Warren Raymond

University of Western Australia | UWA · Internal Medicine

Aim: To explore the association between systemic lupus erythematosus (SLE) with the risk of cancer development and subsequent 5-year mortality in Western Australia (WA). Methods: Population-level, data linkage study of SLE patients (n = 2111) and general population comparators (n = 21 110) hospitalized between 1980 and 2014. SLE patients (identi...

Objective: Patients with rheumatoid arthritis (RA) have shown increased levels of neutrophils generating kallikrein-kinin peptides in blood which are potent mediators of inflammation. This study investigated the association between the bioregulation of kinin-mediated inflammation with the clinical, quality of life, and imaging characteristics (e.g...

Background: Cardiovascular disease is the most common cause of death in people with gout. Acute inflammation, which is a characteristic of gout, may have a mechanistic role in major adverse cardiovascular events (MACEs). We aimed to examine the relationship between admissions to a hospital with acute gout and MACEs in a large population-based data...

Best medical therapy (BMT) for peripheral arterial disease (PAD), carotid artery stenosis (CAS) and abdominal aortic aneurysm (AAA) involving concomitant use of antiplatelets, lipid-lowering agents, and blood pressure control, improves patient survival and prevents clinical cardiovascular disease (CVD). We performed a single-center cross-sectional...

Objective Patients with rheumatoid arthritis (RA) have shown increased levels of neutrophils generating kallikrein-kinin peptides in blood which are potent mediators of inflammation. This study investigated the association between the bioregulation of kinin-mediated inflammation with the clinical characteristics (e.g. ultrasound synovitis or pain s...

Objectives Cardiovascular disease is the largest contributor of increased mortality in patients with gout. Acute inflammation as seen with gout attacks may have a mechanistic role in developing Major Adverse Cardiovascular Events (MACE). We examined the temporal relationship between admission to hospital with acute gout and MACE. ApproachLinked inp...

Aim: Adult-onset Still's disease (ASD) is a rare, potentially life-threatening autoinflammatory condition. As reported prevalence shows regional variation and long-term outcome data are scarce, we investigated epidemiology and long-term health outcomes of ASD in Western Australia (WA). Methods: Population-based cohort study using longitudinally...

Objectives: To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS). Methods: Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group was compared to usual care. Retrospective contro...

Background Systemic lupus erythematosus (SLE) patients have higher fracture risk, driven by primary (chronic inflammation) and secondary (glucocorticoids treatment) osteoporosis. However, there is limited data on fracture recurrence and post-fracture mortality in this vulnerable population. Objectives To describe the association between systemic l...

Background The association between systemic lupus erythematosus (SLE) and cancer risk is unclear. Objectives Describe the association between systemic lupus erythematosus (SLE) and the risk of cancer development and subsequent 5-year mortality in Western Australia (WA). Methods Population-level cohort study of SLE patients (n=2,111) and general p...

Background Adult-onset Stills disease (AOSD) is a rare, potentially life-threatening autoinflammatory condition for which the reported prevalence shows regional variation and where comparative long-term outcome data are scarce (1). Objectives To investigate annual incidence and point prevalence of AOSD in Western Australia (WA) and compare long-te...

Objective To examine the mortality rates in hospitalised patients with ankylosing spondylitis (AS), and the association of extra-articular manifestations (EAM) and co-morbidities with mortality rates. Methods The study was a retrospective population-based cohort study using linked administrative data of hospitalised AS patients (n=1,791) and a mat...

Objective Examine if two inexpensive measures of atherosclerotic vascular diseases (ASVD), abdominal aortic calcification (AAC) and high-sensitivity cardiac troponin I (hs-cTnI) provide complementary information for 10-year ASVD mortality and all-cause mortality risk in older women. Methods 908 community-dwelling women without prevalent ASVD (≥75...

Objective The study objective was to compare incident cancer rates among patients with anti-neutrophil cytoplasm antibody-associated vasculitis (AAV) and polyarteritis nodosa (PAN) in Western Australia (WA) with the general population and perform time-varying analyses to identify periods with greatest excess cancers. Methods Administrative health...

Introduction: Cardiovascular disease is the largest contributor to the increased mortality seen in gout. Acute inflammation, which is characteristic of gout, may have a mechanistic role in Major Adverse Cardiovascular Events (MACE). Hypothesis: TA temporal relationship exists between admissions to hospital with acute gout, and major adverse cardiov...

Objective: To describe the incidence and long-term outcome of non-gonococcal septic arthritis (SA) in Western Australia (WA). Methods: Newman criteria were applied to define culture-positive SA and suspected SA cases in the state-wide West Australian Rheumatic Diseases Epidemiological Registry with longitudinally linked health data for patients...

Objective Mortality rates for patients with SLE have not been reported in Australia. This study determined the association between a hospitalisation for SLE with mortality. Methods Population-level cohort study of patients with SLE (n=2112; 25 710 person-years) and general population comparators (controls) (n=21, 120; 280 637 person-years) identif...

Objective In SLE, smoking increases the burden of cutaneous disease and organ damage, and leads to premature mortality. However, the effect of smoking on disease manifestations and cytokine levels of patients with SLE is unclear. This study compared characteristics of patients with SLE across smoking status, and determined the association of smokin...

Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients ad...

Abstract Background Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and...

Objectives: We compared survival and causes of death in Western Australian (WA) anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and polyarteritis nodosa (PAN) patients with controls and the WA population. Methods: In this data linkage study, we identified patients with incident AAV/PAN and age, sex and temporally matched co...

Background The worldwide incidence of PyA is reportedly rising due to a combination of increased longevity, multi- comorbidity, iatrogenic complications and increasing use of immunomodulating therapies, while there is limited data on longterm outcomes of PyA. Objectives To describe the recent incidence, risk factors and long-term outcomes in adult...

Background The incidence of Septic arthritis (SA) in adults is rising, but few data are available for children (1). SA symptomatology in young children is often atypical and delayed diagnosis can cause significant morbidity. Objectives To describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA...

Background Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable (1). Understanding the driver of health care costs will allow more targeted intervention. Objectives To examine factors associated with high health service utilisation and cost in patients admitted to hospital with go...

Background IgA vasculitis is generally considered to be a self-limiting condition, but this is at odds with the increased mortality observed in adult patients with IgA vasculitis (1). Objectives With sparse data on prognostic factors in IgAV, we investigated whether pre-existing conditions are risk factors for mortality in adult IgAV patients. Me...

Objective: To describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA) in Western Australia (WA). Methods: We extracted state-wide longitudinally linked administrative health data for patients aged < 16 years with a first diagnostic code of 711.X (ICD9-CM) and M00.X (ICD10-AM) in WA in the p...

Objectives With sparse data available, we investigated mortality and risk factors in adults with IgAV. Methods Observational population-based cohort study using state-wide linked longitudinal health data for hospitalised adults with IgAV (n = 267) and matched comparators (n = 1080) between 1980-2015. Charlson comorbidity index (CCI) and serious in...

Objective To investigate the frequency, risk factors and long‐term outcome of gonococcal arthritis in Western Australia (WA). Methods A population‐based data linkage study of patients with a hospital‐based diagnosis of gonococcal arthritis (GA) in WA between 1990‐2014. Demographics, standardised incidence rates (IR) per million and comorbidity acc...

Background/Objective Patients with IgA vasculitis (IgAV aka Henoch Schonlein) may require aggressive initial treatment, are prone to disease relapses and may have sustained abnormal IgA responsiveness. We investigated whether the relatively rare diagnosis of childhood IgAV is associated with subsequent comorbidity, hospitalisation and interventions...

Aim Ankylosing spondylitis (AS) has been associated with a modest increase in the risk of cancer. However, little is known as to how AS influences risk of mortality following cancer diagnosis. This study compared the risk of cancer and subsequent mortality in patients with AS compared with a non‐AS population group. Methods Patients diagnosed with...

IntroductionPatients with IgA vasculitis (IgAV) may require aggressive treatment and are prone to disease relapses, and IgA deposition in tissues can persist. We investigated whether these factors predispose to long-term morbidity in children with IgAV.Methods Observational cohort study comparing rates for comorbidity development by Charlson comorb...

Introduction: A high body mass index is known to adversely affect antitumor necrosis factor-alpha trough levels and secondary loss of response (SLOR) in patients with Crohn's disease. We hypothesize that high levels of adiposity negatively affect these outcomes and aimed to determine if this relationship exists. Methods: We performed a retrospec...

Midkine (MDK), a heparin-binding growth factor cytokine, is involved in the pathogenesis of kidney diseases by augmenting leukocyte trafficking and activation. Animal models and small case control studies have implicated MDK as a pathological biomarker in chronic kidney diseases (CKD), however this is yet to be confirmed in prospective human studie...

Aims To compare the rates of infections (peritonitis and exit site infections) in patients undergoing non-buried versus buried peritoneal dialysis catheterisation for end-stage renal failure. Methods A retrospective review of all patients who underwent peritoneal dialysis catheter placement by one primary surgeon between January 2008 and August 20...

Background There is sparse population-level data on outcome in patients with Immunoglobulin-A vasculitis (IgAV) and none from Australia Objectives We compared long-term mortality for paediatric and adult IgAV patients with age- and gender-matched controls. Methods Linked health data for pediatric (<20 years=473) and adult (20+ years, n=267) IgAV...

Background IgA vasculitis (IgAV) in children is considered a mostly self-limiting disease. However, patients may require aggressive initial treatment, are prone to disease relapses and conceivably have a sustained abnormality in mucosal and /or circulating IgA responsiveness, that can predispose to the development of other conditions. Objectives T...

Background Systemic Lupus Erythematosus (SLE) is a chronic multiorgan disease with an unpredictable disease course, which requires monitoring for disease activity, treatment efficacy and comorbidity. Data on the healthcare utilization and cost of SLE, especially from Australia are scarce. Objectives To determine the healthcare utilisation and esti...

Background Survival in ANCA-associated vasculitis (AAV) has improved substantially in the last fifty years, but Australian data and studies with a control population are scarce. Objectives The aim of this study was to compare the all-cause mortality rate between patients with AAV and matched controls in Western Australia. Methods A retrospective...

Background The increased risk of malignancy in patients with ANCA-associated vasculitis (AAV) and polyarteritis nodosa (PAN) has been attributed to late treatment related effects, with non-melanoma skin and genitourinary cancers most frequently reported in European studies 1,2,3 . Malignancy has not been examined in patients with AAV/PAN in Austral...

Objective: To assess the burden of subclinical intra-articular inflammation using ul-trasound in people with gout. Methods: A pilot, prospective longitudinal cohort of 28 participants with gout were examined twice, once during a gout flare (n = 25) and then during an inter-critical phase (n = 27). At each visit, a 52 joint count was done followed...

Objective To assess the impact of achieving Lupus Low Disease Activity State ≥50% of the time (LLDAS‐50) on damage accrual and mortality in an inception cohort of patients with systemic lupus erythematosus (SLE). Methods We used data from the Tromsø Lupus Cohort, a longitudinal population‐based study of all patients with SLE in the 2 northernmost...

Objective To compare the long-term prevalence, incidence and outcomes of vertebral fracture (VF) between ankylosing spondylitis (AS) patients and matched controls, including the role of extra-articular manifestations (EAM) and osteoporosis. Methods State-wide observational study using linked health data for 2,321 AS patients and 22,976 controls pr...

Background A high body mass index (BMI) is known to adversely affect anti-TNFα trough levels and secondary loss of response (SLOR); however, the literature is scarce in defining what aspect of body mass determine these outcomes. We hypothesise that a large visceral fat area is associated with a lower anti-TNFα level and a higher rate of SLOR. Our a...

Objectives: Transitional care program in Australia targets older patients in hospitals requiring ongoing slow-stream restorative care prior to discharge. Poststroke patients often require extended care and are transferred to these facilities. Transitional care providers require a predicted discharge destination. The aim of this study was to assess...

Tubuloreticular inclusions (TRI) are distinctive cytoplasmic structures of unknown origin that typically associate with autoimmune and viral diseases. We investigated the clinical and prognostic relevance of TRI detection in patients with lupus nephritis (LN). We conducted a single centre study of patients (n=84) with biopsy evidence of LN. Clinica...

Background: Fracture risk calculators (FRC) with DXA can guide osteoporosis (OP) management in the absence of dual X-ray absorptiometry (DXA). There is little information of the role of FRC without DXA. Objectives: Determine the accuracy of age-stratified Garvan FRC thresholds without DXA to manage OP. Methods: Cross-sectional study of 531 par...

Objective Clinical data suggests that infections can trigger IgA vasculitis (IgAV), but longterm observations are lacking. We compared rates, types and microorganisms for serious infection (SI) before and after diagnosis for children with IgAV and non-exposed controls. Methods Using population-based administrative linked health datasets we estimat...

Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who c...

Background Poor sleep is common after stroke and data regarding its’ effect on rehabilitation outcomes are limited. Controversial evidence was found concerning the effect of sedatives on improving sleep quality in poor sleepers after stroke. Method 104 patients after stroke from two major stroke rehabilitation units in Western Australia were enrol...

Objectives: Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy....

Objective To identify Rehabilitation Indices associated with a minimal trauma fracture (MTF) within 12 months poststroke. Methods Retrospective case‐control study. Stroke survivors with MTF were matched 5:1 with stroke survivors without MTF. Logistic regression determined whether Rehabilitation Indices, such as Physiotherapy Ambulation score (Phys...

While it is a common practice to monitor complement levels in patients with systemic lupus erythematosus to aid in flare prediction and detection, it is unclear if this strategy is helpful in preventing subsequent organ damage. We studied longitudinal complement levels in 102 SLE patients during a median follow-up of 13.8 years (IQR 7.0, 23.1). Low...

Objective: Cytokine dysregulation contributes to inflammation and organ damage in Systemic Lupus Erythematosus (SLE). Principle Component Analysis (PCA) can determine which groups of cytokines have the most influence across disease activity states. Material and method: A cross-sectional study of age- and gender-matched SLE patients (n = 100) and...

The erythropoietin receptor (EpoR) stimulates erythrocyte proliferation after erythropoietin binding. EpoR belongs to the cytokine receptor superfamily and can be found on macrophages and endothelial cells. As there are no data on the role of EpoR systemic autoimmune diseases, we investigated the role of soluble EpoR (sEpoR) in patients with system...

Aims The use of swollen (SJC) and tender joint counts (TJC) for rheumatoid arthritis (RA) disease activity and treatment effectiveness is well established. Patient‐reported outcomes (PRO) are important. However, it is unknown if patient scoring is as reliable as that of trained professionals. Methods PRO including SJC and TJC were assessed at base...

Objectives To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating L...

Objectives Immunoglobulin A vasculitis (IgAV) is a systemic small‐vessel vasculitis of unknown aetiology. Although commonest in children, onset in adulthood is not unusual. As Australian data are lacking, we investigated longitudinal hospitalisation rates and characteristics for both adult and paediatric IgAV patients in Western Australia (WA). Me...

Background Disease activity in patients with Systemic Lupus Erythematosus (SLE) is an important contributor to organ damage and premature mortality. Current indices to capture disease activity are not well suited to reflect their contribution to long term outcome. Lupus Low Disease Activity State (LLDAS) has been developed as an alternative measure...

Background Hypocomplementemia (HC) represents a significant clinical finding in Systemic Lupus Erythematosus (SLE) as it suggests complement activation by immune-complexes, which can initiate inflammation. As disease activity contributes to damage accrual in SLE patients, we investigated the role of HC as a predictor of subsequent organ damage. Ob...

Background Renal outcomes for Indigenous Australians (IA) with Lupus Nephritis (LN) are worse than for other ethnic groups. Objectives To investigate whether differences in renal biopsy findings can explain the worse renal outcome in Indigenous patients Methods A single centre cohort study of 83 SLE patients undergoing a first renal biopsy at our...

Background Immunoglobulin A vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is an immune complex mediated small-vessel vasculitis that preferentially affects the skin, intestines and kidneys. While more common in children, IgAV is not unusual in adults, where it has been associated with worse outcomes. Objectives To compare hospital a...

Background Lupus Nephritis (LN) remains a serious complication of Systemic Lupus Erythematosus (SLE) and continuous worldwide demographic changes as well as new mechanistic insights and treatment options necessitate regular updating of our knowledge of LN. Objectives To investigate the current relevance of demographic, clinical and histological ch...

Background In Ankylosing Spondylitis (AS) chronic spinal inflammation contributes to spinal osteoporosis and rigidity. Large scale studies on vertebral fractures in AS patients are scarce with rates reported between 0.4% and 32%1–3. While biological therapy for AS has been associated with better clinical outcomes, the long-term effect on spinal ost...

Background IgA vasculitis (IgAV) is usually a self-limiting condition, but women with a history of IgAV are reported to have an increased risk of complications during pregnancy. There is however little international data regarding obstetric outcomes and risk factors for IgAV patients ¹. Objectives To compare pregnancy outcomes between matched cont...

Background Patients with Systemic Lupus Erythematosus (SLE) are at increased risk of premature mortality. However, population-level mortality rates for SLE have not yet been reported in Australia. Objectives Calculate the standardised mortality rates (SMR) for SLE patients in Western Australia (WA) from 1980 to 2015, overall and by age and gender....

Introduction: The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures. Methods: Pa...

Background Insulin growth factor-1 (IGF1) activates cell proliferation pathways and inhibits apoptosis. IGF1 is involved in tumour growth and required for T-cell independent activation of B cells. Activated B cells and autoantibody production are a hallmark of systemic lupus erythematosus (SLE). To investigate the possible role of IGF1 in SLE, we s...

Background Hospitalisation for Systemic Lupus Erythematosus (SLE) is a significant event. Objectives We aimed to understand the factors leading to an incident admission and its impact on long term outcome in SLE patients in Western Australia (WA). Methods Using whole-population data linkage of hospital admissions, cancer registrations and death r...

Background Lupus Nephritis (LN) is one of the most severe complications that can occur in patients with Systemic Lupus Erythematosus (SLE) as it increases the risk of renal failure, comorbidity and death. As with SLE, there is a significant impact of ethnicity on LN severity and outcome. Objectives To investigate the impact of ethnicity of LN pres...

Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that runs an unpredictable disease course. Objectives We aimed to understand the characteristics and outcomes of incident hospitalisation for conditions other than the underlying disease in SLE patients. Methods Using whole-population data linkage of hospital admissions...

Background Rheumatoid Factors (RF) are antibodies directed against the Fc portion of IgG and are involved in clearance of immune complexes. While RF can develop in a wide range of conditions, higher RF levels indicate a greater risk for a severe disease course in Rheumatoid Arthritis (RA) patients including cardiovascular complications and prematur...

Objective: The interleukin 17 (IL-17) cytokine family is involved in a number of chronic inflammatory diseases. In spite of contradictory findings and a lack of causality in clinical studies, IL-17 inhibition for systemic lupus erythematosus (SLE) has regained attention as a potential therapeutic pathway, after demonstrating disease-modifying capa...

Background and aims Hospitalisation for Systemic Lupus Erythematosus (SLE) is a significant event. We aimed to understand the factors leading to an incident admission and its impact on long term outcome in SLE patients in Western Australia (WA). Methods Using whole-population data linkage of hospital admissions, cancer registrations and death reco...

Background and aims Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that runs an unpredictable disease course. We aimed to understand the characteristics and outcomes of incident hospitalisation for conditions other than the underlying disease in SLE patients. Methods Using whole-population data linkage of hospital admissions an...

Background and aims The successful application of IL-17 inhibitors in a number of chronic inflammatory diseases has increased interest for the role of IL-17 in other conditions. We investigated the clinical associations for the predominant family member IL-17A in patients with Systemic Lupus Erythematosus (SLE). Methods Cross-sectional study of SL...

Background Cytokine dysregulation contributes to immune dysfunction, inflammation and organ damage in Systemic Lupus Erythematosus (SLE). Cytokines have multifarious interactions on other cytokines and immune cells. Thus cytokines studies should reflect this intrinsic complexity. Aim Utilise Principle Component Analysis (PCA) to unravel the interp...

Background To investigate the impact of uric acid (UA) levels on cardiovascular disease and mortality at a population level. Methods Prospective analysis of baseline serum UA measurement and 15 year follow-up data from the Busselton Health Survey (n = 4,173), stratified by existence or absence of baseline cardiovascular disease. Outcomes were asce...

Background: Osteoporosis contributes significantly to morbidity and mortality. Antiresorptive therapy is effective in primary and secondary fracture prevention, but compliance with bisphosphonate therapy is poor, resulting in poorer patient outcomes. Objective: The objectives of this article are to aid clinicians' treatment selection and improve...

Objective: To assess the effect of age-adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients. Methods: This prospective cohort study observed 306 older rehabilitation patients admitted to a secondary hospital between February and April 2015. Groups were compared using...

Background von Willebrand factor (VWF) is involved in platelet plug formation and protein transport. Increased VWF levels in systemic lupus erythematous (SLE) are considered risk factors for vascular events. VWF protein levels, however, do not accurately reflect its platelet-aggregating function, which has not been examined in SLE. Methods Cross-s...