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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Constien D, Chan KK, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips L“R, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:1299-1311. [PMID: 37227071 PMCID: PMC10947582 DOI: 10.1002/art.42507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R. England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | | | - Jennifer L. Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | - Carole V. Dodge
- University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY
| | | | | | | | | | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Chris Y. Lane
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, TN
| | | | | | | | | | - Louise Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Chan KK, Constien D, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips LR, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023. [PMID: 37227116 DOI: 10.1002/acr.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | | | | | | | - Carole V Dodge
- University of Michigan Hospital and Health System, Ann Arbor
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | | | | | | | - Janet Lewis
- University of Virginia, Charlottesville, Virginia
| | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, California
| | | | - Neha Shah
- Stanford Health Care, Palo Alto, California
| | | | | | - Rawan AlHeresh
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Linda C Li
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, Tennesee
| | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Shato T, Humble S, Anandarajah A, Barnette A, Brandt HM, Garbutt J, Klesges L, Thompson VS, Silver MI. Influences of sociodemographic characteristics and parental HPV vaccination hesitancy on HPV vaccination coverage in five US states. Vaccine 2023:S0264-410X(23)00517-0. [PMID: 37198022 DOI: 10.1016/j.vaccine.2023.04.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States (US), half of new human papillomavirus (HPV) infections occur among young people aged 15-24 years. Despite the effectiveness of HPV vaccination in protecting against HPV-associated cancers, its coverage among adolescents remains suboptimal. This study examined the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage in five US states with disproportionately low adolescent coverage rates compared to the national average. METHODS Responses to an online Qualtrics survey from 926 parents of children aged 9-17 years in Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois in July 2021 were analyzed using multivariate logistic regression to estimate the association of sociodemographic characteristics and HPV vaccination hesitancy with HPV vaccination coverage. RESULTS Of the parents, 78 % were female, 76 % were non-Hispanic White, 61.9 % lived in rural areas, 22 % were classified as HPV vaccine hesitant, and 42 % had vaccinated their oldest child between the ages of 9-17 years against HPV. Children of vaccine hesitant parents were less likely to have received any doses of the HPV vaccine than children of non-vaccine hesitant parents (AOR: 0.17, 95 % CI:0.11-0.27). Male children were less likely to have initiated the HPV vaccine series than female children (AOR: 0.70, 95 % CI:0.50-0.97). Older children (13-17 vs 9-12 years), receiving the meningococcal conjugate or most recent seasonal influenza vaccine were all associated with higher likelihoods of receiving any doses of the HPV vaccine (AOR: 6.01, 95 % CI:3.98-9.08; AOR: 2.24, 95 % CI:1.27-3.95; AOR: 2.41, 95 % CI:1.73-3.36, respectively). CONCLUSIONS Adolescent HPV vaccination coverage remains low in our targeted states. Children's age, sex, and parental vaccine hesitancy were significantly associated with likelihood of HPV vaccination. These findings offer the opportunity for targeted interventions among parents in regions with low vaccine uptake and underscore the importance of developing and implementing strategies to address parental HPV vaccination hesitancy to improve uptake in the US.
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Affiliation(s)
- T Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, United States; Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States.
| | - S Humble
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - A Anandarajah
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States; Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110, United States
| | - A Barnette
- Saint Francis Medical Center, 211 St. Francis Drive, Cape Girardeau, MO 63703, United States
| | - H M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
| | - J Garbutt
- Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - L Klesges
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - V S Thompson
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110, United States; Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - M I Silver
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
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Wanty NI, Cooper DL, Simkus A, Twombly EC, McCalla S, Holtz SKD, Langford AT, Cozart T, Gorlitsky B, Moore C, Culton D, Richardson CT, Wardrop RM, Newcomb J, Aranow C, Lim S, Anandarajah A, Sheikh SZ. A Provider-Based Approach to Address Racial Disparities in Lupus Clinical Trial Participation. Arthritis Care Res (Hoboken) 2022. [PMID: 36342382 DOI: 10.1002/acr.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Substantial disparities exist in clinical trial participation, which is problematic in diseases such as lupus that disproportionately affect racial/ethnic minority populations. Our objective was to examine the effectiveness of an online educational course aiming to train medical providers to refer Black and Latino patients to lupus clinical trials (LCTs). METHODS The American College of Rheumatology's Materials to Increase Minority Involvement in Clinical Trials (MIMICT) study used an online, randomized, 2-group, pretest/posttest design with medical and nursing providers of multiple specialties. We exposed intervention group participants to an education course, while the control group participants received no intervention. Controlling for the effects of participant characteristics, including specialty, and professional experience with lupus, we modeled relationships among exposure to the education course and changes in knowledge, attitudes, self-efficacy, and intentions to refer Black and Latino patients to LCTs. We also examined education course satisfaction. RESULTS Compared to the control group, the intervention group had significantly higher posttest scores for knowledge, self-efficacy, and intentions to refer Black and Latino patients to LCTs. Both medical and nursing trained intervention group participants had significantly higher mean posttest scores for knowledge and intentions to refer compared to the medical and nursing trained control group participants. Attitude was insignificant in analysis. The online education course, which received a favorable summary score, indicated that satisfaction and intentions to refer were strongly and positively correlated. CONCLUSION The MIMICT education course is an effective method to educate medical providers about LCTs and to improve their intentions to refer Black and Latino patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
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Anandarajah A, Thirukumaran C, McCarthy K, McMahon S, Feng C, Ritchlin C. Identification and Characterization of a High-Need, High-Cost Group Among Hospitalized Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:648-655. [PMID: 33202104 DOI: 10.1002/acr.24510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify a high-need, high-cost (HNHC) group among hospitalized lupus patients and to compare clinical and social factors of the HNHC group with those of other patients with lupus. METHODS All hospitalizations for lupus in a tertiary care center over a 3-year period were recorded. The number of admissions, 30-day readmissions, length of stay (LOS), and cost of admissions were compared for high-risk patients with those of all other hospitalized lupus patients (OHLP) during this period. We then compared clinical measures (double-stranded DNA [dsDNA] levels, complement proteins, body mass index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI] scores, and Case Mix Index [CMI] scores) for the HNHC cohort with those of the OHLP group. We additionally differentiated social factors (age, race and ethnicity, poverty, and medication adherence) between the 2 groups. RESULTS A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty-four patients had significantly higher admissions, 30-day readmissions, and LOS. Furthermore, the cost for this group was 6-fold that for the OHLP group, confirming the presence of an HNHC cohort. The HNHC group had significantly higher dsDNA levels, SDI scores, and CMI scores compared with the OHLP group. Infections were the most common cause of admission for both groups. Patients in the HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, to have lower medication adherence, and to be significantly more likely to live in areas of poverty. CONCLUSION A small group of patients with lupus (the HNHC group) accounts for most of the hospitalizations and cost. The HNHC group has both social and clinical factors significantly different from other patients with lupus.
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Abstract
Health care disparities are a major cause for large discrepancies in health outcomes between different populations with systemic lupus erythematosus in the United States.A team-based model that incorporates a care coordination strategy in the management of high-risk lupus patients can provide an effective method to overcome the obstacles posed by health care disparities.Access, behavioral modification, community outreach programs, depression, and education are key aspects that need to be addressed when designing interventions to improve the quality of care for high-risk lupus patients.
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Affiliation(s)
- Allen Anandarajah
- Division of Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 695, Rochester, NY 14642, USA.
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Sheikh S, Wanty N, Mccalla S, Santana A, Saxena Beem S, Walker J, Holt D, Howell A, Holtz K, Williams S, Anandarajah A. AB1360-HPR A MODEL TO IMPROVE MINORITY PATIENT RECRUITMENT IN LUPUS CLINICAL TRIALS - THE AMERICAN COLLEGE OF RHEUMATOLOGY MIMICT PROJECT EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In the US, African Americans and Latinos are underrepresented in lupus clinical trials (LCTs),1despite experiencing the greatest lupus disease burden.2,3Low participation in LCTs results in inadequate data on treatment effectiveness for minority patients, and fewer opportunities for better care and treatment options.1Only one percent of minority patients are referred to clinical trials each year.4Provider barriers to making referrals include limited time and unfamiliarity with lupus and LCT opportunities.4Using US fedral grant funds, the American College of Rheumatology (ACR) developed MIMICT, a two-part model with associated materials to address provider-side LCT referral barriers. The materials include a toolkit for clinical trial sites and an educational toolkit for providers.Objectives:Our objectives are to:•Describe the US LCTs disparities.•Discuss the research methodology to evaluate the two-part MIMICT model.•Assess the feasibility of the model to increase minority involvement in clinical trials.Methods:We designed two studies to evaluate the MIMICT model.The first study used an online, pretest/posttest, two-group evaluation approach to assess the extent to which the educational toolkit increased providers‘ knowledge, attitudes, self-efficacy, and behavioral intentions to refer minority patients to clinical trial. We conducted the study in 2018 with primary care providers (PCPs) and again in 2019/2020 with speciality providers. The second study used a longitudinal, mised methods, case-study approach to explore the real-world use of the toolkits with clinical trial site teams at two university medical centers.Results:In the first study,among MIMCT-exposed PCPs, mean scores indicated statistical significance at p≤0.001 with more knowledge about referring [55.84 (sd=23.51) vs 41.76 (sd=19.98)], more self-efficacy to refer [55.00 (sd=37.22) vs. 37.99 (sd=34.42)], and more intentions to refer [61.36 (43.85) vs. 33.41 (41.16)] African American patients to LCTs among the treatment group than the control group, respectively. This presentation will discuss additional data comparing the study in 2018 and the study in 2019/2020 and look comparatively at outcomes across provider type.In the second study, we found that the driver for successful engagemetn of providers and their subsequent use of the educational toolkit was the development of a trusting relationship between the clinical trial site teams and providers in the community. The development of trust took repeated and varied modes of contact, which we will discuss in-depth.Conclusion:The MIMICT educational toolkit increase knowledge, self-efficacy, and intentions to refer lupus patients to LCTs. However, building trust between LCT sites and local providers takes time and repeated outreach, but the potential benefits to medicine and minority health are substantial.References:[1]The Society for Women’s Health Research. (2011). Dialogues on diversifying clinical trials: successful strategies for engaging women and minorities in clinical trials. Washington, DC: Food and Drug Administration, Office of Women’s Health.[2]Falasinnu, T., Chaichian, Y., Bass, M. B., & Simard, J. F. (2018). The representation of gender and race/ethnic groups in randomized clinical trials of individuals with sytemic lupus erythematosus.Current Rheumatology Reports, 20(4).[3]Pons-Estel, G. J., Alarcon, G. S., Scofield, L., Reinlib, L., & Cooper, G. S. (2010). Understanding the epidemiological progression of systemic lupus erythematosus.Seminars in Arthritis and Rheumatism, 39(4).[4]Korieth, K. (2016). Engaging healthcare providers as research facilitators.The CenterWatch Monthly, 23,1-5.Disclosure of Interests:None declared
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Anandarajah A, Thiele R, Giampoli E, Monu J, Seo GS, Feng C, Ritchlin CT. Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histology and imaging studies. J Rheumatol 2014; 41:2153-60. [PMID: 25274900 DOI: 10.3899/jrheum.140411] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology. METHODS We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined. RESULTS Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US. CONCLUSION Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
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Affiliation(s)
- Allen Anandarajah
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
| | - Ralf Thiele
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Ellen Giampoli
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Johnny Monu
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Gwy-Suk Seo
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Changyong Feng
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Christopher T Ritchlin
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
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Bekaert B, Massoli C, Anandarajah A, Van de Voorde W, Decorte R. Multiplex DNA amplification and barcoding in a single reaction for 454 Roche sequencing: A comprehensive study on the control region of the mitochondrial genome. Forensic Science International: Genetics Supplement Series 2013. [DOI: 10.1016/j.fsigss.2013.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Conaghan PG, McQueen FM, Bird P, Peterfy CG, Haavardsholm EA, Gandjbakhch F, Bøyesen P, Coates L, Ejbjerg B, Eshed I, Foltz V, Hermann KG, Freeston J, Lillegraven S, Lassere M, Wiell C, Anandarajah A, Duer-Jensen A, O'Connor P, Genant HK, Emery P, Ostergaard M. Update on research and future directions of the OMERACT MRI inflammatory arthritis group. J Rheumatol 2012; 38:2031-3. [PMID: 21885512 DOI: 10.3899/jrheum.110419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The OMERACT Magnetic Resonance Imaging (MRI) Task Force has developed and evolved the psoriatic arthritis MRI score (PsAMRIS) over the last few years, and at OMERACT 10, presented longitudinal evaluation by multiple readers, using PsA datasets obtained from extremity MRI magnets. Further evaluation of this score will require more PsA imaging datasets. As well, due to improved image resolution since the development of the original rheumatoid arthritis MRI scoring system (RAMRIS), the Task Force has worked on semiquantitative assessment of joint space narrowing, and developed a reliable method as a potential RAMRIS addendum, although responsiveness will need to be evaluated. One of the strengths of MRI is the ability to detect subclinical synovitis, so the group worked on obtaining low disease activity/clinical remission datasets from a number of international centers and presented cross-sectional findings. Subsequent longitudinal evaluation of this unique resource will be a major continuing focus for the group.
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Affiliation(s)
- Philip G Conaghan
- Department of Rheumatology, Pitié Salpetrière Hospital, APHP, Université Paris 6-UPMC, Paris, France.
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Ostergaard M, Bøyesen P, Eshed I, Gandjbakhch F, Lillegraven S, Bird P, Foltz V, Boonen A, Lassere M, Hermann KG, Anandarajah A, Døhn UM, Freeston J, Peterfy CG, Genant HK, Haavardsholm EA, McQueen FM, Conaghan PG. Development and preliminary validation of a magnetic resonance imaging joint space narrowing score for use in rheumatoid arthritis: potential adjunct to the OMERACT RA MRI scoring system. J Rheumatol 2011; 38:2045-50. [PMID: 21885515 DOI: 10.3899/jrheum.110422] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop and validate a magnetic resonance imaging (MRI) method of assessment of joint space narrowing (JSN) in rheumatoid arthritis (RA). METHODS Phase A: JSN was scored 0-4 on MR images of 5 RA patients and 3 controls at 15 wrist sites and 2nd-5th metacarpophalangeal (MCP) joints by 8 readers (7 once, one twice), using a preliminary scoring system. Phase B: Image review, discussion, and consensus on JSN definition, and revised scoring system. Phase C: MR images of 15 RA patients and 4 controls were scored using revised system by 5 readers (4 once, one twice), and results compared with radiographs [Sharp-van der Heijde (SvdH) method]. RESULTS Phase A: Intraobserver agreement: intraclass correlation coefficient (ICC) = 0.99; smallest detectable difference (SDD, for mean of readings) = 2.8 JSN units (4.9% of observed maximal score). Interobserver agreement: ICC = 0.93; SDD = 6.4 JSN units (9.9%). Phase B: Agreement was reached on JSN definition (reduced joint space width compared to normal, as assessed in a slice perpendicular to the joint surface), and revised scoring system (0-4 at 17 wrist sites and 2nd-5th MCP; 0: none; 1: 1-33%; 2: 34-66%; 3: 67-99%; 4: ankylosis). Phase C: Intraobserver agreement: ICC = 0.90; SDD = 6.8 JSN units (11.0%). Interobserver agreement: ICC = 0.92 and SDD = 6.2 JSN units (8.7%). The correlation (ICC) with the SvdH radiographic JSN score of the wrist/hand was 0.77. Simplified approaches evaluating fewer joint spaces demonstrated similar reliability and correlation with radiographic scores. CONCLUSION An MRI scoring system of JSN in RA wrist and MCP joints was developed and showed construct validity and good intra- and interreader agreements. The system may, after further validation in longitudinal data sets, be useful as an outcome measure in RA.
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Affiliation(s)
- Mikkel Ostergaard
- Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark.
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Anandarajah A. Erosive osteoarthritis. Discov Med 2010; 9:468-477. [PMID: 20515616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Erosive osteoarthritis (EOA) represents a subset of symptomatic osteoarthritis of hand, characterized by intermittent and often frequent inflammatory episodes and progressive joint damage. A greater degree of inflammation and the presence of subchondral bone erosions on plain radiographs help distinguish EOA from generalized osteoarthritis of hand. High resolution ultrasound and magnetic resonance imaging (MRI) have demonstrated the presence of synovitis and MRI has additionally highlighted the role of inflammation in bone, tendons, and ligaments in EOA. Further evidence for the crucial role of inflammation comes from recent studies that have unraveled the roles for several cytokines in the pathogenesis of EOA. Despite these advances, treatment options for EOA to date have been of modest benefit. Additional research is therefore needed to better understand the pathogenesis of EOA and lead to the development of novel therapeutic agents for this disabling form of arthritis.
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Affiliation(s)
- Allen Anandarajah
- Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Abstract
PURPOSE OF REVIEW The unexpected success of the tumor necrosis factor antagonists in ankylosing spondylitis and psoriatic arthritis has generated considerable enthusiasm regarding the therapeutic potential of these drugs. By contrast, concerns regarding the high cost and long-term safety of the tumor necrosis factor blocking agents have prompted investigators to take a closer look at more traditional anti-inflammatory agents and to explore novel therapeutic targets. The purpose of this review is to summarize treatment advances in spondylarthropathy over the past year and to discuss potential future therapies. RECENT FINDINGS Recent studies indicate that the morbidity of ankylosing spondylitis and PsA are considerably higher than previously reported. Etanercept, infliximab and adalimumab safely and effectively relieved the signs and symptoms of psoriatic arthritis patients in phase III trials. Etanercept and infliximab were also effective in phase III trials in ankylosing spondylitis. Etanercept slowed radiographic progression in psoriatic arthritis trials, but it is not known whether tumor necrosis factor antagonists can prevent structural damage in ankylosing spondylitis. One trial showed that methotrexate may be effective for relieving the pain of axial disease in ankylosing spondylitis but these findings contradict two previous studies. For reactive arthritis and undifferentiated spondylarthropathy, a combination of antibiotics may be more effective than a single antibiotic for the relief of musculoskeletal symptoms. Last, potential therapeutic targets include interleukin-1, interleukin-12, B lymphocytes, accessory molecules on T lymphocytes, and angiogenic factors. SUMMARY Phase III trials have confirmed that tumor necrosis factor antagonists are effective and safe for the treatment of ankylosing spondylitis and psoriatic arthritis. For patients who do not respond to tumor necrosis factor blockade, several treatment options are under study. Information from these trials will more clearly define the role of disease-modifying antirheumatic drugs, novel therapeutic agents, and antibiotics in the treatment of spondylarthropathy.
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Affiliation(s)
- Allen Anandarajah
- Allergy, Immunology & Rheumatology Unit, University of Rochester Medical Center, Rochester, New York, USA
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Abstract
Methods have recently been developed for calculating the double-layer repulsive and the van der Waals attractive forces between two nonparallel clay particles immersed in a fluid system. In the present study, these theories are used in an approximate model of one-dimensional compression to examine the role of particle orientation on the behavior of a montmorillonite. It is shown that consideration of nonparallel fabric could potentially explain the discrepancy observed in the past between experimental and theoretical behaviors. Copyright 1997 Academic Press. Copyright 1997Academic Press
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Affiliation(s)
- A Anandarajah
- Department of Civil Engineering, The Johns Hopkins University, Baltimore, Maryland, 21218-2686
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