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Tedeschi SK, Hayashi K, Rosenthal A, Gill M, Marrugo J, Fukui S, Gravallese E, Solomon DH. Fractures in Patients With Acute Calcium Pyrophosphate Crystal Arthritis Versus Matched Comparators in a Large Cohort Study. Arthritis Rheumatol 2024; 76:936-941. [PMID: 38221723 PMCID: PMC11136597 DOI: 10.1002/art.42798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/14/2023] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease was associated with osteopenia in two cross-sectional studies. We compared fracture risks in patients with acute calcium pyrophosphate (CPP) crystal arthritis versus matched comparators. METHODS We performed a longitudinal cohort study using electronic health record data from a single large academic health system, with data from 1991 to 2023. Patients with one or more episodes of acute CPP crystal arthritis were matched to comparators on the index date (first documentation of "pseudogout" or synovial fluid CPP crystals or matched encounter) and first encounter in the health system. The primary outcome was first fracture at the humerus, wrist, hip, or pelvis. We excluded patients with fracture before the index date. Covariates included demographics, body mass index, smoking, comorbidities, health care use, glucocorticoids, and osteoporosis treatments. We estimated incidence rates and adjusted hazard ratios for fracture. Sensitivity analyses excluded patients prescribed glucocorticoids, patients prescribed osteoporosis treatments, or patients with rheumatoid arthritis and additionally adjusted for chronic kidney disease. RESULTS We identified 1,148 patients with acute CPP crystal arthritis matched to 3,730 comparators, with a mean age of 73 years. Glucocorticoids and osteoporosis treatments were more frequent in the acute CPP crystal arthritis cohort. Fracture incidence rates were twice as high in the acute CPP crystal arthritis cohort (11.7 per 1,000 person-years) versus comparators (5.5 per 1,000 person-years). After multivariable adjustment, fracture relative risk was twice as high in the acute CPP crystal arthritis cohort (hazard ratio 1.8 [95% confidence interval 1.3-2.3]); results were similar in sensitivity analyses. CONCLUSION In this first published study of fractures and CPPD, fracture risk was nearly doubled in patients with acute CPP crystal arthritis.
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Affiliation(s)
| | | | | | - Muneet Gill
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sho Fukui
- Brigham and Women's Hospital, Boston, Massachusetts
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Pineda C, Sandoval H, Pérez-Neri I, Soto-Fajardo C, Carranza-Enríquez F. Calcium pyrophosphate deposition disease: historical overview and potential gaps. Front Med (Lausanne) 2024; 11:1380135. [PMID: 38638938 PMCID: PMC11024366 DOI: 10.3389/fmed.2024.1380135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
CPPD disease can affect patients’ quality of life through its various clinical presentations. This mini-review discusses the evolution of CPPD from its discovery to current knowledge of its pathogenesis, genetic associations, diagnostics, and treatment options. Despite extensive research, the exact mechanisms of CPPD are not well understood, and there is a notable lack of knowledge about psychosocial impacts and patient experiences. This study aims to present a CPPD Disease Timeline identifying gaps in current knowledge and potential directions for future research. These findings contribute to a broader understanding of CPPD disease and emphasize the importance of continued research and innovation in this field.
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Affiliation(s)
- Carlos Pineda
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Hugo Sandoval
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Iván Pérez-Neri
- Evidence Synthesis Unit, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carina Soto-Fajardo
- Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Fabián Carranza-Enríquez
- Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Yoshida K, Cai T, Bessette LG, Kim E, Lee SB, Zabotka LE, Sun A, Mastrorilli JM, Oduol TA, Liu J, Solomon DH, Kim SC, Desai RJ, Liao KP. Improving the accuracy of automated gout flare ascertainment using natural language processing of electronic health records and linked Medicare claims data. Pharmacoepidemiol Drug Saf 2024; 33:e5684. [PMID: 37654015 PMCID: PMC10873073 DOI: 10.1002/pds.5684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 06/20/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND We aimed to determine whether integrating concepts from the notes from the electronic health record (EHR) data using natural language processing (NLP) could improve the identification of gout flares. METHODS Using Medicare claims linked with EHR, we selected gout patients who initiated the urate-lowering therapy (ULT). Patients' 12-month baseline period and on-treatment follow-up were segmented into 1-month units. We retrieved EHR notes for months with gout diagnosis codes and processed notes for NLP concepts. We selected a random sample of 500 patients and reviewed each of their notes for the presence of a physician-documented gout flare. Months containing at least 1 note mentioning gout flares were considered months with events. We used 60% of patients to train predictive models with LASSO. We evaluated the models by the area under the curve (AUC) in the validation data and examined positive/negative predictive values (P/NPV). RESULTS We extracted and labeled 839 months of follow-up (280 with gout flares). The claims-only model selected 20 variables (AUC = 0.69). The NLP concept-only model selected 15 (AUC = 0.69). The combined model selected 32 claims variables and 13 NLP concepts (AUC = 0.73). The claims-only model had a PPV of 0.64 [0.50, 0.77] and an NPV of 0.71 [0.65, 0.76], whereas the combined model had a PPV of 0.76 [0.61, 0.88] and an NPV of 0.71 [0.65, 0.76]. CONCLUSION Adding NLP concept variables to claims variables resulted in a small improvement in the identification of gout flares. Our data-driven claims-only model and our combined claims/NLP-concept model outperformed existing rule-based claims algorithms reliant on medication use, diagnosis, and procedure codes.
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Affiliation(s)
- Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- OM1, Inc, Boston, MA, USA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erin Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Luke E. Zabotka
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alec Sun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julianna M. Mastrorilli
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Theresa A. Oduol
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rishi J. Desai
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Katherine P. Liao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Whelan MG, Hayashi K, Altwies H, Tedeschi SK. Patient-Reported Outcomes in Calcium Pyrophosphate Deposition Disease Compared to Gout and Osteoarthritis. J Rheumatol 2023; 50:1058-1062. [PMID: 37061233 PMCID: PMC10496647 DOI: 10.3899/jrheum.2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease prevalence is similar to that of gout and osteoarthritis (OA), yet CPPD outcomes research greatly lags behind research in these other forms of arthritis. We compared validated patient-reported outcome measures in patients with CPPD vs gout and OA. METHODS Patients with CPPD were recruited from Brigham and Women's Hospital from 2018 to 2022. Presence of CPPD manifestations (acute calcium pyrophosphate [CPP] crystal arthritis, chronic CPP inflammatory arthritis, and/or OA with CPPD) was confirmed by medical record review. Baseline surveys included the Gout Assessment Questionnaire version 2.0, modified to ask about "pseudogout" rather than "gout"; Routine Assessment of Patient Index Data 3 (RAPID-3); and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We compared responses in patients with CPPD against published gout and OA cohort studies. RESULTS Among 47 patients with CPPD, the mean age was 71.9 years and 51% were female. Sixty-eight percent had at least 1 episode of acute CPP crystal arthritis, 40% had chronic CPP inflammatory arthritis, and 62% had OA with CPPD. Pain visual analog scale scores during a flare were similar in CPPD (mean 6.8 [SD 1.9]) and gout (mean 6.7 [SD 2.6]; P = 0.78). Patients with CPPD reported significantly greater unmet treatment need than patients with gout (P = 0.04). RAPID-3 scores in CPPD (mean 8.1 [SD 5.6]) were lower than in gout (mean 12.1 [SD 6.2]; P < 0.01) and similar in OA (mean 6.8 [SD 6.1]; P = 0.30). Patients with CPPD had significantly worse WOMAC stiffness scores than patients with mild OA, and significantly better WOMAC function scores than patients with severe OA. CONCLUSION Patients with CPPD may experience pain comparable to that in gout and OA and reported substantial unmet treatment needs.
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Affiliation(s)
- Mary Grace Whelan
- M.G. Whelan, BS, K. Hayashi, MD, MPH, H. Altwies, BS, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Keigo Hayashi
- M.G. Whelan, BS, K. Hayashi, MD, MPH, H. Altwies, BS, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Hallie Altwies
- M.G. Whelan, BS, K. Hayashi, MD, MPH, H. Altwies, BS, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Sara K Tedeschi
- S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
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Madrid-García A, Merino-Barbancho B, Rodríguez-González A, Fernández-Gutiérrez B, Rodríguez-Rodríguez L, Menasalvas-Ruiz E. Understanding the role and adoption of artificial intelligence techniques in rheumatology research: An in-depth review of the literature. Semin Arthritis Rheum 2023; 61:152213. [PMID: 37315379 DOI: 10.1016/j.semarthrit.2023.152213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
The major and upward trend in the number of published research related to rheumatic and musculoskeletal diseases, in which artificial intelligence plays a key role, has exhibited the interest of rheumatology researchers in using these techniques to answer their research questions. In this review, we analyse the original research articles that combine both worlds in a five- year period (2017-2021). In contrast to other published papers on the same topic, we first studied the review and recommendation articles that were published during that period, including up to October 2022, as well as the publication trends. Secondly, we review the published research articles and classify them into one of the following categories: disease identification and prediction, disease classification, patient stratification and disease subtype identification, disease progression and activity, treatment response, and predictors of outcomes. Thirdly, we provide a table with illustrative studies in which artificial intelligence techniques have played a central role in more than twenty rheumatic and musculoskeletal diseases. Finally, the findings of the research articles, in terms of disease and/or data science techniques employed, are highlighted in a discussion. Therefore, the present review aims to characterise how researchers are applying data science techniques in the rheumatology medical field. The most immediate conclusions that can be drawn from this work are: multiple and novel data science techniques have been used in a wide range of rheumatic and musculoskeletal diseases including rare diseases; the sample size and the data type used are heterogeneous, and new technical approaches are expected to arrive in the short-middle term.
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Affiliation(s)
- Alfredo Madrid-García
- Grupo de Patología Musculoesquelética. Hospital Clínico San Carlos, Prof. Martin Lagos s/n, Madrid, 28040, Spain; Escuela Técnica Superior de Ingenieros de Telecomunicación. Universidad Politécnica de Madrid, Avenida Complutense, 30, Madrid, 28040, Spain.
| | - Beatriz Merino-Barbancho
- Escuela Técnica Superior de Ingenieros de Telecomunicación. Universidad Politécnica de Madrid, Avenida Complutense, 30, Madrid, 28040, Spain
| | | | - Benjamín Fernández-Gutiérrez
- Grupo de Patología Musculoesquelética. Hospital Clínico San Carlos, Prof. Martin Lagos s/n, Madrid, 28040, Spain
| | - Luis Rodríguez-Rodríguez
- Grupo de Patología Musculoesquelética. Hospital Clínico San Carlos, Prof. Martin Lagos s/n, Madrid, 28040, Spain
| | - Ernestina Menasalvas-Ruiz
- Centro de Tecnología Biomédica. Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, 28223, Spain
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Salis Z, Gallego B, Sainsbury A. Researchers in rheumatology should avoid categorization of continuous predictor variables. BMC Med Res Methodol 2023; 23:104. [PMID: 37101144 PMCID: PMC10134601 DOI: 10.1186/s12874-023-01926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology. METHODS We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes. RESULTS For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association). CONCLUSIONS Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
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Affiliation(s)
- Zubeyir Salis
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Blanca Gallego
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Perth, WA, 6009, Australia.
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Hossain E, Rana R, Higgins N, Soar J, Barua PD, Pisani AR, Turner K. Natural Language Processing in Electronic Health Records in relation to healthcare decision-making: A systematic review. Comput Biol Med 2023; 155:106649. [PMID: 36805219 DOI: 10.1016/j.compbiomed.2023.106649] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Natural Language Processing (NLP) is widely used to extract clinical insights from Electronic Health Records (EHRs). However, the lack of annotated data, automated tools, and other challenges hinder the full utilisation of NLP for EHRs. Various Machine Learning (ML), Deep Learning (DL) and NLP techniques are studied and compared to understand the limitations and opportunities in this space comprehensively. METHODOLOGY After screening 261 articles from 11 databases, we included 127 papers for full-text review covering seven categories of articles: (1) medical note classification, (2) clinical entity recognition, (3) text summarisation, (4) deep learning (DL) and transfer learning architecture, (5) information extraction, (6) Medical language translation and (7) other NLP applications. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULT AND DISCUSSION EHR was the most commonly used data type among the selected articles, and the datasets were primarily unstructured. Various ML and DL methods were used, with prediction or classification being the most common application of ML or DL. The most common use cases were: the International Classification of Diseases, Ninth Revision (ICD-9) classification, clinical note analysis, and named entity recognition (NER) for clinical descriptions and research on psychiatric disorders. CONCLUSION We find that the adopted ML models were not adequately assessed. In addition, the data imbalance problem is quite important, yet we must find techniques to address this underlining problem. Future studies should address key limitations in studies, primarily identifying Lupus Nephritis, Suicide Attempts, perinatal self-harmed and ICD-9 classification.
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Affiliation(s)
- Elias Hossain
- School of Engineering & Physical Sciences, North South University, Dhaka 1229, Bangladesh.
| | - Rajib Rana
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Niall Higgins
- School of Management and Enterprise, University of Southern Queensland, Darling Heights QLD 4350, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4000, Australia; Metro North Mental Health, Herston QLD 4029, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Prabal Datta Barua
- School of Business, University of Southern Queensland, Springfield Central QLD 4300, Australia
| | - Anthony R Pisani
- Center for the Study and Prevention of Suicide, University of Rochester, Rochester, NY, United States
| | - Kathryn Turner
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4000, Australia
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Tedeschi SK, Yoshida K, Huang W, Solomon DH. Confirming Prior and Identifying Novel Correlates of Acute Calcium Pyrophosphate Crystal Arthritis. Arthritis Care Res (Hoboken) 2023; 75:283-288. [PMID: 34397174 PMCID: PMC8847549 DOI: 10.1002/acr.24770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate previously identified and novel correlates of acute calcium pyrophosphate (CPP) crystal arthritis among well-characterized cases. METHODS In this case-control study, we identified cases of acute CPP crystal arthritis using a validated algorithm (positive predictive value 81%) applied in the Partners HealthCare electronic health record (EHR). Cases were matched to general patient controls on the year of first EHR encounter and index date. Prespecified potential correlates included sex, race, and comorbidities and medications previously associated with CPP deposition/acute CPP crystal arthritis in the literature. We estimated odds ratios (ORs) and 95% confidence intervals using conditional logistic regression models adjusted for demographic characteristics, comorbidities, medications prescribed in the past 90 days, health care utilization, and multimorbidity score. RESULTS We identified 1,697 cases matched to 6,503 controls. Mean ± SD age was 73.7 ± 11.8 years, 56.7% were female, 80.8% were White, and 10.3% were Black. All prespecified covariates were more common in cases than controls. Osteoarthritis (OR 3.08), male sex (OR 1.35), rheumatoid arthritis (OR 2.09), gout (OR 2.83), proton pump inhibitors (OR 1.94), loop diuretics (OR 1.60), and thiazides (OR 1.46) were significantly associated with acute CPP crystal arthritis after full adjustment. Black race was associated with lower odds for acute CPP crystal arthritis compared to White race (OR 0.47). CONCLUSION Using a validated algorithm to identify nearly 1,700 patients with acute CPP crystal arthritis, we confirmed important correlates of this acute manifestation of CPP deposition. This is the first study to report higher odds for acute CPP crystal arthritis among males.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Weixing Huang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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9
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Liew JW, Peloquin C, Tedeschi SK, Felson DT, Zhang Y, Choi HK, Terkeltaub R, Neogi T. Proton-Pump Inhibitors and Risk of Calcium Pyrophosphate Deposition in a Population-Based Study. Arthritis Care Res (Hoboken) 2022; 74:2059-2065. [PMID: 35245410 PMCID: PMC9440954 DOI: 10.1002/acr.24876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE There are no proven effective medical treatments to prevent calcium pyrophosphate crystal deposition (CPPD). Hypomagnesemia is a known CPPD risk factor. The present study was undertaken to carry out a real-world epidemiologic study on proton-pump inhibitor (PPI) use, which can cause hypomagnesemia, and CPPD risk. METHODS We conducted a time-stratified, propensity score (PS)-matched cohort study using the UK-based IQVIA Medical Research Data. We compared risk of incident CPPD among PPI users versus H2 blocker users using Cox proportional hazards models. We used greedy matching of incident PPI users 1:1 to incident histamine receptor 2 (H2 ) blocker users in 1-year cohort accrual blocks. Subjects were censored at time of drug switch. We evaluated incident use of PPI and H2 blockers prior to incident CPPD using a nested case-control study within the same cohort, matched 1:4 by age and sex using risk-set sampling. RESULTS We identified 81,102 PPI and H2 blocker initiators, with 113 and 63 incident cases of CPPD, respectively. In the case-control study when compared with nonusers, both PPI and H2 B users had higher risk of incident CPPD, with odds ratios (ORs) of 1.79 (95% confidence interval [95% CI] 1.55-2.07) and 1.52 (95% CI 1.14-2.03), respectively. Incident PPI use was nonsignificantly associated with incident CPPD (hazard ratio 1.03 [95% CI 0.75-1.41]) compared with H2 blocker use. CONCLUSION In this study using real-world data, incident use of PPIs was not associated with a higher risk of CPPD compared with incident H2 blocker use, although use of PPI and H2 blockers had higher risk compared with nonuse.
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Affiliation(s)
- Jean W Liew
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Sara K Tedeschi
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hyon K Choi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert Terkeltaub
- VA San Diego Healthcare System and University of California San Diego, La Jolla
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
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10
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Tedeschi SK, Huang W, Yoshida K, Solomon DH. Risk of cardiovascular events in patients having had acute calcium pyrophosphate crystal arthritis. Ann Rheum Dis 2022; 81:1323-1329. [PMID: 35613842 PMCID: PMC10043830 DOI: 10.1136/annrheumdis-2022-222387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Calcium pyrophosphate deposition (CPPD) disease, broadly defined, has been associated with increased risk of cardiovascular (CV) events. We investigated risk of CV events in patients with acute CPP crystal arthritis, the acute manifestation of CPPD. METHODS Cohort study using Mass General Brigham electronic health record (EHR) data, 1991-2017. Patients with acute CPP crystal arthritis were identified using a published machine learning algorithm with positive predictive value 81%. Comparators were matched on year of EHR entry and index date of patients with acute CPP crystal arthritis (first positive synovial fluid CPP result or mention of 'pseudogout', or matched encounter). Major adverse cardiovascular event (MACE) was a composite of non-fatal CV event (myocardial infarction, acute coronary syndrome, coronary revascularisation, stroke) and death. We estimated incidence rates (IRs) and adjusted hazard ratios for MACE, non-fatal CV event and death, allowing for differential estimates during years 0-2 and 2-10. Sensitivity analyses included: (1) patients with acute CPP crystal arthritis diagnosed during outpatient visits, (2) patients with linked Medicare data, 2007-2016 and (3)patients matched on number of CV risk factors. RESULTS We matched 1200 acute CPP crystal arthritis patients to 3810 comparators. IR for MACE in years 0-2 was 91/1000 person-years (p-y) in acute CPP crystal arthritis and 59/1000 p-y in comparators. In years 2-10, IR for MACE was 58/1000 p-y in acute CPP crystal arthritis and 53/1000 p-y in comparators. Acute CPP crystal arthritis was significantly associated with increased risk for MACE in years 0-2 (HR 1.32, 95% CI 1.01 to 1.73) and non-fatal CV event in years 0-2 (HR 1.92, 95% CI 1.12 to 3.28) and years 2-10 (HR 2.18, 95% CI 1.27 to 3.75), but not death. Results of sensitivity analyses were similar to the primary analysis; in the outpatient-only analysis, risk of non-fatal CVE was significantly elevated in years 2-10 but not in years 0-2. CONCLUSIONS Acute CPP crystal arthritis was significantly associated with elevated short and long-term risk for non-fatal CV event.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Weixing Huang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
This review highlights outcomes for patients with calcium pyrophosphate deposition (CPPD) reported in prior studies and underscores challenges to assessing outcomes of this condition. Prior clinical studies of interventions for CPPD focused on joint damage and calcification on imaging tests, joint pain, swelling, and inflammatory biomarkers. Qualitative interviews with patients with CPPD and healthcare providers additionally identified flares, overall function, and use of analgesic medications as important outcomes. Imaging evidence of joint damage and calcification is likely to be outcomes in future clinical studies of CPPD, though reliability and sensitivity to change in CPPD require further testing for several imaging modalities. Challenges to outcome measurement in CPPD include questions of attribution of signs and symptoms to CPPD versus co-existing forms of arthritis, lack of therapies to prevent or dissolve calcium pyrophosphate crystal deposition, absence of validated patient- or physician-reported CPPD outcome measures, and scarcity of large cohorts in which to study outcomes of different clinical presentations of CPPD.
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Affiliation(s)
- Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Westmead Hospital, Westmead, Australia
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Abstract
With advances in information technology, the demand for using data science to enhance healthcare and disease management is rapidly increasing. Among these technologies, machine learning (ML) has become ubiquitous and indispensable for solving complex problems in many scientific fields, including medical science. ML allows the development of guidelines and framing of the evaluation system for complex diseases based on massive data. In the analysis of rheumatic diseases, which are chronic and remarkably heterogeneous, ML can be anticipated to be extremely helpful in deciphering and revealing the inherent interrelationships in disease development and progression, which can further enhance the overall understanding of the disease, optimize patients' stratification, calibrate therapeutic strategies, and predict prognosis and outcomes. In this review, the basics of ML, its potential clinical applications in rheumatology, together with its strengths and limitations are summarized.
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De Silva K, Mathews N, Teede H, Forbes A, Jönsson D, Demmer RT, Enticott J. Clinical notes as prognostic markers of mortality associated with diabetes mellitus following critical care: A retrospective cohort analysis using machine learning and unstructured big data. Comput Biol Med 2021; 132:104305. [PMID: 33705995 DOI: 10.1016/j.compbiomed.2021.104305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical notes are ubiquitous resources offering potential value in optimizing critical care via data mining technologies. OBJECTIVE To determine the predictive value of clinical notes as prognostic markers of 1-year all-cause mortality among people with diabetes following critical care. MATERIALS AND METHODS Mortality of diabetes patients were predicted using three cohorts of clinical text in a critical care database, written by physicians (n = 45253), nurses (159027), and both (n = 204280). Natural language processing was used to pre-process text documents and LASSO-regularized logistic regression models were trained and tested. Confusion matrix metrics of each model were calculated and AUROC estimates between models were compared. All predictive words and corresponding coefficients were extracted. Outcome probability associated with each text document was estimated. RESULTS Models built on clinical text of physicians, nurses, and the combined cohort predicted mortality with AUROC of 0.996, 0.893, and 0.922, respectively. Predictive performance of the models significantly differed from one another whereas inter-rater reliability ranged from substantial to almost perfect across them. Number of predictive words with non-zero coefficients were 3994, 8159, and 10579, respectively, in the models of physicians, nurses, and the combined cohort. Physicians' and nursing notes, both individually and when combined, strongly predicted 1-year all-cause mortality among people with diabetes following critical care. CONCLUSION Clinical notes of physicians and nurses are strong and novel prognostic markers of diabetes-associated mortality in critical care, offering potentially generalizable and scalable applications. Clinical text-derived personalized risk estimates of prognostic outcomes such as mortality could be used to optimize patient care.
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Affiliation(s)
- Kushan De Silva
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia.
| | - Noel Mathews
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
| | - Andrew Forbes
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, 3004, Australia
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, 21119, Sweden; Swedish Dental Service of Skane, Lund, 22647, Sweden
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Mailman School of Public Health, Columbia University, New York, USA
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
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