John Esdaile

Professor

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Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - May 2019)
Cardiovascular disease associated with the use of glucocorticoids in patients with rheumatoid arthritis : a population-based study. (2010)

Most studies of mortality in rheumatoid arthritis patients (RA) have found increased mortality rates compared with the general population, and the majority suggest that one third to one half of the premature deaths in RA are due to increased cardiovascular disease (CVD), including myocardial infarction (MI) and cerebrovascular accidents (CVA). The increased risk of CVD mortality is not explained by traditional risk factors. The risk could be mediated by the deleterious effects of glucocorticoids (GC) used to treat RA. Alternatively, GC may have cardio-protective effects mediated by their anti-inflammatory and anti-proliferative actions in the endothelial wall, especially at low doses. Little is known regarding the long-term effects of GC on the development of CVD. A systematic review and a meta-analysis of all observational studies was conducted and described in Chapter two. This study found that study design is the main driver in the reported variation in mortality. The increased mortality was attributable to increased death from MI and CVA. In Chapters three and four, we assessed the risk of MI and CVA associated with the use of GC, respectively. We assembled a large population-based cohort using administrative health data that included cases with newly-diagnosed RA that were not exposed to GC prior to disease onset. Thus, for the first time, we assessed GC exposure over the entire course of the disease. We used comprehensive GC exposure measures that considered actual and past cumulative exposure individually or together. In addition to the traditional method that considers the lifetime past cumulative exposure measures (duration of use and dose) regardless of recency of use, we used a novel time-dependent method to evaluate if weighting for recency of use would improve the prediction of MI and CVA risk. This thesis has addressed the associated risk of CVD in patients with RA. Further, we have comprehensively assessed the association between GC use and risk of MI and CVA in unique cohort of patients with RA. Our results showed that GC use is associated with an increased risk of MI but not with an increased risk of CVA .

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Spousal social support for persons living with rheumatoid arthritis (2009)

The progressive debilitating effects of rheumatoid arthritis (RA) make the disease a focusof concern and attention for many health care providers. Among the health professionalscommitted are those whose concern is how varieties of social support can improve the quality oflife for persons living with RA. This research is aimed at providing health care educators withinsights to improve the quality of social support available to persons living with RA. It focusesspecifically on investigation of spousal support as a central dyadic relationship in the provisionof overall social support.Persons living with RA and their spouses (N=222 couples) each completedquestionnaires assessing perspectives on the physical and psychosocial impact of the disease onthe person living with RA. Questionnaire items also assessed both positive and negative aspectsof spousal support provided to the person coping with RA. Data collected were analyzed todetermine couple concordant/discordant perspectives on RA impact variables and the nature ofspousal support.The results of this research suggest that, relative to the perceptions of persons living withRA, spouses evidenced variability in their overestimation and underestimation of fatigue, pain,and physical limitation experienced by their partners with RA. Several of these discordantperspectives were significantly associated with persons living with RA reporting poorer qualityof spousal support. In contrast with previous research, the results of the research on coupleconcordant/discordant perspectives on spousal support provided to the person with RA alsosuggest that spousal support is effective when the support recipient perceives its presence, notwhen it is invisible support. Persons with RA reporting the presence of spousal support were,regardless of the spouses’ perspective, associated with higher levels of well-being.These cross-sectional studies are the springboards from which productive longitudinalstudies might arise. The fresh dyadic information is of potential value to couple-based psychoeducationalinterventions designed to assist in the promotion of desirable spousal support.

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