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Alberghina F, McManus R, Keogh C, Turner H, Moore D, Noël J, Kennedy J, Kiely P. The Evaluation of Serum Metal Ion Levels and Metallosis in Graduated Patients With Magnetically Controlled Growing Rods. J Pediatr Orthop 2024; 44:43-48. [PMID: 37779282 DOI: 10.1097/bpo.0000000000002526] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Magnetically controlled growing rods (MCGR) aim to control curve progression while limiting surgical burden in children with early-onset scoliosis. Systemic and local distribution of metal debris has been documented in children with spinal implants. The aim of the study was to assess serum metal ion levels and local metal debris-related changes at the conclusion of MCGR treatment. METHODS Between February 2019 and September 2022, all patients who had a conversion to definitive fusion at the completion of MCGR treatment in our institution were invited to participate in this study. Consenting patients had serum metal ion levels drawn (titanium, cobalt, and chromium) and histologic analyses of peri-implant tissue samples. RESULTS We enrolled 24 children who underwent definitive fusion post-MCGR treatment for early-onset scoliosis. The average age at definitive fusion was 13.3 years (range: 11 to 17 y). The average length of MCGR treatment was 4.8 years (range: 1.5 to 6.8 y). At the end of the MCGR treatment, 23 (96%) patients had elevated serum metal ion levels. Mean serum titanium levels were 165.4 nmol/L (range: 30 to 390 nmol/L), mean serum cobalt levels were 4.6 nmol/L (range: 1.2 to 14 nmol/L), and mean serum chromium levels were 14 nmol/L (range: 2.4 to 30 nmol/L). Peri-implant soft tissue histologic analysis demonstrated local metal debris and foreign body reactions in all patients. CONCLUSIONS At the completion of MCGR treatment, the majority of patients demonstrate elevated serum metal ion levels and local metal debris-related peri-implant soft tissue changes. Although there is no current literature to suggest these findings are harmful, further research as to the clinical significance is required. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Flavia Alberghina
- Department of Orthopaedics, Children's Health Ireland (CHI) at Crumlin, Crumlin, Dublin, Ireland
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Kelly SA, O'Connell NH, Thompson TP, Dillon L, Wu J, Creevey C, Kiely P, Slevin B, Powell J, Gilmore BF, Dunne CP. Large-scale characterization of hospital wastewater system microbiomes and clinical isolates from infected patients: profiling of multi-drug-resistant microbial species. J Hosp Infect 2023; 141:152-166. [PMID: 37696473 DOI: 10.1016/j.jhin.2023.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) and infectious agents exhibiting antimicrobial resistance (AMR) are challenges globally. Environmental patient-facing wastewater apparatus including handwashing sinks, showers and toilets are increasingly identified as sources of infectious agents and AMR genes. AIM To provide large-scale metagenomics analysis of wastewater systems in a large teaching hospital in the Republic of Ireland experiencing multi-drug-resistant HAI outbreaks. METHODS Wastewater pipe sections (N=20) were removed immediately prior to refurbishment of a medical ward where HAIs had been endemic. These comprised toilet U-bends, and sink and shower drains. Following DNA extraction, each pipe section underwent metagenomic analysis. FINDINGS Diverse taxonomic and resistome profiles were observed, with members of phyla Proteobacteria and Actinobacteria dominating (38.23 ± 5.68% and 15.78 ± 3.53%, respectively). Genomes of five clinical isolates were analysed. These AMR bacterial isolates were from patients >48 h post-admission to the ward. Genomic analysis determined that the isolates bore a high number of antimicrobial resistance genes (ARGs). CONCLUSION Comparison of resistome profiles of isolates and wastewater metagenomes revealed high degrees of similarity, with many identical ARGs shared, suggesting probable acquisition post-admission. The highest numbers of ARGs observed were those encoding resistance to clinically significant and commonly used antibiotic classes. Average nucleotide identity analysis confirmed the presence of highly similar or identical genomes in clinical isolates and wastewater pipes. These unique large-scale analyses reinforce the need for regular cleaning and decontamination of patient-facing hospital wastewater pipes and effective infection control policies to prevent transmission of nosocomial infection and emergence of AMR within potential wastewater reservoirs.
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Affiliation(s)
- S A Kelly
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - T P Thompson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - L Dillon
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J Wu
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C Creevey
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - P Kiely
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B Slevin
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B F Gilmore
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland.
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Weldrick CL, Boers P, Kiely P, O'Halloran L. X-linked cerebral adrenoleukodystrophy. BMJ Case Rep 2023; 16:e237905. [PMID: 37907311 PMCID: PMC10619069 DOI: 10.1136/bcr-2020-237905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
A man in his 30s presented with a 6-month history of progressive left face, arm and leg weakness. Medical history included epilepsy and vitamin B12 deficiency. Three maternal second degree relatives died before the age of 7 from various neurological disorders. Examination revealed a mild left facial droop and weakness of the left shoulder, hip and ankle. Reflexes were symmetrical and tone was normal. Differential diagnosis included glioma, subacute infarction, lymphoma and demyelination. MRI brain showed an extensive right sided subcortical white matter lesion, with extension into the brainstem. The patient's weakness progressed over 3 months. Brain biopsy showed evidence of demyelination and gliosis. A pathological diagnosis of tumefactive multiple sclerosis was made, but also rare metabolic disorders such as X-linked adrenoleukodystrophy (X-ALD) were proposed. Serum very long-chain fatty acids were significantly elevated. Genetic testing showed a mutation in the ABCD1 gene, confirming a diagnosis of X-ALD.
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Affiliation(s)
| | - Peter Boers
- Neurology, University Hospital Limerick, Limerick, Ireland
| | - Patrick Kiely
- Radiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Liam O'Halloran
- Radiology, University Hospital Limerick, Dooradoyle, Ireland
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Zhang H, Nabel CS, Li D, O'Connor RÍ, Crosby CR, Chang SM, Hao Y, Stanley R, Sahu S, Levin DS, Chen T, Tang S, Huang HY, Meynardie M, Stephens J, Sherman F, Chafitz A, Costelloe N, Rodrigues DA, Fogarty H, Kiernan MG, Cronin F, Papadopoulos E, Ploszaj M, Weerasekara V, Deng J, Kiely P, Bardeesy N, Vander Heiden MG, Chonghaile TN, Dowling CM, Wong KK. Histone Deacetylase 6 Inhibition Exploits Selective Metabolic Vulnerabilities in LKB1 Mutant, KRAS Driven NSCLC. J Thorac Oncol 2023; 18:882-895. [PMID: 36958689 PMCID: PMC10332301 DOI: 10.1016/j.jtho.2023.03.014] [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: 08/16/2022] [Revised: 01/24/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION In KRAS-mutant NSCLC, co-occurring alterations in LKB1 confer a negative prognosis compared with other mutations such as TP53. LKB1 is a tumor suppressor that coordinates several signaling pathways in response to energetic stress. Our recent work on pharmacologic and genetic inhibition of histone deacetylase 6 (HDAC6) revealed the impaired activity of numerous enzymes involved in glycolysis. On the basis of these previous findings, we explored the therapeutic window for HDAC6 inhibition in metabolically-active KRAS-mutant lung tumors. METHODS Using cell lines derived from mouse autochthonous tumors bearing the KRAS/LKB1 (KL) and KRAS/TP53 mutant genotypes to control for confounding germline and somatic mutations in human models, we characterize the metabolic phenotypes at baseline and in response to HDAC6 inhibition. The impact of HDAC6 inhibition was measured on cancer cell growth in vitro and on tumor growth in vivo. RESULTS Surprisingly, KL-mutant cells revealed reduced levels of redox-sensitive cofactors at baseline. This is associated with increased sensitivity to pharmacologic HDAC6 inhibition with ACY-1215 and blunted ability to increase compensatory metabolism and buffer oxidative stress. Seeking synergistic metabolic combination treatments, we found enhanced cell killing and antitumor efficacy with glutaminase inhibition in KL lung cancer models in vitro and in vivo. CONCLUSIONS Exploring the differential metabolism of KL and KRAS/TP53-mutant NSCLC, we identified decreased metabolic reserve in KL-mutant tumors. HDAC6 inhibition exploited a therapeutic window in KL NSCLC on the basis of a diminished ability to compensate for impaired glycolysis, nominating a novel strategy for the treatment of KRAS-mutant NSCLC with co-occurring LKB1 mutations.
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Affiliation(s)
- Hua Zhang
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania; Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Christopher S Nabel
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts; Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Dezhi Li
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Ruth Í O'Connor
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Caroline R Crosby
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Sarah M Chang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Yuan Hao
- Applied Bioinformatics Laboratories, Office of Science and Research, New York University Grossman School of Medicine, New York, New York
| | - Robyn Stanley
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Soumyadip Sahu
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Daniel S Levin
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Ting Chen
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Sittinon Tang
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Hsin-Yi Huang
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Mary Meynardie
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Janaye Stephens
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Fiona Sherman
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Alison Chafitz
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | | | - Daniel A Rodrigues
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilda Fogarty
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Fiona Cronin
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Eleni Papadopoulos
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Magdalena Ploszaj
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Vajira Weerasekara
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jiehui Deng
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Patrick Kiely
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nabeel Bardeesy
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts; Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Triona Ni Chonghaile
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Catríona M Dowling
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Kwok-Kin Wong
- Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
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Tanaka Y, Curtis J, Wassenberg S, Kiely P, Ye L, Yin Z, Downie B, Enomoto H, Strengholt S, Akhdar A, Watson C, Atsumi T. P192 Efficacy of filgotinib in rheumatoid arthritis by age, body weight, body mass index: post hoc subgroup analysis of two phase 3 trials. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Filgotinib (FIL), an oral Janus kinase 1 preferential inhibitor, has demonstrated safety and efficacy as treatment for signs and symptoms of RA, and it is approved in Japan and Europe for treatment of RA. Patient characteristics can influence response to RA treatment; this post hoc analysis was performed to determine whether age, body weight (BW), and body mass index (BMI) influenced efficacy.
Methods
Patients from FINCH 1 (F1, n = 1755, inadequate response to methotrexate [MTX-IR]; NCT02889796) or FINCH 3 (F3, n = 1249, MTX-naïve; NCT02886728) were included for analysis of clinical response at week 12 (F1 primary endpoint) or 24 (F3 primary endpoint). Patients were stratified by age (<65, ≥65 years), BW (<60, 60 to < 100, ≥100 kg), and BMI (<25, ≥25 kg/m2). Efficacy was assessed by ACR20, Disease Activity Score-28 <2.6, Clinical Disease Activity Index ≤2.8, Simple Disease Activity Index ≤3.3, Boolean remission, and change from baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI). Selected efficacy endpoints are displayed in Table 1. Patients treated with FIL200+MTX were compared with control arms (F1, placebo+MTX; F3, MTX). Fisher’s exact test was used for binary endpoints; mixed-effects model for repeated measures was used for HAQ-DI. P-values were nominal without adjusting for multiplicity.
Results
FIL200+MTX in MTX-IR patients demonstrated greater efficacy vs placebo+MTX regardless of age, BW, and BMI (Table 1). Apart from the ≥65-year-old subgroup, in which there was no clear pattern, FIL200+MTX in MTX-naïve patients demonstrated greater efficacy vs MTX across subgroups (Table 1). Rates of treatment-emergent adverse events (TEAEs) were greater in the ≥65-year-old subgroup vs the <65-year-old subgroup; there was no discernible pattern between BMI subgroups. Among MTX-naïve patients only, rates of TEAEs were higher in those who weighed ≥100 kg vs lower-weight subgroups.
Conclusion
This exploratory analysis showed FIL200+MTX was efficacious regardless of subgroup characteristics defined by age, BW, or BMI. Most comparisons of FIL200+MTX vs MTX and vs placebo+MTX favored FIL200+MTX.
Disclosure
Y. Tanaka: Consultancies; Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, and AbbVie. Member of speakers’ bureau; Daiichi-Sankyo; Eli Lilly; Novartis; YL Biologics; Bristol-Myers; Eisai; Chugai; AbbVie; Astellas; Pfizer; Sanofi; Asahi-Kasei; GSK; Mitsubishi-Tanabe; Gilead Sciences, Inc.; and Janssen. Grants/research support; AbbVie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, and Daiichi-Sankyo. J. Curtis: Grants/research support; from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB. S. Wassenberg: Consultancies; AbbVie; Amgen; BMS; Gilead Sciences, Inc.; Eli Lilly; Hexal; MSD; Nichi-Iko; Pfizer; and Sanofi. P. Kiely: Member of speakers’ bureau; Novartis, Lilly, Galapagos, Sobi, Abbvie. L. Ye: Shareholder/stock ownership; Employee and shareholder of Gilead Sciences, Inc. Z. Yin: Shareholder/stock ownership; Employee and shareholder of Gilead Sciences, Inc. B. Downie: Shareholder/stock ownership; Employee and shareholder of Gilead Sciences, Inc. H. Enomoto: Shareholder/stock ownership; former employee/shareholder of Gilead Sciences, Inc. S. Strengholt: Shareholder/stock ownership; shareholder of and employee of Galapagos BV. A. Akhdar: Shareholder/stock ownership; shareholder of and employee of Galapagos BV. C. Watson: Shareholder/stock ownership; shareholder of and employee of Galapagos BV. T. Atsumi: Honoraria; Gilead Sciences, Inc.; Mitsubishi Tanabe; Chugai; Astellas Pharma; Takeda; Pfizer; AbbVie: Eisai; Daiichi Sankyo Co. Ltd.; BMS; UCB Japan Co. Ltd.; Eli Lilly, Otsuka Pharmaceutical Co. Alexion Inc.
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Affiliation(s)
- Yoshiya Tanaka
- Graduate School of Medical Science, University of Occupational and Environmental Health, Kitakyushu, JAPAN
| | - Jeffrey Curtis
- Division of Clinical Immunology & Rheumatology, UAB, Birmingham AL, AL
| | | | - Patrick Kiely
- Institute of Medical and Biomedical Education, St George’s, University of London, London, UNITED KINGDOM
| | - Lei Ye
- Biostats, Gilead Sciences, Inc, Foster City, CA
| | - Zhaoyu Yin
- Biostats, Gilead Sciences, Inc, Foster City, CA
| | - Bryan Downie
- Bioinformatics, Gilead Sciences, Inc, Foster City, CA
| | | | | | - Ali Akhdar
- Medical Affairs, Galapagos BV, Leiden, NETHERLANDS
| | - Chris Watson
- Medical Affairs, Galapagos BV, Leiden, NETHERLANDS
| | - Tatsuya Atsumi
- Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, JAPAN
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Jacklin C, Nikiphorou E, Kiely P, Jacklin H, Bosworth A. P202 Impact of ‘moderate' active RA on patient lives. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
The objective of this survey was to highlight the everyday impact of living with active Rheumatoid Arthritis for people not meeting the eligibility criteria (pre-July 2021), to be treated with advanced therapies.
Methods
NRAS wanted to reach people living with RA for more than 2 years but not being treated with any advanced therapies with a national survey to gauge if they had active disease that was not well controlled and the impact of that active disease on their lives. The survey was designed to capture demographics, current treatment, frequency of RA flares, impact of disease (utilising the validated tool of RAID) as well as work status and restrictions on lifestyle. The national online survey was distributed via all NRAS social media platforms as well as email.
Results
612 responses from across the UK with a mean age of 59 years were gathered. 88% were female and 37.7% had a disease duration of 2-5 years with a further 27.9% with disease duration of 5-10 years. 90% declared having RA flare in the previous 12 months with 23% reporting having had six or more flares within the year. A total RAID score was calculated for 611 respondents. A RAID patient acceptable state was recorded in only 12.4%. 74.3% scored sleep problems and 72% fatigue in the high range. Working hours alteration was reported by 70% of respondent. The RAID scores were significantly predictive of number of flares.
Conclusion
Patients not currently treated with biologics/biosimilars or targeted synthetic DMARDs experience profound difficulties affecting their health, emotional state, work and families. NRAS advocate that patient reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life. Since this piece of work was carried out the threshold for accessing some advanced therapies has been lowered by NICE meaning that in England and Wales many of these people will now have access to being treated on an advanced therapy however there still exists issues in Scotland and Northern Ireland in being able to offer such treatments to those with RA disease activity score of less than 5.1 as well as cost barriers.
Disclosure
C. Jacklin: None. E. Nikiphorou: None. P. Kiely: None. H. Jacklin: None. A. Bosworth: None.
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Affiliation(s)
- Clare Jacklin
- CEO, National Rheumatoid Arthritis Society, Maidenhead, UNITED KINGDOM
| | - Elena Nikiphorou
- Dept Of Inflammation Biology, Centre for Rheumatic Diseases, London, UNITED KINGDOM
| | - Patrick Kiely
- Rheumatology, St George's University, London, UNITED KINGDOM
| | - Hannah Jacklin
- Information & Support, National Rheumatoid Arthritis Society, Maidenhead, UNITED KINGDOM
| | - Ailsa Bosworth
- National Patient Champion, National Rheumatoid Arthritis Society, Maidenhead, UNITED KINGDOM
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Rafferty A, Fleming N, Kiely P, Mockler D, Dockrell S. Does exercise therapy improve pulmonary function in patients with Adolescent Idiopathic Scoliosis? Physiother Theory Pract 2022; 39:1095-1105. [PMID: 35176949 DOI: 10.1080/09593985.2022.2034198] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Exercise therapy is frequently used for treating patients with Adolescent Idiopathic Scoliosis (AIS) however no previous review has evaluated the effect of exercise therapy on pulmonary function in this population. OBJECTIVE To systematically analyze the literature on the effect of exercise therapy on pulmonary function in patients with AIS. METHODS A systematic electronic database search (CINAHL, Embase, Medline, Web of Science) was conducted. Manual searches of key reviews and studies were also conducted. Studies that included exercise-based interventions to improve pulmonary function in patients with AIS and reported pre- and post-intervention pulmonary function test scores were included. Test scores were compared using standardized mean difference (SMD) between intervention and control groups in randomized control trials (RCT) and mean ± SD between pre- and post-intervention in prospective intervention studies (PI). Methodological quality was assessed using a modified Downs and Black checklist. RESULTS Fifteen studies met the inclusion criteria (six RCTs and nine PIs). Results indicated the positive effect of exercise-based therapy on lung volumes (FVC/VC) and FEV1 in patients with AIS. CONCLUSION Exercise therapy has a positive effect on lung volumes in patients with AIS. The quality of many studies was only 'fair,' therefore more suitably powered higher level clinical trials are required.
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Affiliation(s)
- Anthony Rafferty
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Neil Fleming
- Department of Anatomy, School of Medicine, Trinity College, Level 1, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Patrick Kiely
- Department of Orthopaedics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - David Mockler
- Trinity Research, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Sara Dockrell
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Langhendries L, Lassel M, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Van Hove K, Meganck S, Maertens L, Boret L, Migliorini F, Forte S, Rocco B, Kiely P, Micali S, Mottrie A, Gallagher A. A prospective, randomized, multi-centre trial on the efficiency and effectiveness of proficiency based progression robotic surgical skills training. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Rocco B, Kiely P, Mottrie A, Gallagher AG. Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study. Int J Comput Assist Radiol Surg 2022; 17:457-465. [PMID: 34997525 PMCID: PMC8740863 DOI: 10.1007/s11548-021-02545-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
Purpose In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.
Methods A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Results The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task. Conclusions PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills. Trial registration ClinicalTrials.gov Identifier: NCT04541615.
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Affiliation(s)
- Stefano Puliatti
- ORSI Academy, Melle, Belgium.
- Department of Urology, OLV, Aalst, Belgium.
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Marco Amato
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rui Farinha
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Artur Paludo
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giuseppe Rosiello
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Lorenzo Bianchi
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Migliorini
- Urology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Saverio Forte
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Bernardo Rocco
- Urology Department, ASST Santi Paolo e Carlo - Milano, Università Statale di Milano, Milan, Italy
| | - Patrick Kiely
- ORSI Academy, Melle, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
- Faculty of Medicine, KU Leuven, Leuven, Belgium
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Gabr A, Cunningham N, Kennedy C, Mohamed A, Okpaje B, Saleh A, Leahy A, El-Kholy K, Carrol I, Paulose S, Daly N, Harnett A, Buckley E, Kiely P, McManus J, Peters C, Quinn C, Prendiville T, Lyons D, Watts M, O’Keefe D, Galvin R, Murphy S, O'Connor M. 241 IMPLEMENTATION OF AN INTRACEREBRAL CEREBRAL HAEMORRHAGE CARE BUNDLE. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Mortality for Intracerebral haemorrhage (ICH) is 31% (Irish National Audit Stroke, 2019). An ICH care bundle focusing on acute anticoagulation reversal, blood pressure lowering, and a neurosurgical care pathway was associated with improved survival. Translating evidence-based medicine into clinical practice is challenging. The aim of this study was to determine feasibility and outcomes of implementation of a care bundle.
Methods
An ICH care bundle was developed using an iterative process involving expert stakeholder review of the evidence-based literature. A pre-and-post quasi-experimental research design was employed to evaluate this intervention. Baseline data were collected before implementation (January 2016-June 2018). Implementation took place in a staged manner in a single university teaching hospital with multiple ‘Plan Do Study Act cycles’ (June 2018 to January 2021). Data on compliance, process measures and outcomes were collected.
Results
Systolic blood pressure (first 24-hours) and anticoagulant reversal were significantly better controlled post-implementation (χ2 (1, N = 91) = 5.34, P = 0.02), (χ2 (1, N = 25) = 5.85, P = 0.016), respectively. DNAR orders were significantly lower in the post-implementation group (χ2 (1, N = 25) = 5.85, P = 0.029). However, ‘Do Not Actively Resuscitate’ status did not significantly differ when accounting for low GCS as a surrogate measure for poor prognosis (χ2 (1, N = 34) = 0.00, P = 0.966). Modified Rankin Scale on discharge did not differ significantly pre-and-post-implementation (z = −0.075, P = 0.94). A greater proportion of patients survived in the post-implementation group; however, this was not statistically significant (χ2 (1, N = 133) = 0.77, P = 0.38). Length of stay significantly increased post implementation.
Conclusion
An ICH care bundle was developed based on expert stakeholder feedback. The feasibility of implementing this bundle of care was demonstrated in a real-world clinical practice setting. A cluster-randomized trial or a large registry study is the next step to evaluate the overall impact of this care bundle on patient outcomes.
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Affiliation(s)
- A Gabr
- University Hospital Limerick , Limerick, Ireland
| | - N Cunningham
- University Hospital Limerick , Limerick, Ireland
| | - C Kennedy
- Trinity College Dublin , Dublin, Ireland
- St James Hospital , Dublin, Ireland
| | - A Mohamed
- University Hospital Limerick , Limerick, Ireland
| | - B Okpaje
- University Hospital Limerick , Limerick, Ireland
| | - A Saleh
- University Hospital Limerick , Limerick, Ireland
| | - A Leahy
- University Hospital Limerick , Limerick, Ireland
- University of Limerick , Limerick, Ireland
| | | | - I Carrol
- University Hospital Limerick , Limerick, Ireland
| | - S Paulose
- University Hospital Limerick , Limerick, Ireland
| | - N Daly
- University Hospital Limerick , Limerick, Ireland
| | - A Harnett
- University Hospital Limerick , Limerick, Ireland
| | - E Buckley
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - P Kiely
- University Hospital Limerick , Limerick, Ireland
| | - J McManus
- University Hospital Limerick , Limerick, Ireland
| | - C Peters
- University Hospital Limerick , Limerick, Ireland
| | - C Quinn
- University Hospital Limerick , Limerick, Ireland
| | | | - D Lyons
- University Hospital Limerick , Limerick, Ireland
| | - M Watts
- University Hospital Limerick , Limerick, Ireland
| | - D O’Keefe
- University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
| | - S Murphy
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - M O'Connor
- University Hospital Limerick , Limerick, Ireland
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11
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Langhendries L, Lassel M, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Rocco B, Kiely P, Mottrie A, Gallagher A. A prospective, randomized, multi-centre trial on the efficiency and effectiveness of proficiency based progression robotic surgical skills training. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Kelly D, Casey M, Beattie McKenna F, McCarthy M, Kiely P, Twomey F, Glynn L, Bargary N, Leddin D. Identifying the gaps in Irish cancer care: Patient, public and providers' perspectives. Health Policy 2021; 125:1482-1488. [PMID: 34629203 DOI: 10.1016/j.healthpol.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The University of Limerick Cancer network (ULCaN) was established in 2019 with funding from the Health Research Institute at the University of Limerick in order to build a network between individuals in academia, primary and secondary care and the general public so that cancer services can be coordinated and more effective. The aim of this paper is to outline our experience of engaging with stakeholders to identify gaps in the cancer journey locally. METHODS Four focus group discussions were conducted with patients; their carers; members of the public; and healthcare providers with 2 main aims: 1) to investigate gaps in cancer services; 2) to identify knowledge, attitudes and opportunities available to promote cancer research. The focus groups were audio recorded, transcribed and thematically analysed. RESULTS 15 themes within the topics of cancer care, palliation, communication, clinical trials, diet and exercise and public and patient involvement in research and advocacy were identified. These include directing people to reliable information and navigating misinformation and stigma linked with cancer, promoting awareness of clinical trials and palliative care services and improving communication when multiple healthcare providers are involved. CONCLUSION The need to make more coherent, efficient and integrated cancer research amongst local stakeholders was evident. Embedding patients and members of the public into ULCaN is an important deliverable for collaborative research.
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Affiliation(s)
- Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Monica Casey
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Miriam McCarthy
- UL Hospitals Group & University of Limerick, Limerick, Ireland
| | - Patrick Kiely
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Feargal Twomey
- UL Hospitals Group and Milford Care Centre, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - Des Leddin
- Dalhousie University, Nova Scotia, Canada
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13
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Motyer G, Dooley B, Kiely P, Fitzgerald A. Parents' information needs, treatment concerns, and psychological well-being when their child is diagnosed with adolescent idiopathic scoliosis: A systematic review. Patient Educ Couns 2021; 104:1347-1355. [PMID: 33280964 DOI: 10.1016/j.pec.2020.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We systematically reviewed the experiences of parents who have a child with adolescent idiopathic scoliosis in order to understand their needs and concerns related to their child's healthcare, and assist health professionals in supporting parents of this paediatric patient group. METHODS A systematic search strategy identified eighteen relevant studies published between 2000 and 2020. Quality was assessed using the Mixed Methods Appraisal Tool and the literature was narratively synthesised. RESULTS Three main themes were evident across the literature including information needs, treatment concerns, and psychological well-being. Studies predominantly focused on the surgical treatment of scoliosis. CONCLUSION Parents face challenges such as acquiring appropriate knowledge about scoliosis to participate in healthcare decisions and coping with their child undergoing invasive spinal surgery. Throughout this time, their psychological well-being can be negatively impacted. Considering parents' experiences and support needs throughout this anxiety-provoking time is an important step in delivering family-centered care and promoting better outcomes for paediatric patients. PRACTICE IMPLICATIONS Providing parents with appropriate resources and addressing concerns around surgical complications, postoperative pain, and how they can best support their child before and after surgery, may alleviate some of the emotional burden that parents experience.
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Affiliation(s)
- Gillian Motyer
- School of Psychology, University College Dublin, Belfield, Dublin, D04V1W8, Ireland.
| | - Barbara Dooley
- School of Psychology, University College Dublin, Belfield, Dublin, D04V1W8, Ireland
| | - Patrick Kiely
- Department of Orthopaedics, Children's Health Ireland at Crumlin, Crumlin, Dublin, D12N512, Ireland
| | - Amanda Fitzgerald
- School of Psychology, University College Dublin, Belfield, Dublin, D04V1W8, Ireland
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14
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Rauf A, Hughes C, Hill D, Kiely P. POS1056 COMPARATIVE EFFICACY OF TNF INHIBITORS VERSUS OTHER CYTOKINE INHIBITOR bDMARDs ON PSORIATIC ARTHRITIS IMPACT OF DISEASE (PsAID) SCORE AND DOMAINS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic arthritis (PsA) has many consequences, reflecting musculoskeletal and skin inflammation, with the potential to adversely affect overall quality of life. Patient reported outcome measures (PROM) assess a holistic range of aspects of quality of life, including physical and mental components, and provide broad detailed information of the impact of disease. Biologic DMARDs (bDMARDs) targeting TNF have been used to treat PsA for over 10 years whereas inhibitors of IL-17, IL-12/23 and Janus kinases (JAK) have only been available more recently. They all target differing cytokines, including JAK inhibitors which inhibit IL-12 and IL-23 signaling but not TNF signaling. Their relative impact on PROMs is unknown.Objectives:To assess, in routine care, the relative impact in PsA of TNF inhibitors (TNFi) versus non-TNFi bDMARDs, targeting IL-17, IL-12/23 and JAK, on PROMs.Methods:We performed a cross section analysis of PsA patients with established disease treated with bDMARDs and JAKi, under routine care at St George’s University Hospital, London, UK. Patients completed the 12-item psoriatic arthritis impact of disease (PsAID) tool. The total PsAID score was calculated using the on-line EULAR toolkit (see reference). The PsAID total and individual domain scores were compared between TNFi and non-TNFi groups using the Mann Whitney U test. A total PsAID score below 4 out of 10 is considered a ‘patient-acceptable state’.Results:A total 95 patients (female n= 53, 56%) completed the PSAID; TNFi n=72 (female 50%, adalimumab n=41, Etanercept n= 24, Golimumab n=4, Infliximab n =2, Certolizumab n=1) and non-TNFi n= 23 (female 74%, Secukinumab n=9, Ixekizumab n=1, Ustekinumab n=9, Tofacitinib n=4). The mean age was 53.6 (TNFi 53.5, non-TNFi 53.7) years, and duration of time on bDMARD treatment was TNFi 49.5 (range 1- 141) months, non-TNFi 25.3 (range 4 -59) months. The total and individual domain PsAID scores are shown in the Table 1. A ‘patient acceptable state’ total score <4 was recorded in TNFi 36/72 (50%) and non-TNFi 11/23 (48%). There was no significant difference between TNFi and non-TNFi groups in the mean total PsAID score, or proportion achieving a patient acceptable state. Patients on TNFi had lower (better outcome) mean scores for all 12 domains except skin, and the differences, versus non-TNFi treated patients, were significant for pain, functional capacity, discomfort and depression.PSAID domainTNFiNon-TNFiP valueTotal score3.314.64N.S.Pain3.675.430.02Fatigue4.045.65N.S.Skin problems3.112.78N.S.Work/leisure activities3.564.78N.S.Functional capacity3.295.040.02Discomfort3.885.650.02Sleep disturbance3.424.78N.S.Coping3.014.09N.S.Anxiety, fear, uncertainty2.644.17N.S.Embarrassment/shame2.283.39N.S.Social participation2.63.48N.S.Depression2.113.910.03Conclusion:In PsA, TNFi appear to have a greater impact over non-TNFi bDMARDs on some aspects of quality of life, including pain and functional capacity. TNFi and non-TNFi were no different with respect to patients’ perspective on skin disease, embarrassment or shame, despite less good cutaneous responses in clinical trials from TNFi agents. Overall, the PsAID tool reveals an unmet burden on quality of life in PsA patients treated with all classes of bDMARDs and JAKi, as 50% fail to achieve a ‘patient acceptable state’. This should prompt scrutiny of the high scoring domains and utilization of additional treatment modalities to achieve better holistic outcomes for PsA patients in routine care.References:[1]PsAID tool: http://pitie-salpetriere.aphp.fr/psaid/raid_psaid_quest_home.phpDisclosure of Interests:Atif Rauf: None declared, Catherine Hughes: None declared, Diane Hill: None declared, Patrick Kiely Speakers bureau: Abbvie.
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15
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Bravi C, Rocco B, Kiely P, Mottrie A, Gallagher A. Does quality assured eLearning provide adequate preparation for robotic surgical skills; A prospective, randomized and multi-center study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Zhao SS, Nikiphorou E, Young A, Kiely P. POS0495 LARGE JOINT DISEASE IN RHEUMATOID ARTHRITIS AND THE ROLE OF RHEUMATOID FACTOR. RESULTS FROM THE EARLY RHEUMATOID ARTHRITIS STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Rheumatoid arthritis (RA) is classically described as a symmetric small joint polyarthritis with additional involvement of large joints. There is a paucity of information concerning the time course of damage in large joints, such as shoulder, elbow, hip, knee and ankle, from early to established RA, or of the influence of Rheumatoid Factor (RF) status. There is a historic perception that patients who do not have RF follow a milder less destructive course, which might promote less aggressive treatment strategies in RF-negative patients. The historic nature of the Ealy Rheumatoid Arthritis Study (ERAS) provides a unique opportunity to study RA in the context of less aggressive treatment strategies.Objectives:To examine the progression of large joint involvement from early to established RA in terms of range of movement (ROM) and time to joint surgery, according to the presence of RF.Methods:ERAS was a multi-centre inception cohort of newly diagnosed RA patients (<2 years disease duration, csDMARD naive), recruited from 1985-2001 with yearly follow-up for up to 25 (median 10) years. First line treatment was csDMARD monotherapy with/without steroids, favouring sulphasalazine for the majority. Outcome data was recorded at baseline, at 12 months and then once yearly. Patients were deemed RF negative if all repeated assessments were negative. ROM of individual shoulder, elbow, wrist, hip, knee, ankle and hindfeet joints was collected at 3, 5, 9 and 12-15 years. The rate of progression from normal to any loss of ROM, from years 3 to 14 was modelled using GEE, adjusting for confounders. Radiographs of wrists taken at years 0, 1, 2, 3, 5, 7, 9 were scored according to the Larsen method. Change in the Larsen wrist damage score was modelled using GEE as a continuous variable, while the erosion score was dichotomised into present/absent. Surgical procedure data were obtained by linking to Hospital Episodes Statistics and the National Joint Registry. Time to joint surgery was analysed using multivariable Cox models.Results:A total of 1458 patients from the ERAS cohort were included (66% female, mean age 55 years) and 74% were RF-positive. The prevalence of any loss of ROM, from year 3 through to 14 was highest in the wrist followed by ankle, knee, elbow and hip. The proportion of patients at year 9 with greater than 25% loss of ROM was: wrist 30%, ankle 12%, elbow 7%, knee 7% and hip 5%. Odds of loss of ROM increased over time in all joint regions, at around 7 to 13% per year from year 3 to 14. There was no significant difference between RF-positive and RF-negative patients (see Figure 1). Larsen erosion and damage scores at the wrists progressed in all patients; annual odds of developing any erosions were higher in RF-positives OR 1.28 (95%CI 1.24-1.32) than RF-negatives OR 1.17 (95%CI 1.09-1.26), p 0.013. Time to surgery was similar according to RF-status for the wrist and ankle, but RF-positive cases had a lower hazard of surgery at the elbow (HR 0.37, 0.15-0.90), hip (HR 0.69, 0.48-0.99) and after 10 years at the knee (HR 0.41, 0.25-0.68). Adjustment of the models for Lawrence assessed osteoarthritis of hand and feet radiographs did not influence these results.Figure 1.Odds of progression to any loss of ROM (from no loss of ROM) per year in the overall population and stratified by RF status.Conclusion:Large joints become progressively involved in RA, most frequently affecting the wrist followed by ankle, which is overlooked in some composite disease activity indices. We confirm a higher burden of erosions and damage at the wrists in RF-positive patients, but have not found RF-negative patients to have a better prognosis over time with respect to involvement of other large joints. In contrast RF-negative patients had more joint surgery at the elbow, hip, and knee after 10 years. There is no justification to adopt a less aggressive treatment strategy for RF-negative RA. High vigilance and treat-to-target approaches should be followed irrespective of RF status.Disclosure of Interests:None declared
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17
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Nikiphorou E, Jacklin H, Bosworth A, Jacklin C, Kiely P. Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society. Rheumatol Adv Pract 2021; 5:rkaa080. [PMID: 34322656 PMCID: PMC8314206 DOI: 10.1093/rap/rkaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The aim was to reveal the everyday impact of living with RA in people not treated with advanced therapies (i.e. biologic or targeted synthetic DMARDs). Methods People with RA, with disease duration >2 years, not currently treated with advanced therapies, completed an online survey promoted by the National Rheumatoid Arthritis Society. Items covered demographics, current treatment, RA flare frequency, the Rheumatoid Arthritis Impact of Disease (RAID) tool and questions reflecting work status and ability. Descriptive and multivariable regression analyses were performed. Results There were 612 responses from patients having a mean age of 59 years, 88% female, 37.7% with disease duration 2–5 years and 27.9% with disease duration 5–10 years. In the last year, 90% reported an RA flare, with more than six flares in 23%. A RAID patient acceptable state was recorded in 12.4%. Each of the seven domains was scored in the high range by >50% respondents; 74.3% scored sleep problems and 72% fatigue in the high range. A need to change working hours was reported by 70%. Multivariable analyses revealed that increasing difficulties with daily physical activities, reduced emotional and physical well-being in the past week were all significantly associated with pain, number of flares and ability to cope (P < 0.005). The RAID score was significantly predictive of the number of flares. Conclusion Patients not currently treated with advanced therapies experience profound difficulties in everyday living with RA, across a broad range of measures. We advocate that patient-reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine
| | | | | | | | - Patrick Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust
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18
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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19
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Walker D, Griffiths B, Kiely P, Marzo-Ortega H. What do UK Rheumatologists do when the patient doesn't fit the guideline for treatment? Rheumatology (Oxford) 2020; 59:1465-1466. [PMID: 32294218 DOI: 10.1093/rheumatology/keaa151] [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: 01/21/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Walker
- Rheumatology, Northumbria Healthcare NHS Trust, North Shields
| | | | - Patrick Kiely
- St Georges Healthcare NHS Trust and Honorary Reader, Institute of Medical and Biomedical Education, St George's, University of London, London
| | - Helena Marzo-Ortega
- Leeds Institute for Rheumatic and Musculoskeletal Research, University of Leeds, Leeds, UK
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20
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Gallagher AG, Hart M, Cleary D, Hamilton C, McGlinchey K, Kiely P, Bunting BP. Proficiency based progression simulation training significantly reduces utility strikes; A prospective, randomized and blinded study. PLoS One 2020; 15:e0231979. [PMID: 32396535 PMCID: PMC7217447 DOI: 10.1371/journal.pone.0231979] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 04/04/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We evaluated a simulation-based training curriculum with quantitatively defined performance benchmarks for utility workers location and excavation of utility services. BACKGROUND Damaging buried utilities is associated with considerable safety risks to workers and substantial cost to employers. METHODS In a prospective, randomized and blinded study we assessed the impact of Proficiency Based Progression (PBP) simulation training on the location and excavation of utility services work. RESULTS PBP simulation training reduced performance errors (33%, p = 0.006) in comparison a standard trained group. When implemented across all workers in the same division there was a 35-61% reduction in utility strikes (p = 0.028) and an estimated cost saving of £116,000 -£2,175,000 in the 12 months (47,000 work hours) studied. CONCLUSIONS The magnitude of the training benefit of PBP simulation training in the utilities sector appears to be the same as it is in surgery, cardiology and procedure-based medicine. APPLICATION Quality-assured utility worker simulation training significantly reduces utility damage and associated costs.
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Affiliation(s)
- Anthony G. Gallagher
- Faculty of Life and Health Sciences, Ulster University, Magee Campus, Londonderry, Northern Ireland, United Kingdom
| | - Martin Hart
- Group Training and Development Manager, ReachActive Unit 4B Lough Sheever Corporate Park, Mullingar, Co. Westmeath, Ireland
| | | | | | | | | | - Brendan P. Bunting
- School of Psychology, Coleraine, Co. Londonderry, Northern Ireland, United Kingdom
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21
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Mistry J, Sharif M, Prideaux A, Smith C, Sumbwanyambe M, Sibley M, Carpenter L, Sweeney M, Kiely P. Use of rheumatoid arthritis impact of disease (RAID) in routine care; identification of DAS28 remission and unmet patient-reported outcomes. Rheumatol Adv Pract 2020; 4:rkaa013. [PMID: 32685911 PMCID: PMC7359769 DOI: 10.1093/rap/rkaa013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/16/2020] [Indexed: 02/02/2023] Open
Abstract
Objective The aim was to assess how the patient-reported outcome RA impact of disease (RAID) relates to DAS28 categories in routine care, its utility in identifying patients in DAS28 remission (RDAS) or low disease activity (LDAS) and the burden of unmet patient-reported needs in those achieving RDAS/LDAS. Methods DAS28 and RAID scores were collected from patients with established RA attending for routine review. The relationship between RAID and DAS28 was assessed with univariate pairwise correlation and mixed-effects linear regression analyses. RAID <2 was defined as a patient-acceptable state. Results One hundred and ninety-eight patients were assessed, with 220 observations, using DAS28-CRP categories: 47.5% RDAS, 14.1% LDAS, 31.8% moderate DAS (MDAS) and 6.6% high DAS (HDAS). Both patient visual analog scale score and tender joint count exhibited a high statistical association with RAID using linear regression (P < 0.0001). The mean RAID score per DAS28-CRP category was RDAS 1.84, LDAS 4.78, MDAS 5.60 and HDAS 7.68, with a statistically significant increase in RAID per unit increase in DAS-CRP or DAS28-ESR on linear regression (P < 0.001). Of 66 patients with RAID <2, 64 (97%) were in RDAS and 65 (98.5%) in RDAS/LDAS. Of 134 patients in RDAS/LDAS, RAID was ≥2 in 69 (51.5%), with fatigue and sleep being the worst-scoring domains. Conclusion RAID functions well as a patient-reported outcome in routine care. Patients with RAID <2 have a high likelihood of being in RDAS/LDAS and, if pre-screened, could avoid a clinic visit. Analysis of RAID domains provides individualized targets for holistic care in RA management, with fatigue and sleep problems dominating unmet needs in those in RDAS/LDAS.
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Affiliation(s)
- Jatin Mistry
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Mohammed Sharif
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Amy Prideaux
- School of Medicine, University of Cardiff, Cardiff
| | - Catherine Smith
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | | | - Margaret Sibley
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London
| | - Lewis Carpenter
- Department of Inflammation Biology, Institute for Psychiatry, Psychology and Neuroscience, King's College, London
| | - Melissa Sweeney
- Department of Inflammation Biology, Institute for Psychiatry, Psychology and Neuroscience, King's College, London
| | - Patrick Kiely
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London.,Institute of Medical and Biomedical Education, St George's University of London, London, UK
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22
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Fitzgerald E, Kiely P, Leary HO. Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy. J Hematol 2020; 8:29-33. [PMID: 32300438 PMCID: PMC7153671 DOI: 10.14740/jh468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 12/05/2022] Open
Abstract
Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amyloidosis. Intracranial involvement is a rare complication of MM occurring in only 1% of patients. It can manifest as a solitary cerebral lesion, intra-parenchymal infiltration, or diffuse leptomeningeal disease. We present a case of a leptomeningeal myeloma in a 71-year-old woman with known relapsed MM presenting with a right sixth nerve palsy. Our patient was receiving spinal irradiation for a paraspinal plasmacytoma when she complained of double vision. Clinical exam revealed a right sixth nerve palsy. MRI revealed diffuse abnormal leptomeningeal thickening and enhancement typical for diffuse leptomeningeal infiltration. She was treated with whole brain irradiation and intrathecal methotrexate combined with a lenalidomide and dexamethasone chemotherapeutic regimen but unfortunately she passed away 5 weeks after onset of visual symptoms. MM involving the central nervous system (CNS) is a rare complication of MM and carries a poor prognosis with an average survival of 3 months. Due to its rarity, treatment of CNS MM is very heterogeneous. Thus case reporting is important to accumulate data on this rare presentation.
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Affiliation(s)
| | - Patrick Kiely
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Hilary O Leary
- Department of Haematology, University Hospital Limerick, Limerick, Ireland
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23
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Onac IA, Tacu C, Clarke BD, Lloyd M, Hajela V, Batty T, Thoroughgood J, Smith S, Irvine H, Hill D, Baxter G, Horwood N, Mahendrakar S, Rajak R, Griffith S, Kiely P, Galloway JB. O19 Secukinumab-related gastrointestinal safety in PsA and AS. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Secukinumab is a selective interleukin-17a inhibitor (anti-IL17) and an effective treatment option for psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Phase III study safety data indicate a possible risk of inflammatory bowel disease (IBD), a link which is biologically plausible as IL-17 is known to influence intestinal immunopathology. Real world data for secukinumab gastrointestinal safety are limited. We set out to describe the post-licensing experience of secukinumab in routine care, evaluating both baseline evaluation of pre-existing IBD as well as incident gastrointestinal adverse effects.
Methods
We undertook a retrospective cohort study. Ten centres from the South East of England participated. All records for patients commencing secukinumab at each centre between 2016-2019 were reviewed. A fully anonymised data collection form was used to collate patient information. Questions sought to answer whether IBD screening had occurred prior to secukinumab initiation. All gastrointestinal adverse events were reviewed. IBD-related adverse events after initiation were defined as: definite (biopsy confirmed, objective inflammation from biomarkers, clear temporal association, improvement on drug withdrawal), probable (as per definite, but without biopsy confirmation) or possible (gastrointestinal symptoms not fulfilling definite or probable criteria).
Results
Data for 306 patients were available: 124 (40.5%) with AS and 182 (59.5%) with PsA. 106 (34.6%) of patients had documented assessment for IBD prior to initiation; 7 of which already had pre-existing diagnoses of IBD. 24 (7.8%) patients experienced gastrointestinal related adverse events after starting secukinumab; 18 of which were formally investigated for bowel disease due to symptoms. Amongst patients who developed gastrointestinal symptoms, 4 (1.3%) had definite, 7 (2.3%) probable and 13 (4.2%) possible IBD. Out of the 4 with definite IBD; all were AS patients, all stopped secukinumab, three had pre-existing IBD and one (0.3%) case of de-novo IBD required surgical management for an inflammatory perianal abscess. All 7 patients with probable IBD had symptom resolution on withdrawal of secukinumab. Of these, 4/7 were PsA and 3/7 were AS. For the 13 patients that fulfilled possible IBD criteria, symptoms resolved without intervention and continued secukinumab treatment.
Conclusion
Absolute rates of new IBD in patients starting secukinumab are low. In addition, a majority of patients developing new gastrointestinal symptoms did not develop objective evidence of IBD or stop therapy. However, our experience suggests that in people with pre-existing IBD the risk is much higher. Only one-third of patients had documented evidence of screening for IBD at baseline. Given that only one patient developed de-novo IBD in the cohort, our experience would not support the practice of pre-screening for IBD prior to starting anti-IL17 therapy. Further research to evaluate this would be wise to focus specifically on the characteristics of AS patients, stratifying IBD risk prior to anti-IL17 initiation.
Disclosures
I.A. Onac: Other; Education support to attend conference from Abbvie. C. Tacu: Honoraria; Novartis Pharmaceutical UK - Speaker Fee. Other; education support- course - Novartis. B.D. Clarke: None. M. Lloyd: Other; departmental support from Novartis. V. Hajela: None. T. Batty: None. J. Thoroughgood: None. S. Smith: None. H. Irvine: None. D. Hill: None. G. Baxter: None. N. Horwood: Other; attend conferences from Lilly and Abbvie. S. Mahendrakar: Other; Education support to attend conferences from Lilly. R. Rajak: Honoraria; Honoraria for speaker: Eli Lilly, Amgen, Internis, Roche, UCB, Abbvie. Honoraria for chairing: Roche, Novartis, Eli Lilly, UCB. S. Griffith: Other; None declared. P. Kiely: Honoraria; Abbvie, BMS, Gilead, Lilly, Novartis, Sanofi. Member of speakers’ bureau; Abbvie, BMS, Lilly, Novartis, Sanofi. J.B. Galloway: Honoraria; Speaker fees, travel support and grants from Lilly, Abbvie, BMS, Celgene, Janssen, Pfizer, UCB, Sanofi.
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Affiliation(s)
- Ioana A Onac
- Rheumatology, Brighton and Sussex University Hospital, Brighton, UNITED KINGDOM
| | - Cristina Tacu
- Rheumatology, Brighton and Sussex University Hospital, Brighton, UNITED KINGDOM
| | - Benjamin D Clarke
- Academic Department of Rheumatology, King's College London, London, UNITED KINGDOM
| | - Mark Lloyd
- Rheumatology, Frimley Park Hospital, Frimley, UNITED KINGDOM
| | - Vijey Hajela
- Rheumatology, Brighton and Sussex University Hospital, Brighton, UNITED KINGDOM
| | - Thomas Batty
- Rheumatology, Brighton and Sussex University Hospital, Brighton, UNITED KINGDOM
| | | | - Sandra Smith
- Rheumatology, Frimley Park Hospital, Frimley, UNITED KINGDOM
| | - Hannah Irvine
- Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM
| | - Diane Hill
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Grace Baxter
- Rheumatology, Croydon University Hospital, Croydon, UNITED KINGDOM
| | - Natalie Horwood
- Rheumatology, Croydon University Hospital, Croydon, UNITED KINGDOM
| | - Suma Mahendrakar
- Rheumatology, Croydon University Hospital, Croydon, UNITED KINGDOM
| | - Rizwan Rajak
- Rheumatology, Croydon University Hospital, Croydon, UNITED KINGDOM
| | - Sian Griffith
- Rheumatology, East Surrey Hospital, Redhill, UNITED KINGDOM
| | - Patrick Kiely
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - James B Galloway
- Academic Department of Rheumatology, King's College London, London, UNITED KINGDOM
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24
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Collinson P, Kiely P. Unexpected Troponin Elevation in a Patient Treated with Atorvastatin. J Appl Lab Med 2020; 5:798-801. [DOI: 10.1093/jalm/jfaa031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/31/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Paul Collinson
- Departments of Clinical Blood Sciences and Cardiology, St George’s University Hospitals NHS Foundation Trust and St George’s University of London, London, UK
| | - Patrick Kiely
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust and Institute of Medical and Biomedical Education, St George’s University of London, London, UK
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25
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Kiely P, Busby AD, Nikiphorou E, Sullivan K, Walsh DA, Creamer P, Dixey J, Young A. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open 2019; 9:e028466. [PMID: 31061059 PMCID: PMC6501950 DOI: 10.1136/bmjopen-2018-028466] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To assess predictive factors for rheumatoid arthritis interstitial lung disease (RA-ILD) in two early rheumatoid arthritis (RA) inception cohorts with a focus on methotrexate (MTX) exposure. DESIGN Multicentre prospective early RA inception cohort studies; the early RA study (ERAS) and the early RA network (ERAN). SETTING Secondary care, ERAS nine centres, ERAN 23 centres in England, Wales and Ireland. PARTICIPANTS Patients with new diagnosis of RA, n=2701. Standardised data including demographics, drug therapies and clinical outcomes including the presence of RA-ILD were collected at baseline, within 3-6 months, at 12 months and annually thereafter. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the association of MTX exposure on RA-ILD diagnosis. Secondary outcomes were the association of demographic, comorbid and RA-specific factors on RA-ILD diagnosis and the association of MTX exposure on time to RA-ILD diagnosis. RESULTS Of 92 eligible ILD cases, 39 occurred in 1578 (2.5%) MTX exposed and 53 in 1114 (4.8%) non-MTX exposed cases. The primary analysis of RA-ILD cases only developing after any conventional synthetic disease-modifying antirheumatic drug treatment (n=67) showed MTX exposure not to be associated with incident RA-ILD (OR 0.85, 95% CI 0.49 to 1.49, p=0.578) and a non-significant trend for delayed ILD diagnosis (OR 0.54, 95% CI 0.28 to 1.06, p=0.072). In an extended analysis including RA-ILD cases present at RA diagnosis (n=92), MTX exposure was associated with a significantly reduced risk of incident RA-ILD (OR 0.48, 95% CI 0.3 to 0.79, p=0.004) and longer time to ILD diagnosis (OR 0.41, 95% CI 0.23 to 0.75, p=0.004). Other independent baseline associations with incident RA-ILD were higher age of RA onset, ever smoking, male gender, rheumatoid nodules and longer time from first RA symptom to first outpatient visit. CONCLUSIONS MTX treatment was not associated with an increased risk of RA-ILD diagnosis. On the contrary, evidence suggested that MTX may delay the onset of ILD.
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Affiliation(s)
- Patrick Kiely
- Department of Rheumatology, St Georges University Hospitals NHS Foundation Trust, London, UK
- Institute of Medical and Biomedical Education, St George’s, University of London, London, UK
| | - A D Busby
- Center for Health Services and Clinical Research and Post Graduate Medicine, University of Hertfordshire, Hatfield, UK
| | - E Nikiphorou
- Department of Academic Rheumatology, King’s College, London, UK
| | - K Sullivan
- Center for Health Services and Clinical Research and Post Graduate Medicine, University of Hertfordshire, Hatfield, UK
| | - D A Walsh
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - P Creamer
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - J Dixey
- Department of Rheumatology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shrewsbury, UK
| | - A Young
- Center for Health Services and Clinical Research and Post Graduate Medicine, University of Hertfordshire, Hatfield, UK
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26
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Howard S, Norton S, Nikiphorou E, Kiely P, Young A. O11 Are the elderly with rheumatoid arthritis treated less aggressively? Findings from an inception cohort. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez105.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone Howard
- Department of Inflammation Biology, King’s College London, London, United Kingdom
| | - Sam Norton
- Psychology Department, King’s College London, London, United Kingdom
- Department of Inflammation Biology, King’s College London, London, United Kingdom
| | - Elena Nikiphorou
- Department of Inflammation Biology, King’s College London, London, United Kingdom
| | - Patrick Kiely
- Rheumatology, St George’s Hospital, London, United Kingdom
| | - Adam Young
- Post Graduate Medical School, University of Hertfordshire, Hatfield, United Kingdom
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27
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Carpenter L, Nikiphorou E, Kiely P, Dixey J, Creamer P, Walsh DA, Young A, Norton S. 213 The long-term progression of disease activity, functional disability and quality of life using data from two early RA cohorts. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez107.029] [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: 11/12/2022] Open
Affiliation(s)
- Lewis Carpenter
- Health Psychology, King’s College London, London, UNITED KINGDOM
| | - Elena Nikiphorou
- Academic Rheumatology, King’s College London, London, UNITED KINGDOM
| | - Patrick Kiely
- Rheumatology, St George’s Hospital, London, UNITED KINGDOM
| | - Josh Dixey
- Rheumatology, THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST, Shropshire, UNITED KINGDOM
| | - Paul Creamer
- Rheumatology, North Bristol NHS Trust, Bristol, UNITED KINGDOM
| | - David A Walsh
- Rheumatology, University of Nottingham, Nottingham, UNITED KINGDOM
| | - Adam Young
- Post Graduate Medical School, University of Hertfordshire, Hatfield, UNITED KINGDOM
| | - Sam Norton
- Health Psychology, King’s College London, London, UNITED KINGDOM
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28
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Kiely P. I042 When the patient doesn’t fit the guideline for treatment: RA. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez109.041] [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: 11/14/2022] Open
Affiliation(s)
- Patrick Kiely
- Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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29
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Stack RJ, Nightingale P, Jinks C, Shaw K, Herron-Marx S, Horne R, Deighton C, Kiely P, Mallen C, Raza K. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open 2019; 9:e024361. [PMID: 30837252 PMCID: PMC6429945 DOI: 10.1136/bmjopen-2018-024361] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Received: 05/23/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. METHODS Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured. RESULTS 822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1-66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4-26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3-20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9-7.5 weeks). CONCLUSION This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.
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Affiliation(s)
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rob Horne
- UCL School of Pharmacy, UCL, London, UK
| | - Chris Deighton
- Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospital NHS Foundation Trust, London, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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30
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Edwards CJ, Kiely P, Arthanari S, Kiri S, Mount J, Barry J, Mitchell CR, Field P, Conaghan PG. Predicting disease progression and poor outcomes in patients with moderately active rheumatoid arthritis: a systematic review. Rheumatol Adv Pract 2019; 3:rkz002. [PMID: 31431990 PMCID: PMC6649936 DOI: 10.1093/rap/rkz002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Access to biologic DMARDs for RA is often restricted to those with severe disease. This systematic review aimed to identify prognostic factors in patients with moderate disease activity who may be at risk of disease progression and poor clinical outcomes. METHODS MEDLINE, Embase and Cochrane databases were searched (final search 22 September 2017), and data from patients with moderate disease [28-joint DAS (DAS28) >3.2-≤5.1] were included. Studies were evaluated according to the measure(s) of progression/poor outcome used: radiographic, disease activity or other indicators. RESULTS The searches identified 274 publications, of which 30 were selected for data extraction. Fourteen studies were prioritized, because they specifically analysed patients with moderate RA. Nine studies reported radiographic progression outcomes for 3241 patients, three studies reported disease activity progression for 1516 patients, and two studies reported other relevant outcomes for 2094 patients. Prognostic factors with consistent evidence for progression/poor outcome prediction were as follows: DAS28 ≥ 4.2, the presence of anti-CCP antibodies, and power Doppler ultrasound score ≥1. Some predictors were specific to either disease activity or radiographic progression. CONCLUSION Several criteria used in standard clinical practice were identified that have the potential to inform the selection of patients with moderate RA who are at greater risk of a poor outcome. A combination of two or more of these factors might enhance their predictive potential. Further work is required to derive clinical decision rules incorporating these factors.
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Affiliation(s)
- Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Patrick Kiely
- Rheumatology Department, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Subhashini Arthanari
- SAMETA (South Asia, Middle East, Turkey and Africa), Eli Lilly (Singapore) Pte Ltd, Singapore
| | | | - Julie Mount
- Global Patient Outcomes and Real Word Evidence (GPORWE) International
| | - Jane Barry
- Medical Affairs, Eli Lilly and Company Ltd, Basingstoke
| | | | - Polly Field
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
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31
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Carpenter L, Norton S, Nikiphorou E, Kiely P, Walsh DA, Dixey J, Young A. Validation of methods for converting the original Disease Activity Score (DAS) to the DAS28. Rheumatol Int 2018; 38:2297-2305. [PMID: 30368562 PMCID: PMC6223857 DOI: 10.1007/s00296-018-4184-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/10/2018] [Accepted: 10/20/2018] [Indexed: 01/09/2023]
Abstract
The Disease Activity Score (DAS) is integral in tailoring the clinical management of rheumatoid arthritis (RA) patients and is an important measure in clinical research. Different versions have been developed over the years to improve reliability and ease of use. Combining the original DAS and the newer DAS28 data in both contemporary and historical studies is important for both primary and secondary data analyses. As such, a methodologically robust means of converting the old DAS to the new DAS28 measure would be invaluable. Using data from The Early RA Study (ERAS), a sub-sample of patients with both DAS and DAS28 data were used to develop new regression imputation formulas using the total DAS score (univariate), and using the separate components of the DAS score (multivariate). DAS were transformed to DAS28 using an existing formula quoted in the literature, and the newly developed formulas. Bland and Altman plots were used to compare the transformed DAS with the recorded DAS28 to ascertain levels of agreement. The current transformation formula tended to overestimate the true DAS28 score, particularly at the higher end of the scale. A formula which uses all separate components of the DAS was found to estimate the scores with a higher level of precision. A new formula is proposed that can be used by other early RA cohorts to convert the original DAS to DAS28.
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Affiliation(s)
- Lewis Carpenter
- Health Psychology Section, King's College London, London, UK.
| | - Sam Norton
- Health Psychology Section, King's College London, London, UK
| | | | - Patrick Kiely
- Department of Rheumatology, St George's University Hospital NHS Foundation Trust, London, UK
| | - David A Walsh
- Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Josh Dixey
- Department of Rheumatology, Wolverhampton NHS Trust, Wolverhampton, UK
| | - Adam Young
- Postgraduate Medicine, University of Hertfordshire, Hatfield, UK
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32
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Cartwright TN, Worrell JC, Marchetti L, Dowling CM, Knox A, Kiely P, Mann J, Mann DA, Wilson CL. HDAC1 interacts with the p50 NF-?B subunit via its nuclear localization sequence to constrain inflammatory gene expression. Biochim Biophys Acta Gene Regul Mech 2018; 1861:962-970. [PMID: 30496041 DOI: 10.1016/j.bbagrm.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
The NF-?B p50 subunit is an important regulator of inflammation, with recent experimental evidence to support it also having a tumor suppressor role. Classically, p50 functions in heterodimeric form with the RelA (p65) NF-?B subunit to activate inflammatory genes. However, p50 also forms homodimers which actively repress NF-?B-dependent inflammatory gene expression and exert an important brake on the inflammatory process. This repressive activity of p50:p50 is thought to be in part mediated by an interaction with the epigenetic repressor protein Histone Deacetylase 1 (HDAC1). However, neither the interaction of p50 with HDAC1 nor the requirement of HDAC1 for the repressive activities of p50 has been well defined. Here we employed in silico prediction with in vitro assays to map sites of interaction of HDAC1 on the p50 protein. Directed mutagenesis of one such region resulted in almost complete loss of HDAC1 binding to p50. Transfected mutant p50 protein lacking the putative HDAC1 docking motif resulted in enhanced cytokine and chemokine expression when compared with cells expressing a transfected wild type p50. In addition, expression of this mutant p50 was associated with enhanced chemoattraction of neutrophils and acetylation of known inflammatory genes demonstrating the likely importance of the p50:HDAC1 interaction for controlling inflammation. These new insights provide an advance on current knowledge of the mechanisms by which NF-?B-dependent gene transcription are regulated and highlight the potential for manipulation of p50:HDAC1 interactions to bring about experimental modulation of chronic inflammation and pathologies associated with dysregulated neutrophil accumulation and activation.
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Affiliation(s)
- Tyrell N Cartwright
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | - Julie C Worrell
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | - Letizia Marchetti
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | | | - Amber Knox
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | - Patrick Kiely
- Health Research Institute, University of Limerick, Ireland
| | - Jelena Mann
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | - Derek A Mann
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK
| | - Caroline L Wilson
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, UK.
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33
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Rodziewicz M, Kiely P. The successful use of subcutaneous abatacept in refractory anti- human transcriptional intermediary factor 1-gamma dermatomyositis skin and oesphagopharyngeal disease. Rheumatology (Oxford) 2018; 57:1866-1867. [PMID: 29796600 DOI: 10.1093/rheumatology/key146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mia Rodziewicz
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Patrick Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
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34
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Day JP, Whiteley E, Freeley M, Long A, Malacrida B, Kiely P, Baillie GS. RAB40C regulates RACK1 stability via the ubiquitin-proteasome system. Future Sci OA 2018; 4:FSO317. [PMID: 30112187 PMCID: PMC6088270 DOI: 10.4155/fsoa-2018-0022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/15/2018] [Indexed: 11/17/2022] Open
Abstract
AIM RACK1 is a multifunctional scaffolding protein that is expressed in many cellular compartments, orchestrating a number of signaling processes. RACK1 acts as a signaling hub to localize active enzymes to discrete locations; therefore tight control of RACK1 is vital to cellular homeostasis. Our aim was to identify the mechanisms responsible for RACK1 turnover and show that degradation is directed by the ubiquitin proteasome system. RESULTS Using siRNA screening, we identified RAB40C as the ubiquitin E3 ligase responsible for ubiquitination of RACK1, and that the action of RAB40C in controlling RACK1 levels is crucial to both cancer cell growth and migration of T cells. CONCLUSION Our data suggest that manipulation of RACK1 levels in this way may provide a novel strategy to explore RACK1 function.
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Affiliation(s)
- Jon P Day
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Ellanor Whiteley
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Michael Freeley
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College, Dublin, D08 W9RT, Ireland
| | - Aideen Long
- Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College, Dublin, D08 W9RT, Ireland
| | - Beatrice Malacrida
- Materials & Surface Science Institute & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Patrick Kiely
- Materials & Surface Science Institute & Health Research Institute, University of Limerick, Limerick, Ireland
| | - George S Baillie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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35
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Watson GA, Ahmed Y, Picardo S, Chew S, Cobbe S, Mahony C, Crotty J, Wallis F, Shelly MJ, Kiely P, Ipadeola OB, Healy V, Osman N, Gupta RK. Unusual Sites of High-Grade Neuroendocrine Carcinomas: A Case Series and Review of the Literature. Am J Case Rep 2018; 19:710-723. [PMID: 29915166 PMCID: PMC6044230 DOI: 10.12659/ajcr.908953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/13/2022]
Abstract
Case series Patient: Female, 29 • Female, 69 • Female, 52 • Female, 71 • Male, 62 • Female, 67 Final Diagnosis: Neuroendocrine carcinoma Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Geoffrey A Watson
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Yasar Ahmed
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Sarah Picardo
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Sonya Chew
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Shona Cobbe
- Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
| | - Cillian Mahony
- Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
| | - James Crotty
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Fintan Wallis
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Martin J Shelly
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Patrick Kiely
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Olu Bunmi Ipadeola
- Department of Histopathology, University Hospital Limerick, Limerick, Ireland
| | - Vourneen Healy
- Department of Histopathology, University Hospital Limerick, Limerick, Ireland
| | - Nemer Osman
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Rajnish K Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
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36
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Kiely P, Styles C. Anti-HCV immunoblot indeterminate results in blood donors: non-specific reactivity or past exposure to HCV? Vox Sang 2018; 112:542-548. [PMID: 28850195 DOI: 10.1111/vox.12547] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The significance of anti-HCV immunoblot (IB) indeterminate results can be difficult to determine. We analysed results for blood donors tested on the MP Diagnostics HCV Blot 3.0 IB assay to determine whether indeterminate results representing past exposure to HCV could be distinguished from those due to non-specific reactivity. MATERIALS AND METHODS Results for all donors tested by IB during the study period (July 2010 to December 2013) were included in this study. RESULTS Of 131 donors tested by IB, 34 (26.0%) were negative, 38 (29.0%) were indeterminate, and 59 (45.0%) were positive. There was no significant difference in IB band reactivity strength between indeterminate and positive donors. The PRISM HCV chemiluminescent immunoassay (ChLIA) sample to cut-off (s/co) ratio distribution for the indeterminate donors was significantly higher than for those with biological false reactivity (P = 0·037), but significantly lower than for donors who were IB positive/HCV RNA negative (P < 0·001) or IB not tested/HCV RNA positive (P < 0·001). Of donors available for follow-up, 53.1% of the indeterminate group disclosed a putative risk factor for HCV infection compared to 39.4% (P < 0·001) for the IB-negative group, 76.6% (P = 0·065) for the IB-positive group and 83.4% (P < 0·001) for the HCV RNA-positive group. CONCLUSION The results of this study indicate that PRISM ChLIA s/co ratios >2·00 with IB indeterminate results predict exposure to HCV, particularly in the presence of putative risk factors for HCV infection. These findings may be applied to optimizing counselling of donors with indeterminate HCV results.
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Affiliation(s)
- P Kiely
- Australian Red Cross Blood Service, Melbourne, Vic., Australia
| | - C Styles
- Australian Red Cross Blood Service, Perth, WA, Australia
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37
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Ali SS, Kiely P. 020 Cardiovascular collapse on the ITU! Call the rheumatologist?! Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.244] [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: 11/14/2022] Open
Affiliation(s)
- Saadia S Ali
- Rheumatology, St George's Hospital, London, UNITED KINGDOM
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38
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Sofat N, Harrison A, Russell M, Kiely P, Barrick T, Howe F. 305 Pregabalin has efficacy for hand osteoarthritis pain: a proof-of-concept study using pain sensitisation measures. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.529] [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: 11/13/2022] Open
Affiliation(s)
- Nidhi Sofat
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
| | - Abiola Harrison
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
| | - Mark Russell
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
| | - Patrick Kiely
- Rheumatology, St George's Hospital, London, UNITED KINGDOM
| | - Thomas Barrick
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
| | - Franklyn Howe
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
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39
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Lloyd M, Kiely P, Sukumaran S, Makanjuola D, Karim Y. 108 Regionalexperience of igg4-related disease. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.332] [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: 11/13/2022] Open
Affiliation(s)
- Mark Lloyd
- Rheumatology, Frimley Park Hospital, Frimley, UNITED KINGDOM
| | - Patrick Kiely
- Rheumatology, St George's, University of London, London, UNITED KINGDOM
| | - Sunil Sukumaran
- Rheumatology, William Harvey Hospital, Ashford, UNITED KINGDOM
| | | | - Yousuf Karim
- Immunology, Frimley Park Hospital, Frimley, UNITED KINGDOM
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40
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Kiely P. i015 Haemochromatosis arthropathy. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.015] [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: 11/14/2022] Open
Affiliation(s)
- Patrick Kiely
- Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UNITED KINGDOM
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41
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Nikiphorou E, Norton S, Young A, Dixey J, Walsh D, Helliwell H, Kiely P. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network UK prospective cohorts. Rheumatology (Oxford) 2018; 57:1194-1202. [PMID: 29590474 DOI: 10.1093/rheumatology/key066] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/14/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine associations between BMI and disease activity, functional ability and quality of life in RA. METHODS Data from two consecutive, similarly designed UK multicentre RA inception cohorts were used: the Early RA Study (ERAS) and the Early RA Network (ERAN). Recruitment figures/median follow-up for the ERAS and ERAN were 1465/10 years (maximum 25 years), and 1236/6 years (maximum 10 years), respectively. Standard demographic and clinical variables were recorded at baseline and annually. Multilevel piecewise longitudinal models with a change point at 2 years were used with the 28-joint DAS (DAS28), ESR, HAQ and 36-item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) components as dependent variables. BMI was examined in separate models as both continuous and categorical variables (based on World Health Organization definitions) and up to 5 years from disease onset. RESULTS BMI data from 2386 newly diagnosed RA patients (11 348 measures) showed an increase in BMI of 0.27 U annually (95% CI 0.21, 0.33). Baseline obesity was associated with a significant reduction in the odds of achieving a low year 2 DAS28 [OR 0.52 (95% CI 0.41, 0.650)]. At year 2, HAQ and SF-36 PCS scores were significantly worse but not at year 5 in patients obese at baseline. Obesity at year 2 was associated with higher DAS28 scores at year 2, but not at year 5, and also associated with significantly higher HAQ and SF-36 PCS scores at years 2 and 5. CONCLUSION Obesity prevalence is rising in early RA and associates with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low DAS28. The data argue strongly for obesity management to become central to treatment strategies in RA.
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Affiliation(s)
- Elena Nikiphorou
- Academic Rheumatology Department, King's College London, UK.,Rheumatology, Whittington Hospital NHS Trust, London, UK
| | - Sam Norton
- Academic Rheumatology Department, King's College London, UK
| | - Adam Young
- Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, Hatfield, UK
| | - Josh Dixey
- Department of Rheumatology, New Cross Hospital, Wolverhampton, UK
| | - David Walsh
- Arthritis UK Pain Centre, University of Nottingham, Nottingham, UK
| | | | - Patrick Kiely
- Department of Rheumatology, St Georges University Hospitals NHS Foundation Trust, London, UK
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42
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Carpenter L, Norton S, Nikiphorou E, Jayakumar K, McWilliams DF, Rennie KL, Dixey J, Kiely P, Walsh DA, Young A. Reductions in Radiographic Progression in Early Rheumatoid Arthritis Over Twenty-Five Years: Changing Contribution From Rheumatoid Factor in Two Multicenter UK Inception Cohorts. Arthritis Care Res (Hoboken) 2017; 69:1809-1817. [DOI: 10.1002/acr.23217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Lewis Carpenter
- Centre for Clinical and Health Service Research; University of Hertfordshire; Hatfield UK
| | - Sam Norton
- Institute of Psychiatry, Psychology and Neuroscience; University of Hertfordshire; Hatfield UK
| | | | | | | | - Kirsten L. Rennie
- Centre for Clinical and Health Service Research; University of Hertfordshire; Hatfield UK
| | | | - Patrick Kiely
- St Georges University Hospitals NHS Foundation Trust; London UK
| | | | - Adam Young
- University of Hertfordshire; Hatfield UK
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43
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Edwards CJ, Östör AJK, Naisbett-Groet B, Kiely P. Tapering versus steady-state methotrexate in combination with tocilizumab for rheumatoid arthritis: a randomized, double-blind trial. Rheumatology (Oxford) 2017; 57:84-91. [DOI: 10.1093/rheumatology/kex358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christopher J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Andrew J K Östör
- Cabrini Medical Centre, Wattletree Road, Malvern, Victoria, Australia
| | | | - Patrick Kiely
- St George's University Hospitals NHS Foundation Trust, London, UK
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44
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Hoad VC, Seed CR, Fryk JJ, Harley R, Flower RLP, Hogema BM, Kiely P, Faddy HM. Hepatitis E virus RNA in Australian blood donors: prevalence and risk assessment. Vox Sang 2017; 112:614-621. [PMID: 28833229 DOI: 10.1111/vox.12559] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Hepatitis E virus (HEV) is a known transfusion-transmissible agent. HEV infection has increased in prevalence in many developed nations with RNA detection in donors as high as 1 in 600. A high proportion of HEV infections are asymptomatic and therefore not interdicted by donor exclusion criteria. To manage the HEV transfusion-transmission (TT) risk some developed nations have implemented HEV RNA screening. In Australia, HEV is rarely notified; although locally acquired infections have been reported, and the burden of disease is unknown. The purpose of this study was to determine the frequency of HEV infection in Australian donors and associated TT risk. MATERIALS AND METHODS Plasma samples (n = 74 131) were collected from whole blood donors during 2016 and screened for HEV RNA by transcription-mediated amplification (TMA) in pools of six. Individual TMA reactive samples were confirmed by RT-PCR and, if positive, viral load determined. Prevalence data from the study were used to model the HEV-TT risk. RESULTS One sample in 74 131 (95% CI: 1 in 1 481 781 to 1 in 15 031) was confirmed positive for HEV RNA, with an estimated viral load of 180 IU/ml, which is below that typically associated with TT. Using a transmission-risk model, we estimated the risk of an adverse outcome associated with TT-HEV of approximately 1 in 3·5 million components transfused. CONCLUSION Hepatitis E virus viremia is rare in Australia and lower than the published RNA prevalence estimates of other developed countries. The risk of TT-HEV adverse outcomes is negligible, and HEV RNA donor screening is not currently indicated.
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Affiliation(s)
- V C Hoad
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, WA, Australia
| | - C R Seed
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, WA, Australia
| | - J J Fryk
- Research and Development, Australian Red Cross Blood Service, Brisbane, QLD, Australia
| | - R Harley
- Clinical Services and Research, Australian Red Cross Blood Service, Brisbane, QLD, Australia
| | - R L P Flower
- Research and Development, Australian Red Cross Blood Service, Brisbane, QLD, Australia
| | - B M Hogema
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - P Kiely
- Clinical Services and Research, Australian Red Cross Blood Service, Melbourne, Vic., Australia
| | - H M Faddy
- Research and Development, Australian Red Cross Blood Service, Brisbane, QLD, Australia
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45
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Affiliation(s)
- Colin Bright
- Institute of Technology Tallaght, Dublin, Ireland
| | | | - Fiona McEvoy
- Institute of Technology Tallaght, Dublin, Ireland
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46
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Suresh R, Kiely P. E23. ANTI–TUMOUR NECROSIS FACTOR COST-SAVING AUDIT. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex063.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Varrier S, Kiely P. O41. PEMBROLIZUMAB THERAPY–INDUCED INFLAMMATORY ARTHROPATHY. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex061.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Nikiphorou E, Carpenter L, Norton S, Morris S, MacGregor A, Dixey J, Williams P, Kiely P, Walsh DA, Young A. Can Rheumatologists Predict Eventual Need for Orthopaedic Intervention in Patients with Rheumatoid Arthritis? Results of a Systematic Review and Analysis of Two UK Inception Cohorts. Curr Rheumatol Rep 2017; 19:12. [DOI: 10.1007/s11926-017-0636-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Daly A, Hoban A, Egan C, Moore D, Kiely P. The Implications of Delayed Access to MRI Imaging: A 3-month Historical Prospective Study. Ir Med J 2017; 110:524. [PMID: 28657268] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A Daly
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - A Hoban
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - C Egan
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - D Moore
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - P Kiely
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
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50
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Nikiphorou E, Norton S, Carpenter L, Dixey J, Andrew Walsh D, Kiely P, Young A. Secular Changes in Clinical Features at Presentation of Rheumatoid Arthritis: Increase in Comorbidity But Improved Inflammatory States. Arthritis Care Res (Hoboken) 2016; 69:21-27. [PMID: 27564223 DOI: 10.1002/acr.23014] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine secular trends in demographics, clinical manifestations, and comorbidity on first presentation of rheumatoid arthritis (RA) prior to disease-modifying antirheumatic drug treatment. METHODS A total of 2,701 patients were recruited over 25 years to 2 UK-based RA inception cohorts: the Early Rheumatoid Arthritis Study (9 centers; 1986-2001) and the Early Rheumatoid Arthritis Network (23 centers; 2002-2012). Trends in demographic and baseline clinical/laboratory and radiographic variables and comorbidities were estimated using mixed-effects models, including random effects for recruitment center. RESULTS Age at onset increased from 53.2 to 57.7 years in 1990 and 2010, respectively (2.6 months/year; 95% confidence interval [95% CI] 1.2, 4.1). Sex ratio, the proportion living in deprived areas, and smoking status were unchanged (P > 0.05) and there were no changes in the proportion seropositive or erosive at baseline (P > 0.05). After controlling for treatment at the time of assessment, erythrocyte sedimentation rate decreased and hemoglobin increased over time (P > 0.05); however, the Health Assessment Questionnaire (HAQ), the Disease Activity Score (DAS), the DAS in 28 joints, and joint counts were unchanged (P > 0.05). The overall prevalence of comorbidity increased from 29.0% in 1990 to 50.7% in 2010, mainly due to cardiovascular and non-cardiac vascular conditions, including hypertension. There was a significant increase in body mass index (0.15 units/year; 95% CI 0.11, 0.18), resulting in an increase in the prevalence of obesity from 13.3% in 1990 to 33.6% in 2010. CONCLUSION Age at onset and comorbidity burden, especially obesity, have increased at RA presentation over 25 years, reflecting wider demographic trends at the population level. In contrast, there were no accompanying changes in disease severity assessed by composite markers of disease activity, radiographic erosions, seropositivity, or HAQ at presentation. Treatment strategies in early RA should take greater account of the impact of comorbidity on outcomes.
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Affiliation(s)
- Elena Nikiphorou
- Whittington Hospital NHS Trust, London, UK, and Early Rheumatoid Arthritis Study, St. Albans City Hospital, St. Albans, UK
| | - Sam Norton
- Institute of Psychiatry, Psychology and Neuroscience, and Faculty of Life and Medical Science, King's College London, London, UK
| | - Lewis Carpenter
- Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield, UK
| | | | | | - Patrick Kiely
- St. Georges University Hospitals NHS Foundation Trust, London, UK
| | - Adam Young
- Early Rheumatoid Arthritis Study, St. Albans City Hospital, St. Albans, UK
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