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Ward NKZ, Pal S, Ruddy K, Savvas S. Attitudes and beliefs towards COVID-19 and COVID-19 vaccination among rheumatology patients in a Los Angeles County safety net clinic. BMC Rheumatol 2023; 7:13. [PMID: 37259135 DOI: 10.1186/s41927-023-00338-7] [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: 05/05/2022] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The novel Coronavirus disease (COVID-19) pandemic has represented an evolving global threat with high morbidity and mortality. Patients with autoimmune rheumatic diseases and on immune-suppressing medications may be at increased risk to more severe disease, hospitalization, and death. Vaccines are essential to combat the COVID-19 pandemic and curb the spread of infection. Rheumatology patients may be more fearful to receive the vaccine compared to the general population. The Los Angeles County rheumatology patients are primarily Hispanic and represent a unique and possibly particularly vulnerable cohort warranting further exploration into barriers to receive the COVID-19 vaccine. We aimed to explore the willingness of COVID-19 vaccine acceptance among patients with rheumatic disease. METHODS We conducted a cross-sectional survey to assess the perceptions and barriers to COVID-19 vaccine acceptance in our Los Angeles County rheumatology clinics between July 2021 to September 2021 and received responses from 116 patients. RESULTS The majority of respondents were female (83.9%), 41-60 years of age (59.8%), Hispanic (89.2%), with high school or lower level of education (68.7%), and had Rheumatoid Arthritis (56.9%). We found most (88.4%) patients received at least one dose of the COVID-19 vaccine. We identified no differences in vaccine acceptance related to age, education, race, and ethnicity. Most respondents agreed that their health condition puts them at high risk of COVID-19 complications. In addition, individuals reported that they valued being engaged by their rheumatologists in discussions of the risk and benefits of the vaccine prior to receiving it. CONCLUSION We found that the majority of patients were already vaccinated or willing to be vaccinated, at higher levels than general United States population and that a conversation initiated by a rheumatologist can have positive effect on patients' health behaviors related to COVID-19.
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Affiliation(s)
- Nicole K Zagelbaum Ward
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Suman Pal
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA
| | - Katherine Ruddy
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Stavros Savvas
- Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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Rai B, Kobashigawa L, Amarnani A, Ward NKZ, Feldman C, Feldman B, Panush RS. Challenges of caring for homeless patients with inflammatory arthritis: 12-month follow-up observations and identification of certain barriers to care. Clin Rheumatol 2022; 41:1653-1657. [PMID: 35499771 PMCID: PMC9058743 DOI: 10.1007/s10067-022-06167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived "greatest need" included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived "greatest needs" went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.
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Affiliation(s)
- Baljeet Rai
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Laura Kobashigawa
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Abhimanyu Amarnani
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Nicole K Zagelbaum Ward
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Corinne Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brett Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard S Panush
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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Zagelbaum Ward NK, Jun JA, Vecerek N, Donaldson M, Quismorio FP. Dissecting cellulitis of the scalp associated with peripheral and axial spondyloarthritis: report of a case and review of the literature. Clin Rheumatol 2022; 41:2553-2560. [PMID: 35460009 DOI: 10.1007/s10067-022-06128-9] [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: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Dissecting cellulitis of the scalp (DCS) is a rare, primary neutrophilic cicatricial alopecia of unknown etiology. The disease follows a chronic, relapsing, and remitting course which may ultimately lead to scar formation and alopecia. The association of seronegative peripheral and/or axial spondyloarthritis in patients with hidradenitis suppurativa (HS) and acne conglobata (AC) is well established. However, the occurrence of spondyloarthropathy in patients with either isolated or combined DCS is relatively rare and therefore underrecognized by clinicians. We report a patient with DCS with inflammatory peripheral arthritis and asymptomatic radiographic sacroiliitis. Using PubMed, Ovid, and Google scholar, we searched for case reports of inflammatory arthritis in HS, AC, and DCS in the English literature from 1982 to present. We identified 12 patients with DCS who had associated spondyloarthropathy with adequate clinical details for a systematic analysis. We outline key clinical features, radiographic findings, and treatment utilized for these patients. Seronegative axial and peripheral spondyloarthritis may occur in the setting of isolated DCS as well with concomitant HS and AC. The inflammatory arthritis often develops during acute flares of the cutaneous disease. Choosing optimal drug therapy may be challenging. Current options include anti-TNF-α medications, which have been reported to be effective for both the cutaneous lesions and the associated spondyloarthritis. The complex pathophysiology of the conditions that comprise the follicular occlusion triad warrants further research into the potential role of additional biologic agents.
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Affiliation(s)
- Nicole K Zagelbaum Ward
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA. .,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Jenny Ann Jun
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Natalia Vecerek
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Marie Donaldson
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Francisco P Quismorio
- Division of Rheumatology, Department of Medicine, and Division of Dermatology, Keck School of Medicine, University of Southern California and Los Angeles County, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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Zagelbaum Ward NK, Linares-Koloffon C, Posligua A, Gandrabur L, Kim WY, Sperber K, Wasserman A, Ash J. Cardiac Manifestations of Systemic Lupus Erythematous: An Overview of the Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology and Treatment Options. Cardiol Rev 2022; 30:38-43. [PMID: 32991394 DOI: 10.1097/crd.0000000000000358] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex connective tissue disease that can potentially affect every organ of the human body. In some cases, SLE may present with diverse cardiac manifestations including pericarditis, myocarditis, valvular disease, atherosclerosis, thrombosis, and arrhythmias. Heart disease in SLE is associated with increased morbidity and mortality. It is unclear whether traditional treatments for coronary artery disease significantly impact mortality in this population. Current therapeutic agents for SLE include glucocorticoids, hydroxychloroquine, mycophenolate mofetil, azathioprine, methotrexate, cyclophosphamide, and B cell-directed therapies. This article will provide a comprehensive review and update on this important disease state.
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Affiliation(s)
- Nicole K Zagelbaum Ward
- From the Department of Rheumatology, Keck School of Medicine/University of Southern California, Los Angeles, CA
| | - Carlos Linares-Koloffon
- Yale Center for Asthma and Airway Disease, Yale University School of Medicine, New Haven, CT
| | - Alba Posligua
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Liliya Gandrabur
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Woo Young Kim
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Kirk Sperber
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Amy Wasserman
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Julia Ash
- Department of Medicine and Division of Rheumatology, Westchester Medical Center and New York Medical College, Valhalla, NY
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Solomon DH, Pincus T, Shadick NA, Stratton J, Ellrodt J, Santacroce L, Katz JN, Smolen JS, Chatpar PC, Stocks M, Mundell B, Downey C, Gebre MA, Torralba KD, White DW, Baudek MM, Szlembarski SJ, Barnhart SI, Bilal J, Lee D, Redford A, Buchfuhrer J, Kramer HR, Kwoh CK, Villatoro‐Villar M, Patnaik A, Guzman E, Trachtman RA, Tesser J, Music D, Mickey L, Amin M, Simpson J, Staniszewski K, Potter J, Sundhar J, Sheingold J, Schmukler J, Horowitz DL, Gulko HE, Kong‐Rosario M, Quinet RJ, Dhulipala S, Patel R, Keshavamurthy C, Bedoya GC, Dunn R, Kumar B, Lenert A, Zembrzuska H, Lenert P, Anandarajah AP, Yang AH, Grinnell‐Merrick L, Goldsmith S, Zelie J, Wise LM, Zagelbaum Ward NK, Kaine J. Implementing Treat to Target (TTT) for Rheumatoid Arthritis (RA) During COVID: Results of a Virtual Learning Collaborative (LC) Program. Arthritis Care Res (Hoboken) 2021; 74:572-578. [PMID: 35119779 PMCID: PMC9011823 DOI: 10.1002/acr.24830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022]
Abstract
Objective A treat‐to‐target (TTT) approach improves outcomes in rheumatoid arthritis (RA). In prior work, we found that a learning collaborative (LC) program improved implementation of TTT. We conducted a shorter virtual LC to assess the feasibility and effectiveness of this model for quality improvement and to assess TTT during virtual visits. Methods We tested a 6‐month virtual LC in ambulatory care. The LC was conducted during the 2020–2021 COVID‐19 pandemic when many patient visits were conducted virtually. All LC meetings used videoconferencing and a website to share data. The LC comprised a 6‐hour kickoff session and 6 monthly webinars. The LC discussed TTT in RA, its rationale, and rapid cycle improvement as a method for implementing TTT. Practices provided de‐identified patient visit data. Monthly webinars reinforced topics and demonstrated data on TTT adherence. This was measured as the percentage of TTT processes completed. We compared TTT adherence between in‐person visits versus virtual visits. Results Eighteen sites participated in the LC, representing 45 rheumatology clinicians. Sites inputted data on 1,826 patient visits, 78% of which were conducted in‐person and 22% of which were held in a virtual setting. Adherence with TTT improved from a mean of 51% at baseline to 84% at month 6 (P for trend < 0.001). Each aspect of TTT also improved. Adherence with TTT during virtual visits was lower (65%) than during in‐person visits (79%) (P < 0.0001). Conclusion Implementation of TTT for RA can be improved through a relatively low‐cost virtual LC. This improvement in TTT implementation was observed despite the COVID‐19 pandemic, but we did observe differences in TTT adherence between in‐person visits and virtual visits.
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Affiliation(s)
| | - Theodore Pincus
- Division of Rheumatology Rush University Medical Center Chicago IL
| | | | | | - Jack Ellrodt
- Division of Rheumatology Brigham and Women’s Hospital Boston MA
| | - Leah Santacroce
- Division of Rheumatology Brigham and Women’s Hospital Boston MA
| | - Jeffrey N. Katz
- Division of Rheumatology Brigham and Women’s Hospital Boston MA
| | - Josef S. Smolen
- Division of Rheumatology University of Vienna Vienna Austria
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