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Gossec L, Kerschbaumer A, Ferreira RJO, Aletaha D, Baraliakos X, Bertheussen H, Boehncke WH, Esbensen BA, McInnes IB, McGonagle D, Winthrop KL, Balanescu A, Balint PV, Burmester GR, Cañete JD, Claudepierre P, Eder L, Hetland ML, Iagnocco A, Kristensen LE, Lories R, Queiro R, Mauro D, Marzo-Ortega H, Mease PJ, Nash P, Wagenaar W, Savage L, Schett G, Shoop-Worrall SJW, Tanaka Y, Van den Bosch FE, van der Helm-van Mil A, Zabotti A, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024:ard-2024-225531. [PMID: 38499325 DOI: 10.1136/ard-2024-225531] [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: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. METHODS Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. RESULTS The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. CONCLUSION These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dennis McGonagle
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kevin L Winthrop
- Division of Infectious Diseases, School of Medicine, School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Andra Balanescu
- Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Peter V Balint
- Medical Imaging Centre, Semmelweis University, 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic Barcelona, Barcelona, Spain
- FCRB, IDIBAPS, Barcelona, Spain
| | - Pascal Claudepierre
- Rheumatology, AP-HP, Henri Mondor University Hospital, Creteil, France
- EA Epiderme, UPEC, Creteil, France
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Hospital, Toronto, Toronto, Canada
| | - Merete Lund Hetland
- The Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche Biologiche, Università di Torino - AO Mauriziano Torino, Turin, Italy
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark
- Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias, Oviedo University School of Medicine, Oviedo, Spain
| | - Daniele Mauro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Helena Marzo-Ortega
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip J Mease
- Rheumatology Research, Providence Swedish, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Wagenaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Young PARE Patient Research Partner, EULAR, Zurich, Switzerland
| | - Laura Savage
- School of Medicine and Dermatology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology and Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie J W Shoop-Worrall
- Children and Young Person's Rheumatology Research Programme, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Coates LC, Bukhari M, Chan A, Choy E, Galloway J, Gullick N, Kent A, Savage L, Siebert S, Tillett W, Wood N, Conaghan PG. Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel. Rheumatology (Oxford) 2024:keae172. [PMID: 38490262 DOI: 10.1093/rheumatology/keae172] [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: 12/08/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Existing guidelines for psoriatic arthritis (PsA) cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance current guidance and develop recommendations for clinical practice that are complementary to existing guidelines. METHODS A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform when 75% of respondents agreed in the range of 7-9 on a 9-point scale. RESULTS The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies to identify PsA early and refer appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance for high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) covered multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimising corticosteroid use was recommended where feasible. CONCLUSION The consensus group have made evidence-based best practice recommendations for the management of PsA to enhance the existing guidelines.
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Affiliation(s)
- Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Marwan Bukhari
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Antoni Chan
- University Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ernest Choy
- Cardiff Regional Experimental Arthritis Treatment and Evaluation (CREATE) Centre, Cardiff University, Cardiff, United Kingdom
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Nicola Gullick
- Rheumatology Department, University Hospitals of Coventry & Warwickshire, Coventry, United Kingdom
| | - Alison Kent
- Department of Rheumatology, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Laura Savage
- Department of Dermatology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - William Tillett
- Rheumatology Department, Royal National Hospital for Rheumatic Disease, Bath, United Kingdom
| | - Natasha Wood
- The Wooda Surgery, Bideford, Devon, United Kingdom
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
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Sonkoly E, Maul JT, Megna M, Gorecki P, Crombag E, Buyze J, Savage L. Guselkumab in Patients with Scalp Psoriasis: A post hoc Analysis of the VOYAGE 2 Phase III Randomized Clinical Trial. Acta Derm Venereol 2024; 104:adv18672. [PMID: 38436429 PMCID: PMC10924269 DOI: 10.2340/actadv.v104.18672] [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: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Scalp psoriasis affects approximately 80% of patients with psoriasis and can negatively impact their quality of life. This post hoc analysis of the VOYAGE 2 Phase III randomized clinical trial evaluated scalp response to guselkumab treatment and its association with skin response and patient-reported outcomes. The study included patients with moderate-to-severe plaque psoriasis and baseline scalp psoriasis who were initially randomized to receive guselkumab. Patients were divided into 3 groups based on their achievement of a Psoriasis Area and Severity Index 90 response at week 28: responder continuation, non-responder continuation and responder withdrawal. In all 3 groups, mean Psoriasis Area and Severity Index head and scalp-specific Investigator's Global Assessment scores improved through week 28. In the responder withdrawal group, these scores worsened after treatment withdrawal at week 28, but remained stable through week 48 in both continuation groups. Trends in Dermatology Life Quality Index and Psoriasis Symptoms and Signs Diary itch scores mirrored those of mean scalp-specific Investigator's Global Assessment scores through week 48. Within-subject correlations were 0.83 between scalp-specific Investigator's Global Assessment and Psoriasis Area and Severity Index head scores and 0.78 between scalp-specific Investigator's Global Assessment and Psoriasis Symptoms and Signs Diary itch scores. Through week 252, Psoriasis Area and Severity Index head scores remained stable in the responder continuation group, improved in the non-responder continuation group and rapidly improved by week 84 in the responder withdrawal group after retreatment.
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Affiliation(s)
- Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Dermatology and Venereology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | | | - Laura Savage
- Leeds Centre for Dermatology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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Ng BCK, Jadon D, Adebajo A, Ayan G, Duffin KC, Chandran V, Coates LC, D'Agostino MA, de Vlam K, Deodhar A, Eder L, Garg A, Gladman DD, Goel N, Gottlieb AB, Husni ME, Katz A, Kavanaugh A, Lubrano E, Mease PJ, Merola JF, Nash P, Ogdie A, Pennington SR, Perez-Chada LM, Proft F, Rosen CF, Savage L, Goldenstein-Schainberg C, Siebert S, Soriano ER, Steinkoenig I, Tillett W, Armstrong AW, FitzGerald O. Proceedings of the GRAPPA 2022 Executive Retreat. J Rheumatol 2023; 50:71-77. [PMID: 37527861 DOI: 10.3899/jrheum.2023-0537] [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] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) leadership congregated for a strategic planning meeting before the 2022 GRAPPA annual meeting in New York, USA. Meeting aims were to review GRAPPA's performance in relation to its 2016 goals and identify successes and areas for further improvement, identify key GRAPPA priorities and activities for the next 5 years, and explore committee structures to best support these aims.
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Affiliation(s)
- Beverly Cheok Kuan Ng
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Deepak Jadon
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Adewale Adebajo
- A. Adebajo, MD, MBE, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Gizem Ayan
- G. Ayan, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Kristina Callis Duffin
- K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Vinod Chandran
- V. Chandran, MD, DM, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Laura C Coates
- L.C. Coates, MD, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Kurt de Vlam
- K. de Vlam, MD, PhD, University Hospitals Leuven, Leuven, Belgium
| | - Atul Deodhar
- A. Deodhar, MD, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Amit Garg
- A. Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dafna D Gladman
- D.D. Gladman, MD, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice B Gottlieb
- A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnon Katz
- A. Katz, MSc, Technion Israel Institute of Technology, Haifa, Israel
| | - Arthur Kavanaugh
- A. Kavanaugh, MD, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Ennio Lubrano
- E. Lubrano, MD, PhD, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Philip J Mease
- P.J. Mease, MD, Rheumatology Research, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Nash
- P. Nash, MBBS, MD, School of Medicine, Griffith University, Brisbane, Australia
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Stephen R Pennington
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabian Proft
- F. Proft, MD, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cheryl F Rosen
- C.F. Rosen, MD, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura Savage
- L. Savage, MBChB, PhD, Department of Dermatology, University of Leeds, Leeds, UK
| | - Claudia Goldenstein-Schainberg
- C. Goldenstein-Schainberg, MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Stefan Siebert
- S. Siebert, MD, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MS, University Institute and Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - William Tillett
- W. Tillet, MBChB, PhD, Department of Life Sciences, Centre for Therapeutic Innovation, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - April W Armstrong
- A.W. Armstrong, MD, MPH, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Oliver FitzGerald
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland;
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Girolomoni G, Savage L, Gisondi P, Svensson Å, Mahé E, Augustin M, Puig L. Increasing Access to Effective Systemic Treatments in Patients with Moderate-to-Severe Psoriasis: Narrative Review. Dermatol Ther (Heidelb) 2023; 13:2171-2185. [PMID: 37710078 PMCID: PMC10539267 DOI: 10.1007/s13555-023-01014-x] [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: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated inflammatory disease with a worldwide prevalence ranging between 0.51 and 11.43%. It results in a large clinical and social burden, with patients frequently suffering from reduced quality of life, psychologic distress and debilitating comorbidities. Biologic agents are used to establish and maintain disease control in patients with moderate-to-severe psoriasis and are essential to improving quality of life. However, a substantial proportion of patients have limited access to therapy due to economics, health policies and clinical considerations, which creates clinical unmet needs that disadvantage both patients and healthcare professionals. Biosimilars are a cost-effective alternative to off-patent biologic therapies, and there is mounting evidence to suggest they offer a valuable pharmacoeconomic strategy to lower healthcare costs in patients with psoriasis. Furthermore, the introduction of biosimilars can increase the number of patients able to receive biologics, allowing these patients to be treated earlier in the disease course, potentially modifying the course of their disease and reducing the risk of comorbidities. In time, the emergence of additional data, particularly those related to long-term safety, efficacy in extrapolated indications and the effects of switching, should reassure physicians and help overcome the final hurdles for a wider implementation of biosimilars. This review aims to provide an overview of current treatment approaches for patients with moderate-to-severe psoriasis in the biosimilars era and explores both the current challenges and potential opportunities to improve access to high-quality, effective treatments.
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Affiliation(s)
- Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Laura Savage
- Department of Dermatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Åke Svensson
- Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Emmanuel Mahé
- Department of Dermatology and Venereology, Department of Medicine, Hospital Victor-Dupouy, Argenteuil, France
| | - Matthias Augustin
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau-Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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6
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Zabotti A, De Marco G, Gossec L, Baraliakos X, Aletaha D, Iagnocco A, Gisondi P, Balint PV, Bertheussen H, Boehncke WH, Damjanov NS, de Wit M, Errichetti E, Marzo-Ortega H, Protopopov M, Puig L, Queiro R, Ruscitti P, Savage L, Schett G, Siebert S, Stamm TA, Studenic P, Tinazzi I, Van den Bosch FE, van der Helm-van Mil A, Watad A, Smolen JS, McGonagle DG. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Ann Rheum Dis 2023; 82:1162-1170. [PMID: 37295926 DOI: 10.1136/ard-2023-224148] [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: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transition from psoriasis (PsO) to psoriatic arthritis (PsA) and the early diagnosis of PsA is of considerable scientific and clinical interest for the prevention and interception of PsA. OBJECTIVE To formulate EULAR points to consider (PtC) for the development of data-driven guidance and consensus for clinical trials and clinical practice in the field of prevention or interception of PsA and for clinical management of people with PsO at risk for PsA development. METHODS A multidisciplinary EULAR task force of 30 members from 13 European countries was established, and the EULAR standardised operating procedures for development for PtC were followed. Two systematic literature reviews were conducted to support the task force in formulating the PtC. Furthermore, the task force proposed nomenclature for the stages before PsA, through a nominal group process to be used in clinical trials. RESULTS Nomenclature for the stages preceding PsA onset, 5 overarching principles and 10 PtC were formulated. Nomenclature was proposed for three stages towards PsA development, namely people with PsO at higher risk of PsA, subclinical PsA and clinical PsA. The latter stage was defined as PsO and associated synovitis and it could be used as an outcome measure for clinical trials evaluating the transition from PsO to PsA. The overarching principles address the nature of PsA at its onset and underline the importance of collaboration of rheumatologists and dermatologists for strategies for prevention/interception of PsA. The 10 PtC highlight arthralgia and imaging abnormalities as key elements of subclinical PsA that can be used as potential short-term predictors of PsA development and useful items to design clinical trials for PsA interception. Traditional risk factors for PsA development (ie, PsO severity, obesity and nail involvement) may represent more long-term disease predictors and be less robust for short-term trials concerning the transition from PsO to PsA. CONCLUSION These PtC are helpful to define the clinical and imaging features of people with PsO suspicious to progress to PsA. This information will be helpful for identification of those who could benefit from a therapeutic intervention to attenuate, delay or prevent PsA development.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Gabriele De Marco
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Nemanja S Damjanov
- Rheumatology, University of Belgrade Faculty of Medicine, Beograd, Serbia
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Enzo Errichetti
- Department of Medical and Biological Sciences University Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Helena Marzo-Ortega
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Lluis Puig
- Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Piero Ruscitti
- University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
| | - Laura Savage
- Chapel Allerton Hospital Department of Dermatology, Leeds, UK
| | - Georg Schett
- Rheumatology, Erlangen University Hospital, Erlangen, Germany
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Ilaria Tinazzi
- Unit of Rheumatology, Don Calabria Sacred Heart Hospital, Negrar, Italy
| | | | - Annette van der Helm-van Mil
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Abdulla Watad
- Internal Medicine, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Dennis G McGonagle
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Merola JF, Liu YH, Yang YW, Miller M, Shawi M, Chan D, Khattri S, Savage L, Han C. 33110 An analysis of fatigue in patients with psoriatic disease utilizing SF-36 vitality scores: Results through week 24 in phase 3 trials of guselkumab in patients with psoriasis and psoriatic arthritis. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Strober B, Liu YH, Yang YW, Miller M, Chan D, Boehncke WH, Savage L, Armstrong A, Han C. 33064 Correlation of fatigue severity and psoriasis severity, and the treatment effect of guselkumab: A detailed analysis of SF-36 vitality scores from the VOYAGE 2 study. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Merola JF, Liu YH, Yang YW, Miller M, Shawi M, Chan D, Khattri S, Savage L, Boehncke WH, Han C. AB0893 An Analysis of Fatigue in Patients With Psoriatic Disease Utilizing SF-36 Vitality Scores: Results Through Week 24 in Phase 3 Trials of Guselkumab in Patients With Psoriasis and Psoriatic Arthritis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with chronic inflammatory diseases can experience significant fatigue, negatively impacting health-related quality-of-life.1,2ObjectivesThis post-hoc analysis evaluated baseline fatigue severity among patients with psoriasis and/or psoriatic arthritis (PsA) and the effect of guselkumab treatment on patient-reported fatigue.MethodsVOYAGE-2 evaluated guselkumab every 8 weeks (Q8W) versus placebo (W16→guselkumab) and adalimumab in treating moderate-to-severe psoriasis.3 DISCOVER-14 and DISCOVER-25 evaluated guselkumab Q4W and Q8W versus placebo in treating active PsA. Fatigue was assessed using 36-item Short Form (SF-36) vitality scale score (includes 4 questions on fatigue/energy level); the US population norm=50±10; 5-10-point decrements are typically observed in conditions known to cause fatigue2; scores ≤35 indicate clinically important fatigue1; increases ≥5 indicate clinically meaningful improvement.2ResultsAcross randomized groups at baseline, mean SF-36 vitality scores were 47.7-48.5 in psoriasis and 42.2-44.0 in PsA patients; 11%-15% of psoriasis and 20%-28% of PsA patients had scores <35. In psoriasis patients, mean increases in SF-36 vitality score at W16 were: placebo, 1.1; adalimumab, 3.9 (p<0.001 versus placebo); guselkumab, 5.6 (p<0.001 versus placebo); at W24: placebo→guselkumab, 4.6; adalimumab, 3.9; guselkumab, 5.8 (p=0.0148 versus adalimumab). In PsA patients, mean increases at W24 were: placebo, 2.3-4.0; guselkumab, 5.5-7.5 (p≤0.001 versus placebo). Through the placebo-controlled periods, significantly greater proportions of guselkumab-treated patients achieved clinically meaningful improvement in fatigue versus placebo (W16 psoriasis: guselkumab, 48%; placebo, 32%; p<0.001; W24 PsA: guselkumab, 53%-55%; placebo, 34%-44%; p<0.05).ConclusionAt baseline, patients with psoriatic disease experienced clinically important fatigue, more so with PsA (20%-28%) than psoriasis (11%-15%). In guselkumab-treated psoriasis and PsA patients, clinically meaningful improvements in fatigue were achieved at W16 and W24, respectively.References[1]Skoie IM et al. Br J Dermatol. 2017;177:505-12[2]Bjorner JB et al. Curr Med Res Opin. 2007;23:731-9[3]Reich K et al. J Am Acad Dermatol. 2017;76:418-31[4]Deodhar A et al. Lancet. 2020;395:1115-25[5]Mease PJ et al. Lancet. 2020;395:1126-36Disclosure of InterestsJoseph F. Merola Consultant of: AbbVie, Arena, Biogen, Bristol-Myers Squibb, Dermavant, Eli Lilly, Janssen, Novartis, Pfizer, Sun Pharma, and UCB Pharma, Yi-Hsuan Liu Employee of: Janssen Global Services, LLC and may own stock or stock options in Johnson & Johnson, Ya-Wen Yang Employee of: Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, and may own stock or stock options in Johnson & Johnson, Megan Miller Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, May Shawi Employee of: Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, and may own stock or stock options in Johnson & Johnson, Daphne Chan Employee of: Janssen Scientific Affairs, LLC and may own stock or stock options in Johnson & Johnson, Saakshi Khattri Speakers bureau: Abbvie, Eli Lilly, UCB, Janssen, Paid instructor for: Abbvie, Eli Lilly, UCB, Janssen, Consultant of: Abbvie, Eli Lilly, UCB, Janssen, Grant/research support from: Pfizer, Abbvie, Leo, BMS, Eli Lilly, Laura Savage Speakers bureau: AbbVie, Almirall, Amgen, Celgene, Celltrion, Eli Lilly, Galderma, Janssen, LEO Pharma, MSD, Novartis, Sanofi and UCB Pharma, Consultant of: AbbVie, Almirall, Amgen, Celgene, Celltrion, Eli Lilly, Galderma, Janssen, LEO Pharma, MSD, Novartis, Sanofi and UCB Pharma, Grant/research support from: Janssen and Pfizer, Wolf-Henning Boehncke Speakers bureau: AbbVie, Almirall, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, and UCB Pharma; and has received a research grant from Pfizer, Consultant of: AbbVie, Almirall, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, and UCB Pharma; and has received a research grant from Pfizer, Chenglong Han Employee of: Janssen Global Services, LLC and may own stock or stock options in Johnson & Johnson
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Kaul A, Savage L, Gorecki P. P255 Collaboration in the treatment of psoriasis and psoriatic arthritis: a survey of UK clinical practice. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Treatment guidelines for psoriatic arthritis consider both skin and joint involvement and recommend collaborative multidisciplinary team (MDT) working when selecting therapy. However, multidisciplinary practice for psoriatic disease (PD) has not been well studied, with little data on service models and current practice. This survey explored collaborative working in PD treatment by rheumatology and dermatology healthcare professionals (HCPs) to provide a better understanding of current working patterns, collaborating specialties, as well as benefits and challenges of combined clinics for PD management.
Methods
An online survey was emailed to rheumatology and dermatology HCPs using professional networks. We requested information on role, collaborating specialties, benefits and barriers to collaborative working in PD, and the impact of COVID-19. The ideal service model and additional comments completed the survey.
Results
We received 80 responses between October 2020 and April 2021, covering England, Wales, Scotland and Northern Ireland. Of these, 56 respondents (70.0%) were consultants, 22 (27.5%) clinical nurse specialists and one each a lead pharmacist (1.3%) and specialist registrar (1.3%). Rheumatology HCPs accounted for 40.0% of respondents (n = 32) and dermatology HCPs for 60.0% (n = 48). As part of their PD MDT, most respondents (n = 60, 75.0%) worked collaboratively with other specialties. Combined clinics, whether virtual, face to face or an MDT, accounted for 51.5% of collaborative working for rheumatology HCPs and 58.9% for dermatology HCPs. Collaboration with other specialists mainly occurred by email or written referrals (Table 1). The most important perceived benefits of combined clinics were shared knowledge, better patient outcomes and patient satisfaction. The biggest challenges to setting up combined clinics were job plan time (rated as ‘difficult’ or ‘very difficult’ by 78.8% of respondents), logistics (67.5%) and unsupportive senior management (66.3%), while 77.5% felt COVID-19 had partial or significant impact on combined clinics.
Conclusion
This is the first survey to explore UK collaborative working in PD. Approaches varied, with different models of working and little consistency. While HCPs appreciated the benefits of collaborative working, numerous challenges in establishing formal arrangements were identified. More evidence is needed to demonstrate the perceived benefits of collaborative working in improving patient outcomes by standardising best practice.
Disclosure
A. Kaul: Consultancies; AK has received payment for advisory boards from AbbVie, Janssen, Leo, MSD, Novartis and Pfizer. Honoraria; AK has received speaker fees from AbbVie, Eli Lilly, Janssen, Leo, MSD, Novartis and Pfizer. L. Savage: Consultancies; LS has received payment for advisory boards from AbbVie, Almirall, Biogen, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer and UCB. Honoraria; LS has received speaker fees from AbbVie, Amgen, Almirall, Celgene, Celltrion, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer, MSD and UCB. Grants/research support; LS has received grants/research funding from Pfizer. P. Gorecki: Other; PG is an employee of Janssen-Cilag Ltd.
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Affiliation(s)
- Arvind Kaul
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Laura Savage
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UNITED KINGDOM
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Faddy S, Stewart P, Savage L, Fletcher P. Prehospital Thrombolysis Program Reduces the Time to Reperfusion Therapy in Patients Suffering STEMI in Rural and Regional NSW. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Crouch L, Kaffenberger M, Savage L. Using learning profiles to inform education priorities: An editors' overview of the Special Issue. Int J Educ Dev 2021; 86:102477. [PMID: 34602726 PMCID: PMC8456693 DOI: 10.1016/j.ijedudev.2021.102477] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
This special issue explores the use of learning profiles for analysing the dynamics of low learning in low- and middle-income countries and informing priorities to address the learning crisis. The 12 papers in the special issue draw on learning data from more than 50 countries and 6 million individuals, with implications for education policy and practice. Taken together, they point to a need to steepen learning trajectories by prioritizing early mastery of foundational skills for all children. The papers show that addressing the learning crisis will not be achieved through more school grade attainment alone, nor through within-country equality across groups (such as girls and boys or rich and poor). Positive examples show that programs focused on foundational learning both improved average learning and reduced inequality. Addressing the learning crisis will require a focus on systems improvement, using foundational learning as a case in point for making the needed systems improvements to steepen learning throughout children's time in school. Learning profiles can provide a guide for education actors aiming to improve learning outcomes.
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Affiliation(s)
| | | | - Laura Savage
- Foreign, Commonwealth, and Development Office, Government of the United Kingdom, United Kingdom
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Gottlieb AB, Merola JF, Armstrong AW, Savage L, Chakravarty SD, Kollmeier AP, Zhou B, Yang YW, Sweet K, Boehncke WH. 27851 Efficacy of guselkumab (GUS) on axial-related endpoints in patients with active psoriatic arthritis (PsA) with imaging-confirmed sacroiliitis: Results through week 52 from DISCOVER-1 and DISCOVER-2. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Orvad H, Savage L, Smith T, Schmidt D, Dee F. Disparity in Management of STEMI—Factors Leading to Missed Acute Myocardial Infarction (MAMI) in Rural Areas. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Dee F, Savage L, Cookson P, Watson O. Establishment of a Centralised Decision Support Service for the Management of Acute Coronary Syndrome in Rural NSW Hospitals. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Savage L, Tinazzi I, Zabotti A, Laws PM, Wittmann M, McGonagle D. Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment. J Clin Med 2020; 9:jcm9103262. [PMID: 33053820 PMCID: PMC7601411 DOI: 10.3390/jcm9103262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 09/03/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023] Open
Abstract
In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA.
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Affiliation(s)
- Laura Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy;
| | - Philip M. Laws
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
- Correspondence:
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McKernan C, Meharg C, Carey M, Donaldson E, Williams P, Savage L, Meharg AA. Feed-derived iodine overrides environmental contribution to cow milk. J Dairy Sci 2020; 103:6930-6939. [PMID: 32475661 DOI: 10.3168/jds.2019-17446] [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: 08/13/2019] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
Diets worldwide are deficient in iodine, leading to a range of undesirable health effects at the population level. Dairy products are a primary source of iodine in diets for those populations in which iodized salt is not systematically used or available. However, the flows of iodine through dairy agroecosystems are not well understood. The aim of this research was to investigate iodine flows though the dairy agroecosystem, including the influence of atmospheric depositional inputs, environmental variables, season, husbandry, and diet. Three farm-based sampling campaigns were carried out in this investigation, with milk, soil, silage, grass, and feed iodine determined by inductively coupled plasma mass spectroscopy, and nonparametric statistical analysis tests were conducted on data sets obtained. Natural iodine inputs into the environment are dominated by atmospheric deposition, which mainly from sea spray, and thus the location of farms relative to the coast and prevailing wind direction. Herbage and silage produced from grass-based systems strongly correlated with soil iodine, yet there was a strong disconnect between soil, forage, and feed and the milk that results. This was due to the levels of iodine in supplemental feeds being approximately 10-fold higher than those in forage-derived feeds. The practice of feed supplementation, accentuated by summer housing of cows, led to elevated milk iodine.
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Affiliation(s)
- C McKernan
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom
| | - C Meharg
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom.
| | - M Carey
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom
| | - E Donaldson
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom
| | - P Williams
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom
| | - L Savage
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom
| | - A A Meharg
- Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, BT9 5DL, United Kingdom.
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Dee F, Bastian B, Savage L, Sverdlov A, McIvor D, Orvad H, McGee M, Boyle A. 463 Comparison of Clinician and Algorithm ECG Interpretation in ACS. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Dee F, Gibbs C, Boyle A, Watson O, Orvad H, McIvor D, Al-Omary M, Savage L. 481 Door to ECG Times in Rural NSW Hospitals. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Savage L, Goodfield M, Horton L, Watad A, Hensor E, Emery P, Wakefield R, Wittmann M, McGonagle D. Regression of Peripheral Subclinical Enthesopathy in Therapy-Naive Patients Treated With Ustekinumab for Moderate-to-Severe Chronic Plaque Psoriasis: A Fifty-Two-Week, Prospective, Open-Label Feasibility Study. Arthritis Rheumatol 2019; 71:626-631. [PMID: 30468001 DOI: 10.1002/art.40778] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate whether sonographically determined subclinical enthesopathy in patients with moderate-to-severe psoriasis regresses with the use of ustekinumab therapy for skin disease. METHODS Seventy-three patients with moderate-to-severe psoriasis, who were not treated with systemic therapy and did not have symptoms of psoriatic arthritis (PsA), and 23 healthy volunteers were screened by ultrasound for subclinical enthesitis. Subsequently, 23 patients with psoriasis whose ultrasound results showed inflammatory changes were treated with ustekinumab for 52 weeks. The evolution of sonographic abnormalities of the upper and lower limb entheses was assessed using an extensive gray-scale and power Doppler (PD) ultrasound protocol at weeks 0, 12, 24, and 52. For each parameter, a gray-scale or PD ultrasound score of >0 was determined to be abnormal, and a summative score based on the Glasgow Ultrasound Enthesitis Scoring System was calculated. RESULTS Of all the patients with psoriasis screened using ultrasound, 49.3% had at least 1 inflammatory entheseal abnormality. Mean ± SD inflammation scores were higher in the patients with psoriasis compared with the healthy volunteers (9.9 ± 6.6 versus 1.0 ± 1.4). With treatment, the mean inflammation scores decreased significantly by 42.2% from week 0 to week 24 (-4.2 [95% confidence interval -6.3, -2.1]; P < 0.001) and by 47.5% by week 42 (-4.7 [95% confidence interval -7.1, -2.3]; P = 0.001). Entheseal structural abnormalities did not change significantly during treatment. CONCLUSION Within 12 weeks of treatment, interleukin-12 (IL-12)/IL-23 inhibition for psoriasis appears to suppress subclinical enthesopathy, and the suppression is maintained through week 52. Further longitudinal studies are needed to determine whether therapy initiated for skin disease may prevent the development of PsA.
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Affiliation(s)
- Laura Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Laura Horton
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Abdulla Watad
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Sheba Medical Center, Ramat-Gan, Israel, and Tel-Aviv University, Tel-Aviv, Israel
| | - Elizabeth Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Miriam Wittmann
- Leeds Teaching Hospitals NHS Trust, Leeds, UK, and University of Bradford, Bradford, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Savage L, Price M, Williams T, Dee F, Collard P, Orvad H. A District Wide ACS Dataset. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Mcivor D, Savage L, Orvad H, Dee F, Price M, Williams T, Al-Omary M, Sverdlov A. Gender and Racial Differences in Rural NSW for Possible Admission With Acute Coronary Syndrome. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Williams T, Condon J, Davies A, Brown J, Matheson L, Warner T, Savage L, Collins N, Boyle A, Inder K. A Nursing-Led Examination of Radial Artery Diameters, Occlusion Rates and Vascular Complications Utilising Ultrasound Measurements. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Dee F, Savage L, Loten C, Chard C, Pallas J. Management of Out of Hospital Cardiac Arrest in a Primary Percutaneous Coronary Intervention Site. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Coates LC, Savage L, Waxman R, McGonagle DG, Moverley AR, Helliwell PS. An educational leaflet improves response to invitation for screening for arthritis in patients with psoriasis in primary care, but only in practices in the most deprived areas. Clin Rheumatol 2016; 36:719-723. [PMID: 27981462 PMCID: PMC5323500 DOI: 10.1007/s10067-016-3503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/21/2016] [Revised: 11/02/2016] [Accepted: 12/02/2016] [Indexed: 01/27/2023]
Abstract
This study hypothesises that an educational leaflet about psoriatic arthritis (PsA) will improve psoriasis patients’ attendance for screening for PsA. A random sample of patients ≥18 years old with a coded diagnosis of psoriasis and no diagnosis of PsA, rheumatoid arthritis or ankylosing spondylitis were identified from five GP surgeries in Yorkshire, UK. Patients were randomised 1:1 to receive study information alone or with the educational leaflet, with an invitation to attend for a screening examination by a dermatologist and rheumatologist. Nine hundred thirty-two invitation packs were sent to recruit 191 (20.5%) participants. One hundred sixty-nine (88.5%) had current or previous psoriasis and 17 (10.1%) had previously undiagnosed PsA. The estimated prevalence of PsA was 18.1% (95% CI: 16.2, 20.1%). The response rate was lower than expected and was not significantly higher when patients received the educational leaflet (22.8 vs 18.3%, p = 0.08). Response rates varied by practice (14.7 to 30.6%). However, deprivation scores for each practice revealed a significant increase in response with the leaflet for deprivation decile of 3 (p < 0.001) but no significant differences in the other practices. An educational leaflet about PsA improves attendance for screening in primary care, but only in those practices with higher levels of socioeconomic deprivation.
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Affiliation(s)
- Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Laura Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Robin Waxman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dennis G McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anna R Moverley
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK. .,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Rutherford J, Savage L, Dee F, Navâthé P. The Effect of Ambulance Bypass on Rural ACS Management. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Khan A, Savage L, Stewart P, Williams T, Bhagwandeen R, Fletcher P, Boyle A. Pre-Hospital ECG and Triage Strategy Improves Survival in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Khan A, Baker D, Savage L, Gordon T, Collins N. Clozapine and Incidence of Myocarditis and Sudden Death – A Regional Australian Experience. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Williams T, Inder K, Savage L, Collins N. Risk Factor Profile of Patients Sustaining Femoral Vascular Complications in a Tertiary Referral Cardiac Catheterisation Laboratory. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khan A, Williams T, Savage L, Stewart P, Bhagwandeen R, Fletcher P, Boyle A. Pre-Hospital Thrombolysis and Transfer Achieves Optimal. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coates LC, Savage L, Waxman R, Moverley AR, Worthington S, Helliwell PS. Comparison of screening questionnaires to identify psoriatic arthritis in a primary-care population: a cross-sectional study. Br J Dermatol 2016; 175:542-8. [PMID: 27031574 DOI: 10.1111/bjd.14604] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many questionnaires are available for assessment of psoriatic arthritis (PsA), but there is little evidence comparing them. OBJECTIVES To test the proposed CONTEST questionnaire, which was developed to identify patients with psoriasis who have undiagnosed PsA, and compare it with the validated Psoriasis Epidemiology Screening Tool (PEST) questionnaire in a primary-care setting. METHODS A random sample of adult patients with psoriasis and no diagnosis of arthritis was identified from five general practice surgeries in Yorkshire, U.K. Consenting patients completed both questionnaires and were assessed by a dermatologist and rheumatologist. Diagnosis of PsA was made by the assessing rheumatologist. Receiver operator characteristic (ROC) curve analysis examined the sensitivity and specificity of potential cut points. RESULTS In total 932 packs were sent to recruit 191 (20·5%) participants. Of these, 169 (88·5%) were confirmed to have current or previous psoriasis. Using physician diagnosis 17 (10·1%) were found to have previously undiagnosed PsA, while 90 (53·3%) had another musculoskeletal complaint and 62 (36·7%) had no musculoskeletal problems. Using ROC curve analysis, all of the questionnaires showed a significant ability to identify PsA. The area under the curve (AUC) for the CONTEST questionnaires was slightly higher than that of PEST (0·69 and 0·70 vs. 0·65), but there was no significant difference identified. Examining the sensitivities and specificities for the different cut points suggested that a PEST score ≥ 2 would perform better in this dataset, and the optimal scores for CONTEST and CONTEST plus joint manikin were 3 and 4, respectively. CONCLUSIONS The accuracy of the questionnaires to identify PsA appeared similar, with a slightly higher AUC for the CONTEST questionnaires. The optimal cut points in this study appeared lower than in previous studies.
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Affiliation(s)
- L C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - L Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - R Waxman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K
| | - A R Moverley
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - S Worthington
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K.,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - P S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, U.K.. .,Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, U.K..
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Abstract
While guidelines have been established for doctors’ and nurses’ ward rounds, there is no protocol in place for surgeons.
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Affiliation(s)
- L Savage
- Royal Free London NHS Foundation Trust
| | - V Vyas
- Royal Free London NHS Foundation Trust
| | - E Akerele
- Royal Free London NHS Foundation Trust
| | - M Klein
- Royal Free London NHS Foundation Trust
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Morrison KE, Dhariwal S, Hornabrook R, Savage L, Burn DJ, Khoo TK, Kelly J, Murphy CL, Al-Chalabi A, Dougherty A, Leigh PN, Wijesekera L, Thornhill M, Ellis CM, O'Hanlon K, Panicker J, Pate L, Ray P, Wyatt L, Young CA, Copeland L, Ealing J, Hamdalla H, Leroi I, Murphy C, O'Keeffe F, Oughton E, Partington L, Paterson P, Rog D, Sathish A, Sexton D, Smith J, Vanek H, Dodds S, Williams TL, Steen IN, Clarke J, Eziefula C, Howard R, Orrell R, Sidle K, Sylvester R, Barrett W, Merritt C, Talbot K, Turner MR, Whatley C, Williams C, Williams J, Cosby C, Hanemann CO, Iman I, Philips C, Timings L, Crawford SE, Hewamadduma C, Hibberd R, Hollinger H, McDermott C, Mils G, Rafiq M, Shaw PJ, Taylor A, Waines E, Walsh T, Addison-Jones R, Birt J, Hare M, Majid T. Lithium in patients with amyotrophic lateral sclerosis (LiCALS): a phase 3 multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2013; 12:339-45. [PMID: 23453347 PMCID: PMC3610091 DOI: 10.1016/s1474-4422(13)70037-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Lithium has neuroprotective effects in cell and animal models of amyotrophic lateral sclerosis (ALS), and a small pilot study in patients with ALS showed a significant effect of lithium on survival. We aimed to assess whether lithium improves survival in patients with ALS. Methods The lithium carbonate in amyotrophic lateral sclerosis (LiCALS) trial is a randomised, double-blind, placebo-controlled trial of oral lithium taken daily for 18 months in patients with ALS. Patients aged at least 18 years who had ALS according to the revised El Escorial criteria, had disease duration between 6 and 36 months, and were taking riluzole were recruited from ten centres in the UK. Patients were randomly assigned (1:1) to receive either lithium or matched placebo tablets. Randomisation was via an online system done at the level of the individual by block randomisation with randomly varying block sizes, stratified by study centre and site of disease onset (limb or bulbar). All patients and assessing study personnel were masked to treatment assignment. The primary endpoint was the rate of survival at 18 months and was analysed by intention to treat. This study is registered with Eudract, number 2008-006891-31. Findings Between May 26, 2009, and Nov 10, 2011, 243 patients were screened, 214 of whom were randomly assigned to receive lithium (107 patients) or placebo (107 patients). Two patients discontinued treatment and one died before the target therapeutic lithium concentration could be achieved. 63 (59%) of 107 patients in the placebo group and 54 (50%) of 107 patients in the lithium group were alive at 18 months. The survival functions did not differ significantly between groups (Mantel-Cox log-rank χ2 on 1 df=1·64; p=0·20). After adjusting for study centre and site of onset using logistic regression, the relative odds of survival at 18 months (lithium vs placebo) was 0·71 (95% CI 0·40–1·24). 56 patients in the placebo group and 61 in the lithium group had at least one serious adverse event. Interpretation We found no evidence of benefit of lithium on survival in patients with ALS, but nor were there safety concerns, which had been identified in previous studies with less conventional designs. This finding emphasises the importance of pursuing adequately powered trials with clear endpoints when testing new treatments. Funding The Motor Neurone Disease Association of Great Britain and Northern Ireland.
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Parker J, Norman D, Savage L, Hussain W. 'Addressing' an under-recognized cause of discomfort for patients undergoing Mohs micrographic surgery. Br J Dermatol 2013; 169:187-8. [PMID: 23301598 DOI: 10.1111/bjd.12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Savage L, Hussain W. Regional anaesthesia: perceptions of competency and an assessment of practice among U.K. dermatology trainees. Br J Dermatol 2012; 167:1390-1. [PMID: 22540413 DOI: 10.1111/j.1365-2133.2012.11027.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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Fletcher P, Faddy S, Gallagher S, Savage L, Stewart P. NSW Pre-hospital Thrombolysis. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Pilgrim G, Savage L, Hamed H, Dani M. Intra-operative specimen microradiography in wide local excision of breast cancer. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Savage L, Pilgrim G, Hamed H. 5150 POSTER Intra-operative Specimen Microradiography in Wide Local Excision of Breast Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Savage L, Tarrant N, Rickards H, Pall H. 039 The Birmingham joint motor disorder clinic: a descriptive study. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.217554.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Heart failure is the only cardiovascular disease that is increasing in prevalence in developing countries. As a result, circulatory assist devices are being used more both as a bridge to heart transplantation and as destination therapy in patients with a failing heart. Nurses must become knowledgeable about these options for their patients. Developing and maintaining competency can be challenging as more devices become available. The principles of adult learners were used by one academic medical center to set up a new circulatory assist program and to maintain ongoing competency among staff working with patients who have these devices.
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Affiliation(s)
- Laura Savage
- Virginia Commonwealth University, Health System, Richmond, Virginia (LS, KJ), Veterans Affairs Medical Center, Richmond, Virginia (JM)
| | - Jennifer Murphey
- Virginia Commonwealth University, Health System, Richmond, Virginia (LS, KJ), Veterans Affairs Medical Center, Richmond, Virginia (JM)
| | - Kenna Joyce
- Virginia Commonwealth University, Health System, Richmond, Virginia (LS, KJ), Veterans Affairs Medical Center, Richmond, Virginia (JM)
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Savage L, Williams T, Hiles S, Clark V. Gender Variances in Chest Pain Presentation: An Audit of 15805 Patients. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Abstract
Congestive heart failure remains one of the leading causes of cardiac death and disability. As pharmacological therapies have advanced, patients are living longer and more productive lives. However, at some point, these interventions begin to fail. Circulatory assist devices have revolutionized the management of patients with end-stage heart disease. These devices successfully bridge patients to cardiac transplantation. The Syncardia Total Artificial Heart provides biventricular support for the failing heart. This case study illustrates the challenges of caring for patients with such a device.
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Affiliation(s)
- Yvonne Allen
- Virginia Commonwealth University, Medical College of Virginia, 1250 East Marshall Street, Box 985871, Richmond, VA 23298, USA
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Allen Y, Collins R, Lester C, Savage L, Vijayan S. Managing the Failing Heart: Total Circulatory Assist—A Case Study. Prog Transplant 2009; 19:13-7. [DOI: 10.1177/152692480901900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congestive heart failure remains one of the leading causes of cardiac death and disability. As pharmacological therapies have advanced, patients are living longer and more productive lives. However, at some point, these interventions begin to fail. Circulatory assist devices have revolutionized the management of patients with end-stage heart disease. These devices successfully bridge patients to cardiac transplantation. The Syncardia Total Artificial Heart provides biventricular support for the failing heart. This case study illustrates the challenges of caring for patients with such a device.
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Affiliation(s)
- Yvonne Allen
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Rachel Collins
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Charnetta Lester
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Laura Savage
- Virginia Commonwealth University, Medical College of Virginia, Richmond
| | - Sajitha Vijayan
- Virginia Commonwealth University, Medical College of Virginia, Richmond
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Savage L. Antioxidant Supplements May Lessen Benefit of Radiation and Chemotherapy. J Natl Cancer Inst 2008. [DOI: 10.1093/jnci/djn201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Savage L. No Association Found Between Vitamin D Concentration in Blood and Risk of Prostate Cancer. J Natl Cancer Inst 2008. [DOI: 10.1093/jnci/djn202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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