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Ghosh N, Jivanelli B, Couette N, Singh N, Kostine M, Simon Meara A, Liew DFL. The Need for Classification Criteria of Immune Checkpoint Inhibitor-induced inflammatory Arthritis: A Scoping Review. Rheum Dis Clin North Am 2024; 50:325-335. [PMID: 38670730 DOI: 10.1016/j.rdc.2024.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is an immune-related adverse event that can occur as a result of receiving ICIs for cancer treatment. Thus far, ICI-IA has been described variably in the literature, in part due to varying presentations that evolve over time, as well as a lack of standardized definitions and classification. This scoping review aggregates various descriptions of ICI-IA, highlighting the most prominent attributes of ICI-IA from categories such as symptoms, signs, imaging, and laboratory findings as well as discussing potential mimic conditions.
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Affiliation(s)
- Nilasha Ghosh
- Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Bridget Jivanelli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Nina Couette
- Department of Rheumatology, Rheumatology Care Center, Genesis Healthcare System, 2525 Maple Avenue, Zanesville, OH 43701, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Marie Kostine
- Department of Rheumatology, Bordeaux University Hospital, 311 Président Wilson Boulevard, Bordeaux 33200, France
| | - Alexa Simon Meara
- Division of Oncology, Department of Medicine, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - David F L Liew
- Department of Rheumatology, Austin Health; Department of Clinical Pharmacology and Therapeutics, Austin Health; Department of Medicine, University of Melbourne, Level 1, North Wing, 300 Waterdale Road, PO Box 5444, Heidelberg West, Victoria 3081, Australia
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Liew DFL, Meara AS. Rheumatic Immune-Related Adverse Events: Current Clinical Imperatives Underpin Future Novel Insights. Rheum Dis Clin North Am 2024; 50:xvii-xix. [PMID: 38670733 DOI: 10.1016/j.rdc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- David F L Liew
- Department of Rheumatology and Clinical Pharmacology and Therapeutics, Austin Health, Level 1, North Wing, 300 Waterdale Road, PO Box 5444, Heidelberg West, Victoria 3081, Australia.
| | - Alexa Simon Meara
- Division of Oncology, Department of Medicine, The Ohio State University, Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
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Liew DFL, Mackie SL, Tison A, Sattui SE, Yates M, Buchanan RRC, Owen CE. Immune Checkpoint Inhibitor-induced Polymyalgia Rheumatica. Rheum Dis Clin North Am 2024; 50:255-267. [PMID: 38670724 DOI: 10.1016/j.rdc.2024.02.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Polymyalgia rheumatica (PMR) immune-related adverse events (ICI-PMRs) represent a novel, distinct entity, despite many clinical, laboratory, and imaging similarities to classical PMR. Important questions remain in differentiating ICI-PMR from classical PMR, as well as other immune-related adverse events and PMR mimics. Despite this, ICI-PMR currently takes treatment cues from classical PMR, albeit with considerations relevant to cancer immunotherapy. Comparisons between ICI-PMR and classical PMR may provide further bidirectional insights, especially given that important questions remain unanswered about both diseases. The cause of classical PMR remains poorly understood, and ICI-PMR may represent a model of induced PMR, with important therapeutic implications.
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Affiliation(s)
- David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg West VIC 3081, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg VIC 3084, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Sarah L Mackie
- Division of Rheumatic and Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, West Yorkshire LS2 9NL, England
| | - Alice Tison
- LBAI UMR1227, Univ Brest, Inserm, Brest, France; Department of Rheumatology, CHU Brest, France Boulevard TANGUY PRIGENT, Brest, Brittany 29609, France
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, BST S723, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Max Yates
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg West VIC 3081, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg West VIC 3081, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria 3052, Australia
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Owen CE, Poon AMT, Liu B, Liew DFL, Yap LP, Yang V, Leung JL, McMaster CR, Scott AM, Buchanan RRC. Characterising polymyalgia rheumatica on whole-body 18F-FDG PET/CT: an atlas. Rheumatol Adv Pract 2024; 8:rkae003. [PMID: 38375531 PMCID: PMC10876394 DOI: 10.1093/rap/rkae003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/12/2023] [Indexed: 02/21/2024] Open
Abstract
The impact of modern imaging in uncovering the underlying pathology of PMR cannot be understated. Long dismissed as an inflammatory syndrome with links to the large vessel vasculitis giant cell arteritis (GCA), a pathognomonic pattern of musculotendinous inflammation is now attributed to PMR and may be used to confirm its diagnosis. Among the available modalities, 18F-fluorodeoxyglucose (18F-FDG) PET/CT is increasingly recognized for its high sensitivity and specificity, as well as added ability to detect concomitant large vessel GCA and exclude other relevant differentials like infection and malignancy. This atlas provides a contemporary depiction of PMR's pathology and outlines how this knowledge translates into a pattern of findings on whole body 18F-FDG PET/CT that can reliably confirm its diagnosis.
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Affiliation(s)
- Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Aurora M T Poon
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Bonnia Liu
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Lee Pheng Yap
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Victor Yang
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Jessica L Leung
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher R McMaster
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew M Scott
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
- Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Liew DFL, Owen CE. Treat-to-target in polymyalgia rheumatica and giant cell arteritis: an impending, multi-faceted challenge. Rheumatology (Oxford) 2024:keae031. [PMID: 38243712 DOI: 10.1093/rheumatology/keae031] [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: 10/09/2023] [Revised: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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Yang V, Kragstrup TW, McMaster C, Reid P, Singh N, Haysen SR, Robinson PC, Liew DFL. Managing Cardiovascular and Cancer Risk Associated with JAK Inhibitors. Drug Saf 2023; 46:1049-1071. [PMID: 37490213 PMCID: PMC10632271 DOI: 10.1007/s40264-023-01333-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
Janus kinase inhibitors (JAKi) have enormous appeal as immune-modulating therapies across many chronic inflammatory diseases, but recently this promise has been overshadowed by questions regarding associated cardiovascular and cancer risk emerging from the ORAL Surveillance phase 3b/4 post-marketing requirement randomized controlled trial. In that study of patients with rheumatoid arthritis with existing cardiovascular risk, tofacitinib, the first JAKi registered for chronic inflammatory disease, failed to meet non-inferiority thresholds when compared with tumor necrosis factor inhibitors for both incident major adverse cardiovascular events and incident cancer. While this result was unexpected by many, subsequently published observational data have also supported this finding. Notably, however, such a risk has largely not yet been demonstrated in patients outside the specific clinical situation examined in the trial, even in the face of many studies examining this. Nevertheless, this signal has practically re-aligned approaches to both tofacitinib and other JAKi to varying extents, in other patient populations and contexts: within rheumatoid arthritis, but also in psoriatic arthritis, axial spondyloarthritis, inflammatory bowel disease, atopic dermatitis, and beyond. Application to individual patients can be more challenging but remains important to harness the substantive potential of JAKi to the maximum extent safely possible. This review not only explores the evolution of the regulatory response to the signal, its informing data, biological plausibility, and its impact on guidelines, but also the many factors that clinicians must consider in navigating cardiovascular and cancer risk for their patients considering JAKi as immune-modulating therapy.
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Affiliation(s)
- Victor Yang
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia
| | - Tue W Kragstrup
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Sector for Rheumatology, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Christopher McMaster
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Pankti Reid
- Division of Rheumatology and Committee on Clinical Pharmacology and Pharmacogenomics, Department of Medicine, University of Chicago Biological Sciences Division, Chicago, IL, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Stine R Haysen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - David F L Liew
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia.
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia.
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Gill T, Putman M, Sattui SE, Hamdulay S, Conway R, Liew DFL, Sharma A, Stone JH, Mackie SL, Mehta P. Should race be considered in diagnosing giant cell arteritis? - Authors' reply. Lancet Rheumatol 2023; 5:e372-e373. [PMID: 38251547 DOI: 10.1016/s2665-9913(23)00156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Tiara Gill
- Department of Rheumatology, London Northwest Hospitals NHS Trust, London, UK
| | - Michael Putman
- Department of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shahir Hamdulay
- Department of Rheumatology, London Northwest Hospitals NHS Trust, London, UK
| | - Richard Conway
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - David F L Liew
- Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Aman Sharma
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Boston, MA, USA
| | - Sarah L Mackie
- Chapel Allerton Hospital, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospital NHS Trust, London, UK.
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McMaster C, Liew DFL, Lester S, Rischin A, Black RJ, Chand V, Fletcher A, Lassere MN, March L, Robinson PC, Buchbinder R, Hill CL. COVID-19 vaccine hesitancy in inflammatory arthritis patients: serial surveys from a large longitudinal national Australian cohort. Rheumatology (Oxford) 2023; 62:1460-1466. [PMID: 36069664 PMCID: PMC9494403 DOI: 10.1093/rheumatology/keac503] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. METHODS This investigation was a prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Association Database (ARAD). Two surveys were conducted, one immediately prior to (pre-pandemic) and another approximately 1 year after the start of the pandemic (follow-up). Coronavirus disease 2019 (COVID-19) vaccine hesitancy was measured at follow-up, and general vaccine hesitancy was inferred pre-pandemic; these were used to identify factors associated with fixed and changing vaccine beliefs, including sources of information and broader beliefs about medication. RESULTS Of the 594 participants who completed both surveys, 74 (12%) were COVID-19 vaccine hesitant. This was associated with pre-pandemic beliefs about medications being harmful (P < 0.001) and overused (P = 0.002), with stronger beliefs resulting in vaccine hesitancy persistent over two time points (P = 0.008, P = 0.005). For those not vaccine hesitant pre-pandemic, the development of COVID-19 vaccine hesitancy was associated with a lower likelihood of seeking out vaccine information from health-care professionals (P < 0.001). COVID-19 vaccine hesitancy was not associated with new influenza vaccine hesitancy (P = 0.138). CONCLUSION In this study of vaccine beliefs before and during the COVID-19 pandemic, factors associated with COVID-19 vaccine hesitancy in inflammatory arthritis patients varied, depending on vaccine attitudes immediately prior to the start of the pandemic. Fixed beliefs reflected broader views about medications, while fluid beliefs were highly influenced by whether they sought out information from health-care professionals, including rheumatologists.
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Affiliation(s)
- Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- The Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, 3052
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- Department of Medicine, University of Melbourne, Parkville, VIC, 3052
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Adam Rischin
- Department of Rheumatology, The Alfred Hospital, Melbourne, VIC, 3004
| | - Rachel J Black
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Vibhasha Chand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Ashley Fletcher
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Marissa N Lassere
- School of Population Health, UNSW Medicine, Sydney, New South Wales, Australia
- Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Royal Brisbane & Women’s Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
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Gill T, Putman M, Sattui SE, Hamdulay S, Conway R, Liew DFL, Sharma A, Stone JH, Mackie SL, Mehta P. Giant cell arteritis can occur in people of colour. Lancet Rheumatol 2023; 5:e175-e177. [PMID: 38251515 DOI: 10.1016/s2665-9913(23)00068-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Tiara Gill
- Department of Rheumatology, London Northwest University Healthcare NHS Trust, London, UK
| | - Michael Putman
- Department of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shahir Hamdulay
- Department of Rheumatology, London Northwest University Healthcare NHS Trust, London, UK
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - David F L Liew
- Department of Rheumatology, Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Aman Sharma
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospital NHS Trust, London, UK.
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Shamdasani P, Liew DFL, Nohrenberg M, Leroi MM, McMaster C, Owen CE, Hardidge A, Buchanan RRC. Diagnosis of septic arthritis in the acute care setting: the value of routine intra-operative sample culture. Rheumatol Adv Pract 2023; 7:i12-i18. [PMID: 36968633 PMCID: PMC10036992 DOI: 10.1093/rap/rkad008] [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: 07/13/2022] [Accepted: 01/06/2023] [Indexed: 03/26/2023] Open
Abstract
Objective Diagnosing septic arthritis can be challenging and frequently involves clinical assessment, laboratory investigations and synovial fluid analysis. We sought to determine the utility of synovial aspiration and intra-operative synovial fluid and tissue culture for the accurate diagnosis of septic arthritis. Methods We carried out a retrospective review of the records of patients referred to a tertiary orthopaedic unit with possible septic arthritis between 2015 and 2019 inclusive, including clinical and laboratory data for this cohort study. Performance characteristics were determined for synovial aspiration, intra-operative synovial fluid and tissue culture in diagnosing expert review-determined true septic arthritis. Concordance between discharge diagnosis, antibiotic prescribing and true septic arthritis was determined. Results Of 268 patients identified with suspected septic arthritis, 143 underwent both synovial fluid aspiration and intra-operative synovial fluid and tissue biopsy culture. True septic arthritis was not differentiated significantly by laboratory parameters including serum white cell count (WCC), CRP or synovial WCC. Considering only patients with negative pre-operative synovial aspirate cultures, intra-operative samples led to diagnosis of true septic arthritis in 6 of 63 patients [number needed to treat (NNT) 10.5]. For all patients sampled in theatre, positive synovial tissue biopsy was the only evidence of true septic arthritis in six (NNT 23.9). Despite insufficient microbiological evidence, 27 of the 59 patients who did not have septic arthritis received a discharge diagnosis of septic arthritis, 26 of whom were discharged with antibiotics. Conclusion Intra-operative sample collection, particularly tissue biopsy, increases the likelihood of a true septic arthritis diagnosis. Such measures might help to reduce diagnostic ambiguity in clinical practice and might therefore reduce overtreatment.
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Affiliation(s)
- Pallavi Shamdasani
- Correspondence to: Pallavi Shamdasani, Rheumatology Department, Heidelberg Repatriation Hospital, Level 1, Tobruk Building, 300 Waterdale Road, Heidelberg, VIC 3084, Australia. E-mail:
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - Marcel M Leroi
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Microbiology, Austin Pathology, Austin Health, Heidelberg, VIC, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia
- Centre for Digital Transformation in Health, University of Melbourne, Parkville, VIC, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Hardidge
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
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11
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Owen CE, Yates M, Liew DFL, Poon AMT, Keen HI, Hill CL, Mackie SL. Imaging of giant cell arteritis - recent advances. Best Pract Res Clin Rheumatol 2023; 37:101827. [PMID: 37277245 DOI: 10.1016/j.berh.2023.101827] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023]
Abstract
Imaging is increasingly being used to guide clinical decision-making in patients with giant cell arteritis (GCA). While ultrasound has been rapidly adopted in fast-track clinics worldwide as an alternative to temporal artery biopsy for the diagnosis of cranial disease, whole-body PET/CT is emerging as a potential gold standard test for establishing large vessel involvement. However, many unanswered questions remain about the optimal approach to imaging in GCA. For example, it is uncertain how best to monitor disease activity, given there is frequent discordance between imaging findings and conventional disease activity measures, and imaging changes typically fail to resolve completely with treatment. This chapter addresses the current body of evidence for the use of imaging modalities in GCA across the spectrum of diagnosis, monitoring disease activity, and long-term surveillance for structural changes of aortic dilatation and aneurysm formation and provides suggestions for future research directions.
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Affiliation(s)
- Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Max Yates
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Aurora M T Poon
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Helen I Keen
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR-Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom
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12
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Sim BL, Sim BZ, Tunbridge M, Liew DFL, Robinson PC. Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review. J Rheumatol 2023; 50:400-407. [PMID: 36319015 DOI: 10.3899/jrheum.220524] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The use of colchicine has been associated with varying degrees of myelosuppression. Despite expanded use in cardiovascular and inflammatory conditions, there remains clinician concern because of potential myelosuppressive side effects. A systematic review was conducted to explore the reported myelosuppressive events of colchicine. METHODS A systematic review was conducted using the MeSH terms ("colchicine") AND ("myelosuppression," "bone*," "marrow," "suppression," "aplasia," "leukopenia/leucopenia," "lymphopenia," "neutropenia") on September 1, 2020, and was updated on November 30, 2021. The search was conducted in PubMed, ScienceDirect, Scopus, Embase, and Cochrane Library. The search included references published from 1978 to 2020 and was limited to English-language observational studies (ie, case reports, case series, case control studies, and cohort studies) or trial data. RESULTS In total, 3233 articles were screened, with 30 studies of 47 patients with myelosuppression from colchicine identified. Most patients with myelosuppression had comorbidities, including renal impairment (21/47, 44.7%). Out of 47 patients, 15 (31.9%) and 13 (27.7%) were reported to be concurrently taking cytochrome P450 3A4 (CYP3A4) inhibitors and P-glycoprotein (P-gp) efflux transporter inhibitors, respectively. Patients with renal impairment accounted for the majority of overall patients taking these CYP3A4 and P-gp inhibitors (8/15, 53.3%, and 8/13, 61.5%, respectively). Out of 21 patients with renal impairment, 13 had worsening cytopenia during colchicine use. The presentations ranged from moderate anemia (grade 2) to severe thrombocytopenia, neutropenia, and leukopenia (grade 4). CONCLUSION Colchicine has few reports of myelosuppression. The majority of patients with myelosuppression had preexisting renal impairment or concomitant CYP3A4 or P-gp inhibitor use. Caution should be taken in this subset of patients with increased monitoring.
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Affiliation(s)
- Bernice L Sim
- B.L. Sim, BSc, MPH, St George's Hospital Medical School, London, UK
| | - Beatrice Z Sim
- B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Matthew Tunbridge
- B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - David F L Liew
- D.F.L. Liew, MBBS, Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Philip C Robinson
- P.C. Robinson, MBChB, PhD, The University of Queensland Faculty of Medicine, School of Medicine, Royal Brisbane Hospital Herston, and Royal Brisbane and Women's Hospital, Department of Rheumatology, Herston, Queensland, Australia.
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McMaster C, Chan J, Liew DFL, Su E, Frauman AG, Chapman WW, Pires DEV. Developing a deep learning natural language processing algorithm for automated reporting of adverse drug reactions. J Biomed Inform 2023; 137:104265. [PMID: 36464227 DOI: 10.1016/j.jbi.2022.104265] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
The detection of adverse drug reactions (ADRs) is critical to our understanding of the safety and risk-benefit profile of medications. With an incidence that has not changed over the last 30 years, ADRs are a significant source of patient morbidity, responsible for 5%-10% of acute care hospital admissions worldwide. Spontaneous reporting of ADRs has long been the standard method of reporting, however this approach is known to have high rates of under-reporting, a problem that limits pharmacovigilance efforts. Automated ADR reporting presents an alternative pathway to increase reporting rates, although this may be limited by over-reporting of other drug-related adverse events. We developed a deep learning natural language processing algorithm to identify ADRs in discharge summaries at a single academic hospital centre. Our model was developed in two stages: first, a pre-trained model (DeBERTa) was further pre-trained on 1.1 million unlabelled clinical documents; secondly, this model was fine-tuned to detect ADR mentions in a corpus of 861 annotated discharge summaries. This model was compared to a version without the pre-training step, and a previously published RoBERTa model pretrained on MIMIC III, which has demonstrated strong performance on other pharmacovigilance tasks. To ensure that our algorithm could differentiate ADRs from other drug-related adverse events, the annotated corpus was enriched for both validated ADR reports and confounding drug-related adverse events using. The final model demonstrated good performance with a ROC-AUC of 0.955 (95% CI 0.933 - 0.978) for the task of identifying discharge summaries containing ADR mentions, significantly outperforming the two comparator models.
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Affiliation(s)
- Christopher McMaster
- Department of Clinical Pharmacology & Therapeutics, Austin Health, Melbourne, Victoria, Australia; Department of Rheumatology, Austin Health, Melbourne, Victoria, Australia; The Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia; School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.
| | - Julia Chan
- Department of Rheumatology, Austin Health, Melbourne, Victoria, Australia
| | - David F L Liew
- Department of Clinical Pharmacology & Therapeutics, Austin Health, Melbourne, Victoria, Australia; Department of Rheumatology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Su
- Department of Clinical Pharmacology & Therapeutics, Austin Health, Melbourne, Victoria, Australia
| | - Albert G Frauman
- Department of Clinical Pharmacology & Therapeutics, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Wendy W Chapman
- The Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas E V Pires
- The Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia; School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia
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Yang V, McMaster C, Owen CE, Leung JLY, Liu B, Buchanan RRC, Liew DFL. Better diagnostic tools needed for biopsy-negative giant cell arteritis. Lancet Rheumatol 2023; 5:e8-e10. [PMID: 38251510 DOI: 10.1016/s2665-9913(22)00252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Victor Yang
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
| | - Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia; Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Jessica L Y Leung
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Bonnia Liu
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
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15
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Tsakas JJ, Liew DFL, Adams CL, Hill CL, Proudman S, Whittle S, Buchbinder R, Robinson PC. Attitudes and practices in the laboratory monitoring of conventional synthetic disease modifying anti-rheumatic drugs by rheumatologists and rheumatology trainees. BMC Rheumatol 2022; 6:59. [PMID: 36244979 PMCID: PMC9575262 DOI: 10.1186/s41927-022-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
There is scant research about laboratory monitoring in people taking conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for rheumatic disease. Our objective was to conduct a scoping study to assess the range of current attitudes and the variation in practice of laboratory monitoring of csDMARDs by rheumatologists and trainees.
Methods
Australian and overseas rheumatologists or trainees were invited through newsletter, Twitter and personal e-mail, to complete an anonymous online survey between 1 February and 22 March 2021. Questions focused on laboratory tests requested by csDMARD prescribed, frequency/pattern of monitoring, influence of additional factors and combination therapy, actions in response to abnormal tests, and attitudes to monitoring frequencies. Results were presented descriptively and analysed using linear and logistic regression.
Results
There were 221 valid responses. Most respondents were from Australia (n = 53, 35%) followed by the US (n = 39, 26%), with a slight preponderance of women (n = 84, 56%), ≥ 11 years in rheumatology practice (n = 83, 56%) and in mostly public practice (n = 79, 53%). Respondents had a wide variation in the frequency and scheduling of tests. In general, respondents reported increasing monitoring frequency if patients had numerous comorbidities or if both methotrexate and leflunomide were being taken concurrently. There was a wide variety of responses to abnormal monitoring results and 27 (40%) considered that in general, monitoring tests are performed too frequently.
Conclusions
The results demonstrated a wide variation in the frequency of testing, factors that should influence this, and what responses to abnormal test results are appropriate, indicates a likely lack of evidence and the need to define the risks, benefits and costs of different csDMARD monitoring regimens.
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16
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Liew DFL, Robinson PC. Preventive medicine in rheumatology: COVID-19 and its lessons for better health outcomes. The Lancet Rheumatology 2022; 4:e743-e745. [PMID: 35991761 PMCID: PMC9381024 DOI: 10.1016/s2665-9913(22)00229-6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David F L Liew
- Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD 4006, Australia
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17
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McMaster C, Liew DFL, Liu B, Schachna L. Comment on: Deep learning algorithms for magnetic resonance imaging of inflammatory sacroiliitis in axial spondyloarthritis. Rheumatology (Oxford) 2022; 61:e316-e317. [PMID: 35416954 DOI: 10.1093/rheumatology/keac215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg VIC 3084, AUSTRALIA.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg VIC 3084, AUSTRALIA.,The Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, 3052, AUSTRALIA
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg VIC 3084, AUSTRALIA.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg VIC 3084, AUSTRALIA.,Department of Medicine, University of Melbourne, Parkville VIC 3052, AUSTRALIA
| | - Bonnia Liu
- Department of Rheumatology, Austin Health, Heidelberg VIC 3084, AUSTRALIA.,Department of Molecular Imaging & Therapy, Austin Health, Heidelberg VIC 3084, AUSTRALIA
| | - Lionel Schachna
- Department of Rheumatology, Austin Health, Heidelberg VIC 3084, AUSTRALIA
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18
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Putman M, Kennedy K, Sirotich E, Liew JW, Sattui SE, Moni TT, Akpabio AA, Alpizar-Rodriguez D, Angevare S, Beesley RP, Berenbaum F, Bulina I, Chock YPE, Conway R, Duarte-García A, Singh AD, Duff E, Durrant KL, Gheita TA, Hill CL, Howard R, Hoyer BF, Hsieh E, El Kibbi L, Kilian A, Kim AHJ, Liew DFL, Lo C, Mateus EF, Miller B, Mingolla S, Nudel M, Singh JA, Singh N, Ugarte-Gil MF, Wallace J, Young KJ, Zamora-Tehozol EA, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Harrison C, Larché MJ, Levine M, Foster G, Thabane L, Hausmann JS, Sparks JA, Simard JF. COVID-19 vaccine perceptions and uptake: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. Lancet Rheumatol 2022; 4:e237-e240. [PMID: 35156060 PMCID: PMC8824526 DOI: 10.1016/s2665-9913(22)00001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kevin Kennedy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Tarin T Moni
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Akpabio A Akpabio
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - Saskya Angevare
- Stichting KAISZ, Amsterdam, The Netherlands
- ENCA, Paris, France
- Autoinflammatory Alliance, Amsterdam, The Netherlands
| | | | - Francis Berenbaum
- Sorbonne University, INSERM, AP-HP Saint-Antoine hospital, Paris, France
| | - Inita Bulina
- Center of Rheumatology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Yu Pei Eugenia Chock
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Ali Duarte-García
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aman Dev Singh
- Department of Community Medicine, GMC Patiala, Punjab, India
| | - Eimear Duff
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | | | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | | | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Section of Rheumatology, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, University of Washington, St Louis, MO, USA
| | - David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Chieh Lo
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Comprehensive Health Research Centre, Lisbon, Portugal
| | - Bruce Miller
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Serena Mingolla
- Associazione Nazionale Persone con Malattie Reumatologiche e Rare APMARR APS, Lecca, Italy
| | | | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, University of Washington, St Louis, MO, USA
| | - Manuel F Ugarte-Gil
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud and School of Medicine, Universidad Cientifica del Sur, Lima, Peru
| | | | - Kristen J Young
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Maggie J Larché
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, ON, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital and Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, and Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Affiliation(s)
- David F L Liew
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Herston, QLD, Australia
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, QLD, Australia
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Sattui SE, Liew JW, Kennedy K, Sirotich E, Putman M, Moni TT, Akpabio A, Alpízar-Rodríguez D, Berenbaum F, Bulina I, Conway R, Singh AD, Duff E, Durrant KL, Gheita TA, Hill CL, Howard RA, Hoyer BF, Hsieh E, El Kibbi L, Kilian A, Kim AH, Liew DFL, Lo C, Miller B, Mingolla S, Nudel M, Palmerlee CA, Singh JA, Singh N, Ugarte-Gil MF, Wallace J, Young KJ, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Harrison C, Larché M, Levine M, Foster G, Thabane L, Rider LG, Hausmann JS, Simard JF, Sparks JA. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021; 7:e001814. [PMID: 34493645 PMCID: PMC8424419 DOI: 10.1136/rmdopen-2021-001814] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [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: 07/09/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
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Affiliation(s)
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Kennedy
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Putman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tarin T Moni
- Department of Biochemistry & Biomedical Sciences, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Akpabio Akpabio
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Eimear Duff
- Department of Rheumatology, Saint James's Hospital, Dublin, Ireland
| | | | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Catherine L Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Bimba F Hoyer
- Medical Department I, Department for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Rheumatology, VA Connecticut Healthcare System-West Haven Campus, West Haven, Connecticut, USA
| | - Lina El Kibbi
- Rheumatology, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | - Adam Kilian
- Department of Internal Medicine, Division of Rheumatology, Saint Louis University, Saint Louis, Missouri, USA
| | - Alfred Hyoungju Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - David F L Liew
- Rheumatology, Austin Health, Heidelberg West, Victoria, Australia
- Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Chieh Lo
- I-Shou University College of Medicine, Yanchau Sheng, Taiwan
| | - Bruce Miller
- Medicine, University of California San Diego, La Jolla, California, USA
| | - Serena Mingolla
- Italian National Patient Association for Rehumatoid and Rare Disease (APMARR), Rome, Italy
| | - Michal Nudel
- The Israeli Association for RMD Patients "Mifrakim Tz'eirim", Haifa, Israel
| | - Candace A Palmerlee
- Relapsing Polychondritis Foundation, International Relapsing Polychondritis Research Network, Walnut Creek, California, USA
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Namrata Singh
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Manuel Francisco Ugarte-Gil
- Department of Rheumatology, Universidad Cientifica del Sur, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | | | - Kristen J Young
- Division of Rheumatology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | | | - Zachary S Wallace
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology,Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | | | - Maggie Larché
- Division of Clinical Immunology and Allergy, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact (HEI); Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lisa G Rider
- Environmental Autoimmunity Group, NIEHS/NIH/DHHS, Bethesda, Maryland, USA
| | - Jonathan S Hausmann
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia F Simard
- Epidemiology and Population Health and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Department of Medicine, Clinical Epidemiology Unit, Sweden
| | - Jeffrey A Sparks
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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Truong SL, Chin J, Liew DFL, Zahir SF, Ryan EG, Rubel D, Radford-Smith G, Robinson PC. Systematic Review and Meta-Analysis of Inflammatory Bowel Disease Adverse Events with Anti-Interleukin 17A Agents and Tumor Necrosis Factor Inhibitors in Rheumatic Disease and Skin Psoriasis. Rheumatol Ther 2021; 8:1603-1616. [PMID: 34449067 PMCID: PMC8572260 DOI: 10.1007/s40744-021-00360-6] [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: 07/17/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of this work is to perform a systematic review and meta-analysis of anti-tumor necrosis factor (anti-TNF) and anti-interleukin-17 (anti-IL-17) trials for spondyloarthritis, psoriatic arthritis, and psoriasis comparing rates of inflammatory bowel disease (IBD) events compared to placebo. Methods MEDLINE, EMBASE, and The Cochrane Library were searched for double-blind, randomized placebo-controlled anti-TNF and anti-IL-17 trials of included diseases. Inflammatory bowel disease events from the RCT period were pooled and meta-analyzed using statistical methods suitable for low-event-rate meta-analysis (Peto’s, Mantel–Haenszel, hypergeometric-normal model, and Shuster-Guo-Skyler). When observed data were insufficient, we performed an exploratory sensitivity analysis to compare methods. Results We identified 9551 original papers, and included 96 publications: 65 anti-TNF and 31 anti-IL-17 trials, containing 21 new and 12 flare IBD events in 28,209 participants. New IBD on anti-IL-17 occurred 0.23/100 patient-years (PY) in psoriasis, 0.61/100 PY in PsA and 1.63/100 PY in spondyloarthritis, rates similar to observational cohorts, and less commonly on anti-TNF (0/100 PY, 0/100 PY, 0.32/100 PY, respectively). No evidence of difference between groups was found, with wide CI from many pooled counts of zero, especially in placebo arms. Conclusions IBD events were rare, occurring at rates similar to biologic-naive groups. We could not find statistically significant differences in risk of new or recurrent IBD between treatment and control groups using selected meta-analytical methods for low event rate scenarios. Meta-analyses of this topic require more IBD events, ideally without pooling heterogeneous groups. Larger, thoroughly reported trials with systematic and detailed safety reporting are required to improve risk estimation and to make accurate inferences. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00360-6.
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Affiliation(s)
- Steven L Truong
- Department of Medicine, Griffith University, Brisbane, QLD, Australia.,Coast Joint Care, Maroochydore, QLD, Australia
| | - Jasmine Chin
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia.,Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
| | - Syeda Farah Zahir
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Diana Rubel
- Australian National University and Woden Dermatology, Canberra, Australia
| | | | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia. .,School of Clinical Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, QLD, 4006, Australia.
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22
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Hausmann JS, Kennedy K, Simard JF, Liew JW, Sparks JA, Moni TT, Harrison C, Larché MJ, Levine M, Sattui SE, Semalulu T, Foster G, Surangiwala S, Thabane L, Beesley RP, Durrant KL, Mateus EF, Mingolla S, Nudel M, Palmerlee CA, Richards DP, Liew DFL, Hill CL, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Sirotich E. Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases. Lancet Rheumatol 2021; 3:e707-e714. [PMID: 34316727 PMCID: PMC8298011 DOI: 10.1016/s2665-9913(21)00175-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide. Methods Survey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis. Findings 12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514). Interpretation People with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity. Funding American College of Rheumatology.
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Affiliation(s)
- Jonathan S Hausmann
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kevin Kennedy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Julia F Simard
- Department of Epidemiology and Population Health, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Jean W Liew
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tarin T Moni
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Maggie J Larché
- Divisions of Rheumatology/Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, ON, Canada
| | - Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Teresa Semalulu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard P Beesley
- Juvenile Arthritis Research, Tonbridge, UK
- European Network for Childhood Arthritis, Tonbridge, UK
| | | | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Comprehensive Health Research Centre, Lisbon, Portugal
| | - Serena Mingolla
- Italian National Association of People with Rheumatic and Rare Diseases, Brindisi, Italy
| | - Michal Nudel
- The Israeli association for RMDs patients "Mifrakim Tz'eirim", Haifa, Israel
| | - Candace A Palmerlee
- Relapsing Polychondritis Foundation, International Relapsing Polychondritis Research Network, Walnut Creek, CA, USA
| | | | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | | | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emily Sirotich
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
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23
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Yang V, McMaster C, Owen CE, Leung JL, Schachna L, Buchanan RRC, Liew DFL. Comment on: Epidemiology of biopsy-confirmed giant cell arteritis in southern Sweden-an update on incidence and first prevalence estimate. Rheumatology (Oxford) 2021; 60:e421-e422. [PMID: 34264311 DOI: 10.1093/rheumatology/keab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victor Yang
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jessica L Leung
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Lionel Schachna
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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24
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Liew DFL, Dau J, Robinson PC. Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond. Curr Rheumatol Rep 2021; 23:36. [PMID: 33909169 DOI: 10.1007/s11926-021-01003-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs. RECENT FINDINGS There are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and medication tapering may be appropriate. Increasing the value of the care we provide to patients can occur across domains and directly and indirectly improves patient outcomes. Taking the time to integrate principles of VBHC into our practice will allow us to justifiably gain and maintain access to diagnostic and therapeutic advances for the benefit of all our patients.
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Affiliation(s)
- David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Dau
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, 4006, Australia. .,Department of Rheumatology, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Bowen Bridge Road, Herston, Queensland, 4006, Australia.
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25
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Abstract
Coronavirus disease 2019 (COVID-19) currently has few effective treatments. Given the uncertainty surrounding the effectiveness and uptake of a vaccine, it is important that the search for treatments continue. An exaggerated inflammatory state is likely responsible for much of the morbidity and mortality in COVID-19. Elevated levels of tumor necrosis factor (TNF), a key pro-inflammatory cytokine, have been shown to be associated with increased COVID-19 mortality. In patients with rheumatoid arthritis, TNF blockade reduces not only biologically active TNF but other pro-inflammatory cytokines important in COVID-19 hyperinflammation. Observational data from patients already on anti-TNF therapy show a reduced rate of COVID-19 poor outcomes and death compared with other immune-suppressing therapies. Anti-TNF has a long history of safe use, including in special at-risk populations, and is widely available. The case to adequately assess anti-TNF as a treatment for COVID-19 is compelling.
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Affiliation(s)
- Philip C Robinson
- University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Department of Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Claudia Monaco
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
| | - Duncan Richards
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
| | - Senthuran Shivakumar
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Helen L Tanner
- University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Department of Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marc Feldmann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
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26
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Owen CE, McMaster C, Liew DFL, Leung JL, Scott AM, Buchanan RRC. Neutrophil to lymphocyte ratio predicts glucocorticoid resistance in polymyalgia rheumatica. Int J Rheum Dis 2020; 24:56-62. [PMID: 33043616 DOI: 10.1111/1756-185x.14000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/23/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
AIM Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) correlate with disease activity in several rheumatic diseases; however, their utility in polymyalgia rheumatica (PMR) remains unclear. This study evaluated their relationship with disease activity and glucocorticoid resistance in PMR. METHOD Data for disease activity (PMR-AS) and full blood examination was obtained from a prospective observational cohort comprising newly diagnosed, steroid-naïve PMR patients treated with low-dose glucocorticoid therapy. Glucocorticoid resistance was defined as non-response to prednisolone 15 mg/d or initial response followed by flare (PMR-AS ≥ 9.35 or ∆ ≥6.6) upon weaning to 5 mg/d. Univariable Bayesian linear regression analysis of the relationship between PMR-AS (baseline and mean) and NLR and PLR was performed. Predictors of glucocorticoid resistance were identified using a multivariable outcome model, with variables derived from Bayesian model selection. RESULTS Of the 32 included patients, 16 (50%) fulfilled the primary outcome measure of glucocorticoid resistance. These participants were older, typically female, and had higher baseline C-reactive protein than their glucocorticoid-responsive counterparts. A statistically significant relationship was identified between PMR-AS and both NLR (odds ratio [OR] 28.1; 95% CI 1.6-54.7) and PLR (OR 40.6; 95% CI 10.1-71.4) at baseline, with PLR also found to correlate with disease activity during follow-up (OR 15.6; 95% CI 2.7-28.2). Baseline NLR proved a statistically significant predictor of glucocorticoid-resistant PMR (OR 14.01; 95% CI 1.49-278.06). CONCLUSION Baseline NLR can predict glucocorticoid resistance in newly diagnosed PMR patients. Both NLR and PLR may be reliable biomarkers of disease activity in PMR.
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Affiliation(s)
- Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Jessica L Leung
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Andrew M Scott
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia.,Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La Trobe University, Heidelberg, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
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27
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Shamdasani P, Trubiano JA, Smibert OC, Owen CE, Liew DFL. COVID
‐19: collaboration will keep us ahead of the curve. Intern Med J 2020; 50:784-786. [PMID: 32656972 PMCID: PMC7404842 DOI: 10.1111/imj.14888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Jason A. Trubiano
- COVID Unit, Department of Infectious DiseasesAustin Health Melbourne Victoria Australia
- Department of MedicineUniversity of Melbourne Melbourne Victoria Australia
- The National Centre for Infections in CancerPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Olivia C. Smibert
- COVID Unit, Department of Infectious DiseasesAustin Health Melbourne Victoria Australia
- Department of MedicineUniversity of Melbourne Melbourne Victoria Australia
- The National Centre for Infections in CancerPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Claire E. Owen
- Department of RheumatologyAustin Health Melbourne Victoria Australia
- Department of MedicineUniversity of Melbourne Melbourne Victoria Australia
| | - David F. L. Liew
- Department of RheumatologyAustin Health Melbourne Victoria Australia
- Department of MedicineUniversity of Melbourne Melbourne Victoria Australia
- Department of Clinical Pharmacology and TherapeuticsAustin Health Melbourne Victoria Australia
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28
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Affiliation(s)
- Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, and Department of Medicine, University of Melbourne, Parkville, Victoria;
| | - David F L Liew
- Department of Rheumatology, and Department of Clinical Pharmacology, Austin Health, Heidelberg, Victoria, and Department of Medicine, University of Melbourne, Parkville, Victoria
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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29
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Affiliation(s)
- Jessica L. Leung
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Claire E. Owen
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Russell R. C. Buchanan
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - David F. L. Liew
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
- Department of Clinical Pharmacology and Therapeutics Austin Health Melbourne Australia
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30
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Liew DFL, Owen CE, Buchanan RRC. Letter to the editor: Comments on 'A case of pembrolizumab-induced autoimmune haemolytic anaemia with polymyalgia rheumatica'. Eur J Cancer 2019; 111:59-60. [PMID: 30826657 DOI: 10.1016/j.ejca.2018.11.034] [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: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
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31
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Liew DFL, Leung JLY, Liu B, Cebon J, Frauman AG, Buchanan RRC. Association of good oncological response to therapy with the development of rheumatic immune-related adverse events following PD-1 inhibitor therapy. Int J Rheum Dis 2018; 22:297-302. [PMID: 30549256 DOI: 10.1111/1756-185x.13444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 04/22/2018] [Revised: 10/03/2018] [Accepted: 10/19/2018] [Indexed: 01/19/2023]
Abstract
AIM To investigate whether any patient or treatment characteristics are associated with the development of rheumatic immune-related adverse events (irAEs) following programmed cell death protein 1 (PD-1) inhibitor therapy for cancer. METHOD This was a retrospective chart review of all patients who were dispensed nivolumab or pembrolizumab at a single center before 1 January, 2017, with follow-up until 1 July, 2017. Patients with any diagnosis of a non-cutaneous irAE were identified, regardless of severity, and rheumatic irAEs were characterized. RESULTS Of 244 episodes of therapy, a non-cutaneous irAE occurred in 72 (29.5%). Rheumatic irAEs were diagnosed in 19 episodes of therapy (7.8%), with 12 de novo diagnoses (5.1% of episodes without a pre-existing autoimmune rheumatic disease) and 7 exacerbations of existing disease. Review by a rheumatologist occurred in only 11 of these. Rheumatic irAEs were more common in patients with a good oncological response to therapy (relative risk [RR] 11.16), those being treated for melanoma (RR 2.94) and those who developed another non-cutaneous irAE (RR 2.64). CONCLUSION Rheumatic irAEs are relatively common with PD-1 inhibitor therapy, and appear to be associated with a good oncological response to therapy. Many rheumatic irAEs were not referred to rheumatological services. Prospective systematic investigation would be of benefit to explore these characteristics.
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Affiliation(s)
- David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Jessica L Y Leung
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia
| | - Bonnia Liu
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia
| | - Jonathan Cebon
- Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, VIC, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Albert G Frauman
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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32
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Owen CE, Poon AMT, Lee ST, Yap LP, Zwar RB, McMenamin CM, Lam SKL, Liew DFL, Pathmaraj K, Kemp A, Scott AM, Buchanan RRC. Fusion of positron emission tomography/computed tomography with magnetic resonance imaging reveals hamstring peritendonitis in polymyalgia rheumatica. Rheumatology (Oxford) 2017; 57:345-353. [DOI: 10.1093/rheumatology/kex411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 11/14/2022] Open
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