1
|
Kay J, Nikolov NP, Weisman MH. American College of Rheumatology (ACR) and Food and Drug Administration (FDA) Summit: Summary of the Meeting May 17-18, 2022. Arthritis Rheumatol 2024. [PMID: 38622107 DOI: 10.1002/art.42864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
On May 17-18, 2022, the ACR and the FDA co-sponsored a public meeting to address topics of mutual interest and importance in assessing long-term safety and clinical efficacy, as well as novel approaches to clinical trials in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). During the two-day consensus-building summit, rheumatologists, other health care professionals, and FDA staff provided a broad perspective on current clinical development challenges and potential approaches to address them. Key takeaways are summarized in this document, including issues related to innovative clinical trial designs, use of novel outcome measures such as magnetic resonance imaging (MRI) and patient-reported outcomes (PROs), and use of innovative approaches to collecting data including registries and digital health technology (DHT).
Collapse
Affiliation(s)
- Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Chan Medical School and UMass Memorial Medical Center, Worcester, MA
| | - Nikolay P Nikolov
- Division of Rheumatology and Transplant Medicine (CRTM), Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | | |
Collapse
|
2
|
Simard JF, Liu EF, Chakravarty E, Rector A, Cantu M, Kuo DZ, Shaw GM, Druzin ML, Weisman MH, Hedderson MM. Pregnancy Outcomes in a Diverse US Lupus Cohort. Arthritis Care Res (Hoboken) 2024; 76:526-530. [PMID: 38221659 PMCID: PMC11042669 DOI: 10.1002/acr.25279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Although the population of patients with systemic lupus erythematosus (SLE) is racially and ethnically diverse, many study populations are homogeneous. Further, data are often lacking on critical factors, such as antiphospholipid antibodies (aPLs). We investigated live birth rates in patients with SLE at Kaiser Permanente Northern California, including race and ethnicity and aPL data. METHODS Electronic health records of pregnancies with outcomes observed from 2011 to 2020 were identified among patients with SLE. Prevalent SLE was defined as two or more International Classification of Diseases-coded visits seven or more days apart before the last menstrual period. We summarized patient characteristics, medication orders, health care use, and medication use. Pregnancy outcomes (live birth, stillbirth, spontaneous abortion, ectopic pregnancy, and molar pregnancy) were presented overall and stratified by race and ethnicity, aPL status, and nephritis history. RESULTS We identified 657 pregnancies among 453 patients with SLE. The cohort was diverse, reflecting the Northern California population (27% Asian, 26% Hispanic, 26% Non-Hispanic White, 13% Non-Hispanic Black, 5% multiracial, and approximately 2% Pacific Islander and Native American). Approximately 74% of observed pregnancies ended in live birth, 23% resulted in spontaneous abortion, 2% were ectopic or molar pregnancies, and <1% were stillbirths. There was limited variability in live births by race and ethnic group (72%-79%), aPL status (69.5%-77%), and nephritis history (71%-75%). CONCLUSION Our findings are consistent with previous studies; however, some methodologic differences may yield a range of live birth rates. We found that approximately 74% of pregnancies in patients with SLE ended in live birth, with modest variability in spontaneous abortion by race and ethnicity, nephritis history, and aPL status.
Collapse
Affiliation(s)
- Julia F Simard
- Stanford University School of Medicine, Stanford, California
| | - Emily F Liu
- Kaiser Permanente Northern California, Oakland
| | | | - Amadeia Rector
- Stanford University School of Medicine, Stanford, California
| | | | - Daniel Z Kuo
- Kaiser Permanente, Redwood City Medical Center, Redwood City, California
| | - Gary M Shaw
- Stanford University School of Medicine, Stanford, California
| | | | | | | |
Collapse
|
3
|
Carlucci PM, Preisinger K, Deonaraine KK, Zaminski D, Dall'Era M, Gold HT, Kalunian K, Fava A, Belmont HM, Wu M, Putterman C, Anolik J, Barnas JL, Furie R, Diamond B, Davidson A, Wofsy D, Kamen D, James JA, Guthridge JM, Apruzzese W, Rao D, Weisman MH, Izmirly PM, Buyon J, Petri M. Extrarenal symptoms associate with worse quality of life in patients enrolled in the AMP RA/SLE Lupus Nephritis Network. Rheumatology (Oxford) 2024:keae189. [PMID: 38530774 DOI: 10.1093/rheumatology/keae189] [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: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE Lupus nephritis (LN) can occur as an isolated component of disease activity or be accompanied by diverse extrarenal manifestations. Whether isolated renal disease is sufficient to decrease health related quality of life (HRQOL) remains unknown. This study compared Patient-Reported Outcomes Measurement Information System 29-Item (PROMIS-29) scores in LN patients with isolated renal disease to those with extrarenal symptoms to evaluate the burden of LN on HRQOL and inform future LN clinical trials incorporating HRQOL outcomes. METHODS A total of 181 LN patients consecutively enrolled in the multicentre multi-ethnic/racial Accelerating Medicines Partnership completed PROMIS-29 questionnaires at the time of a clinically indicated renal biopsy. Raw PROMIS-29 scores were converted to standardized T scores. RESULTS Seventy-five (41%) patients had extrarenal disease (mean age 34, 85% female) and 106 (59%) had isolated renal (mean age 36, 82% female). Rash (45%), arthritis (40%) and alopecia (40%) were the most common extrarenal manifestations. Compared with isolated renal, patients with extrarenal disease reported significantly worse pain interference, ability to participate in social roles, physical function, and fatigue. Patients with extrarenal disease had PROMIS-29 scores that significantly differed from the general population by > 0.5 SD of the reference mean in pain interference, physical function, and fatigue. Arthritis was most strongly associated with worse scores in these three domains. CONCLUSION Most patients had isolated renal disease and extrarenal manifestations associated with worse HRQOL. These data highlight the importance of comprehensive disease management strategies that address both renal and extrarenal manifestations to improve overall patient outcomes.
Collapse
Affiliation(s)
- Philip M Carlucci
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Katherine Preisinger
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | | | - Devyn Zaminski
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Maria Dall'Era
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Heather T Gold
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Kenneth Kalunian
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Andrea Fava
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - H Michael Belmont
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Ming Wu
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | | | - Jennifer Anolik
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer L Barnas
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Furie
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Betty Diamond
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Anne Davidson
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - David Wofsy
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Diane Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Judith A James
- Department of Medicine, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Joel M Guthridge
- Department of Medicine, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Deepak Rao
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Peter M Izmirly
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jill Buyon
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Michelle Petri
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
4
|
Alhassan E, Yi BY, Rodman J, Weisman MH, Crew A, Wise L. Unique characteristics of anti-MDA-5 associated dermatomyositis in southern california with a large hispanic population. Semin Arthritis Rheum 2024; 66:152434. [PMID: 38503149 DOI: 10.1016/j.semarthrit.2024.152434] [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: 10/08/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES There is little to no data about the presentation and clinical course of anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5) dermatomyositis in a primarily U.S. Hispanic population. We describe the clinical course of anti-MDA-5 dermatomyositis in our majority Hispanic population. METHODS This is a multicenter, retrospective case series of anti-MDA-5 dermatomyositis. Patients diagnosed with anti-MDA-5 dermatomyositis from June 2015 to March 2023 at four medical centers in Los Angeles, California, were included. Demographics and clinical characteristics were obtained. Descriptive statistics, Pearson's chi-squared, Fisher's exact, Wilcoxon rank sum, and Kruskal-Wallis tests were performed as applicable. RESULTS Thirty anti-MDA-5 dermatomyositis patients were included. Twenty-two (73 %) were Hispanic. Twenty-one patients (70 %) were female, with a median age of 40.5 years. Hispanic patients were diagnosed with anti-MDA-5 dermatomyositis at a younger age than non-Hispanic patients (p = 0.025). Inflammatory arthritis was prominent; more males were affected than females (p = 0.027). Thirteen patients (43 %) were amyopathic. Twenty-five patients (83.3 %) had evidence of interstitial lung disease (ILD), and a higher ferritin level was associated with ILD (p = 0.049). There were six deaths (20 %); five (17 %) were ascribed to rapidly progressive ILD. CONCLUSION ILD was the most common presentation of anti-MDA-5 dermatomyositis in our cohort and was associated with higher ferritin levels. Hispanic patients had a younger age of diagnosis than non-Hispanic patients. Necrotic skin lesions and inflammatory arthritis were frequently seen. This is the first study looking at clinical phenotypes and outcomes of anti-MDA-5 dermatomyositis in a primarily Hispanic U.S. POPULATION Future studies are needed to better understand the clinical manifestations (to promptly recognize and treat) of this population of anti-MDA-5 dermatomyositis.
Collapse
Affiliation(s)
- Eaman Alhassan
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Belina Y Yi
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jack Rodman
- Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashley Crew
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Leanna Wise
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
5
|
Ermann J, Deodhar A, Khan MA, Weisman MH, Reveille JD. Twenty Years of SPARTAN: From Inception to Impact (SPARTAN 2023 Annual Meeting Proceedings). Curr Rheumatol Rep 2024; 26:96-101. [PMID: 38214805 DOI: 10.1007/s11926-023-01131-8] [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: 12/28/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE OF REVIEW This review takes a look at the past, present, and future of SPARTAN, the Spondyloarthritis Research and Treatment Network, an organization of North American healthcare professionals dedicated to advancing research, education, and patient care in spondyloarthritis. RECENT FINDINGS In 2022, SPARTAN completed the Classification of Axial SpondyloarthritiS Inception Cohort (CLASSIC) study, a collaboration with the Assessment in SpondyloArthritis International Society (ASAS). CLASSIC aimed to validate the 2009 ASAS classification criteria for axial spondyloarthritis. Other ongoing SPARTAN endeavors include the development of US referral recommendations for axial spondyloarthritis, an update of the 2019 ACR/SAA/SPARTAN treatment recommendations for axial spondyloarthritis and multiple educational initiatives. Twenty years after its inception, SPARTAN continues to grow and broaden its impact, guided by the SPARTAN vision of "a world free of spondyloarthritis through leadership in research and education."
Collapse
Affiliation(s)
- Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, HBTM, Room 06002P, 60 Fenwood Road, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - John D Reveille
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
6
|
Dhital R, Baer RJ, Bandoli G, Guma M, Poudel DR, Kalunian K, Weisman MH, Chambers C. Maternal cardiovascular events in autoimmune rheumatic diseases and antiphospholipid syndrome pregnancies. Am J Obstet Gynecol MFM 2024; 6:101319. [PMID: 38428526 DOI: 10.1016/j.ajogmf.2024.101319] [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: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Rashmi Dhital
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0656.
| | - Rebecca J Baer
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; The California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA
| | - Gretchen Bandoli
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Monica Guma
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA; Department of Rheumatology, Veteran Affairs San Diego Healthcare System, San Diego, CA
| | - Dilli R Poudel
- Department of Medicine, Indiana Regional Medical Center, Indiana, PA
| | - Kenneth Kalunian
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA
| | - Michael H Weisman
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Christina Chambers
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| |
Collapse
|
7
|
Izmirly PM, Kim MY, Carlucci PM, Preisinger K, Cohen BZ, Deonaraine K, Zaminski D, Dall'Era M, Kalunian K, Fava A, Belmont HM, Wu M, Putterman C, Anolik J, Barnas JL, Diamond B, Davidson A, Wofsy D, Kamen D, James JA, Guthridge JM, Apruzzese W, Rao DA, Weisman MH, Petri M, Buyon J, Furie R. Longitudinal patterns and predictors of response to standard-of-care therapy in lupus nephritis: data from the Accelerating Medicines Partnership Lupus Network. Arthritis Res Ther 2024; 26:54. [PMID: 38378664 PMCID: PMC10877793 DOI: 10.1186/s13075-024-03275-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Leveraging the Accelerating Medicines Partnership (AMP) Lupus Nephritis (LN) dataset, we evaluated longitudinal patterns, rates, and predictors of response to standard-of-care therapy in patients with lupus nephritis. METHODS Patients from US academic medical centers with class III, IV, and/or V LN and a baseline urine protein/creatinine (UPCR) ratio ≥ 1.0 (n = 180) were eligible for this analysis. Complete response (CR) required the following: (1) UPCR < 0.5; (2) normal serum creatinine (≤ 1.3 mg/dL) or, if abnormal, ≤ 125% of baseline; and (3) prednisone ≤ 10 mg/day. Partial response (PR) required the following: (1) > 50% reduction in UPCR; (2) normal serum creatinine or, if abnormal, ≤ 125% of baseline; and (3) prednisone dose ≤ 15 mg/day. RESULTS Response rates to the standard of care at week 52 were CR = 22.2%; PR = 21.7%; non-responder (NR) = 41.7%, and not determined (ND) = 14.4%. Only 8/180 (4.4%) patients had a week 12 CR sustained through week 52. Eighteen (10%) patients attained a week 12 PR or CR and sustained their responses through week 52 and 47 (26.1%) patients achieved sustained PR or CR at weeks 26 and 52. Week 52 CR or PR attainment was associated with baseline UPCR > 3 (ORadj = 3.71 [95%CI = 1.34-10.24]; p = 0.012), > 25% decrease in UPCR from baseline to week 12 (ORadj = 2.61 [95%CI = 1.07-6.41]; p = 0.036), lower chronicity index (ORadj = 1.33 per unit decrease [95%CI = 1.10-1.62]; p = 0.003), and positive anti-dsDNA antibody (ORadj = 2.61 [95%CI = 0.93-7.33]; p = 0.069). CONCLUSIONS CR and PR rates at week 52 were consistent with the standard-of-care response rates observed in prospective registrational LN trials. Low sustained response rates underscore the need for more efficacious therapies and highlight how critically important it is to understand the molecular pathways associated with response and non-response.
Collapse
Affiliation(s)
- Peter M Izmirly
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA.
| | - Mimi Y Kim
- Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Philip M Carlucci
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Katherine Preisinger
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Brooke Z Cohen
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Kristina Deonaraine
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Devyn Zaminski
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Maria Dall'Era
- University of California San Francisco, San Francisco, CA, USA
| | | | - Andrea Fava
- Johns Hopkins University, Baltimore, MD, USA
| | - H Michael Belmont
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Ming Wu
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | | | | | | | - Betty Diamond
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Anne Davidson
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - David Wofsy
- University of California San Francisco, San Francisco, CA, USA
| | - Diane Kamen
- Medical University of South Carolina, Charleston, SC, USA
| | - Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | | | | | - Jill Buyon
- New York University Grossman School of Medicine, 550 First Avenue, MSB 593D, New York, NY, 10016, USA
| | - Richard Furie
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| |
Collapse
|
8
|
Kesarwani V, Sinnappan S, Husni ME, Weisman MH, Ermann J. Screening Tools for Spondyloarthritis in Patients with Psoriasis, Uveitis, and Inflammatory Bowel Disease - A Scoping Review. Arthritis Care Res (Hoboken) 2024. [PMID: 38303576 DOI: 10.1002/acr.25308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Extra-musculoskeletal manifestations of Spondyloarthritis (SpA) may precede the development of articular features. Patients seen in ophthalmology, dermatology, and gastroenterology clinics with uveitis, psoriasis, or inflammatory bowel disease (IBD) may have undiagnosed SpA. We set out to identify and evaluate screening tools for SpA in patients with psoriasis, uveitis, and IBD and determine factors that influence the performance of these instruments. METHODS Scoping review following PRISMA guidelines. PubMed, EMBASE, and Web of Science were searched from inception to January 2022. RESULTS We identified 13 screening tools for PsA, 2 SpA screening tools in uveitis, and 3 SpA screening tools in IBD. All screening tools were patient-oriented questionnaires except for the Dublin Uveitis Evaluation Tool, a physician-applied algorithm. The questionnaires varied in length, scoring method, cut-off score, and spectrum of included SpA features. Average completion time was <5 minutes. Across the three patient populations, the sensitivities and specificities of these screening tools were comparable in the primary validation cohorts. Sensitivities and specificities were generally lower in secondary validation studies, with marked variability between cohorts. CONCLUSION Our results highlight the heterogeneity and limitations of existing SpA screening tools. While these tools show promise for use within a specific target population, none are generalizable to all patients with extra-musculoskeletal manifestations at risk for SpA. Future studies should explore the utility of a generic patient-oriented SpA screening tool that can be applied to patients with psoriasis, uveitis, or IBD, is easy to use and comprehend, and captures all clinical domains of SpA.
Collapse
Affiliation(s)
- Vartika Kesarwani
- University of Connecticut, 263 Farmington Ave, Farmington, CT, 06030
| | | | | | - Michael H Weisman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305
| | - Joerg Ermann
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| |
Collapse
|
9
|
Karmacharya P, Crowson CS, Lennon RJ, Poudel D, Davis JM, Ogdie A, Liew JW, Ward MM, Ishimori M, Weisman MH, Brown MA, Rahbar MH, Hwang MC, Reveille JD, Gensler LS. Multimorbidity phenotypes in ankylosing spondylitis and their association with disease activity and functional impairment: Data from the prospective study of outcomes in ankylosing spondylitis cohort. Semin Arthritis Rheum 2024; 64:152282. [PMID: 37995469 PMCID: PMC10872589 DOI: 10.1016/j.semarthrit.2023.152282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/01/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To examine the association of multimorbidity phenotypes at baseline with disease activity and functional status over time in ankylosing spondylitis (AS). METHODS Patient-reported AS morbidities (comorbidities, N = 28 and extra-musculoskeletal manifestations, EMMs, N = 3) within 3 years of enrollment with a prevalence ≥1 %, were included from the Prospective Study of Outcomes in Ankylosing Spondylitis (PSOAS) cohort. We defined multimorbidity as ≥2 morbidities (MM2+) and substantial multimorbidity as ≥5 morbidities (MM5+). Multimorbidity clusters or phenotypes were identified using K-median clustering. Disease activity (ASDAS-CRP) and functional status (BASFI) measures were collected every 6 months. Generalized estimating equation method was used to examine the associations of multimorbidity counts and multimorbidity clusters with measures of disease activity and functional status over time. RESULTS Among 1,270 AS patients (9,885 visits) with a median follow-up of 2.9 years (IQ range: 1.0-6.8 years), the prevalence of MM2+ and MM5+ was 49 % and 9 % respectively. We identified five multimorbidity clusters: depression (n = 321, 25 %), hypertension (n = 284, 22 %), uveitis (n = 274, 22 %), no morbidities (n = 238, 19 %), and miscellaneous (n = 153, 12 %). Patients in the depression cluster were more likely to be female and had significantly more morbidities and worse disease activity and functional status compared to those with no morbidities. CONCLUSION Approximately 49 % of AS patients in the PSOAS cohort had multimorbidity and five distinct multimorbidity phenotypes were identified. In addition to the number of morbidities, the type of morbidity appears to be important to longitudinal outcomes in AS. The depression cluster was associated with worse disease activity and function.
Collapse
Affiliation(s)
- Paras Karmacharya
- Vanderbilt University Medical Center, Division of Rheumatology & Immunology, Nashville, TN, United States of America; Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America.
| | - Cynthia S Crowson
- Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America; Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, United States of America
| | - Ryan J Lennon
- Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, United States of America
| | - Dilli Poudel
- Indiana Regional Medical Center, Indiana, PA, United States of America
| | - John M Davis
- Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Philadelphia, United States of America
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Intramural Research Program, Bethesda, USA
| | - Mariko Ishimori
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, USA
| | - Michael H Weisman
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, USA
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, Faculty of Health, King's College London, England; Genomics England, London, England
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, McGovern Medical School, and Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, (CCTS) at the University of Texas Health Science Center at Houston, USA
| | - Mark C Hwang
- McGovern Medical School at the University of Texas Health Science Center, Division of Rheumatology and Clinical Immunogenetics, Houston, USA
| | - John D Reveille
- McGovern Medical School at the University of Texas Health Science Center, Division of Rheumatology and Clinical Immunogenetics, Houston, USA
| | - Lianne S Gensler
- University of California San Francisco, Department of Medicine, Division of Rheumatology, San Francisco, USA
| |
Collapse
|
10
|
Affiliation(s)
- Michael H Weisman
- David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Centers, 10800 Wilshire Boulevard, #404, Los Angeles, CA 90024, USA.
| |
Collapse
|
11
|
Rector A, Marić I, Chaichian Y, Chakravarty E, Cantu M, Weisman MH, Shaw GM, Druzin ML, Simard JF. Hydroxychloroquine in Lupus Pregnancy and Risk of Preeclampsia. Arthritis Rheumatol 2024. [PMID: 38272838 DOI: 10.1002/art.42793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) disproportionately affects women during childbearing years, and hydroxychloroquine (HCQ) is the standard first-line treatment. Preeclampsia complicates up to one-third of pregnancies in lupus patients, although reports vary by parity and multifetal gestation. We investigated whether taking HCQ early in pregnancy may reduce the risk of preeclampsia. METHODS We studied 1,068 live birth singleton pregnancies among 1,020 privately insured patients with SLE (2007-2016). HCQ treatment was defined as three months preconception through the first trimester, and prescription fills were a proxy for taking HCQ. Modified Poisson regression estimated risk ratios (RRs) and 95% confidence intervals (CIs), stratified by parity. Propensity scores accounted for confounders, and stratified analyses examined effect modification. RESULTS Approximately 15% of pregnant patients were diagnosed with preeclampsia. In 52% of pregnancies, patients had one or more HCQ fills. Pregnant patients exposed to HCQ had more comorbidities, SLE activity, and azathioprine treatment. We found no evidence of a statistical association between HCQ and preeclampsia among nulliparous (RR 1.26 [95% CI 0.82-1.93]) and multiparous pregnancies (RR 1.20 [95% CI 0.80-1.70]). Additional controls for confounding decreased the RRs toward the null (nulliparous pregnancy, propensity score-adjusted [PS-adj] RR 1.09 [95% CI 0.68-1.76]; multiparous pregnancy, PS-adj RR 1.01 [95% CI 0.66-1.53]). CONCLUSION Using a large insurance-based database, we did not observe a decreased risk of preeclampsia associated with HCQ treatment in pregnancy, although we cannot rule out residual and unmeasured confounding and misclassification. Further studies leveraging large population-based data and prospective collection could characterize how HCQ influences preeclampsia risk in pregnant patients with SLE and among persons at greater risk of hypertensive disorders of pregnancy.
Collapse
Affiliation(s)
- Amadeia Rector
- Stanford University School of Medicine, Stanford, California
| | - Ivana Marić
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - Gary M Shaw
- Stanford University School of Medicine, Stanford, California
| | | | - Julia F Simard
- Stanford University School of Medicine, Stanford, California
| |
Collapse
|
12
|
Adami G, Alarcon G, Albert D, Allen K, Aringer M, Arkema EV, Ashour HM, Atzeni F, Ayan G, Baer A, Baker J, Barber C, Bautista-Molano W, Beça S, Beamer B, Bergstra SA, Bermas B, Bilgin E, Boers M, Bolster M, Bosco J, Bowden JL, Buttgereit F, Calabrese L, Campochiaro C, Cappelli L, Carmona L, Carvalho J, Castañeda S, Chao Chao CM, Chatterjee S, Cherry L, Christensen R, Coates LC, Cohen SB, Collins JE, Cornec D, D'Agostino MA, Daikeler T, D'Angelo S, de Boysson H, de Jong P, de Wit M, Dellaripa P, Dessein P, Diekhoff T, Doumen M, Eckstein F, Elhai M, Fairley JL, Felson D, Amaro IF, Ferucci E, Fiorentino D, FitzGerald J, Fleischmann R, Galloway J, Salinas RG, Giorgi V, Golightly Y, Gono T, Gonzalez-Gay MA, Goules A, Gravallese E, Griffith M, Grosman S, Gupta L, Hamuryudan V, Hana C, Haschka J, Hawker G, Hervas-Perez JP, Hocevar A, Iudici M, Iyer P, Jasmin M, Judson M, Kerschbaumer A, Kiefer D, Kiltz U, Kivity S, Kremer JM, Kroon FPB, Kviatkovsky S, Lee BS, Liew D, Lim SY, Littlejohn G, Medina CL, Maksymowych W, March L, Marotte H, Navarro OM, Mavragani C, McInnes I, McMahan Z, Meara A, Mecoli C, Merriman T, Mikdashi J, Mikuls T, Misra DP, Mitchell BD, Moore T, Moutsopoulos H, Naredo E, Nash P, Nurmohamed M, Oddis C, Ojaimi S, Oliver M, Ozen S, Ozgocmen S, Palmowski A, Pascart T, Perelas A, Pile K, Pincus T, Poddubnyy D, Ramiro S, Reddy A, Regierer A, Roccatello D, Rookes T, Rosenthal A, Rubinstein T, Rudwaleit M, Rueda-Gotor J, Rus V, Saketkoo LA, Samson M, Schur P, Sepriano A, Shadmanfar S, Shmagel A, Sibbitt WL, de Souza AWS, Sims C, Singh N, Sjöwall C, Smith V, Song JJ, Soriano ER, Sparks J, Studenic P, Sugihara T, Suissa S, Szekanecz Z, Tascilar K, Taylor P, Terkeltaub R, Tiniakou E, Todd N, Vilarino GT, Treemarcki E, Tsuji H, Turesson C, Twilt M, Vassilopoulos D, Vojinovic T, Volkmann E, Vosse D, Wagner-Weiner L, Wallace ZS, Wallace D, Wang GC, Wei J, Weisman MH, Westhovens R, Winthrop K, Wysham KD, Xue J, Yang C, Yau M, Yazici Y, Yazici H, YIM ICW, Young J, Zhang W. Referees. Semin Arthritis Rheum 2024:152375. [PMID: 38245402 DOI: 10.1016/j.semarthrit.2024.152375] [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: 01/22/2024]
|
13
|
Sun W, Mu W, Jefferies C, Learch T, Ishimori M, Wu J, Yan Z, Zhang N, Tao Q, Kong W, Yan X, Weisman MH. Interaction effects of significant risk factors on low bone mineral density in ankylosing spondylitis. PeerJ 2023; 11:e16448. [PMID: 38025753 PMCID: PMC10676083 DOI: 10.7717/peerj.16448] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background To analyze individually and interactively critical risk factors, which are closely related to low bone mineral density (BMD) in patient with ankylosing spondylitis (AS). Methods A total of 249 AS patients who visited China-Japan Friendship Hospital were included in this training set. Patients with questionnaire data, blood samples, X-rays, and BMD were collected. Logistic regression analysis was employed to identify key risk factors for low BMD in different sites, and predictive accuracy was improved by incorporating the selected significant risk factors into the baseline model, which was then validated using a validation set. The interaction between risk factors was analyzed, and predictive nomograms for low BMD in different sites were established. Results There were 113 patients with normal BMD, and 136 patients with low BMD. AS patients with hip involvement are more likely to have low BMD in the total hip, whereas those without hip involvement are more prone to low BMD in the lumbar spine. Chest expansion, mSASSS, radiographic average grade of the sacroiliac joint, and hip involvement were significantly associated with low BMD of the femoral neck and total hip. Syndesmophytes, hip involvement and higher radiographic average grade of the sacroiliac joint increases the risk of low BMD of the femoral neck and total hip in an additive manner. Finally, a prediction model was constructed to predict the risk of low BMD in total hip and femoral neck. Conclusions This study identified hip involvement was strongly associated with low BMD of the total hip in AS patients. Furthermore, the risk of low BMD of the femoral neck and total hip was found to increase in an additive manner with the presence of syndesmophytes, hip involvement, and severe sacroiliitis. This finding may help rheumatologists to identify AS patients who are at a high risk of developing low BMD and prompt early intervention to prevent fractures.
Collapse
Affiliation(s)
- Wenting Sun
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenjun Mu
- Beijing University of Chinese Medicine, Beijing, China
| | - Caroline Jefferies
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - Thomas Learch
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - Juan Wu
- Beijing University of Chinese Medicine, Beijing, China
| | - Zeran Yan
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of TCM Rheumatology, China‐Japan Friendship Hospital, Beijing, China
| | - Nan Zhang
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of TCM Rheumatology, China‐Japan Friendship Hospital, Beijing, China
| | - Qingwen Tao
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of TCM Rheumatology, China‐Japan Friendship Hospital, Beijing, China
| | - Weiping Kong
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of TCM Rheumatology, China‐Japan Friendship Hospital, Beijing, China
| | - Xiaoping Yan
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of TCM Rheumatology, China‐Japan Friendship Hospital, Beijing, China
| | | |
Collapse
|
14
|
Weisman MH. Emerging Concepts in Immune Dysregulation. Rheum Dis Clin North Am 2023; 49:xiii-xiv. [PMID: 37821204 DOI: 10.1016/j.rdc.2023.08.013] [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: 10/13/2023]
Affiliation(s)
- Michael H Weisman
- Adjunct Professor of Medicine, Stanford University, Distinguished Professor of Medicine Emeritus, David Geffen School of Medicine at UCLA, Professor of Medicine Emeritus, Cedars-Sinai Medical Center, 10800 Wilshire Boulevard #404, Los Angeles, CA 90024, USA.
| |
Collapse
|
15
|
Shridharmurthy D, Lapane KL, Nunes AP, Baek J, Weisman MH, Kay J, Liu SH. Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study. J Rheumatol 2023; 50:1287-1295. [PMID: 37399461 DOI: 10.3899/jrheum.2023-0105] [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: 06/05/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD). METHODS A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group. RESULTS Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36). CONCLUSION Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.
Collapse
Affiliation(s)
- Divya Shridharmurthy
- D. Shridharmurthy, MMBS, MPH, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Anthony P Nunes
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jonggyu Baek
- J. Baek, PhD, Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Michael H Weisman
- M.H. Weisman, MD, Division of Immunology and Rheumatology, School of Medicine, Stanford University, Palo Alto, California
| | - Jonathan Kay
- J. Kay, MD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Division of Rheumatology, Department of Medicine, UMass Chan Medical School, and Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shao-Hsien Liu
- S.H. Liu, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
| |
Collapse
|
16
|
Weisman MH. Vasculitis. Rheum Dis Clin North Am 2023; 49:xiii-xiv. [PMID: 37331743 DOI: 10.1016/j.rdc.2023.04.002] [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] [Indexed: 06/20/2023]
Affiliation(s)
- Michael H Weisman
- Adjunct Professor of Medicine, Stanford University, 10800 Wilshire Boulevard, #404, Los Angeles, CA 90024, USA.
| |
Collapse
|
17
|
Weisman MH. Scleroderma: Best Approaches to Patient Care. Rheum Dis Clin North Am 2023; 49:xvii-xviii. [PMID: 37028850 DOI: 10.1016/j.rdc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Michael H Weisman
- Adjunct Professor of Medicine, Stanford University, Distinguished Professor of Medicine Emeritus, David Geffen School of Medicine at UCLA, Professor of Medicine Emeritus, Cedars-Sinai Medical Center, 10800 Wilshire Boulevard #404, Los Angeles, CA 90024, USA.
| |
Collapse
|
18
|
Seifert JA, Bemis EA, Ramsden K, Lowell C, Polinski K, Feser M, Fleischer C, Demoruelle MK, Buckner J, Gregersen PK, Keating RM, Mikuls TR, O’Dell JR, Weisman MH, Deane KD, Norris JM, Steere AC, Holers VM. Association of Antibodies to Prevotella copri in Anti-Cyclic Citrullinated Peptide-Positive Individuals At Risk of Developing Rheumatoid Arthritis and in Patients With Early or Established Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:507-516. [PMID: 36259174 PMCID: PMC10065886 DOI: 10.1002/art.42370] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Prevotella copri (P copri), a gut commensal, has been reported to be an immune-relevant organism in individuals with rheumatoid arthritis (RA). This study sought to evaluate anti-P copri (anti-Pc) antibody responses in our participant cohorts and to determine when in the natural history of RA such responses develop. METHODS We analyzed serum levels of immunoglobulin A (IgA) and IgG antibodies from a 27-kd protein of P copri (anti-Pc-p27), an immunogenic P copri protein, in study participants at risk of developing RA, participants who transitioned to RA, participants with early RA (<1 year of disease), and participants with established RA, with comparisons made to their matched controls. We also evaluated anti-Pc-p27 antibody levels in individuals stratified by RA-related autoantibody status. RESULTS Overall, participants with RA had significantly higher IgA anti-Pc-p27 antibody levels and trended toward higher IgG anti-Pc-p27 antibody levels compared with matched controls. When stratified by early versus established RA, participants with early RA had median IgG anti-Pc-p27 antibody levels that were overall higher, whereas median IgA anti-Pc-p27 antibody levels were statistically significantly higher in participants with established RA compared with their matched controls. In the autoantibody-specific analyses, the at-risk population with anti-cyclic citrullinated peptide (anti-CCP) antibodies, but not rheumatoid factor (RF), trended toward increased levels of IgG anti-Pc-p27. Additionally, RA participants who were seropositive for both CCP and RF had significantly increased levels of IgA anti-Pc-p27 antibodies and trended toward higher levels of IgG anti-Pc-p27 antibodies compared with matched controls. CONCLUSION Our findings support a potential etiologic role for P copri in both RA preclinical evolution and the subsequent pathogenesis of synovitis.
Collapse
Affiliation(s)
| | | | - Kristina Ramsden
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cassidy Lowell
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Marie Feser
- University of Colorado Denver, Aurora, Colorado
| | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Peter K. Gregersen
- Feinstein Institutes for Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York
| | | | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | - James R. O’Dell
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | | | | | | | - Allen C. Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
19
|
Weisman MH, Oleg Stens, Seok Kim H, Hou JK, Miller FW, Dillon CF. US Inflammatory Bowel Disease Prevalence: Surveillance Data from the U.S. National Health and Nutrition Examination Survey. Prev Med Rep 2023; 33:102173. [DOI: 10.1016/j.pmedr.2023.102173] [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] [Received: 09/08/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
|
20
|
Ridley LK, Hwang MC, Reveille JD, Gensler LS, Ishimori ML, Brown MA, Rahbar MH, Tahanan A, Ward MM, Weisman MH, Learch TJ. Why Do Some Patients Have Severe Sacroiliac Disease But No Syndesmophytes in Ankylosing Spondylitis? Data From a Nested Case-Control Study. J Rheumatol 2023; 50:335-341. [PMID: 36182115 DOI: 10.3899/jrheum.211230] [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: 09/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sacroiliac (SI) joint and spinal inflammation are characteristic of ankylosing spondylitis (AS), but some patients with AS have been identified who have discordant radiographic disease. We studied an AS subgroup with long-standing disease and fused SI joints. We identified factors associated with discrepant degrees of radiographic damage between the SI joints and spine. METHODS From the Prospective Study of Outcomes in AS (PSOAS) cohort, patients with a disease duration ≥ 20 years and fused SI joints were included in a nested case-control design. Patients with and without syndesmophytes were used as cases and controls for analysis. We used classification and regression tree (CART) analysis to determine risk factors for syndesmophytes presence and reexamined the validity of the risk factors using univariable logistic regression models. RESULTS There were 354 patients in the subgroup, 23 of whom lacked syndesmophytes. CART analysis showed females were less likely to have syndesmophytes. The next important predictor was age of symptom onset in males, with age of onset ≤ 16 years being less likely to have syndesmophytes. Univariable analysis confirmed females were less likely to have syndesmophytes (odds ratio [OR] 0.17, 95% CI 0.07-0.41). Syndesmophyte presence was associated with HLA-B27 positivity (P = 0.03) and age of symptom onset > 16 years old (OR 2.72, 95% CI 1.15-6.45). All 23 patients who lacked syndesmophytes were HLA-B27 positive. CONCLUSION Using CART analysis and univariable modeling, women were less likely to have syndesmophytes despite advanced disease duration and SI joint disease. Patients with younger age of symptom onset were less likely to have syndesmophytes. All patients without syndesmophytes were HLA-B27 positive, indicating HLA-B27 positivity may be more associated with SI disease than spinal disease.
Collapse
Affiliation(s)
- Lauren K Ridley
- L.K. Ridley, MD, John P. and Katherine G. McGovern Medical School, University of Texas Health Center at Houston, Houston, Texas, USA;
| | - Mark C Hwang
- M.C. Hwang, MD, J.D. Reveille, MD, Division of Rheumatology and Clinical Immunogenetics, Department of Internal medicine, John P. and Katherine G. McGovern Medical School, University of Texas at Houston, Houston, Texas, USA
| | - John D Reveille
- M.C. Hwang, MD, J.D. Reveille, MD, Division of Rheumatology and Clinical Immunogenetics, Department of Internal medicine, John P. and Katherine G. McGovern Medical School, University of Texas at Houston, Houston, Texas, USA
| | - Lianne S Gensler
- L.S. Gensler, MD, Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Mariko L Ishimori
- M.L. Ishimori, MD, Division of Rheumatology, University of California San Francisco, San Francisco, California
| | - Matthew A Brown
- M.A. Brown, MD, PhD, Guy's & St Thomas' NHS Foundation Trust, and King's College London NIHR Biomedical Research Centre, London, UK
| | - Mohammad H Rahbar
- M.H. Rahbar, PhD, Center for Clinical and Translational Studies, University of Texas at Houston Medical School, Houston, Texas, USA
| | - Amirali Tahanan
- A. Tahanan, MS, Center for Clinical and Transnational Science, University of Texas Health Science Center at Houston, Texas, USA
| | - Michael M Ward
- M.M. Ward, MD, MPH, National Institutes of Health, NIAMS/IRP, Bethesda, Maryland, USA
| | - Michael H Weisman
- M.H. Weisman, MD, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Thomas J Learch
- T.J. Learch, MD, Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
21
|
Nelson DA, Kaplan RM, Kurina LM, Weisman MH. Incidence of Ankylosing Spondylitis Among Male and Female United States Army Personnel. Arthritis Care Res (Hoboken) 2023; 75:332-339. [PMID: 34459565 DOI: 10.1002/acr.24774] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Incidence rates of ankylosing spondylitis (AS) among males versus females are poorly understood. Results of prior research have been mixed, including findings of a 3:1 incidence ratio for males versus females, but with increasing AS rates among females. The objective was to estimate the incidence of AS among members of the US military. METHODS We estimated the incidence of AS in a retrospective cohort study of diverse, working-age US military service members during March 2014 to June 2017 (n = 728,556) who underwent clinical practice guideline-directed screening for chronic back pain. Incident AS cases were identified using diagnostic codes from electronic medical and administrative records. RESULTS In contrast to some prior studies, AS incidence was similar among males and females (incidence rate ratio 1.16, P = 0.23; adjusted odds ratio [OR] 0.79 [95% confidence interval (95% CI) 0.61-1.02]; P = 0.072). AS rates increased approximately monotonically with age. Consistent with prior research, the AS incidence rate was greater in the White population than in the Black population (adjusted OR 1.39 [95% CI 1.01-1.66]; P = 0.04). CONCLUSION In this study population, the incidence of AS was similar for the sexes. Previous observations of male predominance have typically been derived from clinic populations that are less representative of the US race/ethnicity distribution and based on disease ascertainment tools that may have identified subjects later in their disease course. Our study population also differed in being subject to organized screenings for musculoskeletal symptoms. Our findings suggest that sex may not predict AS incidence in the US population.
Collapse
Affiliation(s)
- D Alan Nelson
- Stanford University School of Medicine, Stanford, California
| | - Robert M Kaplan
- Stanford University School of Medicine, Stanford, California
| | - Lianne M Kurina
- Stanford University School of Medicine, Stanford, California
| | | |
Collapse
|
22
|
Weisman MH. Cardiovascular Comorbidities in Inflammatory Rheumatic Diseases. Rheum Dis Clin North Am 2023; 49:xiii-xiv. [PMID: 36424030 DOI: 10.1016/j.rdc.2022.09.002] [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] [Indexed: 11/22/2022]
Affiliation(s)
- Michael H Weisman
- Division of Immunology and Rheumatology, Stanford University School of Medicine.
| |
Collapse
|
23
|
Carlucci PM, Li J, Fava A, Deonaraine KK, Wofsy D, James JA, Putterman C, Diamond B, Davidson A, Fine DM, Monroy-Trujillo J, Atta MG, DeJager W, Guthridge JM, Haag K, Rao DA, Brenner MB, Lederer JA, Apruzzese W, Belmont HM, Izmirly PM, Zaminski D, Wu M, Connery S, Payan-Schober F, Furie R, Dall'Era M, Cho K, Kamen D, Kalunian K, Anolik J, Barnas J, Ishimori M, Weisman MH, Buyon JP, Petri M. High incidence of proliferative and membranous nephritis in SLE patients with low proteinuria in the Accelerating Medicines Partnership. Rheumatology (Oxford) 2022; 61:4335-4343. [PMID: 35212719 PMCID: PMC9629353 DOI: 10.1093/rheumatology/keac067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Delayed detection of LN associates with worse outcomes. There are conflicting recommendations regarding a threshold level of proteinuria at which biopsy will likely yield actionable management. This study addressed the association of urine protein:creatinine ratios (UPCR) with clinical characteristics and investigated the incidence of proliferative and membranous histology in patients with a UPCR between 0.5 and 1. METHODS A total of 275 SLE patients (113 first biopsy, 162 repeat) were enrolled in the multicentre multi-ethnic/racial Accelerating Medicines Partnership across 15 US sites at the time of a clinically indicated renal biopsy. Patients were followed for 1 year. RESULTS At biopsy, 54 patients had UPCR <1 and 221 had UPCR ≥1. Independent of UPCR or biopsy number, a majority (92%) of patients had class III, IV, V or mixed histology. Moreover, patients with UPCR <1 and class III, IV, V, or mixed had a median activity index of 4.5 and chronicity index of 3, yet 39% of these patients had an inactive sediment. Neither anti-dsDNA nor low complement distinguished class I or II from III, IV, V or mixed in patients with UPCR <1. Of 29 patients with baseline UPCR <1 and class III, IV, V or mixed, 23 (79%) had a UPCR <0.5 at 1 year. CONCLUSION In this prospective study, three-quarters of patients with UPCR <1 had histology showing class III, IV, V or mixed with accompanying activity and chronicity despite an inactive sediment or normal serologies. These data support renal biopsy at thresholds lower than a UPCR of 1.
Collapse
Affiliation(s)
- Philip M Carlucci
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Jessica Li
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Andrea Fava
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - David Wofsy
- Rheumatology Division, Department of Medicine, Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA
| | - Judith A James
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Chaim Putterman
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Betty Diamond
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Anne Davidson
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Derek M Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jose Monroy-Trujillo
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohamed G Atta
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Wade DeJager
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Joel M Guthridge
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Kristin Haag
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael B Brenner
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James A Lederer
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - H Michael Belmont
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Peter M Izmirly
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Devyn Zaminski
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Ming Wu
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Sean Connery
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Fernanda Payan-Schober
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Richard Furie
- Division of Rheumatology, Department of Medicine, Northwell Health, Great Neck, NY
| | - Maria Dall'Era
- Rheumatology Division, Department of Medicine, Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA
| | - Kerry Cho
- Nephrology Division, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kenneth Kalunian
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA
| | - Jennifer Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Jennifer Barnas
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jill P Buyon
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
24
|
Weisman MH. Environmental Triggers for Rheumatic Diseases. Rheum Dis Clin North Am 2022; 48:xi. [PMID: 36333005 DOI: 10.1016/j.rdc.2022.07.001] [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] [Indexed: 12/14/2022]
|
25
|
Simard JF, Liu EF, Chakravarty E, Rector A, Cantu M, Kuo DZ, Shaw GM, Druzin M, Weisman MH, Hedderson MM. Reconciling Between Medication Orders and Medication Fills for Lupus in Pregnancy. ACR Open Rheumatol 2022; 4:1021-1026. [PMID: 36252776 PMCID: PMC9746661 DOI: 10.1002/acr2.11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Most studies consider either medications ordered or filled, but not both. Medication underuse based on filling data cannot necessarily be ascribed to patient nonadherence. Using both data sources, we quantified primary medication adherence in a cohort of prevalent systemic lupus erythematosus (SLE) pregnancies. METHODS We identified 419 pregnancies in Kaiser Permanente Northern California in patients with prevalent SLE from 2011 to 2020. We calculated the number of physician-initiated orders or pharmacy-initiated reorders during pregnancy and a comparable 9-month window the year before (prepregnancy) and the proportion of orders ever filled and filled within 30 days for hydroxychloroquine (HCQ), azathioprine, and corticosteroids. For pregnancies without an order or reorder, we identified the proportion with previous prescription fills overlapping into the respective study period. RESULTS New orders for lupus medications were usually filled. HCQ was prescribed most often (45.8% pregnancies) and usually filled (89.7% in prepregnancy, 93.2% during pregnancy). The majority filled within 30 days (80.5% prepregnancy, 83.3% pregnancy). Some pregnancies without new HCQ orders had continuous refills from prior orders; 53% of 2011-2015 pregnancies either had a new order or fill coverage from a previous period, compared to 63.2% of pregnancies delivering in 2016-2019. Corticosteroid fill frequencies were 90.6% in prepregnancy and 83.6% during pregnancy. Fewer patients used azathioprine; however, most new orders were filled (94.3% prepregnancy, 91.7% pregnancy). For azathioprine and corticosteroids, fill rates were modestly higher in prepregnancy compared to pregnancy. CONCLUSION We observed that patients have high adherence to filling new orders for lupus medications, such as HCQ and azathioprine, in pregnancy.
Collapse
Affiliation(s)
| | - Emily F. Liu
- Kaiser Permanente Northern California Division of ResearchOakland
| | | | - Amadeia Rector
- Stanford University School of MedicineStanfordCalifornia
| | | | - Daniel Z. Kuo
- Kaiser Permanente Redwood City Medical CenterRedwood CityCalifornia
| | - Gary M. Shaw
- Stanford University School of MedicineStanfordCalifornia
| | - Maurice Druzin
- Stanford University School of MedicineStanfordCalifornia
| | | | | |
Collapse
|
26
|
Nelson DA, Kaplan RM, Weisman MH, Kurina LM. Service discharges among US Army personnel with selected musculoskeletal and skin conditions: a retrospective cohort study. BMJ Open 2022; 12:e063371. [PMID: 36241350 PMCID: PMC9577895 DOI: 10.1136/bmjopen-2022-063371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous. METHODS All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records. Diagnostic codes were used to identify incident cases of the four musculoskeletal and skin diseases and, for comparison, diabetes mellitus (DM). Time to discharge was modelled using sex stratified multivariate survival analysis. RESULTS The analysis included 657 417 individuals with a total of 1.2 million person-years of observation. An elevated risk of discharge was observed in association with each of the five chronic conditions studied. The increase in adjusted risk of discharge was highest among soldiers with AS (men, HR=2.5, 95% CI 2.1 to 3.0; women, HR=2.1, 95% CI 1.4 to 3.2) and with DM (men, HR=2.4, 95% CI 2.2 to 2.7; women, HR=2.2, 95% CI 1.8 to 2.5), followed by those with RA (men, HR=1.8, 95% CI 1.5 to 2.2; women, HR=1.8, 95% CI 1.4 to 2.4). CONCLUSIONS Military discharges are consequential for the service and the service member. The doubling in risk of discharge for those with AS or RA was comparable to that for personnel with DM. Conditions that affect the spine and peripheral joints may often be incompatible with military readiness. Nevertheless, a substantial fraction of service members with these diagnoses continued in service.
Collapse
Affiliation(s)
- D Alan Nelson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Robert M Kaplan
- Department of Medicine, Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Michael H Weisman
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lianne M Kurina
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
27
|
Weisman MH, Stens O, Kim HS, Hou JK, Miller FW, Dillon CF. Axial Pain and Arthritis in Diagnosed Inflammatory Bowel Disease: US National Health and Nutrition Examination Survey Data. Mayo Clin Proc Innov Qual Outcomes 2022; 6:443-449. [PMID: 36147868 PMCID: PMC9485826 DOI: 10.1016/j.mayocpiqo.2022.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To estimate the nationally representative prevalence of chronic axial pain, inflammatory back pain (IBP), axial spondyloarthritis (axSpA), and peripheral arthritis in persons diagnosed with inflammatory bowel disease (IBD). Patients and Methods US National Health and Nutrition Examination Survey (NHANES) data from the 1976-1980 and 2009-2010 survey cycles. Results In NHANES 1976-1980, the chronic axial pain prevalence in participants with diagnosed ulcerative colitis (UC) was 19.5% vs 7.2% in the general population (P<.01). Neck or upper back, lower back, and Amor criteria-based axial pain were also significantly increased (11.2%, 14.5%, and 13.0%, respectively, vs 3%-5% in the general population (P<.01). In those with diagnosed UC, 40% had axial pain onset at an age older than 45 years; 30.2% reported peripheral arthralgias, and 12.2% reported peripheral arthritis. Arthritis findings on examination were uncommon. In NHANES 2009-2010, axial pain in those diagnosed with IBD had similar patterns. Conclusion Despite high rates of chronic axial pain in those with IBD, few cases met the IBP and axSpA classification criteria. This apparent discrepancy is unexplained. However, in IBD, axial pain onset at an age older than 45 years is common; and these may not meet IBP and axSpA age criteria. Also, neck pain was increased in those with IBD but is not included in most IBP and axSpA criteria. Peripheral arthralgias and chronic arthritis symptoms were common, but examination findings were not, suggesting that tenosynovitis or enthesitis is more likely than frank arthritis to occur in patients with UC.
Collapse
Affiliation(s)
- Michael H. Weisman
- School of Medicine, Stanford University Medical Center, Palo Alto, CA
- Correspondence: Address to Michael H. Weisman, MD, School of Medicine, Stanford University Medical Center, Palo Alto, CA 90024.
| | | | - Hyun-Seok Kim
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jason K. Hou
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Department of Medicine, Section of Gastroenterology, Baylor College of Medicine, Houston, TX
| | - Frederick W. Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Charles F. Dillon
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| |
Collapse
|
28
|
Weisman MH. Guideline Development and Implementation in Rheumatic Disease. Rheum Dis Clin North Am 2022; 48:xiii-xiv. [PMID: 35953235 DOI: 10.1016/j.rdc.2022.06.013] [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: 11/17/2022]
|
29
|
Vanderlinden LA, Bemis EA, Seifert J, Guthridge JM, Young KA, Demoruelle MK, Feser M, DeJager W, Macwana S, Mikuls TR, O'Dell JR, Weisman MH, Buckner J, Keating RM, Gaffney PM, Kelly JA, Langefeld CD, Deane KD, James JA, Holers VM, Norris JM. Relationship Between a Vitamin D Genetic Risk Score and Autoantibodies Among First-Degree Relatives of Probands With Rheumatoid Arthritis and Systemic Lupus Erythematosus. Front Immunol 2022; 13:881332. [PMID: 35720397 PMCID: PMC9205604 DOI: 10.3389/fimmu.2022.881332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/09/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Higher 25-hydroxyvitamin D (25(OH)D) levels have been associated with reduced risk for autoimmune diseases and are influenced by vitamin D metabolism genes. We estimated genetically-determined vitamin D levels by calculating a genetic risk score (GRS) and investigated whether the vitamin D GRS was associated with the presence of autoantibodies related to rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in those at increased risk for developing RA and SLE, respectively. Methods In this cross-sectional study, we selected autoantibody positive (aAb+) and autoantibody negative (aAb-) individuals from the Studies of the Etiologies of Rheumatoid Arthritis (SERA), a cohort study of first-degree relatives (FDRs) of individuals with RA (189 RA aAb+, 181 RA aAb-), and the Lupus Family Registry and Repository (LFRR), a cohort study of FDRs of individuals with SLE (157 SLE aAb+, 185 SLE aAb-). Five SNPs known to be associated with serum 25(OH)D levels were analyzed individually as well as in a GRS: rs4588 (GC), rs12785878 (NADSYN1), rs10741657 (CYP2R1), rs6538691 (AMDHD1), and rs8018720 (SEC23A). Results Both cohorts had similar demographic characteristics, with significantly older and a higher proportion of males in the aAb+ FDRs. The vitamin D GRS was inversely associated with RA aAb+ (OR = 0.85, 95% CI = 0.74-0.99), suggesting a possible protective factor for RA aAb positivity in FDRs of RA probands. The vitamin D GRS was not associated with SLE aAb+ in the LFRR (OR = 1.09, 95% CI = 0.94-1.27). The SEC23A SNP was associated with RA aAb+ in SERA (OR = 0.65, 95% CI = 0.43-0.99); this SNP was not associated with SLE aAb+ in LFRR (OR = 1.41, 95% CI = 0.90 - 2.19). Conclusion Genes associated with vitamin D levels may play a protective role in the development of RA aAbs in FDRs of RA probands, perhaps through affecting lifelong vitamin D status. The GRS and the SEC23A SNP may be of interest for future investigation in pre-clinical RA. In contrast, these results do not support a similar association in SLE FDRs, suggesting other mechanisms involved in the relationship between vitamin D and SLE aAbs not assessed in this study.
Collapse
Affiliation(s)
- Lauren A Vanderlinden
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth A Bemis
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Seifert
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joel M Guthridge
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Kendra A Young
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mary Kristen Demoruelle
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie Feser
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Wade DeJager
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Susan Macwana
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - James R O'Dell
- Division of Rheumatology and Immunology, University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jane Buckner
- Center for Translational Immunology, Benaroya Research Institute (BRI) at Virginia Mason, Seattle, WA, United States
| | - Richard M Keating
- Division of Rheumatology, Scripps Health, La Jolla, CA, United States
| | - Patrick M Gaffney
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Jennifer A Kelly
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States.,Center for Precision Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Kevin D Deane
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Judith A James
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Vernon Michael Holers
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jill M Norris
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
30
|
Munroe ME, Young KA, Guthridge JM, Kamen DL, Gilkeson GS, Weisman MH, Ishimori ML, Wallace DJ, Karp DR, Harley JB, Norris JM, James JA. Pre-Clinical Autoimmunity in Lupus Relatives: Self-Reported Questionnaires and Immune Dysregulation Distinguish Relatives Who Develop Incomplete or Classified Lupus From Clinically Unaffected Relatives and Unaffected, Unrelated Individuals. Front Immunol 2022; 13:866181. [PMID: 35720322 PMCID: PMC9203691 DOI: 10.3389/fimmu.2022.866181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is propelled by pathogenic autoantibody (AutoAb) and immune pathway dysregulation. Identifying populations at risk of reaching classified SLE is essential to curtail inflammatory damage. Lupus blood relatives (Rel) have an increased risk of developing SLE. We tested factors to identify Rel at risk of developing incomplete lupus (ILE) or classified SLE vs. clinically unaffected Rel and healthy controls (HC), drawing from two unique, well characterized lupus cohorts, the lupus autoimmunity in relatives (LAUREL) follow-up cohort, consisting of Rel meeting <4 ACR criteria at baseline, and the Lupus Family Registry and Repository (LFRR), made up of SLE patients, lupus Rel, and HC. Medical record review determined ACR SLE classification criteria; study participants completed the SLE portion of the connective tissue disease questionnaire (SLE-CSQ), type 2 symptom questions, and provided samples for assessment of serum SLE-associated AutoAb specificities and 52 plasma immune mediators. Elevated SLE-CSQ scores were associated with type 2 symptoms, ACR scores, and serology in both cohorts. Fatigue at BL was associated with transition to classified SLE in the LAUREL cohort (p≤0.01). Increased levels of BLyS and decreased levels of IL-10 were associated with type 2 symptoms (p<0.05). SLE-CSQ scores, ACR scores, and accumulated AutoAb specificities correlated with levels of multiple inflammatory immune mediators (p<0.05), including BLyS, IL-2Rα, stem cell factor (SCF), soluble TNF receptors, and Th-1 type mediators and chemokines. Transition to SLE was associated with increased levels of SCF (p<0.05). ILE Rel also had increased levels of TNF-α and IFN-γ, offset by increased levels of regulatory IL-10 and TGF-β (p<0.05). Clinically unaffected Rel (vs. HC) had higher SLE-CSQ scores (p<0.001), increased serology (p<0.05), and increased inflammatory mediator levels, offset by increased IL-10 and TGF-β (p<0.01). These findings suggest that Rel at highest risk of transitioning to classified SLE have increased inflammation coupled with decreased regulatory mediators. In contrast, clinically unaffected Rel and Rel with ILE demonstrate increased inflammation offset with increased immune regulation, intimating a window of opportunity for early intervention and enrollment in prevention trials.
Collapse
Affiliation(s)
- Melissa E. Munroe
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- *Correspondence: Melissa E. Munroe,
| | - Kendra A. Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Joel M. Guthridge
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Diane L. Kamen
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC, United States
| | - Gary S. Gilkeson
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC, United States
| | - Michael H. Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mariko L. Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel J. Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David R. Karp
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - John B. Harley
- US Department of Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Judith A. James
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
31
|
Falloon K, Cohen B, Ananthakrishnan AN, Barnes EL, Bhattacharya A, Colombel JF, Cross RK, Driscoll MS, Fernandez AP, Ha C, Herfarth H, Horst S, Hou J, Husni ME, Kroshinsky D, Kuhn KA, Lowder CY, Martin G, Parikh D, Sayed CJ, Schocket L, Siaton BC, Vedak P, Weisman MH, Rieder F. A United States expert consensus to standardise definitions, follow-up, and treatment targets for extra-intestinal manifestations in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55:1179-1191. [PMID: 35277863 PMCID: PMC10022869 DOI: 10.1111/apt.16853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS Extra-intestinal manifestations (EIMs) are a common complication of inflammatory bowel diseases (IBD), affecting up to half of the patients. Despite their high prevalence, information on standardised definitions, diagnostic strategies, and treatment targets is limited. METHODS As a starting point for a national EIM study network, an interdisciplinary expert panel of 12 gastroenterologists, 4 rheumatologists, 3 ophthalmologists, 6 dermatologists, and 4 patient representatives was assembled. Modified Delphi consensus methodology was used. Fifty-four candidate items were derived from the literature review and expert opinion focusing on five major EIMs (erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis) were rated in three voting rounds. RESULTS For use in a clinical practice setting and as part of the creation of a prospective registry of patients with EIMs, the panel developed definitions for erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis; identified the appropriate and optimal subspecialists to diagnose and manage each; provided methods to monitor disease course; offered guidance regarding monitoring intervals; and defined resolution and recurrence. CONCLUSIONS Consensus criteria for appropriate and optimal means of diagnosing and monitoring five EIMs have been developed as a starting point to inform clinical practice and future trial design. Key findings include straightforward diagnostic criteria, guidance regarding who can appropriately and optimally diagnose each, and monitoring options that include patient and physician-reported outcomes. These findings will be used in a national multicenter study network to optimise the management of EIMs.
Collapse
Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Edward L. Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Raymond K. Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Christina Ha
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hou
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center & Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - M. Elaine Husni
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristine A. Kuhn
- Department of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Careen Y. Lowder
- Cleveland Clinic Foundation Cole Eye Institute, Cleveland, OH, USA
| | - George Martin
- Dr. George Martin Dermatology Associates, Kihei, HI, USA
| | - Deep Parikh
- Department of Ophthalmology New York Eye and Ear Infirmary of Mount Sinai, Department of Ophthalmology, New York University Langone Health, New York, NY, USA
| | | | - Lisa Schocket
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Bernadette C. Siaton
- Division of Rheumatology and Clinical Immunology, University of Maryland, Baltimore, MD, USA
| | - Priyanka Vedak
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael H. Weisman
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Florian Rieder
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
32
|
Weisman MH. Rheumatology Pearls for the Primary Care Physician. Rheum Dis Clin North Am 2022; 48:xi. [PMID: 35400380 DOI: 10.1016/j.rdc.2022.03.003] [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] [Indexed: 10/18/2022]
|
33
|
Hwang MC, Rozycki M, Kauffman D, Arndt T, Yi E, Weisman MH. Does Gender Impact a Diagnosis of Ankylosing Spondylitis? ACR Open Rheumatol 2022; 4:540-546. [PMID: 35352497 PMCID: PMC9190217 DOI: 10.1002/acr2.11428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The study objective was to explore differences in ankylosing spondylitis (AS) diagnosis experiences between men and women by examining the coding of health events over the 2 years preceding AS diagnosis. Methods Claims data (January 2006–April 2019) from the MarketScan databases were examined. Patients who had received two or more AS diagnoses at least 30 days apart and had at least 2 years of insurance enrollment before their first AS diagnosis were analyzed. Men were matched 1:1 to women by age, diagnosis date, insurance type, and enrollment duration. Health events (diagnosis and provider codes) were examined over 2 years before AS diagnosis and stratified by gender. Data were analyzed using univariate χ2 tests. Results Among 7744 patients, 274 of 1906 AS‐related codes showed statistically significant differences between men and women. Women received more diagnosis codes than men across diagnoses and providers; the largest difference in diagnosis codes among women versus men was in peripheral symptom coding (57.7% vs. 43.9%, respectively). More women than men received diagnosis codes for depression (21.2% vs. 9.8%) and other musculoskeletal symptoms (52.8% vs. 40.0%); only gout was more common in men (6.5%) than in women (2.2%). Among men, backache codes gradually increased 12 months before AS diagnosis, whereas axial and sacroiliitis coding increased sharply immediately before diagnosis. The greatest difference in physician types visited was for rheumatologists: 64.2% of women had visits compared with 45.1% of men. Conclusion Further investigation into the dissimilarities in diagnostic experiences between men and women is needed to determine whether differences are due to disease phenotype or potential cognitive bias influencing diagnostic decision‐making.
Collapse
Affiliation(s)
- Mark C Hwang
- McGovern Medical School at The University of Texas Health Science Center, Houston
| | | | | | | | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | |
Collapse
|
34
|
Rianon NJ, Lee M, des Bordes JK, Rahbar MH, Weisman MH, Reveille JD. Chronic inflammatory back pain commencing late in life: a neglected concept. Intern Med J 2022; 52:485-487. [DOI: 10.1111/imj.15711] [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: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Nahid J. Rianon
- Department of Family and Community Medicine The University of Texas McGovern Medical School Houston Texas USA
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences University of Texas Southwestern Medical Center Dallas Texas USA
| | - Jude K. des Bordes
- Department of Family and Community Medicine The University of Texas McGovern Medical School Houston Texas USA
| | - Mohammad H. Rahbar
- Biostatistics/Epidemiology/Research Design (BERD) Core Center for Clinical and Translational Sciences, The University of Texas Health Science Center at Houston Dallas Texas USA
| | - Michael H. Weisman
- Division of Rheumatology Cedars Sinai Medical Center Los Angeles California USA
| | - John D. Reveille
- Division of Rheumatology, Department of Internal Medicine McGovern Medical School, The University of Texas Health Science Center at Houston Houston Texas USA
| |
Collapse
|
35
|
Schwartzman M, Ermann J, Kuhn KA, Schwartzman S, Weisman MH. Spondyloarthritis in inflammatory bowel disease cohorts: systematic literature review and critical appraisal of study designs. RMD Open 2022; 8:rmdopen-2021-001777. [PMID: 35046098 PMCID: PMC8772455 DOI: 10.1136/rmdopen-2021-001777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022] Open
Abstract
To critically appraise study designs evaluating spondyloarthritis (SpA) phenotypes in patients with inflammatory bowel disease (IBD). A systematic literature review of PubMed, Ovid, Scopus, Cinahl, Medline, Web of Science, and Cochrane databases was performed. Articles published from January 2000 - March 2020 were included if they evaluated the prevalence/incidence of musculoskeletal disease in cohorts of IBD patients. Most of the 69 included studies were clinic based (54/69, 78%), single center (47/69, 68%) and cross-sectional (60/69, 87%). The median prevalence of axial and peripheral SpA in IBD was 5% (range 1 - 46%) and 16% (range 1 - 43%), respectively. In 38 studies that evaluated axial disease in prospectively enrolled patients, inflammatory back pain was analyzed in 53%. SpA classification criteria were used in 68% and imaging was performed in 76%. In 35 studies that evaluated peripheral disease in prospectively enrolled patients, SpA classification criteria were used in 46%. A physical exam was performed in 74%, and it was performed by a rheumatologist in 54% of studies with a physical exam. Sub-phenotypes of peripheral SpA (mono- or oligo-arthritis, polyarthritis, enthesitis, dactylitis) were variably reported. Seventy-four percent of studies did not mention whether osteoarthritis and fibromyalgia had been assessed or excluded. The spectrum of SpA phenotypes in IBD patients remains incompletely characterized. Future studies should focus on standardizing the variables collected in IBD-SpA cohorts and defining musculoskeletal phenotypes in IBD-SpA in order to better characterize this disease entity and advance the field for clinical and research purposes.
Collapse
Affiliation(s)
- Monica Schwartzman
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine A Kuhn
- Department of Medicine, Division of Rheumatology, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sergio Schwartzman
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Michael H Weisman
- Department of Rheumatology and Immunology, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
36
|
Kong W, Jefferies C, Learch TJ, Gan X, Zhu F, Zhang N, Jin D, Zhang Y, Tao Q, Yan X, Ishimori ML, Weisman MH. Risk Factors for Spinal Structural Damage in a Chinese Cohort With Ankylosing Spondylitis. J Clin Rheumatol 2022; 28:e118-e124. [PMID: 33394829 DOI: 10.1097/rhu.0000000000001658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A cross-sectional study was conducted in 270 Chinese patients with ankylosing spondylitis (AS) in order to identify potential risk factors for severity of spinal structural damage. METHODS Two hundred seventy AS patients fulfilled the Modified New York Criteria. Computed tomography (CT) was used to scan sacroiliac and hip joints, and radiography was used to scan anteroposterior and lateral lumbar spine, as well as lateral cervical spine. Bath Ankylosing Spondylitis Radiology Index and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) were scored in duplicate. RESULTS One hundred eighty-three patients had low mSASSS (mSASSS, <10), and 87 patients had high mSASSS (mSASSS, ≥10). Univariate analysis revealed that AS age of onset, body mass index (BMI), smoking duration, duration of symptoms, diagnostic delay, hip involvement, and sacroiliitis grade were significantly associated with the risk of having high mSASSS after adjustment (all p's < 0.05). Hip involvement interacted significantly with BMI and smoking duration in a graded manner. Particularly, relative to patients with low BMI-negative hip involvement, those with high BMI-negative hip involvement, low BMI-positive hip involvement, and high BMI-positive hip involvement had a 1.94-fold, 3.29-fold, and 5.07-fold increased risk of high mSASSS (95% confidence interval, 0.84-4.47, 1.37-7.89, and 1.97-13.06, p = 0.118, 0.008, and 0.001, respectively). Finally, a nomogram graph based on 7 significant risk factors was generated with substantial prediction accuracy (concordance index, 0.906). CONCLUSIONS We have identified 7 potential risk factors for the severity of spinal structural damage in Chinese AS patients. Importantly, positive hip involvement, combined with high BMI or long smoking duration, was associated with a remarkably increased risk of having severe spinal structural damage.
Collapse
Affiliation(s)
| | | | - Thomas J Learch
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Xiaowei Gan
- Department of Traditional Chinese Medicine Rheumatology, Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Feng Zhu
- Neuroanatomical Department, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nan Zhang
- From the Department of Traditional Chinese Medicine Rheumatology
| | - Dier Jin
- From the Department of Traditional Chinese Medicine Rheumatology
| | - Yingze Zhang
- From the Department of Traditional Chinese Medicine Rheumatology
| | | | | | | | | |
Collapse
|
37
|
Abstract
"Lifestyle Factors and Disease Activity Over Time in Early Axial Spondyloarthritis: The SPondyloArthritis Caught Early (SPACE) Cohort" by Exarchou et al aimed at looking at the importance of baseline lifestyle factors of BMI, smoking, and alcohol consumption (AC) on disease activity in recent-onset axial spondyloarthritis (axSpA).1 Does this study add to our knowledge of the natural history of axSpA?
Collapse
Affiliation(s)
- Mark Hwang
- M. Hwang, MD, MS, Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas; M.H. Weisman, MD, Stanford University School of Medicine, Stanford, California, USA. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M.H. Weisman, Cedars-Sinai Medical Center, 8700 Beverly Bl, #B-131, Los Angeles, CA 90048, USA.
| | - Michael H Weisman
- M. Hwang, MD, MS, Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas; M.H. Weisman, MD, Stanford University School of Medicine, Stanford, California, USA. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M.H. Weisman, Cedars-Sinai Medical Center, 8700 Beverly Bl, #B-131, Los Angeles, CA 90048, USA.
| |
Collapse
|
38
|
Rosenbaum JT, Weisman MH, Hamilton H, Shafer C, Aslanyan E, Howard RA, Ogle K, Reveille JD, Winthrop KL, Choi D. The Interplay Between COVID-19 and Spondyloarthritis or Its Treatment. J Rheumatol 2021; 49:225-229. [PMID: 34599048 DOI: 10.3899/jrheum.210742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has created multiple uncertainties regarding rheumatic diseases or their treatment, with regard to the susceptibility to or severity of the viral disease. We aimed to address these questions as they relate to spondyloarthritis (SpA). METHODS We created a longitudinal survey from April 10, 2020, to April 26, 2021. There were 4723 subjects with SpA and 450 household contacts who participated worldwide. Of these, 3064 respondents were from the US and 70.4% of them provided longitudinal data. To control for the duration of potential risk of COVID-19, the rate of contracting the disease was normalized for person-months of exposure. RESULTS In an analysis of US subjects who provided longitudinal data, the incident rate ratio for the 159 (out of 2157) subjects who tested positive for COVID-19 was 1.16 compared to the US population as adjusted for age and sex (range 0.997-1.361, P = 0.06). A paired evaluation using patients and household members did not show a statistically significant effect to indicate a predisposition for developing COVID-19 as a result of SpA or its treatment. Our data failed to show that any class of medication commonly used to treat SpA significantly affected the risk of developing COVID-19 or increasing the severity of COVID-19. CONCLUSION These data do not exclude a small increased risk of developing COVID-19 as a result of SpA, but the risk, if it exists, is low and not consistently demonstrated. The data should provide reassurance to patients and to rheumatologists about the risk that COVID-19 poses to patients with SpA.
Collapse
Affiliation(s)
- James T Rosenbaum
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Michael H Weisman
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Hedley Hamilton
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Cassie Shafer
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Elin Aslanyan
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Richard A Howard
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Kimberly Ogle
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - John D Reveille
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Kevin L Winthrop
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Dongseok Choi
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| |
Collapse
|
39
|
Hughes-Austin JM, Ix JH, Ward SR, Weisman MH, ODell JR, Mikuls TR, Buckner JH, Gregersen PK, Keating RM, Demoruelle MK, Deane KD, Holers VM, Norris JM. Evaluating associations of joint swelling, joint stiffness and joint pain with physical activity in first-degree relatives of patients with rheumatoid arthritis: Studies of the Aetiology of Rheumatoid Arthritis (SERA), a prospective cohort study. BMJ Open 2021; 11:e050883. [PMID: 34521672 PMCID: PMC8442039 DOI: 10.1136/bmjopen-2021-050883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Physical activity (PA) in preclinical rheumatoid arthritis (RA) is associated with lower RA risk and disease severity. As joint signs and symptoms of inflammatory arthritis serve as a barrier to PA in RA, it is important to consider whether they affect PA in the time prior to RA. Therefore, we investigated whether joint swelling, stiffness or pain were associated with PA in first-degree relatives (FDRs) of patients with RA, a population at higher risk for future RA. DESIGN Prospective study design. SETTING We recruited FDRs of patients with RA from academic centres, Veterans' hospitals and rheumatology clinics or through responses to advertising from six sites across the USA. PARTICIPANTS We evaluated associations of joint stiffness, joint swelling and joint pain with PA time in 268 FDRs with ≥2 visits over an average 1.2 years. Clinicians confirmed joint swelling. Participants self-reported joint stiffness and/or pain. PRIMARY OUTCOME MEASURES PA during a typical 24-hour day was quantified via questionnaire, weighted to reflect metabolic expenditure, where 24 hours was the minimum PA time. Linear mixed models evaluated associations between symptoms and change in PA over time, adjusting for age, sex, race, body mass index, smoking and RA-related autoantibodies. RESULTS Average weighted PA time was 37±7 hours. In the cross-sectional analysis, PA time was 1.3±0.9 hours higher in FDRs reporting joint pain (p=0.15); and 0.8±1.6 and 0.4±1 hours lower in FDRs with joint swelling (p=0.60) and stiffness (p=0.69), respectively. Longitudinally, adjusting for baseline PA time, baseline symptoms were not significantly associated with changes in PA time. However, on average over time, joint stiffness and pain were associated with lower PA time (pinteraction=0.0002, pinteraction=0.002), and joint swelling was associated with higher PA time (pinteraction <0.0001). CONCLUSION Baseline symptoms did not predict future PA time, but on average over time, joint symptoms influenced PA time.
Collapse
Affiliation(s)
- Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
| | - Joachim H Ix
- Department of Medicine, Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Michael H Weisman
- School of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James R ODell
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ted R Mikuls
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane H Buckner
- Translational Research Institute, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter K Gregersen
- Roberts S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Richard M Keating
- Division of Rheumatology, Scripps Green Hospital, La Jolla, California, USA
| | - M Kristen Demoruelle
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin D Deane
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - V Michael Holers
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
40
|
Hwang MC, Lee M, Gensler LS, Brown MA, Tahanan A, Rahbar MH, Hunter T, Shan M, Ishimori ML, Reveille JD, Weisman MH, Learch TJ. Identifying Trajectories of Radiographic Spinal Disease in Ankylosing Spondylitis: A 15-year follow up study of the PSOAS Cohort. Rheumatology (Oxford) 2021; 61:2079-2087. [PMID: 34427579 DOI: 10.1093/rheumatology/keab661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/17/2021] [Accepted: 08/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Little is known with certainty about the natural history of spinal disease progression in Ankylosing Spondylitis (AS). Our objective was to discover if there were distinct patterns of change in vertebral involvement over time and to study associated clinical factors. METHODS Data were analyzed from the Prospective Study of Outcomes in Ankylosing Spondylitis (PSOAS) observational cohort. All patients met modified New York Criteria for AS and had ≥2 sets of radiographs scored by modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) by two independent readers between 2002-2017. Group-based trajectory modeling (GBTM) was used to classify patients into distinct groups of longitudinal mSASSS considering sociodemographic and clinical covariables. The optimal trajectory model and number of trajectories was selected using Nagin's Bayesian information criterion (BIC). RESULTS A total of 561 patients with 1618 radiographs was analyzed. The optimum number of trajectory groups identified was four (BIC -4062). These groups were subsequently categorized as: non-progressors (204 patients), late-progressors (147 patients), early-progressors (107 patients) and rapid-progressors (103 patients). Baseline predictors associated with higher spinal disease burden groups included: baseline mSASSS, male gender, longer disease duration, elevated C-reactive protein and smoking history. In addition, time-varying anti-TNF use per year was associated with decreased mSASSS progression only in the rapid-progressor group. CONCLUSIONS GBTM identified 4 distinct patterns of spinal disease progression in the PSOAS cohort. Male gender, longer disease duration, elevated C-reactive protein and smoking were associated with higher spinal disease groups. Independent confirmation in other AS cohorts is needed to confirm these radiographic patterns.
Collapse
Affiliation(s)
- Mark C Hwang
- Department of Internal Medicine-Division of Rheumatology, John P. and Katherine G. McGovern School of Medicine at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - MinJae Lee
- Department of Population & Data Sciences-Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine-Division of Clinical and Translational Sciences, John P. and Katherine G. McGovern School of Medicine at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lianne S Gensler
- Department of Medicine-Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Matthew A Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Queensland, Australia.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Amirali Tahanan
- Department of Internal Medicine-Division of Clinical and Translational Sciences, John P. and Katherine G. McGovern School of Medicine at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mohammad H Rahbar
- Department of Internal Medicine-Division of Clinical and Translational Sciences, John P. and Katherine G. McGovern School of Medicine at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | - Mariko L Ishimori
- Department of Medicine-Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John D Reveille
- Department of Internal Medicine-Division of Rheumatology, John P. and Katherine G. McGovern School of Medicine at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael H Weisman
- Department of Medicine-Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas J Learch
- Department of Medicine-Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | |
Collapse
|
41
|
Deonaraine KK, Carlucci PM, Fava A, Li J, Wofsy D, James JA, Putterman C, Diamond B, Davidson A, Fine DM, Monroy-Trujillo J, Atta MG, Haag K, Rao DA, Apruzzese W, Belmont HM, Izmirly PM, Wu M, Connery S, Payan-Schober F, Furie RA, Berthier CC, Dall'Era M, Cho K, Kamen DL, Kalunian K, Anolik J, Ishimori M, Weisman MH, Petri MA, Buyon JP. Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network. Lupus Sci Med 2021; 8:8/1/e000522. [PMID: 34389634 PMCID: PMC8354250 DOI: 10.1136/lupus-2021-000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022]
Abstract
Objectives In lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis. Methods 475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines. Results 34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved. Conclusions Procurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.
Collapse
Affiliation(s)
- Kristina K Deonaraine
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Philip M Carlucci
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrea Fava
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - David Wofsy
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Chaim Putterman
- Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Betty Diamond
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Anne Davidson
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Derek M Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mohamed G Atta
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Haag
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ming Wu
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean Connery
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Fernanda Payan-Schober
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard A Furie
- Division of Rheumatology, Northwell Health, Great Neck, NY, USA
| | - Celine C Berthier
- Internal Medicine, Department of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Maria Dall'Era
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Kerry Cho
- Nephrology Division, University of California San Francisco, San Francisco, CA, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jennifer Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mariko Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
42
|
Affiliation(s)
- Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
| |
Collapse
|
43
|
Affiliation(s)
- Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine at University of California, Los Angeles, 1545 Calmar Court, Los Angeles, CA 90024, USA.
| |
Collapse
|
44
|
Hwang MC, Lee M, Gensler LS, Ward MM, Brown MA, Learch TJ, Tahanan A, Rahbar MH, Ishimori M, Weisman MH, Reveille JD. Repeated Spinal Mobility Measures and Their Association With Radiographic Damage in Ankylosing Spondylitis. ACR Open Rheumatol 2021; 3:413-421. [PMID: 34042330 PMCID: PMC8207687 DOI: 10.1002/acr2.11261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/09/2022] Open
Abstract
Objective We sought to explore the relationship between changes in repeated mobility measures and spinal structural progression in patients with ankylosing spondylitis (AS) over time. Methods We studied patients with AS from the PSOAS (Prospective Study of Outcomes in AS) cohort and performed longitudinal multivariable regression modeling to assess the relationship of structural damage measured by their regional (cervical or lumbar) modified Stoke AS Spinal Score(mSASSS) and selected cervical (eg, cervical rotation, lateral bending, and occiput‐to‐wall distance) and lumbar spinal mobility measures (eg, Schöber’s test and lumbar lateral bending) that were collected at least every 2 years from 2003 to 2019. Results The median length of follow‐up for our 518 patients with cervical mSASSS measurements and 573 with lumbar mSASSS measurements was 4.08 (interquartile range [IQR] 2.25‐6.67) and 4.17 (IQR 2.25‐6.67) years, respectively. Among the mobility measures, based on multivariable regression models adjusting for clinical/demographic variables and C‐reactive protein, we did not observe meaningful associations between changes in spinal mobility with their respective regional mSASSS. Baseline mSASSS, male sex, increased C‐reactive protein (CRP), and longer disease duration were associated with increased longitudinal mSASSS in all analyses. Conclusion Our study shows that 2‐year changes in individual spinal mobility measures are not reliably associated with increased, longitudinal, AS‐related spinal structural progression. We also confirmed the relationship of baseline mSASSS, sex, CRP, and disease duration with AS‐related structural spinal progression over time.
Collapse
Affiliation(s)
- Mark C Hwang
- John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center, Houston
| | - MinJae Lee
- John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center, Houston
| | | | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Matthew A Brown
- National Institute for Health Research Biomedical Research Centre, Guy's and St, Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom
| | | | - Amirali Tahanan
- John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center, Houston
| | - Mohammad H Rahbar
- John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center, Houston
| | | | | | - John D Reveille
- John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center, Houston
| | | |
Collapse
|
45
|
Rosenbaum JT, Weisman MH, Shafer C, Aslanyan E, Howard RA, Ogle K, Hamilton H, Reveille JD, Winthrop KL, Choi D. Correspondence on 'Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry'. Ann Rheum Dis 2021; 82:e138. [PMID: 33985940 DOI: 10.1136/annrheumdis-2021-220588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- James Todd Rosenbaum
- Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA .,Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Michael H Weisman
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Cassie Shafer
- Spondylitis Association of America, Van Nuys, California, USA
| | - Elin Aslanyan
- Spondylitis Association of America, Van Nuys, California, USA
| | | | - Kimberly Ogle
- Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Kevin L Winthrop
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Dongseok Choi
- Public Health, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
46
|
Son JJ, Ishimori M, Mirocha J, Weisman MH, Forbess LJ. Low levels of anti-cyclic citrullinated peptide (CCP) 3.1 associated with diseases other than rheumatoid arthritis. Medicine (Baltimore) 2021; 100:e25558. [PMID: 33879708 PMCID: PMC8078438 DOI: 10.1097/md.0000000000025558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/29/2021] [Indexed: 01/04/2023] Open
Abstract
Our aim was to investigate the newest generation anti-cyclic citrullinated peptide (CCP) antibody 3.1 assay in diagnosing rheumatoid arthritis (RA) compared with other autoimmune and non-autoimmune diseases. We performed a retrospective observational chart review of patients with a positive CCP level over a one-year period at a single academic institution and assessed the associated diagnoses after at least six-months of follow-up. Of the 281 CCP positive patients during that period, 48% had a diagnosis of RA. The positive predictive value of RA in patients with a high CCP 3.1 assay was 0.619 compared to 0.248 with a low positive CCP 3.1 assay (P < .0001). Overall, there was a lower than expected positive predictive value of CCP 3.1 level with an RA diagnosis, though the likelihood of having an RA diagnosis was higher with a higher CCP level.
Collapse
Affiliation(s)
| | - Mariko Ishimori
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
| | - James Mirocha
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
| | | | - Lindsy J. Forbess
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
| |
Collapse
|
47
|
Li Z, Wu X, Leo PJ, De Guzman E, Akkoc N, Breban M, Macfarlane GJ, Mahmoudi M, Marzo-Ortega H, Anderson LK, Wheeler L, Chou CT, Harrison AA, Stebbings S, Jones GT, Bang SY, Wang G, Jamshidi A, Farhadi E, Song J, Lin L, Li M, Wei JCC, Martin NG, Wright MJ, Lee M, Wang Y, Zhan J, Zhang JS, Wang X, Jin ZB, Weisman MH, Gensler LS, Ward MM, Rahbar MH, Diekman L, Kim TH, Reveille JD, Wordsworth BP, Xu H, Brown MA. Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitis. Ann Rheum Dis 2021; 80:1168-1174. [PMID: 34161253 PMCID: PMC8364478 DOI: 10.1136/annrheumdis-2020-219446] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 11/04/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022]
Abstract
Objective We sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain. Methods PRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI. Results In people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924. This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively. Conclusions PRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied.
Collapse
Affiliation(s)
- Zhixiu Li
- Queensland University of Technology, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Paul J Leo
- Queensland University of Technology, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Erika De Guzman
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Nurullah Akkoc
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Maxime Breban
- UMR 1173, Inserm, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France.,Service de Rhumatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.,Laboratoire d'Excellence Inflamex, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lisa K Anderson
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Lawrie Wheeler
- Australian Translational Genomics Centre, Queensland University of Technology (QUT), Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Andrew A Harrison
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gareth T Jones
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - So-Young Bang
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea (the Republic of)
| | - Geng Wang
- University of Queensland Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Elham Farhadi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Jing Song
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - Mengmeng Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - MinJae Lee
- Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yuqin Wang
- State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Zhan
- Institute for Glycomics, Griffith University, Nathan, Queensland, Australia
| | - Jin-San Zhang
- Center for Precision Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Institute of Life Sciences, Wenzhou University, Wenzhou, Zhejiang, China
| | - Xiaobing Wang
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, Beijing, China
| | - Michael H Weisman
- Department of Medicine/Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lianne S Gensler
- Division of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammad Hossein Rahbar
- Internal Medicine, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Laura Diekman
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA
| | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea (the Republic of)
| | - John D Reveille
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas, USA
| | - Bryan Paul Wordsworth
- NIHR Oxford Musculoskeletal Biomedical Research Unit, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, Shanghai, China .,School of Clinical Medicine, Tsinghua University, Beijing, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
| | - Matthew A Brown
- Center for Precision Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China .,NIHR Biomedical Research Centre at Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
| | | |
Collapse
|
48
|
Ashrafi M, Kuhn KA, Weisman MH. The arthritis connection to inflammatory bowel disease (IBD): why has it taken so long to understand it? RMD Open 2021; 7:e001558. [PMID: 33863841 PMCID: PMC8055104 DOI: 10.1136/rmdopen-2020-001558] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) associated arthritis is a subgroup of spondyloarthritis (SpA) that has suffered from lack of recognition in rheumatology clinical and research circles for over 100 years. Although clinically distinguishable from rheumatoid arthritis and ankylosing spondylitis, it took advances in detection systems in the middle of the last century (rheumatoid factor, HLA-B27) to convincingly make the final separations. We now know that significant numbers of patients with SpA have associated clinical IBD and almost half of them show subclinical gut inflammation, yet the connection between the gut and the musculoskeletal system has remained a vexing problem. Two publications from Nathan Zvaifler (one in 1960, the other in 1975) presciently described the relationship between the gut and the spine/peripheral joints heralding much of the work present today in laboratories around the world trying to examine basic mechanisms for the connections (there are likely to be many) between the gut, the environment (presumably our intestinal flora) and the downstream effect on the musculoskeletal system. The role of dysregulated microbiome along with microbiome-driven T helper 17 cell expansion and immune cell migration to the joints has been recognised, all of which occur in the appropriate context of genetic background inside and outside of the human leucocyte antigen system. Moreover, different adhesion molecules that mediate immune cells homing to the gut and joints have been noted. In this review, we studied the origins and evolution of IBD-arthritis, proposed pathogenic mechanisms and the current gaps that need to be filled for a complete understanding of IBD-arthritis.
Collapse
Affiliation(s)
- Maedeh Ashrafi
- Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Kristine A Kuhn
- Internal Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael H Weisman
- Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
49
|
Chaichian Y, Weisman MH, Simard JF. Pulse dose steroid experience among hospitalized patients with systemic lupus erythematosus: a single-center feasibility study. Clin Rheumatol 2021; 40:1317-1320. [PMID: 33608793 DOI: 10.1007/s10067-021-05644-4] [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: 09/13/2020] [Revised: 01/16/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION/OBJECTIVES Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. METHOD Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. RESULTS Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations. CONCLUSIONS Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis. Key Points • Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes. • Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients. • Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis.
Collapse
Affiliation(s)
- Yashaar Chaichian
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA.
| | - Michael H Weisman
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Julia F Simard
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA.,Department of Epidemiology & Population Health, Stanford University, CA, Palo Alto, USA
| |
Collapse
|
50
|
Bemis EA, Demoruelle MK, Seifert JA, Polinski KJ, Weisman MH, Buckner JH, Gregersen PK, Mikuls TR, ODell JR, Keating RM, Deane KD, Holers VM, Norris JM. Factors associated with progression to inflammatory arthritis in first-degree relatives of individuals with RA following autoantibody positive screening in a non-clinical setting. Ann Rheum Dis 2021; 80:154-161. [PMID: 32928740 PMCID: PMC7855648 DOI: 10.1136/annrheumdis-2020-217066] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Little is known about the likelihood of developing inflammatory arthritis (IA) in individuals who screen autoantibody positive (aAb+) in a non-clinical research setting. METHODS We screened for serum cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor isotype aAbs in subjects who were at increased risk for rheumatoid arthritis (RA) because they are a first-degree relative of an individual with classified RA (n=1780). We evaluated combinations of aAbs and high titre aAbs, as defined by 2-times (2 x) the standard cut-off and an optimal cut-off, as predictors of our two outcomes, aAb+ persistence and incident IA. RESULTS 304 subjects (17.1%) tested aAb+; of those, 131 were IA-free and had at least one follow-up visit. Sixty-four per cent of these tested aAb+ again on their next visit. Anti-CCP+ at levels ≥2 x the standard cut-off was associated with 13-fold higher likelihood of aAb +persistence. During a median of 4.4 years (IQR: 2.2-7.2), 20 subjects (15.3%) developed IA. Among subjects that screened anti-CCP+ at ≥ 2 x or ≥an optimal cut-off, 32% and 26% had developed IA within 5 years, respectively. Both anti-CCP cut-offs conferred an approximate fourfold increased risk of future IA (HR 4.09 and HR 3.95, p<0.01). CONCLUSIONS These findings support that aAb screening in a non-clinical setting can identify RA-related aAb+ individuals, as well as levels and combinations of aAbs that are associated with higher risk for future IA. Monitoring for the development of IA in aAb+ individuals and similar aAb testing approaches in at-risk populations may identify candidates for prevention studies in RA.
Collapse
Affiliation(s)
- Elizabeth A Bemis
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jennifer A Seifert
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane H Buckner
- Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York, USA
| | - Ted R Mikuls
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Division of Rheumatology, Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - James R ODell
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Division of Rheumatology, Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Richard M Keating
- Division of Rheumatology, Scripps Clinic/Scripps Green Hospital, San Diego, California, USA
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| |
Collapse
|