Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Speechley, Mark

2nd Supervisor

Pope, Janet



Viruses can trigger rheumatoid arthritis (RA) or inflammatory arthritis (IA). Our study provides insight into etiology of RA/IA. We analyzed the evidence relating to the risk of RA after viral infections; estimated the distribution of IA onsets over time; quantified the effect of influenza on the risk of IA.

Results of systematic review and meta-analysis showed that the risk of RA/IA is increased after parvovirus B19 and chikungunya virus. There seems to be a risk of RA after chronic hepatitis C (HCV), but whether it is a true RA or HCV-associated arthritis is not clear.

We estimated the distribution of IA onset for 10 years of observations using data from the Canadian Early Arthritis cohort of adults with incident early IA. We found that IA onset clusters in winter compared to other seasons. We applied time series regression analysis to estimate the effect of influenza time series on IA time series from 2010 to 2016. Influenza time series was based on laboratory confirmed influenza A and B cases retrieved from the Canadian FluWatch surveillance program. Our study showed on average 0.003% increase in IA onset with every influenza onset.