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Objective  To evaluate seasonal patterns of early inflammatory arthritis ( IA ) onset and potential associations with  IA  symptom onset.    Methods  The Canadian Early Arthritis Cohort ( CATCH ) is an inception cohort study of adults with early (12 months or less)  IA . We used patient reports of symptom onset as a proxy of  IA  onset and examined the seasonal distribution of  IA  onset over 10 years. Influenza time series was based on laboratory‐confirmed influenza A and B from the Canadian FluWatch surveillance from 2010‐2016. Bivariate analysis of influenza and  IA  was performed using cross‐correlations with different time lags and Poisson regression.  IA  and influenza were recorded as monthly total frequencies.    Results  Of 2519  IA  patients, 88% had confirmed rheumatoid arthritis ( RA ). Significantly, more  IA  onsets occurred in winter compared with other seasons  (P =  0.03); although  IA  onset was more frequent in January, the difference between months was not statistically significant. Compared to months with the lowest influenza rates, months with the highest influenza rates had a statistically significant, but trivial, increase of 0.003% in the incidence of  IA  (incidence rate ratio (95% confidence interval): 1.00003 (1.00005; 1.000053),  P  = 0.02).    Conclusion  Although  IA  symptom onset occurs more frequently in winter, we found that flu outbreaks were not associated with a meaningful increase in  IA  symptom onset in a large, well‐characterized cohort of Canadian adults over 6 years.

Association of Arthritis Onset with Influenza: Analysis of the Canadian Early Inflammatory Arthritis Cohort