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Pauling JD, Yu L, Frech TM, Herrick AL, Hummers LK, Shah AA, Denton CP, Saketkoo LA, Withey J, Khanna D, Domsic RT. Construct validity and reliability of the Assessment of Systemic Sclerosis-Associated Raynaud's Phenomenon (ASRAP) questionnaire. Rheumatology (Oxford) 2024; 63:1281-1290. [PMID: 37481713 DOI: 10.1093/rheumatology/kead371] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/27/2023] [Accepted: 06/27/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVES Assessment of construct validity and reliability of a novel patient-reported outcome (PRO) instrument for assessing the severity and impact of RP in SSc. METHODS An international multicentre study validation study of the 27-item Assessment of Systemic Sclerosis-Associated Raynaud's Phenomenon (ASRAP) and 10-item short-form (ASRAP-SF) questionnaires. The relationship between ASRAP questionnaires and demographics, clinical phenotype and legacy instruments for assessing SSc-RP severity, disability and pain was assessed. Repeatability was evaluated at 1 week. Anchor-based statements of health status facilitated assessment of ASRAP thresholds of meaning. RESULTS A total of 420 SSc subjects were enrolled. There was good correlation between ASRAP (and ASRAP-SF) with RP visual analogue scale (VAS) and Scleroderma Health Assessment Questionnaire RP VAS (rho range 0.648-0.727, P < 0.001). Correlation with diary-based assessment of SSc-RP attack frequency and duration was lower (rho range 0.258-0.504, P < 0.001). ASRAP questionnaires had good correlation with instruments for assessing disability, hand function, pain and global health assessment (rho range 0.427-0.575, P < 0.001). Significantly higher ASRAP scores were identified in smokers, patients with active digital ulceration (DU), previous history of DU and calcinosis (P < 0.05 for all comparisons). There was excellent repeatability at 1 week among patients with stable SSc-RP symptoms (intra-class coefficients of 0.891 and 0.848, P < 0.001). Patient-acceptable symptom state thresholds for ASRAP and ASRAP-SF were 45.34 and 45.77, respectively. A preliminary Minimally Important Clinical Difference threshold of 4.17 (95% CI 0.53, 7.81, P = 0.029) was estimated. CONCLUSION ASRAP and ASRAP-SF questionnaires are valid and reliable novel PRO instruments for assessing the severity and impact of SSc-RP.
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Affiliation(s)
- John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals NHS Foundation Trust), Bath, UK
| | - Lan Yu
- Department of Medicine, University of Pittsburgh, PA, USA
| | | | - Ariane L Herrick
- The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Laura K Hummers
- Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
| | - Lesley Ann Saketkoo
- Department of Rheumatology, University of Tulane Medical Center, New Orleans, LA, USA
| | - Jane Withey
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals NHS Foundation Trust), Bath, UK
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Robyn T Domsic
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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Lammi MR, Mukherjee M, Saketkoo LA, Carey K, Hummers L, Hsu S, Krishnan A, Sandi M, Shah AA, Zimmerman SL, Hassoun PM, Mathai SC. Sildenafil Versus Placebo for Early Pulmonary Vascular Disease in Scleroderma (SEPVADIS): protocol for a randomized controlled trial. BMC Pulm Med 2024; 24:211. [PMID: 38689245 PMCID: PMC11061972 DOI: 10.1186/s12890-024-02892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/29/2023] [Accepted: 02/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a leading cause of death in patients with systemic sclerosis (SSc). An important component of SSc patient management is early detection and treatment of PH. Recently the threshold for the diagnosis of PH has been lowered to a mean pulmonary artery pressure (mPAP) threshold of > 20 mmHg on right heart catheterization (RHC). However, it is unknown if PH-specific therapy is beneficial in SSc patients with mildly elevated pressure (SSc-MEP, mPAP 21-24 mmHg). METHODS The SEPVADIS trial is a randomized, double-blind, placebo-controlled phase 2 trial of sildenafil in SSc-MEP patients with a target enrollment of 30 patients from two academic sites in the United States. The primary outcome is change in six-minute walk distance after 16 weeks of treatment. Secondary endpoints include change in pulmonary arterial compliance by RHC and right ventricular function by cardiac magnetic resonance imaging at 16 weeks. Echocardiography, serum N-terminal probrain natriuretic peptide, and health-related quality of life is being measured at 16 and 52 weeks. DISCUSSION The SEPVADIS trial will be the first randomized study of sildenafil in SSc-MEP patients. The results of this trial will be used to inform a phase 3 study to investigate the efficacy of treating patients with mild elevations in mPAP. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04797286.
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Affiliation(s)
- Matthew R Lammi
- Louisiana State University Health Sciences, 1901 Perdido St, 70112, New Orleans, LA,, USA.
- Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, USA.
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA.
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, USA.
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA
- Tulane University School of Medicine, New Orleans, USA
| | - Kyle Carey
- Institute for Clinical and Translational Medicine, Johns Hopkins University, Baltimore, USA
| | - Laura Hummers
- Johns Hopkins University, Division of Rheumatology, Baltimore, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, USA
| | - Amita Krishnan
- Louisiana State University Health Sciences, 1901 Perdido St, 70112, New Orleans, LA,, USA
- Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, USA
| | - Marie Sandi
- Louisiana State University Health Sciences, 1901 Perdido St, 70112, New Orleans, LA,, USA
| | - Ami A Shah
- Johns Hopkins University, Division of Rheumatology, Baltimore, USA
| | - Stefan L Zimmerman
- Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, USA
| | - Paul M Hassoun
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, USA
| | - Steven C Mathai
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, USA
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Coursen JC, Tuhy T, Naranjo M, Woods A, Hummers LK, Shah AA, Suresh K, Visovatti SH, Mathai SC, Hassoun PM, Damico RL, Simpson CE. Aberrant Long-Chain Fatty Acid Metabolism Associated with Evolving Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Am J Physiol Lung Cell Mol Physiol 2024. [PMID: 38651694 DOI: 10.1152/ajplung.00057.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
We sought to investigate differential metabolism in patients with systemic sclerosis (SSc) who develop pulmonary arterial hypertension (PAH) versus those who do not, as a method of identifying potential disease biomarkers. In a nested case-control design, serum metabolites were assayed in SSc subjects who developed right heart catheterization-confirmed PAH (n=22) while under surveillance in a longitudinal cohort from Johns Hopkins, then compared to metabolites assayed in matched SSc patients who did not develop PAH (n=22). Serum samples were collected at "proximate" (within 12 months) and "distant" (within 1-5 years) time points relative to PAH diagnosis. Metabolites were identified using liquid chromatography-mass spectroscopy (LC-MS). An LC-MS dataset from SSc subjects with either mildly elevated pulmonary pressures or overt PAH from the University of Michigan was compared. Differentially abundant metabolites were tested as predictors of PAH in two additional validation SSc cohorts. Long-chain fatty acid metabolism (LCFA) consistently differed in SSc-PAH versus SSc without PH. LCFA metabolites discriminated SSc-PAH patients with mildly elevated pressures in the Michigan cohort and predicted SSc-PAH up to two years prior to clinical diagnosis in the Hopkins cohort. Acylcholines containing LCFA residues and linoleic acid metabolites were most important for discriminating SSc-PAH. Combinations of acylcholines and linoleic acid metabolites provided good discrimination of SSc-PAH across cohorts. Aberrant lipid metabolism is observed throughout the evolution of PAH in SSc. Lipidomic signatures of abnormal LCFA metabolism distinguish SSc-PAH patients from those without PH, including prior to clinical diagnosis and in mild disease.
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Affiliation(s)
- Julie C Coursen
- Division of Hospital Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Tijana Tuhy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mario Naranjo
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States
| | - Adrianne Woods
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Suresh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Scott H Visovatti
- Department of Medicine, Ohio State University Hospital, Columbus, OH, United States
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
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Dou DR, Zhao Y, Belk JA, Zhao Y, Casey KM, Chen DC, Li R, Yu B, Srinivasan S, Abe BT, Kraft K, Hellström C, Sjöberg R, Chang S, Feng A, Goldman DW, Shah AA, Petri M, Chung LS, Fiorentino DF, Lundberg EK, Wutz A, Utz PJ, Chang HY. Xist ribonucleoproteins promote female sex-biased autoimmunity. Cell 2024; 187:733-749.e16. [PMID: 38306984 PMCID: PMC10949934 DOI: 10.1016/j.cell.2023.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/28/2023] [Revised: 10/03/2023] [Accepted: 12/31/2023] [Indexed: 02/04/2024]
Abstract
Autoimmune diseases disproportionately affect females more than males. The XX sex chromosome complement is strongly associated with susceptibility to autoimmunity. Xist long non-coding RNA (lncRNA) is expressed only in females to randomly inactivate one of the two X chromosomes to achieve gene dosage compensation. Here, we show that the Xist ribonucleoprotein (RNP) complex comprising numerous autoantigenic components is an important driver of sex-biased autoimmunity. Inducible transgenic expression of a non-silencing form of Xist in male mice introduced Xist RNP complexes and sufficed to produce autoantibodies. Male SJL/J mice expressing transgenic Xist developed more severe multi-organ pathology in a pristane-induced lupus model than wild-type males. Xist expression in males reprogrammed T and B cell populations and chromatin states to more resemble wild-type females. Human patients with autoimmune diseases displayed significant autoantibodies to multiple components of XIST RNP. Thus, a sex-specific lncRNA scaffolds ubiquitous RNP components to drive sex-biased immunity.
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Affiliation(s)
- Diana R Dou
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yanding Zhao
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julia A Belk
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yang Zhao
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kerriann M Casey
- Department of Comparative Medicine, Stanford University, Stanford, CA, USA
| | - Derek C Chen
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rui Li
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bingfei Yu
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Suhas Srinivasan
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brian T Abe
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Katerina Kraft
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ceke Hellström
- Autoimmunity and Serology Profiling, Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Ronald Sjöberg
- Autoimmunity and Serology Profiling, Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Sarah Chang
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan Feng
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel W Goldman
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Petri
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lorinda S Chung
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Emma K Lundberg
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden; Departments of Bioengineering and Pathology, Stanford University, Stanford, CA, USA
| | - Anton Wutz
- Department of Biology, Institute of Molecular Health Sciences, Swiss Federal Institute of Technology, ETH Hönggerberg, Zurich, Switzerland
| | - Paul J Utz
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA; Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Howard Y Chang
- Center for Personal Dynamic Regulomes, Program in Epithelial Biology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA.
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Kim JS, Woods A, Gutierrez-Alamillo L, Laffoon M, Wigley FM, Hummers LK, Rosen A, Zeger S, Domsic RT, Casciola-Rosen L, Shah AA. Distinct Scleroderma Autoantibody Profiles Stratify Patients for Cancer Risk at Scleroderma Onset and During the Disease Course. Arthritis Rheumatol 2024; 76:68-77. [PMID: 37488962 PMCID: PMC10807373 DOI: 10.1002/art.42663] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES We examined whether an array of scleroderma autoantibodies associates with risk of cancer and could be useful tools for risk stratification. METHODS Scleroderma cancer cases and scleroderma controls without cancer from the Johns Hopkins Scleroderma Center and the University of Pittsburgh Scleroderma Center were studied. Sera were assayed by Lineblot and enzyme-linked immunosorbent assay (ELISA) for autoantibodies against centromere, topoisomerase 1, RNA polymerase (POLR) 3, PM/Scl, Th/To, NOR90, U3 RNP, Ku, Ro52, U1RNP, and RNPC3. Logistic regression models were constructed to examine whether distinct autoantibodies associated with overall cancer at any time and cancer-associated scleroderma (cancer occurring three years before and after scleroderma onset). The effects of having more than one autoantibody on cancer were further examined using random forest analysis. RESULTS A total of 676 cases and 687 controls were studied. After adjusting for relevant covariates, anti-POLR3 (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.03-2.11) and monospecific anti-Ro52 (OR 2.19, 95% CI 1.29-3.74) were associated with an increased overall cancer risk, whereas anticentromere (OR 0.69, 95% CI 0.51-0.93) and anti-U1RNP (OR 0.63, 95% CI 0.43-0.93) were associated with lower risk. When examining risk of cancer-associated scleroderma, these immune responses remained associated with increased or decreased risk: anti-POLR3 (OR 2.28, 95% CI 1.33-3.91), monospecific anti-Ro52 (OR 2.58, 95% CI 1.05-6.30), anticentromere (OR 0.39, 95% CI 0.20-0.74), and anti-U1RNP (OR 0.32, 95% CI 0.11-0.93). Anti-Ro52 plus anti-U1RNP or anti-Th/To was associated with decreased cancer risk compared with anti-Ro52 alone. CONCLUSIONS These data suggest that five distinct scleroderma immune responses, alone or in combination, may be useful tools to stratify the risk of cancer for scleroderma patients. Further study examining cancer risk in autoantibody subgroups relative to the general population is warranted.
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Affiliation(s)
- Ji Soo Kim
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD USA
| | - Adrianne Woods
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | | | | | - Fredrick M. Wigley
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Laura K. Hummers
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Antony Rosen
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Scott Zeger
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD USA
| | | | - Livia Casciola-Rosen
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Ami A. Shah
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
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Richardson C, Perin J, Zeger S, Wigley FM, Hummers LK, Casciola-Rosen L, Rosen A, Shah AA. Cumulative disease damage and anti-PM/Scl antibodies are associated with a heavy burden of calcinosis in systemic sclerosis. Rheumatology (Oxford) 2023; 62:3636-3643. [PMID: 36469337 PMCID: PMC10629791 DOI: 10.1093/rheumatology/keac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/20/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Ectopic calcification (calcinosis) is a common complication of SSc, but a subset of SSc patients has a heavy burden of calcinosis. We examined whether there are unique risk factors for a heavy burden of calcinosis, as compared with a light burden or no calcinosis. METHODS We reviewed the medical records of all patients in the Johns Hopkins Scleroderma Center Research Registry with calcinosis to quantify calcinosis burden using pre-specified definitions. We performed latent class analysis to identify SSc phenotypic classes. We used multinomial logistic regression to determine whether latent phenotypic classes and autoantibodies were independent risk factors for calcinosis burden. RESULTS Of all patients, 29.4% (997/3388) had calcinosis, and 13.5% (130/963) of those with calcinosis had a heavy burden. The latent phenotypic class with predominantly diffuse skin disease and higher disease severity (characterized by pulmonary hypertension, interstitial lung disease, cardiomyopathy, severe RP, gastrointestinal involvement, renal crisis, myopathy and/or tendon friction rubs) was associated with an increased risk of both a heavy burden [odds ratio (OR) 6.92, 95% CI 3.66, 13.08; P < 0.001] and a light burden (OR 2.88, 95% CI 2.11, 3.95; P < 0.001) of calcinosis compared with the phenotypic class with predominantly limited skin disease. Autoantibodies to PM/Scl were strongly associated with a heavy burden of calcinosis (OR 17.31, 95% CI 7.72, 38.81; P < 0.001) and to a lesser degree a light burden of calcinosis (OR 3.59, 95% CI 1.84, 7.00; P < 0.001). CONCLUSIONS Calcinosis burden is associated with cumulative SSc-related tissue damage. Independent of disease severity, autoantibodies to PM/Scl are also associated with a heavy burden of calcinosis.
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Affiliation(s)
- Carrie Richardson
- Department of Medicine (Rheumatology), Northwestern University, Chicago, IL, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott Zeger
- Departments of Biostatistics, Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fredrick M Wigley
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura K Hummers
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Livia Casciola-Rosen
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antony Rosen
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Simpson CE, Ambade AS, Harlan R, Roux A, Aja S, Graham D, Shah AA, Hummers LK, Hemnes AR, Leopold JA, Horn EM, Berman-Rosenzweig ES, Grunig G, Aldred MA, Barnard J, Comhair SAA, Tang WHW, Griffiths M, Rischard F, Frantz RP, Erzurum SC, Beck GJ, Hill NS, Mathai SC, Hassoun PM, Damico RL. Kynurenine pathway metabolism evolves with development of preclinical and scleroderma-associated pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol 2023; 325:L617-L627. [PMID: 37786941 DOI: 10.1152/ajplung.00177.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/05/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023] Open
Abstract
Understanding metabolic evolution underlying pulmonary arterial hypertension (PAH) development may clarify pathobiology and reveal disease-specific biomarkers. Patients with systemic sclerosis (SSc) are regularly surveilled for PAH, presenting an opportunity to examine metabolic change as disease develops in an at-risk cohort. We performed mass spectrometry-based metabolomics on longitudinal serum samples collected before and near SSc-PAH diagnosis, compared with time-matched SSc subjects without PAH, in a SSc surveillance cohort. We validated metabolic differences in a second cohort and determined metabolite-phenotype relationships. In parallel, we performed serial metabolomic and hemodynamic assessments as the disease developed in a preclinical model. For differentially expressed metabolites, we investigated corresponding gene expression in human and rodent PAH lungs. Kynurenine and its ratio to tryptophan (kyn/trp) increased over the surveillance period in patients with SSc who developed PAH. Higher kyn/trp measured two years before diagnostic right heart catheterization increased the odds of SSc-PAH diagnosis (OR 1.57, 95% CI 1.05-2.36, P = 0.028). The slope of kyn/trp rise during SSc surveillance predicted PAH development and mortality. In both clinical and experimental PAH, higher kynurenine pathway metabolites correlated with adverse pulmonary vascular and RV measurements. In human and rodent PAH lungs, expression of TDO2, which encodes tryptophan 2,3 dioxygenase (TDO), a protein that catalyzes tryptophan conversion to kynurenine, was significantly upregulated and tightly correlated with pulmonary hypertensive features. Upregulated kynurenine pathway metabolism occurs early in PAH, localizes to the lung, and may be modulated by TDO2. Kynurenine pathway metabolites may be candidate PAH biomarkers and TDO warrants exploration as a potential novel therapeutic target.NEW & NOTEWORTHY Our study shows an early increase in kynurenine pathway metabolism in at-risk subjects with systemic sclerosis who develop pulmonary arterial hypertension (PAH). We show that kynurenine pathway upregulation precedes clinical diagnosis and that this metabolic shift is associated with increased disease severity and shorter survival times. We also show that gene expression of TDO2, an enzyme that generates kynurenine from tryptophan, rises with PAH development.
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Affiliation(s)
- Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Anjira S Ambade
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert Harlan
- Johns Hopkins All Children's Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Aurelie Roux
- Johns Hopkins All Children's Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Susan Aja
- Johns Hopkins All Children's Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - David Graham
- Johns Hopkins All Children's Molecular Determinants Core, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Anna R Hemnes
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Evelyn M Horn
- Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, New York, United States
| | - Erika S Berman-Rosenzweig
- Division of Pediatric Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Gabriele Grunig
- Divisions of Environmental and Pulmonary Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States
| | - Micheala A Aldred
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - John Barnard
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
| | - Suzy A A Comhair
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
| | - W H Wilson Tang
- Division of Heart Failure and Transplant Medicine, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States
| | - Megan Griffiths
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Franz Rischard
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Robert P Frantz
- Division of Circulatory Failure, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Serpil C Erzurum
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
| | - Gerald J Beck
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
| | - Nicholas S Hill
- Pulmonary, Critical Care and Sleep Division, Tufts University, Boston, Massachusetts, United States
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Rachel L Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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Luebker S, Frech TM, Assassi S, Skaug B, Gordon JK, Lakin K, Bernstein EJ, Luo Y, Steen VD, Shah AA, Hummers LK, Richardson C, Moore DF, Khanna D, Castelino FV, Chung L, Kapoor P, Hant FN, Shanmugam VK, VanBuren JM, Alvey J, Harding M, Shah A, Makol A, Lebiedz-Odrobina D, Thomas JK, Volkmann ER, Molitor JA, Sandorfi N. CONQUER Scleroderma: association of gastrointestinal tract symptoms in early disease with resource utilization. Rheumatology (Oxford) 2023; 62:3433-3438. [PMID: 37079727 PMCID: PMC10547507 DOI: 10.1093/rheumatology/kead176] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/02/2023] [Revised: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES SSc is associated with increased health-care resource utilization and economic burden. The Collaborative National Quality and Efficacy Registry (CONQUER) is a US-based collaborative that collects longitudinal follow-up data on SSc patients with <5 years of disease duration enrolled at scleroderma centres in the USA. The objective of this study was to investigate the relationship between gastrointestinal tract symptoms and self-reported resource utilization in CONQUER participants. METHODS CONQUER participants who had completed a baseline and 12-month Gastrointestinal Tract Questionnaire (GIT 2.0) and a Resource Utilization Questionnaire (RUQ) were included in this analysis. Patients were categorized by total GIT 2.0 severity: none-to-mild (0-0.49); moderate (0.50-1.00), and severe-to-very severe (1.01-3.00). Clinical features and medication exposures were examined in each of these categories. The 12-month RUQ responses were summarized by GIT 2.0 score categories at 12 months. RESULTS Among the 211 CONQUER participants who met the inclusion criteria, most (64%) had mild GIT symptoms, 26% had moderate symptoms, and 10% severe GIT symptoms at 12 months. The categorization of GIT total severity score by RUQ showed that more upper endoscopy procedures and inpatient hospitalization occurred in the CONQUER participants with severe GIT symptoms. These patients with severe GIT symptoms also reported the use of more adaptive equipment. CONCLUSION This report from the CONQUER cohort suggests that severe GIT symptoms result in more resource utilization. It is especially important to understand resource utilization in early disease cohorts when disease activity, rather than damage, primarily contributes to health-related costs of SSc.
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Affiliation(s)
- Sarah Luebker
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Tennessee Valley Health Care System, Veterans Affair Medical Center, Nashville, TN, USA
| | - Tracy M Frech
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Tennessee Valley Health Care System, Veterans Affair Medical Center, Nashville, TN, USA
| | - Shervin Assassi
- Division of Rheumatology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brian Skaug
- Division of Rheumatology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jessica K Gordon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York City, NY, USA
| | - Kimberly Lakin
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York City, NY, USA
| | - Elana J Bernstein
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yiming Luo
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Virginia D Steen
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura K Hummers
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carrie Richardson
- Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Duncan F Moore
- Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Dinesh Khanna
- Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Flavia V Castelino
- Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Puneet Kapoor
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Faye N Hant
- Division of Rheumatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Victoria K Shanmugam
- Department of Anatomy, George Washington University, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John M VanBuren
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jessica Alvey
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Monica Harding
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Ankoor Shah
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, USA
| | - Ashima Makol
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dorota Lebiedz-Odrobina
- Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Julie K Thomas
- Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jerry A Molitor
- Division of Rheumatic and Autoimmune Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nora Sandorfi
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Mecoli CA, Chee B, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Kelly W, Mammen AL, Platz EA, Casciola-Rosen L, Christopher-Stine L, Shah AA. Diagnostic Yield of Computed Tomography for Cancer Detection in a Tertiary Referral Population of Idiopathic Inflammatory Myositis Patients. Arthritis Care Res (Hoboken) 2023; 75:2142-2150. [PMID: 36913182 PMCID: PMC10497706 DOI: 10.1002/acr.25114] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/11/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To inform guidance for cancer detection in patients with idiopathic inflammatory myopathy (IIM), we evaluated the diagnostic yield of computed tomography (CT) imaging for cancer screening/surveillance within distinct IIM subtypes and myositis-specific autoantibody strata. METHODS We conducted a single-center, retrospective cohort study in IIM patients. Overall diagnostic yield (number of cancers diagnosed/number of tests performed), percentage of false positives (number of biopsies performed not leading to cancer diagnosis/number of tests performed), and test characteristics were determined on CT of the chest and abdomen/pelvis. RESULTS Within the first 3 years since IIM symptom onset, a total of 9 of 1,011 (0.9%) chest CT scans and 12 of 657 (1.8%) abdomen/pelvis CT scans detected cancer. Diagnostic yields for both CT of the chest and CT of the abdomen/pelvis were highest in dermatomyositis, specifically anti-transcription intermediary factor 1γ (2.9% and 2.4% for CT of the chest and abdomen/pelvis, respectively). The highest percentage of false positives was in patients with antisynthetase syndrome (ASyS) (4.4%) and immune-mediated necrotizing myopathy (4.4%) on CT of the chest, and ASyS (3.8%) on CT of the abdomen/pelvis. Patients ages <40 years old at IIM onset had both low diagnostic yields (0% and 0.5%) and high false-positive rates (1.9% and 4.4%) for CT of the chest and abdomen/pelvis, respectively. CONCLUSION In a tertiary referral cohort of IIM patients, CT imaging has a wide range of diagnostic yield and frequency of false positives for contemporaneous cancer. These findings suggest that cancer detection strategies targeted according to IIM subtype, autoantibody positivity, and age may maximize cancer detection while minimizing the harms and costs of over-screening.
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Affiliation(s)
| | - Brant Chee
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Mengkun Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - XingYao Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Will Kelly
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and the NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Elizabeth A Platz
- Johns Hopkins Bloomberg School of Public Health and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | | | | | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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Ghanem P, Murray JC, Marrone KA, Scott SC, Feliciano JL, Lam VK, Hann CL, Ettinger DS, Levy BP, Forde PM, Shah AA, Mecoli C, Brahmer J, Cappelli LC. Improved lung cancer clinical outcomes in patients with autoimmune rheumatic diseases. RMD Open 2023; 9:e003471. [PMID: 37914179 PMCID: PMC10619011 DOI: 10.1136/rmdopen-2023-003471] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Concomitant autoimmune rheumatic diseases (ARD) can add morbidity and complicate treatment decisions for patients with lung cancer. We evaluated the tumour characteristics at diagnosis and clinical outcomes in lung cancer patients with or without ARD. METHODS This retrospective cohort study included 10 963 patients with lung cancer, treated at Johns Hopkins. Clinical data including tumour characteristics and outcomes were extracted from the cancer registry. Data on patients' history of 20 ARD were extracted from the electronic medical record. Logistic regression was used to compare tumour characteristics between those with and without ARD; Kaplan-Meier curves and Cox proportional hazards models were performed to compare survival outcomes. RESULTS ARD was present in 3.6% of patients (n=454). The mean age at diagnosis was 69 (SD 10) and 68 (SD 12) in patients with and without ARD (p=0.02). Female sex and smoking history were significantly associated with a history of ARD (OR: 1.75, OR: 1.46, p<0.05). Patients with ARD were more likely to be diagnosed with stage 1 lung cancer (36.8% vs 26.9%, p<0.001) and with smaller tumour size (OR: 0.76, p=0.01), controlling for sex, race and histology. Notably, lung cancer patients with ARD had a significantly prolonged median overall survival (OS) (7.11 years vs 1.7 years, p<0.001), independent of stage. CONCLUSION Patients with ARD and lung cancer had better OS compared with their counterparts, independent of cancer stage and treatments and were less likely to have advanced stage lung cancer at diagnosis. Additional studies are needed to investigate the differential immunological anti-tumour immune activity and genomic variations in patients with and without ARD.
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Affiliation(s)
- Paola Ghanem
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph C Murray
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristen A Marrone
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan C Scott
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Josephine L Feliciano
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vincent K Lam
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine L Hann
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David S Ettinger
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Benjamin P Levy
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick M Forde
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Mecoli
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Brahmer
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura C Cappelli
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Cappelli LC, Kamal O, Jones M, Bingham CO, Shah AA. Baseline predictors of disease severity in immune checkpoint inhibitor-induced inflammatory arthritis. Rheumatology (Oxford) 2023:kead438. [PMID: 37647635 DOI: 10.1093/rheumatology/kead438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To determine baseline risk factors for requiring immunosuppression and having persistent arthritis in patients with immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA). METHODS Participants were adults with rheumatologist diagnosed ICI-IA. The primary outcome was requirement of conventional synthetic (cs) or biologic (b) DMARDs; other outcomes were persistence of IA > 6 months after ICI cessation and requirement of corticosteroids. Logistic regression models evaluated associations between clinical features and primary and secondary outcomes, with adjustment for potential confounders, as appropriate. RESULTS 126 patients with ICI-IA were included; 53 patients (42%) required a csDMARD/bDMARD. In univariate logistic regressions, higher CDAI, tenosynovitis, longer symptom duration before first rheumatology visit, and longer ICI duration were significantly associated with a higher likelihood of requiring DMARDs; there was a trend toward those treated with prior chemotherapy being less likely to need DMARDs. After adjustment, tenosynovitis, longer symptom duration, and higher CDAI remained associated with requiring DMARDs, while those with prior chemotherapy were significantly less likely to require DMARDs. Combination anti-CTLA-4/PD-1 therapy and steroid use at baseline were associated with a higher risk of persistent IA. CONCLUSION Higher levels of disease activity, tenosynovitis, and longer symptom duration prior to rheumatology referral were associated with requiring DMARDs for ICI-IA, while those treated previously with chemotherapy were less likely to require additional immunosuppression. The presence of risk factors for severe disease at baseline may indicate a role for higher initial steroid dose, earlier rheumatology referral, and adoption of immunosuppression beyond steroids to improve outcomes.
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Affiliation(s)
| | | | - Michelle Jones
- Johns Hopkins Division of Rheumatology, Baltimore, MD, USA
| | | | - Ami A Shah
- Johns Hopkins Division of Rheumatology, Baltimore, MD, USA
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12
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Tucker AE, Perin J, Volkmann ER, Abdi T, Shah AA, Pandolfino J, Silver RM, McMahan ZH. Associations Between Patterns of Esophageal Dysmotility and Extra-Intestinal Features in Patients With Systemic Sclerosis. Arthritis Care Res (Hoboken) 2023; 75:1715-1724. [PMID: 36576023 PMCID: PMC11019887 DOI: 10.1002/acr.25080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The gastrointestinal tract is commonly involved in patients with systemic sclerosis (SSc) with varied manifestations. As our understanding of SSc gastrointestinal disease pathogenesis and risk stratification is limited, we sought to investigate whether patterns of esophageal dysfunction associate with specific clinical phenotypes in SSc. METHODS Patients enrolled in the Johns Hopkins Scleroderma Center Research Registry who completed high-resolution esophageal manometry (HREM) studies as part of their clinical care between 2011 and 2020 were identified. Associations between esophageal abnormalities on HREM (absent contractility [AC], ineffective esophageal motility [IEM], hypotensive lower esophageal sphincter [hypoLES]) and patient demographic information, clinical characteristics, and autoantibody profiles were examined. RESULTS Ninety-five patients with SSc had HREM data. Sixty-five patients (68.4%) had AC (37 patients with only AC, 28 patients with AC and a hypoLES), 9 patients (9.5%) had IEM, and 11 patients (11.6%) had normal studies. AC was significantly associated with diffuse cutaneous disease (38.5% versus 10.0%; P < 0.01), more severe Raynaud's phenomenon, including digital pits, ulcers, or gangrene (56.9% versus 30.0%; P = 0.02), and reduced median diffusing capacity of lung for carbon monoxide (50.6% versus 72.2%; P = 0.03). AC was observed in most of the patients who died (13 of 14; P = 0.06). These findings were not seen in patients with IEM. CONCLUSION Among patients with SSc, AC is associated with a significantly more severe clinical phenotype. IEM may associate with a milder phenotype. Further studies are needed to evaluate AC, IEM, and their clinical impact relative to the timing of other end-organ complications in SSc.
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Affiliation(s)
- Ana E Tucker
- Medical University of South Carolina, Charleston
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tsion Abdi
- Johns Hopkins University, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University, Baltimore, Maryland
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13
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Luebker S, Frech TM, Assassi S, Gordon JK, Bernstein EJ, Steen VD, Shah AA, Hummers LK, Richardson C, Khanna D, Castelino F, Chung L, Hant FN, Shanmugam VK, VanBuren JM, Alvey J, Harding M, Sandorfi N. The Collaborative National Quality and Efficacy Registry for Scleroderma: association of medication use on gastrointestinal tract symptoms in early disease and the importance of tobacco cessation. Clin Exp Rheumatol 2023:19407. [PMID: 37497718 DOI: 10.55563/clinexprheumatol/04rauu] [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: 11/21/2022] [Accepted: 03/17/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Systemic Sclerosis (SSc) is frequently associated with gastrointestinal tract (GIT) involvement. The Collaborative National Quality and Efficacy Registry (CONQUER) is a US-based collaborative study collecting longitudinal follow up data on SSc patients with less than 5-years disease duration enrolled at Scleroderma centres of excellence. This manuscript presents the GIT natural history and outcomes in relation to other scleroderma manifestations and medication exposures. METHODS CONQUER participants that had completed a minimum of two serial Scleroderma Clinical Trials Consortium GIT Questionnaires (GIT 2.0) were included in this analysis. Patients were categorised by total GIT 2.0 severity at baseline, and by category change: none-to-mild (0.49); moderate (0.50-1.00), and severe-to-very severe (1.01-3.00) at the subsequent visit. Based on this data, four groups were identified: none-to-mild with no change, moderate-to-severe with no change, improvement, or worsening. Clinical features and medications, categorised as gastrointestinal tract targeted therapy, anti-fibrotic, i, or immunomodulatory drugs, were recorded. Analysis included a proportional odds model accounting for linear and mixed effects of described variables. RESULTS 415 enrolled CONQUER participants met project inclusion criteria. Most participants had stable mild GIT symptoms at baseline and were on immunomodulatory and anti-reflux therapy. In most patients, anti-reflux medication and immunosuppression initiation preceded the baseline visit, whereas anti-fibrotic initiation occurred at or after the baseline visit. In the proportional odds model, worsening GIT score at the follow-up visit was associated with current tobacco use (odds ratio: 3.48 (1.22, 9.98, p 0.020). CONCLUSIONS This report from the CONQUER cohort, suggests that most patients with early SSc have stable and mild GIT disease. Closer follow-up was associated with milder, stable GIT symptoms. There was no clear association between immunosuppression or anti-fibrotic use and severity of GIT symptoms. However, active tobacco use was associated with worse GIT symptoms, highlighting the importance of smoking cessation counselling in this population.
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Affiliation(s)
- Sarah Luebker
- Vanderbilt University Medical Center, Division of Rheumatology and Immunology, Nashville, TN; and Tennessee Valley Health Care System, Veterans Affair Medical Center, Nashville, TN, USA
| | - Tracy M Frech
- Vanderbilt University Medical Center, Division of Rheumatology and Immunology, Nashville, TN; and Tennessee Valley Health Care System, Veterans Affair Medical Center, Nashville, TN, USA
| | - Shervin Assassi
- University of Texas Houston, Division of Rheumatology, Houston, TX, USA
| | - Jessica K Gordon
- Hospital for Special Surgery, Division of Rheumatology, New York City, NY, USA
| | - Elana J Bernstein
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Ami A Shah
- Johns Hopkins University, Division of Rheumatology, Baltimore, MD, USA
| | - Laura K Hummers
- Johns Hopkins University, Division of Rheumatology, Baltimore, MD, USA
| | | | - Dinesh Khanna
- University of Michigan, Division of Rheumatology, Ann Arbor, MI, USA
| | | | - Lorinda Chung
- Stanford University, Division of Rheumatology, Palo Alto, CA, USA
| | - Faye N Hant
- Medical University of South Carolina, Division of Rheumatology, Charleston, SC, USA
| | | | - John M VanBuren
- University of Utah, Division of Paediatric Critical Care, Department of Paediatrics, Salt Lake City, UT, USA
| | - Jessica Alvey
- University of Utah, Division of Paediatric Critical Care, Department of Paediatrics, Salt Lake City, UT, USA
| | - Monica Harding
- University of Utah, Division of Paediatric Critical Care, Department of Paediatrics, Salt Lake City, UT, USA
| | - Nora Sandorfi
- University of Pennsylvania, Division of Rheumatology, Philadelphia, PA, USA.
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14
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Wallwork RS, Shah AA, Casciola-Rosen L. Association between anti-SSSCA1 antibodies and cancer in systemic sclerosis. Rheumatology (Oxford) 2023; 62:2539-2543. [PMID: 36375819 PMCID: PMC10321112 DOI: 10.1093/rheumatology/keac614] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/02/2022] [Accepted: 10/13/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To define the clinical phenotype of SSc patients with antibodies against Sjogren's syndrome (SS)/scleroderma autoantigen 1 (SSSCA1), and to examine the association between these antibodies and cancer in SSc patients. METHODS We conducted a case-control study using data from 209 patients with SSc and cancer, and 205 SSc patients without cancer. All were randomly selected from the Johns Hopkins Scleroderma Center Research Registry. Antibodies against SSSCA1 were assayed by immunoprecipitation of 35S-methionine-labelled protein generated by in vitro transcription and translation. We performed logistic regression analysis to examine the relationship between anti-SSSCA1 antibodies and cancer. RESULTS Among the 414 study patients, 31 (7%) were anti-SSSCA1 antibody positive. Antibody-positive patients were more likely to have severe RP, a lower minimum ejection fraction, a trend towards more severe heart involvement and a lower baseline diffusing capacity of the lungs for carbon monoxide percent predicted than anti-SSSCA1-negative patients. Patients with cancer were significantly more likely to be anti-SSSCA1 positive compared with those without cancer [22/209 (11%) vs 9/205 (4%), respectively; P = 0.018]. Among patients with cancer, there was a trend towards longer cancer-SSc interval in anti-SSSCA1-positive patients compared with anti-SSSCA1-negative patients. Patients with anti-SSSCA1 antibodies had an increased adjusted risk of cancer (odds ratio 2.46, 95% CI 1.06, 5.70) compared with anti-SSSCA1-negative patients. CONCLUSIONS These data suggest anti-SSSCA1 antibody status may be of utility as a cancer biomarker in SSc. Anti-SSSCA1-positive patients with SSc may be more likely to have severe Raynaud's and cardiac involvement.
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Affiliation(s)
- Rachel S Wallwork
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Fiorentino D, Mecoli CA, Igusa T, Albayda J, Paik JJ, Tiniakou E, Adler B, Mammen AL, Shah AA, Rosen A, Christopher-Stine L, Casciola-Rosen L. Association of Anti-CCAR1 Autoantibodies With Decreased Cancer Risk Relative to the General Population in Patients With Anti-Transcriptional Intermediary Factor 1γ-Positive Dermatomyositis. Arthritis Rheumatol 2023; 75:1238-1245. [PMID: 36762496 PMCID: PMC10313743 DOI: 10.1002/art.42474] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/28/2022] [Revised: 09/19/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To describe the disease specificity, clinical phenotype, and risk of cancer in dermatomyositis (DM) patients with autoantibodies against cell division cycle and apoptosis regulator protein 1 (anti-CCAR1). METHODS The frequency of anti-CCAR1 autoantibodies was measured by enzyme-linked immunosorbent assay in the serum of DM patients from 2 independent cohorts (Johns Hopkins and Stanford), with patients with several other rheumatic diseases and healthy controls used as comparators. Clinical features and the risk of cancer incidence relative to that in the general population were determined in anti-CCAR1-positive DM patients. RESULTS Anti-CCAR1 antibodies were significantly associated with anti-transcriptional intermediary factor 1γ (anti-TIF1γ) antibodies present in the serum of patients with DM: 80 (32%) of 252 anti-TIF1γ-positive DM patients versus 14 (8%) of 186 anti-TIF1γ-negative DM patients were positive for anti-CCAR1 antibodies (P < 0.001). Anti-CCAR1 antibodies were not detected in any of the 32 serum samples from healthy controls, and were present at very low frequencies in the sera of patients with other rheumatic diseases: 1 (2.3%) of 44 patients with anti-hydroxymethylglutaryl-coenzyme A reductase-positive necrotizing myopathy, 1 (2.3%) of 44 patients with inclusion body myositis, and 3 (6.5%) of 46 patients with systemic lupus erythematosus were positive for anti-CCAR1 antibodies. Upon examining data on occurrence of cancer from the onset of DM onward, the observed number of cancers diagnosed in anti-TIF-1γ-positive DM patients was significantly greater than expected in both cohorts, with a standardized incidence ratio (SIR) of 3.49 (95% confidence interval [95% CI] 2.39-4.92) in the Johns Hopkins cohort and a SIR of 4.54 (95% CI 3.04-6.52) in the Stanford cohort (each P < 0.001). DM patients who were both anti-TIF1γ positive and anti-CCAR1 positive had lower SIRs for cancer, with a SIR of 1.78 (95% CI 0.77-3.51) (P = 0.172) in the Johns Hopkins cohort and a SIR of 1.61 (95% CI 0.44-4.13) (P = 0.48) in the Stanford cohort. CONCLUSION Anti-CCAR1 autoantibodies are specific for anti-TIF1γ-positive DM. Their presence in anti-TIF1γ-positive patients attenuates the risk of cancer to a level comparable to that seen in the general population.
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Affiliation(s)
- David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Christopher A Mecoli
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tak Igusa
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jemima Albayda
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Ami A Shah
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antony Rosen
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Livia Casciola-Rosen
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Calderon LM, Domsic RT, Shah AA, Pope JE. Preventative Care in Scleroderma: What Is the Best Approach to Bone Health and Cancer Screening? Rheum Dis Clin North Am 2023; 49:411-423. [PMID: 37028844 PMCID: PMC10845237 DOI: 10.1016/j.rdc.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a rare multisystem autoimmune disease characterized by fibrosis, vasculopathy, and autoimmunity. Lesser known complications inherent to SSc, such as malignancies and osteoporosis, can lead to decreased quality of life and increased morbidity and mortality. Patients with SSc have a greater risk of developing malignancies than the general population. In addition, they are more likely to be vitamin D deficient and are at great risk of osteoporosis-related fractures. However, these complications can be addressed through preventative measures. The purpose of this review is to provide clinicians with an approach to bone health and cancer screening in SSc.
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Affiliation(s)
- Leonardo Martin Calderon
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Robyn T Domsic
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ami A Shah
- Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA.
| | - Janet E Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Division of Rheumatology, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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Calderon LM, Pope JE, Shah AA, Domsic RT. Preventative Care in Scleroderma: What Is the Best Approach to Vaccination? Rheum Dis Clin North Am 2023; 49:401-410. [PMID: 37028843 PMCID: PMC10875978 DOI: 10.1016/j.rdc.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a rare multisystem autoimmune disease characterized by fibrosis, vasculopathy, and autoimmunity. There are multiple complications inherent to SSc and its management. One of these complications is increased infection risk, which can lead to decreased quality of life and increased morbidity and mortality. Patients with SSc have lower vaccination rates and decreased vaccine seroconversion secondary to immunosuppressive medications compared with the general population. The purpose of this review is to provide clinicians with an approach to vaccinations in SSc.
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Affiliation(s)
- Leonardo Martin Calderon
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Johns Hopkins Scleroderma Center, Baltimore, MD, USA
| | - Robyn T Domsic
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Pittsburgh, PA 15261, USA.
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18
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Bass AR, Abdel-Wahab N, Reid PD, Sparks JA, Calabrese C, Jannat-Khah DP, Ghosh N, Rajesh D, Aude CA, Gedmintas L, MacFarlane L, Arabelovic S, Falohun A, Mushtaq K, Haj FA, Diab A, Shah AA, Bingham CO, Chan KK, Cappelli LC. Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis. Ann Rheum Dis 2023:ard-2023-223885. [PMID: 37019614 DOI: 10.1136/ard-2023-223885] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 01/11/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES To compare the safety and effectiveness of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) for immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA). METHODS The retrospective multicentre observational study included patients with a diagnosis of ICI-IA treated with a tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL6Ri) and/or methotrexate (MTX); patients with pre-existing autoimmune disease were excluded. The primary outcome was time to cancer progression from ICI initiation; the secondary outcome was time to arthritis control from DMARD initiation. Cox proportional hazard models were used to compare medication groups, adjusting for confounders. RESULTS 147 patients were included (mean age 60.3 (SD 11.9) years, 66 (45%) women). ICI-IA treatment was TNFi in 33 (22%), IL6Ri 42 (29%) and MTX 72 (49%). After adjustment for time from ICI initiation to DMARD initiation, time to cancer progression was significantly shorter for TNFi compared with MTX (HR 3.27 (95% CI 1.21 to 8.84, p=0.019)) while the result for IL6Ri was HR 2.37 (95% CI 0.94 to 5.98, p=0.055). Time to arthritis control was faster for TNFi compared with MTX (HR 1.91 (95% CI 1.06 to 3.45, p=0.032)) while the result for IL6Ri was HR 1.66 (95% CI 0.93 to 2.97, p=0.089). A subset analysis in patients with melanoma gave similar results for both cancer progression and arthritis control. CONCLUSION The treatment of ICI-IA with a biologic DMARD is associated with more rapid arthritis control than with MTX, but may be associated with a shorter time to cancer progression.
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Affiliation(s)
- Anne R Bass
- Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Noha Abdel-Wahab
- Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pankti D Reid
- Rheumatology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Deanna P Jannat-Khah
- Jannat Khah: Medicine; Aude: Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Epidemiology in Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Nilasha Ghosh
- Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Divya Rajesh
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Andres Aude
- Jannat Khah: Medicine; Aude: Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Lydia Gedmintas
- Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Senada Arabelovic
- Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adewunmi Falohun
- Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Farah Al Haj
- Hematology and Medical Oncology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Adi Diab
- Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ami A Shah
- Medicine/Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karmela Kim Chan
- Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Laura C Cappelli
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Mecoli CA, Igusa T, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Richardson C, Kelly W, Danoff S, Mammen AL, Platz EA, Rosen A, Christopher-Stine L, Casciola-Rosen L, Shah AA. Subsets of Idiopathic Inflammatory Myositis Enriched for Contemporaneous Cancer Relative to the General Population. Arthritis Rheumatol 2023; 75:620-629. [PMID: 35878018 PMCID: PMC9873833 DOI: 10.1002/art.42311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/04/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study investigates cancer risk in idiopathic inflammatory myopathy (IIM) relative to the general population. METHODS We conducted a single-center, retrospective cohort study of IIM patients and malignancy. Myositis-specific and -associated autoantibodies were determined by Euroimmun line blot, enzyme-linked immunosorbent assay, and immunoprecipitation. We calculated standardized prevalence ratios (SPRs) and adjusted for calendar year, age, sex, race, and ethnicity by comparing observed cancers in IIM patients versus expected cancers in the general population using the Surveillance, Epidemiology, and End Results registry. RESULTS Of 1,172 IIM patients, 203 (17%) patients with a cancer history were studied. Over a median follow-up of 5.2 years, the observed number of IIM patients diagnosed with cancer was increased 1.43-fold (SPR 1.43 [95% confidence interval (95% CI) 1.15-1.77]; P = 0.002). Within 3 years of IIM symptom onset, an increased SPR was observed for anti-transcription intermediary factor 1γ (anti-TIF1γ)-positive patients for ovarian and breast cancer (ovarian SPR 18.39 [95% CI 5.01-47.08], P < 0.001; breast SPR 3.84 [95% CI 1.99-6.71], P < 0.001). As expected, anti-TIF1γ positivity was associated with a significantly elevated SPR; however, only 55% (36 of 66) of all cancers within 3 years of dermatomyositis onset were observed in anti-TIF1γ-positive patients. Other myositis-specific autoantibodies, including anti-Mi-2, anti-small ubiquitin-like modifier activating enzyme (SAE), and anti-nuclear matrix protein 2 (NXP-2), accounted for 26% (17 of 66) of cancers diagnosed within 3 years of dermatomyositis onset. No cancer association, positive or negative, was observed for patients with antisynthetase, anti-melanoma differentiation-associated protein 5 (anti-MDA-5), or anti-hydroxymethylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies. CONCLUSION In a tertiary referral center population, anti-TIF1γ was most strongly associated with breast and ovarian cancer. Patients with antisynthetase, anti-MDA-5, or anti-HMGCR antibodies had the same cancer risk as the general population.
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Affiliation(s)
- Christopher A Mecoli
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tak Igusa
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Mengkun Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - XingYao Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carrie Richardson
- Feinberg School of Medicine, Northwestern University, Division of Rheumatology, Chicago, Illinois
| | - Will Kelly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonye Danoff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Medicine and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Muscle Disease Unit, National Institute of Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Antony Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Livia Casciola-Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Domsic RT, Pokrzywinski R, Stassek L, Benton WW, Vampola CL, Furst DE, Chung L, Steen V, Mayes MD, Shah AA, Molitor JA, Oliver K, Nagaraja V, Khanna D. Qualitative Interviews to Assess the Content Validity and Usability of the Electronic Raynaud Diary in Patients with Systemic Sclerosis. ACR Open Rheumatol 2023; 5:132-141. [PMID: 36727567 PMCID: PMC10010488 DOI: 10.1002/acr2.11522] [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: 03/30/2022] [Revised: 08/17/2022] [Accepted: 09/04/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To better understand the symptoms and impacts of Raynaud phenomenon (RP) in patients with systemic sclerosis (SSc) and to evaluate the content validity and usability of a new electronic patient-reported outcome (PRO) measure for RP: the Raynaud Diary. METHODS The Raynaud Diary was developed as a daily eDiary for assessing the number and duration of symptomatic Raynaud attacks; worst pain, numbness, tingling, and discomfort in the fingers; and overall disease severity, captured using the Raynaud's Condition Score. The Raynaud Diary was debriefed in two waves of qualitative interviews with adults with self-reported RP secondary to SSc. All interviews included open-ended questions about participants' experiences of RP. RESULTS Participants (N = 39) had a mean age of 55.1 years, and 87% were female. Frequently reported RP symptoms were color change (reported by all participants), numbness (90%), tingling (82%), pain (77%), and discomfort (72%). Common attack triggers included temperature-related factors and stress. Participants reported being unable to be outside or do outdoor activities and had problems gripping objects. All participants demonstrated understanding of the Raynaud Diary instructions. Most participants indicated that they would be able to use the Raynaud Diary to record the worst severity of individual RP symptoms in the previous 24 hours. CONCLUSION Patients with RP secondary to SSc bear a heavy symptom burden. The Raynaud Diary is a content valid PRO measure that captures the most frequent symptoms of RP in patients with SSc.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ami A Shah
- Johns Hopkins University School of Medicine, Maryland, Baltimore
| | | | | | - Vivek Nagaraja
- University of Michigan Scleroderma Program, Ann Arbor, Michigan
| | - Dinesh Khanna
- Eicos Sciences, Inc., San Mateo, California, and University of Michigan Scleroderma Program, Ann Arbor, Michigan
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21
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Lu J, Jani V, Mercurio V, Hsu S, Hummers LK, Wigley F, Hassoun PM, Mathai SC, Shah AA, Mukherjee M. Stress Echocardiographic Prediction of Emerging Pulmonary Vascular Disease in Systemic Sclerosis. J Am Soc Echocardiogr 2023; 36:259-261. [PMID: 36243216 PMCID: PMC9899304 DOI: 10.1016/j.echo.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jim Lu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vivek Jani
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Steven Hsu
- Johns Hopkins University Division of Cardiology, Baltimore, Maryland
| | - Laura K Hummers
- Johns Hopkins University Division of Rheumatology, Baltimore, Maryland
| | - Fredrick Wigley
- Johns Hopkins University Division of Rheumatology, Baltimore, Maryland
| | - Paul M Hassoun
- Johns Hopkins University Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland
| | - Stephen C Mathai
- Johns Hopkins University Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University Division of Rheumatology, Baltimore, Maryland
| | - Monica Mukherjee
- Johns Hopkins University Division of Cardiology, Baltimore, Maryland.
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22
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Yu L, Domsic RT, Saketkoo LA, Withey J, Frech TM, Herrick AL, Hummers LK, Shah AA, Denton CP, Khanna D, Pauling JD. Assessment of the Systemic Sclerosis-Associated Raynaud's Phenomenon Questionnaire: Item Bank and Short-Form Development. Arthritis Care Res (Hoboken) 2022. [PMID: 36214062 DOI: 10.1002/acr.25038] [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: 06/24/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To develop, refine, and score a novel patient-reported outcome instrument to assess the severity and impact of Raynaud's phenomenon (RP) in systemic sclerosis (SSc). METHODS The Assessment of Systemic Sclerosis-Associated Raynaud's Phenomenon (ASRAP) questionnaire items were developed with patient insight partner support and grounded in the lived patient experience of SSc-RP. ASRAP items underwent formal qualitative assessment and linguistic testing. An international multicenter study was undertaken to field test the preliminary ASRAP questionnaire. RESULTS A preliminary 37-item ASRAP questionnaire was supplemented with 2 additional items following expert review to enhance content coverage before undergoing formal linguistic testing to optimize readability. Patient cognitive debriefing interviews were undertaken to enhance comprehension, ambiguity, cognitive difficulty, relevance, and content coverage of both the ASRAP items and instructions. We enrolled 420 SSc patients from scleroderma centers in the UK and US over 2 consecutive winters. Factor analysis with item response theory was undertaken to remove redundant and poorly fitting items. The retained 27-item long-form ASRAP questionnaire was calibrated and scored using the graded response model. A fixed 10-item short-form ASRAP questionnaire was developed using computerized adaptive testing simulations. CONCLUSION The ASRAP questionnaire has been developed with extensive SSc patient input, with items grounded in the lived experience of SSc-RP to ensure strong content validity, with a focus on how patients feel and function. An advanced psychometric approach with expert input has removed redundant and/or poorly fitting items without eroding content validity. Long- and short-form ASRAP questionnaires have been calibrated and scored to permit formal validation.
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Affiliation(s)
- Lan Yu
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jane Withey
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | | | - Ariane L Herrick
- The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester, UK, and Salford Royal NHS Foundation Trust, Salford, UK
| | - Laura K Hummers
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, UK, and North Bristol NHS Trust and University of Bristol, Bristol, UK
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23
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DiRenzo DD, Hunt C, Sibinga EM, Gould NF, Shah AA, Bartlett SJ, Bingham CO. Feasibility and acceptability of using a meditation app in adults with rheumatic disease. Explore (NY) 2022; 18:523-525. [PMID: 34801408 PMCID: PMC9081288 DOI: 10.1016/j.explore.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/27/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Meditation is a stress-reduction and contemplative technique that can improve emotional distress in people with chronic disease and may be especially beneficial for patients with rheumatic diseases. However, patient access to in-person programs is challenging. The goal of this pilot study was to evaluate the feasibility/acceptability associated with physician-directed use of a widely available smartphone application (app), Calm©. METHODS In this single-arm, pre-post intervention study with recruitment over a 10-month period, adults with rheumatic disease were asked to use the app for ≥5 min/day for 30 days. Participants completed sociodemographic surveys and validated health related quality of life (HRQL) questionnaires from the Patient Reported Outcomes Information System (PROMIS) and NIH Toolbox at baseline and 30-days. RESULTS Thirty-five participants who were mostly well-educated (66% ≥college degree) females (91%) with a mean age of 50 (SD 13) completed baseline questionnaires; 18 participants completed post-study questionnaires ("full completers"). Full completers had higher baseline stress, anxiety, pain, and patient global assessment scores (p's <0.05) compared to partial completers. Full completers who provided data used the app on average for 283 min/30 days (SD 257; n = 16) and showed significant improvements in fatigue (-7.6 T-Score units, p = 0.017), with trends for improvement in perceived stress, anxiety, sleep disturbance, self-efficacy for managing symptoms, and pain intensity (p's <0.15). CONCLUSIONS A 30-day meditation, stress-reduction app used by patients with rheumatic disease revealed that this is a feasible non-pharmacologic modality to target HRQL and problematic symptoms like fatigue. More rigorous study on app use and potential effect is needed.
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Affiliation(s)
- Dana D DiRenzo
- The Johns Hopkins University, Baltimore, MD, United States.
| | - Carly Hunt
- The Johns Hopkins University, Baltimore, MD, United States.
| | | | - Neda F Gould
- The Johns Hopkins University, Baltimore, MD, United States.
| | - Ami A Shah
- The Johns Hopkins University, Baltimore, MD, United States.
| | - Susan J Bartlett
- The Johns Hopkins University, Baltimore, MD, United States; McGill University, Montreal, QC, Canada.
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Cappelli LC, Bingham CO, Forde PM, Anagnostou V, Brahmer J, Lipson EJ, Mammen J, Schollenberger M, Shah AA, Darrah E. Anti-RA33 antibodies are present in a subset of patients with immune checkpoint inhibitor-induced inflammatory arthritis. RMD Open 2022; 8:rmdopen-2022-002511. [PMID: 36096522 PMCID: PMC9472204 DOI: 10.1136/rmdopen-2022-002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Patients with inflammatory arthritis (IA) associated with immune checkpoint inhibitor (ICI) treatment for cancer are typically seronegative for anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor, but little is known about the presence of other autoantibodies in this patient population. We investigated the prevalence and characteristics of anti-RA33 antibodies in patients with ICI-induced IA. METHODS Anti-RA33 ELISAs were performed on sera from four groups of patients: 79 with ICI-induced IA, 52 with rheumatoid arthritis (RA), 35 treated with ICIs without IA during follow-up and 50 healthy controls. Anti-RA33 positivity and level, clinical and demographic data were compared across groups. RESULTS Anti-RA33 antibodies were found in 9/79 (11.4%) patients with ICI-induced IA but in 0/35 patients treated with ICIs who did not develop IA (0%; p=0.04). Of the patients positive for anti-RA33, two had sera available from before ICI treatment; anti-RA33 antibodies were present in both pre-ICI treatments. In patients with RA, 7.7% were positive for anti-RA33 antibodies as were 2% of healthy controls. In ICI-induced IA, anti-RA33 antibodies were associated with anti-CCP antibodies (p=0.001). We found no statistically significant differences in other clinical characteristics in those with and without anti-RA33 antibodies. CONCLUSIONS Anti-RA33 antibodies are present in a subset of patients with ICI-induced IA, absent in other ICI-treated patients and may be a biomarker for developing IA. Additional studies evaluating serial samples before and after ICI treatment will further establish the temporal relationship of these antibodies to IA development.
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Affiliation(s)
- Laura C Cappelli
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Patrick M Forde
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Valsamo Anagnostou
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie Brahmer
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Evan J Lipson
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Mammen
- Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Schollenberger
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Erika Darrah
- Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Chhabra N, Cebak JE, Schmitt A, Lal D, Rosenthal AC, Taylor CM, Thorwarth RM, Shah AA, Rodriguez-Pla A. Concomitant presentation of eosinophilic or oncocytic mucoepidermoid carcinoma, immunoglobulin G4-related disease, and adult-onset asthma and periocular xanthogranuloma: Case report of 3 uncommon clinical entities. Medicine (Baltimore) 2022; 101:e30067. [PMID: 35960078 PMCID: PMC9371478 DOI: 10.1097/md.0000000000030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Immunoglobulin (Ig) G4-related disease (IgG4-RD) reportedly has a strong relationship with adult-onset asthma and periocular xanthogranuloma (AAPOX) and may be linked to sclerosing mucoepidermoid carcinoma (MEC). We present a rare case of IgG4-RD and AAPOX occurring in a patient with resected eosinophilic or oncocytic MEC. PATIENT CONCERNS A 52-year-old woman was referred to our rheumatology clinic in 2020 to be evaluated for suspected IgG4-RD. DIAGNOSES The patient had diagnoses of periorbital xanthelasmas, worsening glucocorticoid-dependent chronic rhinosinusitis and adult-onset asthma, and cervical lymphadenopathy persisting 2 years after resection of a low-grade MEC of a minor salivary gland. INTERVENTIONS Because the patient's symptomatic relief was glucocorticoid dependent, IgG4-RD was suspected, and she was referred to our medical center. Her amylase and lipase levels were elevated. Serum IgG4 levels were initially within normal limits, but IgG4-RD was diagnosed because of the presence of lymphadenopathy and evidence of pancreatitis, which was shown on positron emission tomography/computed tomography. Furthermore, the IgG4 levels later increased without explanation. After the patient began combination therapy with a glucocorticoid (prednisone) and methotrexate, her symptoms improved but recurred when the daily oral glucocorticoid dosage decreased below 10 mg. An excisional biopsy of her right submandibular gland in 2021 yielded results consistent with IgG4-RD. In addition, AAPOX was diagnosed, given the presence of periocular edema and plaques, adult-onset asthma, and rhinosinusitis. OUTCOME The patient was carcinoma free at last follow-up and was receiving medication to treat the other conditions. LESSONS The diagnosis of these 3 concomitant, uncommon entities required approximately 7 years of medical investigations. Clinicians should know that IgG4-RD, AAPOX, and MEC may occur together.
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Affiliation(s)
- Nikita Chhabra
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | - John E. Cebak
- Department of Neurology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
| | | | - Devyani Lal
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - Cullen M. Taylor
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ryan M. Thorwarth
- Department of Otorhinolaryngology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Ami A. Shah
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
| | - Alicia Rodriguez-Pla
- Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona
- *Correspondence: Alicia Rodriguez-Pla, Division of Rheumatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (e-mail: )
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Bernstein EJ, Assassi S, Castelino FV, Chung L, Correia C, Evnin LB, Frech TM, Gordon JK, Skaug BA, Hant FN, Hummers LK, Sandorfi N, Shah AA, Shanmugam VK, Steen VD, Khanna D. Computed Tomography of the Chest to Screen for Interstitial Lung Disease in Patients With Systemic Sclerosis at Expert Scleroderma Centers in the United States. ACR Open Rheumatol 2022; 4:596-602. [PMID: 35460213 PMCID: PMC9274361 DOI: 10.1002/acr2.11434] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Although a high-resolution computed tomography (HRCT) scan of the chest is the gold standard test for the detection of interstitial lung disease (ILD), there is no consensus among rheumatologists regarding the use of HRCT to screen for ILD in their patients with systemic sclerosis (SSc). The aims of this study were to describe the HRCT ordering practices at SSc centers in the United States and to determine which patient characteristics are associated with HRCT performance. METHODS We performed a prospective cohort study of patients with SSc enrolled in the US-based Collaborative National Quality and Efficacy Registry (CONQUER). We performed univariate logistic regression followed by multivariable logistic regression to determine which patient characteristics were associated with HRCT performance. RESULTS Of the 356 patients with SSc enrolled in CONQUER, 286 (80.3%) underwent HRCT at some point during their disease course. On multivariable analyses, missing total lung capacity percent predicted (odds ratio [OR] 3.26, 95% confidence interval [CI]: 1.53-7.41, P = 0.007) was positively associated with ever having undergone HRCT, whereas a positive anti-centromere antibody (OR 0.27, 95% CI: 0.12-0.61, P = 0.008) and missing forced vital capacity percent predicted (OR 0.29, 95% CI: 0.10-0.80, P = 0.005) were negatively associated with ever having undergone HRCT. There was a trend toward a positive association between crackles on pulmonary exam and ever having undergone HRCT (OR 2.28, 95% CI: 0.97-6.05, P = 0.058), although this relationship did not reach statistical significance. CONCLUSION The majority of patients with SSc enrolled in CONQUER underwent HRCT. A positive anti-centromere antibody was the key clinical variable inversely associated with performance of HRCT.
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Affiliation(s)
- Elana J Bernstein
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Shervin Assassi
- University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Lorinda Chung
- Stanford University and Palo Alto VA Healthcare System, Palo Alto, California
| | - Chase Correia
- Northwestern University, Chicago, Illinois.,Riverside Rheumatology Specialists, Hampton, Virginia
| | - Luke B Evnin
- Scleroderma Research Foundation, San Francisco, California
| | - Tracy M Frech
- University of Utah, Salt Lake City, and Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Brian A Skaug
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Faye N Hant
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Nora Sandorfi
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ami A Shah
- Johns Hopkins University, Baltimore, Maryland
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Mukherjee M, Mercurio V, Balasubramanian A, Shah AA, Hsu S, Simpson CE, Damico R, Kolb TM, Hassoun PM, Mathai SC. Defining minimal detectable difference in echocardiographic measures of right ventricular function in systemic sclerosis. Arthritis Res Ther 2022; 24:146. [PMID: 35717399 PMCID: PMC9206258 DOI: 10.1186/s13075-022-02835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiography (2DE) is integral for screening and longitudinal evaluation of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). In the present study, we sought to establish the reliability, repeatability, and reproducibility of 2DE parameters in SSc patients with and without PAH and to define the minimal detectable difference (MDD), the smallest change detected beyond measurement error. METHODS SSc patients without known PAH and with invasively confirmed PAH on stable therapies underwent 2DE with strain at two time points. Analysis of variance (ANOVA) and coefficients of variation (CV) were calculated to assess for repeatability, reliability, and reproducibility. Intra- and inter-observer agreement were assessed using intraclass correlation. Bland-Altman analysis explored the level of agreement between evaluations. MDD was calculated using the standard error of measurement for each parameter by cohort. RESULTS ANOVA demonstrated few significant differences between evaluations across groups. Global right ventricular longitudinal systolic strain (GRVLSS, 9.7%) and fractional area change (FAC, 21.3%) had the largest CV, while tricuspid annular plane excursion (TAPSE), S' wave, and right ventricular outflow track velocity time integral (RVOT VTI) were 0.87%, 3.2%, and 6.0%, respectively. Intra- and inter-observer agreement was excellent. MDD for TAPSE, FAC, S' wave, RVOT VTI, GRVLSS, and RVSP were 0.11 cm, 0.03%, 1.27 cm/s, 0.81 cm, 1.14%, and 6.5 mmHg, respectively. CONCLUSIONS We demonstrate minimal measurement error in clinically important 2DE-based measures in SSc patients with and without PAH. Defining the MDD in this population has important implications for PAH screening, assessment of therapeutic response, and sample size calculations for future clinical trials.
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Affiliation(s)
- Monica Mukherjee
- Divisions of Cardiology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Ami A Shah
- Divison of Rheumatology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Steven Hsu
- Divisions of Cardiology, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument Street, Room 540, Baltimore, MD, 21205, USA.
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Javad S, Shah AA, Ramzan M, Sardar R, Javed T, Al-Huqail AA, Ali HM, Chaudhry O, Yasin NA, Ahmed S, Hussain RA, Hussain I. Hydrogen sulphide alleviates cadmium stress in Trigonella foenum-graecum by modulating antioxidant enzymes and polyamine content. Plant Biol (Stuttg) 2022; 24:618-626. [PMID: 35114051 DOI: 10.1111/plb.13393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/06/2022] [Indexed: 05/02/2023]
Abstract
Cadmium (Cd) toxicity reduces growth and yield of crops grown in metal-polluted sites. Research was conducted to estimate the potential of hydrogen sulphide (H2 S) to mitigate toxicity caused by Cd in fenugreek seedlings (Trigonella foenum-graecum L.). Different concentrations of CdCl2 (Cd1-1 mM, Cd2-1.5 mM, Cd3-2mM) and H2 S (HS1-100 µM, HS2-150 µM, HS3-200 µM) were assessed. Seeds of fenugreek were primed with sodium hydrosulphide (NaHS), as H2 S donor. Seedlings growing in Cd-spiked media treated with H2 S were harvested after 2 weeks. Cd stress affected growth of fenugreek seedlings. Cd toxicity decreased leaf relative water content (LRWC), intercellular CO2 concentration, net photosynthesis, stomatal conductance and transpiration. However, application of H2 S significantly improved seedling morphological attributes by increasing the activity of antioxidant enzymes, i.e. APX, CAT and SOD, in Cd-contaminated soil. H2 S treatment also regulated phenolic and flavonoid content. H2 S-induced biosynthesis of spermidine (Spd) and putrescine (Put) could account for the enhancement of growth and physiological performance of fenugreek seedlings under Cd stress. H2 S treatment also reduced H2 O2 production (38%) and electrolyte leakage (EL, 51%) in seedlings grown in different concentrations of Cd. It is recommended to evaluate the efficacy of H2 S in alleviating Cd toxicity in other crop plants.
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Affiliation(s)
- S Javad
- Department of Botany, Lahore College for Women University, Lahore, Pakistan
| | - A A Shah
- Department of Botany, Division of Science and Technology., University of Education, Lahore, Pakistan., Lahore, Pakistan
| | - M Ramzan
- Department of Botany, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - R Sardar
- Institute of Botany, University of the Punjab, Lahore, Pakistan
| | - T Javed
- College of Agriculture, Fujian Agriculture and Forestry University, Fuzhou, China
- Department of Agronomy, University of Agriculture, Faisalabad, Pakistan
| | - A A Al-Huqail
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - H M Ali
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - O Chaudhry
- Ontario Institute of Agrology, Biology and Environmental Sciences, Albert Campbell Collegiate Institute (NS), Scarborough, Ontario, Canada
| | - N A Yasin
- Senior Superintendent Garden, RO-II Office, University of the Punjab, Lahore, Pakistan
| | - S Ahmed
- Institute of Botany, University of the Punjab, Lahore, Pakistan
| | - R A Hussain
- Department of Botany, Division of Science and Technology., University of Education, Lahore, Pakistan., Lahore, Pakistan
| | - I Hussain
- Department of Agronomy, Faculty of Agriculture, Gomal University, Dera Ismail Khan, KPK, Pakistan
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Connolly CM, Chiang TPY, Teles M, Frey S, Alejo JL, Massie A, Shah AA, Albayda J, Christopher-Stine L, Werbel WA, Segev DL, Paik JJ. Factors associated with poor antibody response to third-dose SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases. Lancet Rheumatol 2022; 4:e382-e384. [PMID: 35368386 PMCID: PMC8963771 DOI: 10.1016/s2665-9913(22)00065-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - William A Werbel
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Connolly CM, Frey S, Chiang TPY, Teles M, Alejo JL, Albayda J, Shah AA, Werbel WA, Segev DL, Christopher-Stine L, Paik JJ. Safety of third-dose SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal disease. Rheumatology (Oxford) 2022; 61:e302-e304. [PMID: 35583259 PMCID: PMC9129174 DOI: 10.1093/rheumatology/keac298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah Frey
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mayan Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Werbel
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Hinze AM, Perin J, Woods A, Hummers LK, Wigley FM, Mukherjee M, Shah AA. Diastolic Dysfunction in Systemic Sclerosis: Risk Factors and Impact on Mortality. Arthritis Rheumatol 2022; 74:849-859. [PMID: 34927390 PMCID: PMC9050815 DOI: 10.1002/art.42054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/04/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the independent risk factors for diastolic dysfunction (DD) in patients with systemic sclerosis (SSc) and to evaluate the impact of DD on mortality. METHODS SSc patients enrolled in the Johns Hopkins Scleroderma Center Cohort between November 1, 2006 and November 1, 2017 with ≥1 analyzable 2-dimensional (2-D) echocardiogram in our system were included (n = 806). DD risk factors and SSc disease characteristics were prospectively obtained, and the presence or absence of DD was determined using the most recent 2-D echocardiogram. Logistic regression models examined associations between clinical risk factors and DD, and Cox proportional hazards models were used to assess survival. RESULTS DD was present in 18.6% of participants. The majority of participants were female (84%) with a median age of 58.4 years (interquartile range 48.8-68.1). Older age (odds ratio [OR] 1.12 [95% confidence interval (95% CI) 1.09-1.15], P < 0.001), coronary artery disease (OR 3.69 [95% CI 1.52-8.97], P = 0.004), obesity (OR 4.74 [95% CI 2.57-8.74], P < 0.001), longer SSc disease duration (OR 1.04 [95% CI 1.01-1.06], P = 0.004), diffusing capacity for carbon monoxide ≤60% of predicted (OR 2.41 [95% CI 1.40-4.16], P = 0.002), and history of scleroderma renal crisis (OR 3.18 [95% CI 1.12-9.07], P = 0.031) were all independently associated with an increased risk of DD. Anti-Scl-70 positivity (OR 0.49 [95% CI 0.26-0.93], P = 0.03) and severe gastrointestinal disease (OR 0.48 [95% CI 0.30-0.79], P = 0.004) were associated with a reduced risk of DD. The presence of DD was independently associated with an increase in the risk of mortality (hazard ratio 1.69 [95% CI 1.07-2.68], P = 0.027). CONCLUSION DD is independently associated with an increased risk of mortality in patients with SSc. Potentially modifiable risk factors, including coronary artery disease and obesity, should be addressed in patients with SSc to reduce mortality risk.
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Affiliation(s)
- Alicia M. Hinze
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adrianne Woods
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura K. Hummers
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fredrick M. Wigley
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Mukherjee
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ami A. Shah
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
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Smith JF, Shah AA, Qureshi MB, Luong HN, Adeleye O, Adams OE, Shen JF. Characterizing Extremely Negative Reviews of Ophthalmologists on Yelp.Com. Semin Ophthalmol 2022; 37:661-667. [DOI: 10.1080/08820538.2022.2064193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jacob F. Smith
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Ami A. Shah
- Department of Ophthalmology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Hanna N. Luong
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Olufemi E. Adams
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA
| | - Joanne F. Shen
- Department of Ophthalmology, Mayo Clinic, Phoenix, AZ, USA
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33
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Wallwork R, Connolly CM, Shneyderman M, McMahan Z, Mecoli CA, Wigley F, Hummers LK, Shah AA, Paik JJ. Effect of mycophenolate mofetil dose on antibody response following initial SARS-CoV-2 vaccination in patients with systemic sclerosis. The Lancet Rheumatology 2022; 4:e462-e464. [PMID: 35502180 PMCID: PMC9045742 DOI: 10.1016/s2665-9913(22)00100-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fitzgerald KC, Mecoli CA, Douglas M, Harris S, Aravidis B, Albayda J, Sotirchos ES, Hoke A, Orbai AM, Petri M, Christopher-Stine L, Baer AN, Paik JJ, Adler BL, Tiniakou E, Timlin H, Bhargava P, Newsome SD, Venkatesan A, Chaudhry V, Lloyd TE, Pardo CA, Stern BJ, Lazarev M, Truta B, Saidha S, Chen ES, Sharp M, Gilotra N, Kasper EK, Gelber AC, Bingham CO, Shah AA, Mowry EM. Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases. Clin Infect Dis 2022; 74:427-436. [PMID: 33956972 PMCID: PMC8135997 DOI: 10.1093/cid/ciab407] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. METHODS We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health. RESULTS In total, 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95% CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95% CI: 1.24, 2.28), and kidney disease (OR: 1.76; 95% CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income. CONCLUSIONS Glucocorticoid exposure may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.
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Affiliation(s)
- Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Morgan Douglas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Samantha Harris
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Berna Aravidis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jemima Albayda
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ana-Maria Orbai
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Brittany L Adler
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Homa Timlin
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pavan Bhargava
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Vinay Chaudhry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Barney J Stern
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mark Lazarev
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Brindusa Truta
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nisha Gilotra
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Edward K Kasper
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Allan C Gelber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Castelino FV, VanBuren JM, Startup E, Assassi S, Bernstein EJ, Chung L, Correia C, Evnin LB, Frech TM, Gordon JK, Hant FN, Hummers LK, Khanna D, Sandorfi N, Shah AA, Shanmugam VK, Steen V. Baseline characteristics of systemic sclerosis patients with restrictive lung disease in a multi-center US-based longitudinal registry. Int J Rheum Dis 2022; 25:163-174. [PMID: 34841681 DOI: 10.1111/1756-185x.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/30/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
AIM Interstitial lung disease (ILD) is the leading cause of disease-related death in systemic sclerosis (SSc). Here, we assess baseline characteristics of SSc subjects with and without restrictive lung disease (RLD) in a multi-center, US-based registry. METHODS SSc patients within 5 years of disease onset were enrolled in the Collaborative National Quality and Efficacy Registry (CONQUER), a multi-center US-based registry of SSc study participants (age ≥ 18 years) enrolled at 13 expert centers. All subjects met 2013 American College of Rheumatology / European League Against Rheumatism criteria. Subjects with a pulmonary function test (PFT) at baseline before April 1, 2020 were included. High-resolution computed tomography scan of the chest was not available to characterize ILD for all subjects. RLD was defined as forced vital capacity (FVC) <80% or total lung capacity (TLC) <80% predicted. RESULTS There were 160 (45%) SSc subjects characterized as having RLD. There was no significant difference in age, gender or disease duration. RLD subjects had a mean disease duration from date of first non-Raynaud's symptom of 2.6 years and a mean FVC% predicted of 67% at baseline. In multivariable analysis, non-White race, higher physician global health assessment and modified Medical Research Council (mMRC) dyspnea scores, were independently associated with RLD. In the subgroup of RLD subjects with ILD, ILD had a negative correlation with RNA polymerase III antibody. CONCLUSION CONQUER is the largest, multi-center, prospective cohort of early SSc patients in the US. Non-White race was independently associated with RLD. In addition, 45% of CONQUER subjects already had RLD, highlighting the importance of screening for SSc-ILD at initial diagnosis.
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Affiliation(s)
- Flavia V Castelino
- Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John M VanBuren
- Department or Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Emily Startup
- Department or Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Shervin Assassi
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elana J Bernstein
- Division of Rheumatology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Lorinda Chung
- Division of Rheumatology, Department of Medicine and Dermatology, Stanford University and Palo Alto Veterans Affairs Health Care System, Stanford, California, USA
| | - Chase Correia
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Luke B Evnin
- Scleroderma Research Foundation, San Francisco, California, USA
| | - Tracy M Frech
- Division of Rheumatology, Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Salt Lake City, Utah, USA
| | | | - Faye N Hant
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Laura K Hummers
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan, USA
| | - Nora Sandorfi
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Victoria K Shanmugam
- Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Virginia Steen
- Georgetown University School of Medicine, Washington, District of Columbia, USA
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36
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Wallwork R, Casciola-Rosen L, Shah AA. Anti-ANP32A antibodies in systemic sclerosis. Ann Rheum Dis 2022; 81:301-302. [PMID: 34697026 PMCID: PMC8961456 DOI: 10.1136/annrheumdis-2021-221354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Rachel Wallwork
- Department of Medicine/Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Livia Casciola-Rosen
- Department of Medicine/Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Department of Medicine/Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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37
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Connolly CM, Chiang TPY, Boyarsky BJ, Ruddy JA, Teles M, Alejo JL, Massie A, Werbel WA, Shah AA, Christopher-Stine L, Garonzik-Wang J, Segev DL, Paik JJ. Temporary hold of mycophenolate augments humoral response to SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases: a case series. Ann Rheum Dis 2022; 81:293-295. [PMID: 34556484 PMCID: PMC11034709 DOI: 10.1136/annrheumdis-2021-221252] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Jake A Ruddy
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mayan Teles
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Allan Massie
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - William A Werbel
- Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ami A Shah
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Dorry L Segev
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julie J Paik
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
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38
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Teles M, Connolly CM, Frey S, Chiang TPY, Alejo JJ, Boyarsky BJ, Shah AA, Albayda J, Christopher-Stine L, Werbel WA, Segev DL, Paik JJ. Attenuated response to fourth dose SARS-CoV-2 vaccination in patients with autoimmune disease: a case series. Ann Rheum Dis 2022; 81:738-740. [PMID: 35039324 DOI: 10.1136/annrheumdis-2021-221641] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mayan Teles
- Surgery, Johns Hopkins, Baltimore, Maryland, USA
| | - Caoilfhionn M Connolly
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Frey
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William A Werbel
- Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dorry L Segev
- Surgery, Johns Hopkins, Baltimore, Maryland, USA .,Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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39
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Cappelli LC, Bingham CO, Braaten T, Shah AA. Response to: Correspondence on "Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation" by Braaten et al. Ann Rheum Dis 2022; 81:e14. [PMID: 31959594 PMCID: PMC7369218 DOI: 10.1136/annrheumdis-2019-216892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Laura C Cappelli
- Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tawnie Braaten
- Rheumatology, University of Utah, Salt Lake City, Utah, USA
| | - Ami A Shah
- Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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40
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Kim JS, Shah AA, Hummers LK, Zeger SL. Predicting clinical events using Bayesian multivariate linear mixed models with application to scleroderma. BMC Med Res Methodol 2021; 21:249. [PMID: 34773969 PMCID: PMC8590788 DOI: 10.1186/s12874-021-01439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scleroderma is a serious chronic autoimmune disease in which a patient's disease state manifests in several irregularly spaced longitudinal measures of lung, heart, skin, and other organ systems. Threshold crossings of pulmonary and cardiac measures indicate potentially life-threatening key clinical events including interstitial lung disease (ILD), cardiomyopathy, and pulmonary hypertension (PH). The statistical challenge is to accurately and precisely predict these events by using all of the clinical history for the patient at hand and for a reference population of patients. METHODS We use a Bayesian mixed model approach to simultaneously characterize each individual's future trajectories for several biomarkers. We estimate this model using a large population of patients from the Johns Hopkins Scleroderma Center Research Registry. The joint probabilities of critical lung and heart events are then calculated as a byproduct of the mixed model. RESULTS The performance of this approach is substantially better than standard, more common alternatives. In order to predict an individual's risks in a clinical setting, we also develop a cross-validated, sequential prediction (CVSP) algorithm. As additional data are observed during a patient's visit, the algorithm sequentially produces updated predictions for the future longitudinal trajectories and for ILD, cardiomyopathy, and PH. The updated prediction distributions with little additional computing, for example within an electronic health record (EHR). CONCLUSIONS This method that generates real-time personalized risk estimates has been implemented within the electronic health record system for clinical testing. To our knowledge, this work represents the first approach to compute personalized risk estimates for multiple scleroderma complications.
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Affiliation(s)
- Ji Soo Kim
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura K Hummers
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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41
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Cappelli LC, Darrah E, Shah AA, Bingham CO. Patients with checkpoint inhibitor-induced inflammatory arthritis do not become seropositive for anti-cyclic citrullinated peptide when followed over time. ACR Open Rheumatol 2021; 4:83-84. [PMID: 34757698 PMCID: PMC8754020 DOI: 10.1002/acr2.11363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Erika Darrah
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, MD
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42
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Shuaib M, Hussain F, Rauf A, Jan F, Romman M, Parvez R, Zeb A, Ali S, Abidullah S, Bahadur S, Shah AA, Azam N, Dilbar S, Begum K, Khan H, Sajjad S, Muhammad I, Shah NA. Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan. BRAZ J BIOL 2021; 83:e246803. [PMID: 34495160 DOI: 10.1590/1519-6984.246803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.
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Affiliation(s)
- M Shuaib
- Yunnan University, School of Ecology and Environmental Science, Kunming, PR China
| | - F Hussain
- Cholistan University of Veterinary & Animal Sciences, Department of Microbiology, Bahawalpur, Pakistan
| | - A Rauf
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan
| | - F Jan
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan
| | - M Romman
- University of Chitral, Department of Botany, Chitral, Pakistan
| | - R Parvez
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan.,Government Girls Degree College Dargai, Department of Botany, District Malakand, Pakistan
| | - A Zeb
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan
| | - S Ali
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan
| | - S Abidullah
- Abdulwali Khan University, Department of Botany, Mardan, Pakistan
| | - S Bahadur
- Hainan University, College of Forestry, Haikou, China
| | - A A Shah
- Jazan University, Department of Medical Laboratory Technology, Jazan, Saudi Arabia
| | - N Azam
- University of Peshawar, Centre of Plant Biodiversity, Peshawar, Pakistan
| | - S Dilbar
- University of Swat, Centre of Plant Biodiversity, Swat, Pakistan
| | - K Begum
- University of Hazara, Department of Genetic, Manshera, Pakistan
| | - H Khan
- University of Swat, Center of Biotechnology and Microbiology, Swat, Pakistan
| | - S Sajjad
- COMSATS University, Department of Biosciences, Park Road Islamabad, Pakistan
| | - I Muhammad
- University of Hazara, Department of Genetic, Manshera, Pakistan
| | - N A Shah
- COMSATS University, Department of Biosciences, Park Road Islamabad, Pakistan
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43
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Saketkoo LA, Frech T, Varjú C, Domsic R, Farrell J, Gordon JK, Mihai C, Sandorfi N, Shapiro L, Poole J, Volkmann ER, Lammi M, McAnally K, Alexanderson H, Pettersson H, Hant F, Kuwana M, Shah AA, Smith V, Hsu V, Kowal-Bielecka O, Assassi S, Cutolo M, Kayser C, Shanmugam VK, Vonk MC, Fligelstone K, Baldwin N, Connolly K, Ronnow A, Toth B, Suave M, Farrington S, Bernstein EJ, Crofford LJ, Czirják L, Jensen K, Hinchclif M, Hudson M, Lammi MR, Mansour J, Morgan ND, Mendoza F, Nikpour M, Pauling J, Riemekasten G, Russell AM, Scholand MB, Seigart E, Rodriguez-Reyna TS, Hummers L, Walker U, Steen V. A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc. Best Pract Res Clin Rheumatol 2021; 35:101707. [PMID: 34538573 PMCID: PMC8670736 DOI: 10.1016/j.berh.2021.101707] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 12/14/2022]
Abstract
Systemic sclerosis (SSc), the most lethal of rheumatologic conditions, is the cause of death in >50% of SSc cases, led by pulmonary fibrosis followed by pulmonary hypertension and then scleroderma renal crisis (SRC). Multiple other preventable and treatable SSc-related vascular, cardiac, gastrointestinal, nutritional and musculoskeletal complications can lead to disability and death. Vascular injury with subsequent inflammation transforming to irreversible fibrosis and permanent damage characterizes SSc. Organ involvement is often present early in the disease course of SSc, but requires careful history-taking and vigilance in screening to detect. Inflammation is potentially reversible provided that treatment intensity quells inflammation and other immune mechanisms. In any SSc phenotype, opportunities for early treatment are prone to be under-utilized, especially in slowly progressive phenotypes that, in contrast to severe progressive ILD, indolently accrue irreversible organ damage resulting in later-stage life-limiting complications such as pulmonary hypertension, cardiac involvement, and malnutrition. A single SSc patient visit often requires much more physician and staff time, organization, vigilance, and direct management for multiple organ systems compared to other rheumatic or pulmonary diseases. Efficiency and efficacy of comprehensive SSc care enlists trending of symptoms and bio-data. Financial sustainability of SSc care benefits from understanding insurance reimbursement and health system allocation policies for complex patients. Sharing care between recognised SSc centers and local cardiology/pulmonary/rheumatology/gastroenterology colleagues may prevent complications and poor outcomes, while providing support to local specialists. As scleroderma specialists, we offer a practical framework with tools to facilitate an optimal, comprehensive and sustainable approach to SSc care. Improved health outcomes in SSc relies upon recogntion, management and, to the extent possible, prevention of SSc and treatment-related complications.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA.
| | - Tracy Frech
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | | | - Jessica Farrell
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Jessica K Gordon
- Department of Rheumatology at Hospital for Special Surgery, New York, NY, USA
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Lee Shapiro
- Steffens Scleroderma Foundation, Albany, NY, USA; Division of Rheumatology, Albany Medical Center, Albany, NY, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | | | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | - Helene Alexanderson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Faye Hant
- Division of Rheumatology, Medical University of South Caroline, SC, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Vivien Hsu
- Rutgers- RWJ Scleroderma Program, New Brunswick, NJ, USA
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Shervin Assassi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genova, Italy
| | - Cristiane Kayser
- Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) São Paulo, SP, Brazil
| | - Victoria K Shanmugam
- Department of Rheumatology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Madelon C Vonk
- Department of the rheumatic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Fligelstone
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Nancy Baldwin
- Patient Research Partner, Scleroderma Foundation, Chicago, IL, USA
| | | | - Anneliese Ronnow
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Beata Toth
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | | | - Sue Farrington
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Elana J Bernstein
- Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Kelly Jensen
- Tulane University School of Medicine, New Orleans, USA; Oregon Health and Science University, Portland, OR, USA
| | - Monique Hinchclif
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA
| | - Marie Hudson
- Division of heumatology and Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA
| | | | - Nadia D Morgan
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian Mendoza
- Rheumatology Division, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mandana Nikpour
- Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Pauling
- University of Melbourne, Melbourne at St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Gabriela Riemekasten
- Royal National Hospital for Rheumatic Diseases, Bath, UK; University of Lübeck, University Clinic of Schleswig-Holstein, Dept Rheumatology and Clinical Immunology, Lübeck, Germany
| | | | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Elise Seigart
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Laura Hummers
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Walker
- Dept. of Rheumatology, Basel University Hospital, Basel, Switzerland
| | - Virginia Steen
- Division of Rheumatology, Department of Medicine, Georgetown University, Washington, DC, USA
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Khattak RH, Xin Z, Ahmad S, Bari F, Khan A, Nabi G, Shah AA, Khan S, Rehman EU. Feral dogs in Chitral gol national park, Pakistan: a potential threat to the future of threatened Kashmir Markhor (Capra falconeri cashmiriensis). BRAZ J BIOL 2021; 83:e245867. [PMID: 34431907 DOI: 10.1590/1519-6984.245867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
Feral dogs are well-organized hunters of ungulates in many parts of the world, causing great damage to wildlife populations and ultimately to the ecosystem. In Pakistan, the impacts of feral dogs on the wildlife have not been documented yet. In a period of fifteen years (2006-2020), feral dogs have killed hundreds of threatened markhor in Chitral gol national park (CGNP), Pakistan. Despite direct predation other impacts including disturbance and competition with other natural predators, could compromise conservation and management efforts. The population of feral dogs seems to have been increased with the increase of dumping sites by communities. Our findings suggest that there are pressing needs of controlling the feral dogs population and eradicating them from the core zone of CGNP and surrounding buffer communities. Conventional culling of dogs should be coupled with modern techniques like castration and sterilization. Communities should be educated regarding the clean environment, proper disposal of home wastes and, biodiversity conservation.
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Affiliation(s)
- R H Khattak
- Northeast Forestry University, College of Wildlife and Protected Areas, Harbin 150040, P.R. China
| | - Z Xin
- Library of Northeast Forestry University, Harbin 150040, P.R. China.,Tarim University, Alar 843300, P.R. China
| | - S Ahmad
- Quaid I Azam University, Department of Zoology, Carnivores Conservation Lab, Islamabad, Pakistan
| | - F Bari
- University of Chitral, Department of Zoology, Wildlife and Ecosystem Research Lab, Chitral, Pakistan
| | - A Khan
- ABD Media, Islamabad, Pakistan
| | - G Nabi
- Hebei Normal University, College of Life Sciences, Key Laboratory of Animal Physiology, Bichemistry and Molecular Biology of Hebei Province, Shijiazhuang, China
| | - A A Shah
- Wildlife Department Chitral Division, Khyber Pakhtunkhwa, Pakistan
| | - S Khan
- Snow Leopard Foundation, Islamabad, Pakistan
| | - E Ur Rehman
- Snow Leopard Foundation, Islamabad, Pakistan
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Paik JJ, Choi DY, Mukherjee M, Hsu S, Wigley F, Shah AA, Hummers LK. Troponin elevation independently associates with mortality in systemic sclerosis. Clin Exp Rheumatol 2021; 40:1933-1940. [DOI: 10.55563/clinexprheumatol/fytfmy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Julie J. Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Deborah Y. Choi
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fredrick Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A. Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura K. Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mecoli CA, Gutierrez-Alamillo L, Yang Q, Sampedro M, Woods A, Hummers LK, Wigley F, Shah AA, Casciola-Rosen L. PM-Scl and Th/To in systemic sclerosis: a comparison of different autoantibody assays. Clin Rheumatol 2021; 40:2763-2769. [PMID: 33459953 PMCID: PMC8192488 DOI: 10.1007/s10067-021-05586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/14/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare test characteristics of the Euroimmun line blot assay with other assays for two uncommon autoantibody specificities in systemic sclerosis (SSc). METHODS Patients from the Johns Hopkins Scleroderma Center were assayed routinely using the Euroimmun platform. Patients positive for anti-Th/To (N = 73) and anti-PM-Scl (PM75 and/or PM100; N = 290) by Euroimmun were compared with SSc patients negative for these autoantibodies. For Th/To antibodies, the comparison assay was immunoprecipitation (IP), performed using 4 Th/To complex components: POP1, RPP40, RPP30, and RPP25. For anti-PM-Scl, IPs were performed with PM100 and PM75. Different Euroimmun cut-offs for assigning antibody positive status (≥ 15/+, ≥ 36/++, ≥ 71/+++) were examined. Kappa statistics were calculated to determine agreement between assays. RESULTS The best performing thresholds for defining anti-PM-Scl positivity were both PM75 and PM100 ≥ 15/+ on Euroimmun, corresponding to a kappa statistic of 0.79, sensitivity 72% and specificity 100%. For anti-Th/To, kappa values were lower for all comparisons (κ < 0.5). Given the high sensitivity of defining anti-Th/To by ≥ 15/+ (91-95%), a potential approach is to use Euroimmun screening (15/+ cut-off), followed by confirmatory IP. CONCLUSION Given the increasing utilization of Euroimmun and the importance of comparing data across cohorts, continued use of this platform is warranted, acknowledging discordance with IP for some specificities. For these, using a two-step approach (Euroimmun to maximize sensitivity, confirmatory assay to increase specificity) is suggested. KEY POINTS • For less common SSc autoantibody specificities, some discordances exist between IP and Euroimmun LIA. • The best performing thresholds for defining anti-PM-Scl positivity were both PM75 and PM100 ≥ 15/+ on Euroimmun. • For Th/To, a two-step approach (Euroimmun to maximize sensitivity, confirmatory assay to increase specificity) is suggested.
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Affiliation(s)
- C A Mecoli
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| | - L Gutierrez-Alamillo
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Q Yang
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - M Sampedro
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - A Woods
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - L K Hummers
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - F Wigley
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - A A Shah
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - L Casciola-Rosen
- Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
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Jaafar S, Lescoat A, Huang S, Gordon J, Hinchcliff M, Shah AA, Assassi S, Domsic R, Bernstein EJ, Steen V, Elliott S, Hant F, Castelino FV, Shanmugam VK, Correia C, Varga J, Nagaraja V, Roofeh D, Frech T, Khanna D. Clinical characteristics, visceral involvement, and mortality in at-risk or early diffuse systemic sclerosis: a longitudinal analysis of an observational prospective multicenter US cohort. Arthritis Res Ther 2021; 23:170. [PMID: 34127049 PMCID: PMC8201684 DOI: 10.1186/s13075-021-02548-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early diffuse cutaneous systemic sclerosis (dcSSc) has the highest case fatality among rheumatic diseases. We report baseline characteristics, current immunosuppressive therapies, progression of skin and internal organ involvement, and mortality in a multicenter prospective cohort from the United States (US) of America. METHODS We performed a longitudinal analysis of participants from 12 US centers, from April 2012 to July 2020. All participants had early dcSSc or were at-risk for dcSSc, with ≤2 years since the first non-Raynaud's phenomenon (RP) symptom. RESULTS Three hundred one patients were included with a baseline median disease duration of 1.2 years since RP and a mean modified skin score of 21.1 units. At baseline, 263 (87.3%) had definite dcSSc and 38 (12.7%) were classified as at-risk; 112 (49.6%) patients were positive for anti-RNA polymerase III antibodies. The median follow-up duration was 24.5 months (IQR = 10.3-40.7 months). One hundred ninety (63.1%) participants were treated with an immunosuppressive therapy, of which mycophenolate mofetil was most used at baseline and follow-up. Of 38 who were classified as at-risk at baseline, 27 (71%) went on to develop dcSSc; these patients were characterized by higher baseline mean HAQ-DI (0.8 versus 0.4, p = 0.05) and higher baseline mRSS (8.8 versus 4.4, p < 0.01) in comparison with those who remained as limited cutaneous SSc. In the overall cohort, 48 participants (21.1%) had clinically significant worsening of skin fibrosis, mainly occurring in the first year of follow-up; 41 (23.3%) had an absolute forced vital capacity decline of ≥10%. Twenty participants (6.6%) died, of which 18 died in the first 3 years of follow-up. Cardiac involvement (33.3%), gastrointestinal dysmotility (22.2%), and progressive interstitial lung disease (ILD) (16.7%) were the main causes of death. CONCLUSION This US cohort highlights the management of early SSc in the current era, demonstrating progression of skin and lung involvement despite immunosuppressive therapy and high mortality due to cardiac involvement.
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Affiliation(s)
- Sara Jaafar
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Alain Lescoat
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Univ Rennes, Rennes, France
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail, Rennes, France
| | - Suiyuan Huang
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Jessica Gordon
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | | | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shervin Assassi
- Department of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Robyn Domsic
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Virginia Steen
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Sabrina Elliott
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Faye Hant
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Chase Correia
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - John Varga
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Vivek Nagaraja
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - David Roofeh
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Tracy Frech
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dinesh Khanna
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA.
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Robinett DM, Hummers LK, Morris M, Duffield AS, Shah AA. Primary CNS lymphoma in scleroderma: a case series. J Scleroderma Relat Disord 2021; 6:214-219. [PMID: 34350365 PMCID: PMC8330379 DOI: 10.1177/2397198320970395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
Many studies have demonstrated an increased risk of cancer in patients with rheumatologic diseases, including systemic sclerosis. Less explored is the role of immunosuppressive therapy as a contributing factor in cancer emergence or detection. This series introduces two cases of patients with systemic sclerosis who demonstrated clinical improvement in their rheumatic disease process with immunosuppression, but both of whom developed neurologic symptoms in the setting of decreasing or discontinuing immunosuppressive therapy, leading to the ultimate diagnosis of Epstein Barr Virus positive (EBV+) diffuse large B cell lymphoma of the CNS. To our knowledge, primary CNS lymphoma has not been previously described in systemic sclerosis patients. Immunosuppressive therapies could promote the development of virus-associated malignancies due to decreased viral clearance. We hypothesize that removing immunosuppression could allow the immune system to generate an inflammatory response to an underlying tumor or viral antigen, contributing to development of neurologic symptoms and detection of underlying disease.
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Affiliation(s)
- Danielle M Robinett
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Laura K Hummers
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Meaghan Morris
- Department of Pathology, School of
Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Amy S Duffield
- Department of Pathology, School of
Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Ami A Shah
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Scleroderma Center,
Baltimore, MD, USA
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DiRenzo DD, Smith TR, Frech TM, Shah AA, Pauling JD. Effect of Coping Strategies on Patient and Physician Perceptions of Disease Severity and Disability in Systemic Sclerosis. J Rheumatol 2021; 48:1569-1573. [PMID: 33934078 DOI: 10.3899/jrheum.201612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) results in impaired function, disability, and reduced health-related quality of life. We investigated the effect of coping strategies on the patient global assessment of health (PtGA) and Health Assessment Questionnaire-Disability Index (HAQ-DI), after controlling for clinical characteristics and disease activity. We also explored the relationship between coping strategies and the correlation between the PtGA and physician global assessment (PGA) in SSc. METHODS We undertook posthoc analyses using baseline data obtained from the Raynaud Symptom Study (RSS). The PtGA, Coping Strategies Questionnaire, Pain Catastrophizing Scale, and Scleroderma Health Assessment Questionnaire were collected alongside the PGA, clinical characteristics, and patient demographics. Multivariable linear regression models and correlations were used to evaluate the relationship between coping strategies with the PtGA, HAQ-DI, and PGA. RESULTS Of the 107 patients with SSc enrolled in the RSS, there were sufficient data available for the analysis of 91 participants. The mean PtGA was 40/100 (SD 27) and the mean HAQ-DI was 0.87/3.0 (SD 0.73). After controlling for clinical and patient demographics, pain catastrophizing and maladaptive coping skills were significantly associated with the PtGA and HAQ-DI scores (P < 0.05 for both), but not the PGA. CONCLUSION The effect of coping strategies on PtGA and HAQ-DI (but not PGA in SSc) could influence the result of composite measures incorporating these outcome measures. Interventions to improve patient coping skills may support increased resilience and improve patient-perceived functional status and PtGA in SSc.
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Affiliation(s)
- Dana D DiRenzo
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Theresa R Smith
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Tracy M Frech
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - Ami A Shah
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
| | - John D Pauling
- DDD is supported by the Jerome L. Greene Foundation. D.D. DiRenzo, MD, MHS, A.A. Shah, MD, MHS, Johns Hopkins Division of Rheumatology, Baltimore, Maryland, USA; T.R. Smith, PhD, Department of Mathematical Sciences, University of Bath, Bath, UK; T.M. Frech, MD, MS, University of Utah, Salt Lake City, Utah, USA; J.D. Pauling, BMedSci, BMBS, PhD, FRCP, Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. A.A. Shah and J.D. Pauling are joint senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J.D. Pauling, Consultant Rheumatologist & Senior Lecturer, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases (part of the Royal United Hospitals Bath NHS Foundation Trust), Combe Park, Avon, Bath, BA1 3NG, UK. . Accepted for publication April 14, 2021
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Assassi S, Li N, Volkmann ER, Mayes MD, Rünger D, Ying J, Roth MD, Hinchcliff M, Khanna D, Frech T, Clements PJ, Furst DE, Goldin J, Bernstein EJ, Castelino FV, Domsic RT, Gordon JK, Hant FN, Shah AA, Shanmugam VK, Steen VD, Elashoff RM, Tashkin DP. Predictive Significance of Serum Interferon-Inducible Protein Score for Response to Treatment in Systemic Sclerosis-Related Interstitial Lung Disease. Arthritis Rheumatol 2021; 73:1005-1013. [PMID: 33350170 DOI: 10.1002/art.41627] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/15/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Response to immunosuppression is highly variable in systemic sclerosis (SSc)-related interstitial lung disease (ILD). This study was undertaken to determine whether a composite serum interferon (IFN)-inducible protein score exhibits predictive significance for the response to immunosuppression in SSc-ILD. METHODS Serum samples collected in the Scleroderma Lung Study II, a randomized controlled trial of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC), were examined. Results were validated in an independent observational cohort receiving active treatment. A composite score of 6 IFN-inducible proteins IFNγ-inducible 10-kd protein, monokine induced by IFNγ, monocyte chemotactic protein 2, β2 -microglobulin, tumor necrosis factor receptor type II, and macrophage inflammatory protein 3β) was calculated, and its predictive significance for longitudinal forced vital capacity percent predicted measurements was evaluated. RESULTS Higher baseline IFN-inducible protein score predicted better response over 3 to 12 months in the MMF arm (point estimate = 0.41, P = 0.001) and CYC arm (point estimate = 0.91, P = 0.009). In contrast, higher baseline C-reactive protein (CRP) levels were predictive of a worse ILD course in both treatment arms. The predictive significance of the IFN-inducible protein score and CRP levels remained after adjustment for baseline demographic and clinical predictors. During the second year of treatment, in which patients in the CYC arm were switched to placebo, a higher IFN-inducible protein score at 12 months showed a trend toward predicting a worse ILD course (point estimate = -0.61, P = 0.068), while it remained predictive of better response to active immunosuppression in the MMF arm (point estimate = 0.28, P = 0.029). The predictive significance of baseline IFN-inducible protein score was replicated in the independent cohort (rs = 0.43, P = 0.028). CONCLUSION A higher IFN-inducible protein score in SSc-ILD is predictive of better response to immunosuppression and could potentially be used to identify patients who may derive the most benefit from MMF or CYC.
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Affiliation(s)
| | - Ning Li
- University of California, Los Angeles
| | | | | | | | - Jun Ying
- University of Texas Health Science Center at Houston
| | | | | | | | | | | | | | | | | | - Flavia V Castelino
- Massachusetts General Hospital and Harvard University, Boston, Massachusetts
| | | | | | - Faye N Hant
- Medical University of South Carolina, Charleston
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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