravité des poussées d'arthrose est essentiel pour guider les traitements. L'objectif était de comparer plusieurs méthodes de construction d'un score composite pour l'auto-questionnaire Flare-OA-16 de mesure de la poussée d'arthrose du genou et de la hanche, défini comme un ensemble de symptômes d'une durée...

Objectives: To determine long-term (20 year) survival in RA patients enrolled in the Australian Rheumatology Association Database (ARAD). Methods: ARAD patients with RA and data linkage consent who were diagnosed from 1995 onwards were included. Death data were obtained through linkage to the Australian National Death Index. Results were compare...

Objective To determine vaccination rates, perceptions, and information sources in people with inflammatory arthritis. Methods Participants enrolled in the Australian Rheumatology Association Database were invited to participate in an online questionnaire, conducted in January 2020, prior to the COVID‐19 pandemic. Included questions were about vacc...

Background Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the association between multimorbidity and osteoporosis investigation and treatment in persons at hig...

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Background To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. Methods Global Burden of Disease (GBD) 2019...

Aims: The Outcome Measures in Rheumatology Trials (OMERACT) Remission in Rheumatoid Arthritis (RA) patient perspective working group has previously found that patients prioritised independence, pain, and fatigue as key domains of remission in RA. However, there is currently no clear definition of independence. Consequently, this scoping review aim...

Background: Global policy to guide action on musculoskeletal (MSK) health is in a nascent phase. Lagging behind other non-communicable diseases (NCDs) there is currently little global policy to assist governments to develop national approaches to MSK health. Considering the importance of comparison and learning for global policy development, we ai...

Background Bisphosphonates have been reported to be cardio-protective in some, but not all studies. It is unknown whether denosumab use protects against cardiovascular events (CVE). Objectives To determine whether oral bisphosphonate (oBP) or denosumab (Dmab) use is associated with CVE in persons with incident fracture. Design 267,357 participant...

Objectives: To investigate the knowledge and beliefs of Australian patients with inflammatory arthritis regarding biologic/targeted synthetic DMARDs (b/tsDMARDs) and biosimilars and their sources of information. Methods: Participants enrolled in the Australian Rheumatology Association Database (ARAD) with RA, PsA and axial SpA were sent an onlin...

Objective To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis and osteoarthritis (OA). Methods We performed a systematic review and meta‐analysis. Data were collected through electronic searches of Cochrane CENTRAL, MEDLINE, Embase, PsycInfo, and CINAHL databases up to March 2019....

Objectives To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. Methods Prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Associa...

Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management...

Objective To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. Design A longitudinal cohort study. Setting Community-dwelling adults who had previously undergone total knee replacement. Methods Five-year follow-up questionnaire data were obtained from pa...

Objective: To evaluate the effect of annual infusions of zoledronic acid (ZA) with or without a single injection of methylprednisolone, compared to placebo, on quantitative magnetic resonance imaging 3-D bone area and bone shape in participants with symptomatic knee osteoarthritis (OA). Methods: This was a post-hoc analysis of the ZAP2 trial. Ac...

In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113–7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722–921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327–3,061,066) prevalent cases o...

Objective To describe the burden of osteoarthritis (OA) in India from 1990 to 2019. Design Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA –knee OA, hip OA, hand OA, and other OA– was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incide...

Objective To describe the associations between OA-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years. Methods Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06;n=156) and 10-13 year follow-up at CDAH-3 (n=167) were analysed...

OBJECTIVE To describe treatment patterns in rheumatoid arthritis (RA) including the frequency and reasons for switching or stopping biologic and targeted synthetic DMARDs (b/tsDMARDs). METHODS Reasons for switching or stopping b/tsDMARDs were extracted from the Australian Rheumatology Association Database (ARAD) from 2003 to 2018 for RA participan...

Objective Ability to assess flares in osteoarthritis (OA) of the knee and hip (KHOA) is important in clinical care and research. Using mixed methods, we developed a self-reported instrument measuring flare and assessed its psychometric properties. Methods We constructed questionnaire items from semi-structured interviews and a focus group (patient...

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with excessive inflammation and defective skin barrier function. Activated protein C (APC) is a natural anticoagulant with anti-inflammatory and barrier protective functions. However, the effect of APC on AD and its engagement with protease activated receptor (PAR)1 and PAR2 a...

Background Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for...

Introduction: A key element in the big data revolution is large-scale biobanking and the associated development of high-quality data collections and supporting informatics solutions. As such, in establishing the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), we sought to establish a low-cost, nation-scale data management system c...

The OMERACT Technical Advisory Group recognises that working groups during the process of creating a core outcome set may identify an outcome domain that would be best represented as a composite that encapsulates these component outcome domains by bringing them together into a single outcome. A multi-outcome domain (MOD) is a within-patient combina...

The skin barrier is broadly composed of two elements—a physical barrier mostly localised in the epidermis, and an immune barrier localised in both the dermis and epidermis. These two systems interact cooperatively to maintain skin homeostasis and overall human health. However, if dysregulated, several skin diseases may arise. Psoriasis is one of th...

Background: Residual/reconverted red bone marrow (RBM) in adult knees is occasionally observed on routine knee magnetic resonance imaging (MRI). We aimed to identify its prevalence, distribution, and associations with lifestyle factors, knee structural abnormalities, and knee symptoms in young adults. Methods: Participants (n = 327; aged = 31–41 ye...

Objectives: To identify patient-centered core domains for prospective longitudinal observational studies (LOS) in rheumatoid arthritis. Methods: Our working group held a virtual meeting in November 2020 to review data from a literature review and patient qualitative interviews, and to discuss strategies to move forward on domain identification and...

We aimed to describe associations between diet quality in adolescence and adulthood and knee symptoms in adulthood. 275 participants had adolescent diet measurements, 399 had adult diet measurements, and 240 had diet measurements in both timepoints. Diet quality was assessed by Dietary Guidelines Index (DGI), reflecting adherence to Australian Diet...

Background Research on adherence interventions in rheumatology is limited by methodological issues, particularly heterogeneous outcomes. We aimed to describe researchers’ experiences with conducting interventional studies targeting medication adherence in rheumatology and their perspectives on establishing core outcomes. Methods Semi-structured in...

Aim: There is a lack of data on OA-related serum biomarkers’ (cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA)) association with MRI-markers in the middle-aged general population. Therefore, our aim was to investigate the association between OA-related biomarkers and MRI-markers in middle-aged adults...

Background The aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over 1 to 2 years in people with painful medial knee osteoarthritis. Methods A longitudinal study was conducted within a randomised controlled trial, the “Long-term Evaluation of Glucosamine Sulfate” (LEGS study). Re...

Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strate...

Objective To describe the perspectives of patients with inflammatory arthritis (IA) on outcome domains of trials evaluating medication adherence interventions. Methods Adult patients (≥18 years) with IA using disease-modifying anti-rheumatic drugs (DMARDs) from centres across Australia, Canada, and the Netherlands participated in six focus groups...

Community restrictions due to COVID‐19 have changed healthcare, including increased telehealth use. During the early pandemic phase, a cohort of Australian patients with inflammatory arthritis was surveyed. Self‐reported access to healthcare was maintained and physical health was more likely to be self‐rated poorly than mental health. There was a h...

Objectives To develop an operational definition of contextual factors (CF) [1]. Methods Based on previously conducted interviews, we presented three CF types in a Delphi survey; Effect Modifying -, Outcome Influencing - and Measurement Affecting CFs. Subsequently, a virtual Special Interest Group (SIG) session was held for in depth discussion of E...

Objective To gain consensus on the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials of shared decision making (SDM) interventions. Methods The process followed the OMERACT Filter 2.1 methodology, and used consensus-building methods, with patients involved since the inception. After developing the draft core domain...

Objective Towards developing an instrument to measure knee and hip osteoarthritis (KHOA) flare, the Outcome Measures in Rheumatology (OMERACT) Flares in OA Working Group first sought to identify and define relevant domains of flare in KHOA. Methods Guided by OMERACT Filter 2.1, candidate domains were identified from data generated in interviews, i...

Objective To report the levels and trends of prevalence, deaths, and disability‐adjusted life years (DALYs) due to musculoskeletal disorders, categorized as low back pain, neck pain, osteoarthritis (OA), rheumatoid arthritis (RA), gout, and other musculoskeletal disorders, across 195 countries and territories from 1990 to 2017 according to age, sex...

Significance: Dermal fibroblasts are the major cell type in the skin's dermal layer. These cells originate from distinct locations of the embryo and reside in unique niches in the dermis. Different dermal fibroblasts exhibit distinct roles in skin development, homeostasis and wound healing. Therefore, these cells are becoming attractive candidates...

Objectives: Protease-activated receptor (PAR) 1 and PAR2 have been implicated in RA, however their exact role is unclear. Here, we detailed the mechanistic impact of these receptors on the onset and development of inflammatory arthritis in murine CIA and antigen-induced arthritis (AIA) models. Methods: CIA or AIA was induced in PAR1 or PAR2 gene...

Objective To describe the association between change in subchondral bone marrow lesions (BMLs) and change in tibiofemoral cartilage volume and knee symptoms in patients with symptomatic knee OA. Methods In total, 251 participants (mean 61.7 years, 51% female) were included. Tibiofemoral cartilage volume was measured at baseline and 24 months, and...

Objectives The Outcome Measures in Rheumatology Initiative established the Contextual Factors Working Group to guide the understanding, identification and handling of contextual factors for clinical trials. In clinical research, different uses of the term ‘contextual factors’ exist. This study explores the perspectives of researchers (including cli...

Objective This study aimed to identify and prioritize factors important to patients and caregivers with regard to medication adherence in gout, osteoporosis (OP), and rheumatoid arthritis (RA) and to describe the reasons for their decisions. Methods Patients with gout, OP, and RA and their caregivers, purposively sampled from 5 rheumatology clinic...

Objective To describe the levels and trends of point prevalence, annual incidence, and years lived with disability (YLD) for gout and its attributable risk factors in 195 countries and territories from 1990 to 2017 according to age, sex, and Sociodemographic Index (SDI; a composite of sociodemographic factors). Methods Data were extracted from the...

Background: The aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over one-to-two years in people with painful medial knee osteoarthritis. Methods: A longitudinal study was conducted within a randomised controlled trial, the “Long-term Evaluation of Glucosamine Sulfate” (LEGS study...

Objectives: To describe the level and trends of point prevalence, deaths and disability-adjusted life years (DALYs) for other musculoskeletal (MSK) disorders, i.e. those not covered by specific estimates generated for RA, OA, low back pain, neck pain and gout, from 1990 to 2017 by age, sex and sociodemographic index. Methods: Publicly available...

Objective: To describe associations of body composition, physical activity and physical performance with knee cartilage thickness and subchondral bone area in young adults. Methods: Body composition, physical activity and physical performance were measured 4-5 years prior to knee MRI. Cartilage thickness and bone area were measured quantitativel...

Background: Recommended first-line management of lower limb osteoarthritis (OA) includes support for self-management, exercise and weight loss. However, many Australians with OA do not receive these. A National Osteoarthritis Strategy (the Strategy) was developed to outline a national plan to achieve optimal health outcomes for people at risk of,...

Objectives. To describe oral complementary medicine (CM) use in people with inflammatory arthritis, associations with use, and changes in use over time. Methods. Demographic, clinical, and patient-reported outcome data from 5,630 participants with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and juvenile idiopa...

Objectives To report the level and trends of prevalence, incidence and years lived with disability (YLDs) for osteoarthritis (OA) in 195 countries and territories from 1990 to 2017 by age, sex and Socio-demographic index (SDI; a composite of sociodemographic factors). Methods Publicly available modelled data from the Global Burden of Diseases, Inj...

Importance A proof-of-principle study suggested that intravenous zoledronic acid may reduce knee pain and the size of bone marrow lesions in people with knee osteoarthritis, but data from large trials are lacking. Objective To determine the effects of intravenous zoledronic acid on knee cartilage volume loss in patients with symptomatic knee osteo...

Objective To use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for neck pain in the general population of 195 countries. Design Systematic analysis. Data source Global Burden of Diseases, Injuries, and Risk Factors Study 2017...

Background: Low back pain (LBP) is a common musculoskeletal problem globally. Updating the prevalence and burden of LBP is important for researchers and policy makers. This paper presents, compares and contextualizes the global prevalence and years lived with disability (YLDs) of LBP by age, sex and region, from 1990 to 2017. Methods: Data were...

Objectives: Lay descriptions of mild, moderate and severe disease states have been utilized in Global Burden of Disease studies in the calculation of years lived with disability, and may be a useful brief starting point for clinical care. The primary aims of this study were to estimate the proportion of an OA cohort within each severity level, and...

Objective: Non-adherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. Methods: We searc...

Background: Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic in...