Spring 2019 (Volume 29, Number 1)
Update on CanVasc Initiatives and the
Consolidated Place of Canada in the
International Vasculitis Research Field
By Christian Pagnoux, MD, MSc, MPH
The objectives of the Canadian Vasculitis
network (CanVasc), when it was founded
in 2010, were to optimize the care of patients
with vasculitis in Canada by identifying
centres with expertise and interest in vasculitis;
to develop recommendations, educational and
awareness programs for health care providers; promote
and develop studies on vasculitis; and increase Canadian
participation and recognition in the international
Nineteen centres across Canada are now affiliated with
CanVasc, with the recent addition of the Victoria, BC centre
(Dr. C. Baldwin). More collaborators from various specialties
have joined the CanVasc centres, including Dr. J.W.
Cohen-Tervaert, an internationally renowned rheumatologist
and immunologist, who has conducted and participated
in many seminal studies of vasculitis and moved a
couple of years ago from The Netherlands to Edmonton.
Results of several cohort studies or series from a few
CanVasc centres have been published and involved Canadian
or international vasculitis fellows (e.g., L. McGeoch,
M. Soowamber, M. Rhéaume), rheumatology or internal
medicine residents, or medical students (e.g., B. Russell).
Other study projects are ongoing, and ideas for new ones
Collaborations with the Vasculitis Clinical Research
Consortium (VCRC), led by Dr. P.A. Merkel in the United
States, have grown further. Toronto (Dr. S. Carette) and
Hamilton (Dr. N. Khalidi) were the first centres, in 2006,
to participate in this huge U.S. National Institutes of
Health-funded network. A few other CanVasc centres, including
Montreal, Ottawa, London, Calgary and Vancouver
recently joined for some specific sub-studies, and others
will. Of note, a few CanVasc core members are now leading
some VCRC sub-studies. Dr. N. Milman (Ottawa) leads the
newly launched VCRC longitudinal cohort study for isolated
aortitis. Dr. C. Pagnoux (Toronto) leads the ongoing
ARAMIS study, the second ever-conducted randomized trial
for isolated skin vasculitis.
Many Canadian centres participated in the recently
completed PEXIVAS study (assessing plasma exchange and
steroid dosing in severe ANCA-associated vasculitis), led by
Drs. M. Walsh, nephrologist and associated
CanVasc core member in Hamilton, P.A. Merkel
(VCRC) and D. Jayne (EUVAS). Several Canadian
centres also took part in the pharma-sponsored
studies on giant cell arteritis (GiACTA;
study of tocilizumab) or EGPA (MIRRA; study of
In parallel, CanVasc core members achieved important
national, practice-oriented or educational projects. The
first CanVasc recommendations, for the diagnosis and management
of ANCA-associated vasculitis, were published in
2016, and the process of updating them has just begun,
with Dr. A. Mendel, current vasculitis fellow in Toronto and
future staff rheumatologist in Montreal. Several systematic
reviews of various aspects of the management of Takayasu
arteritis have been published by the groups of Dr. L. Barra
(London, ON) and Dr. E. Yacyshyn (Edmonton), and others
are ongoing, including on giant cell arteritis (Dr. P. Liang’s
In total, 400 books of the first edition of CaVALI (Canadian
VAsculitis Learning Initiative) were distributed, free-of-
charge, across Canada, to CanVasc members, fellows and
residents. This unique tool includes real-life case-scenarios,
with practical questions and answers. A second edition,
entirely updated, is in press; 800 books will be printed, for
core members to distribute in their centres. The electronic
version will be available in fall 2019 on the CanVasc website,
where various teaching or conference presentations by
core members are already available.
Hence, core members can be proud of what they have
accomplished or participated in. Several new projects are
ongoing, and collaborations will be expanding. There are
persistent challenges, some with no clear solution yet, such
as assuring the funding of future CanVasc activities, or the
need to develop more original, multicentre, institution-driven
studies, especially when a nation-wide, centralized process
for ethics approvals is still lacking. All hands on deck!
Christian Pagnoux, MD, MSc, MPH
Founder and Current Director of CanVasc, Vasculitis Clinic,
Division of Rheumatology, Department of Medicine,
Mount Sinai Hospital, Toronto, Ontario
1. Baldwin C, Carette S, Pagnoux C. Linking classification and therapeutic management of vasculitides.
Arthritis Res Ther 2015; 17:138.
2. Barra L, Kanji T, Malette J, Pagnoux C, CanVasc. Imaging modalities for the diagnosis and disease
activity assessment of Takayasu's arteritis: A systematic review and meta-analysis. Autoimmun Rev
3. Barra L, Liang P, Benseler SM, et al. Variations in the clinical practice of physicians managing
Takayasu arteritis: a nationwide survey. Open Access Rheumatol 2017; 9:91-9.
4. Barra L, Yang G, Pagnoux C, CanVasc. Non-glucocorticoid drugs for the treatment of Takayasu's
arteritis: A systematic review and meta-analysis. Autoimmun Rev 2018; 17:683-93.
5. Barra L, Borchin RL, Burroughs C, et al. Impact of vasculitis on employment and income. Clin Exp
Rheumatol 2018; 36 Suppl 111:58-64.
6. McGeoch L, Twilt M, Famorca L, et al. CanVasc Recommendations for the Management of Antineutrophil
Cytoplasm Antibody-associated Vasculitides. J Rheumatol 2016; 43:97-120.
7. McGeoch L, Carette S, Cuthbertson D, et al. Cardiac involvement in granulomatosis with polyangiitis
J Rheumatol 2015; 42:1209-12.
8. Osman M, Pagnoux C, Dryden DM, et al. The role of biological agents in the management of large
vessel vasculitis (LVV): a systematic review and meta-analysis PLoS One 2014; 9:e115026.
9. Pagnoux C, Nair P, Xi Y, et al. Serum cytokine and chemokine levels in patients with eosinophilic
granulomatosis with polyangiitis, hypereosinophilic syndrome, or eosinophilic asthma. Clin Exp
10. Rheaume M, Rebello R, Pagnoux C, et al. High-resolution magnetic resonance imaging of scalp
arteries for the diagnosis of giant cell arteritis: Results of a prospective cohort study. Arthritis
Rheumatol 2017; 69:161-8.
11. Russell BA, Mohan S, Chahal R, Carette S, Pagnoux C, CanVasc. Prognostic significance of cavitary
lung nodules in granulomatosis with polyangiitis – A clinical and imaging study of 225 patients.
Arthritis Care Res (Hoboken) 2017.
12. Stone JH, Tuckwell K, Dimonaco S, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med
13. Soowamber M, Weizman AV, Pagnoux C. Gastrointestinal aspects of vasculitides. Nat Rev Gastroenterol
Hepatol 2017; 14:185-94.
14. Walsh M, Merkel PA, Peh CA, et al. Plasma exchange and glucocorticoid dosing in the treatment
of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS): protocol for a randomized
controlled trial. Trials 2013; 14:73.
15. Wechsler ME, Akuthota P, Jayne D, et al. Mepolizumab or placebo for eosinophilic granulomatosis
with polyangiitis. N Engl J Med 2017; 376:1921-32.