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Harmer JR, Wyles CC, Duong SQ, Morgan Iii RJ, Maradit-Kremers H, Abdel MP. Depression and anxiety are associated with an increased risk of infection, revision, and reoperation following total hip or knee arthroplasty. Bone Joint J 2023; 105-B:526-533. [PMID: 37121583 DOI: 10.1302/0301-620x.105b5.bjj-2022-1123.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation. Between January 2000 and March 2019, 21,469 primary and revision arthroplasties (10,011 THAs; 11,458 TKAs), which were undertaken in 15,504 patients at a single academic medical centre, were identified from a 27-county linked electronic medical record (EMR) system. Depressive and anxiety disorders were identified by diagnoses in the EMR or by using a natural language processing program with subsequent validation from review of the medical records. Patients with mental health diagnoses other than anxiety or depression were excluded. Depressive and/or anxiety disorders were common before THA and TKA, with a prevalence of 30% in those who underwent primary THA, 33% in those who underwent revision THA, 32% in those who underwent primary TKA, and 35% in those who underwent revision TKA. The presence of depressive or anxiety disorders was associated with a significantly increased risk of any infection (primary THA, hazard ratio (HR) 1.5; revision THA, HR 1.9; primary TKA, HR 1.6; revision TKA, HR 1.8), revision (THA, HR 1.7; TKA, HR 1.6), re-revision (THA, HR 2.0; TKA, HR 1.6), and reoperation (primary THA, HR 1.6; revision THA, HR 2.2; primary TKA, HR 1.4; revision TKA, HR 1.9; p < 0.03 for all). Patients with preoperative depressive and/or anxiety disorders were significantly less likely to report "much better" joint function after primary THA (78% vs 87%) and primary TKA (86% vs 90%) compared with those without these disorders at two years postoperatively (p < 0.001 for all). The presence of depressive or anxiety disorders prior to primary or revision THA and TKA is common, and associated with a significantly higher risk of infection, revision, reoperation, and dissatisfaction. This topic deserves further study, and surgeons may consider mental health optimization to be of similar importance to preoperative variables such as diabetic control, prior to arthroplasty.
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Affiliation(s)
- Joshua R Harmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie Q Duong
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Robert J Morgan Iii
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Chen C, Milbrandt TA, Babadi E, Duong SQ, Larson DR, Shaughnessy WJ, Stans AA, Hull NC, Peterson HA, Larson AN. Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children. J Bone Joint Surg Am 2023; 105:468-478. [PMID: 36727888 DOI: 10.2106/jbjs.22.00690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of the GA cohort. METHODS A retrospective review of scanograms and upright slot-scanning radiographs obtained in otherwise healthy children between 2008 and 2020 was completed. A search of a radiology registry revealed 3,508 unique patients between the ages of 2 and 18 years for whom a standard-of-care scanogram or slot-scanning radiograph had been made. All patients with systemic illness, genetic conditions, or generalized diseases that may affect height were excluded. Measurements from a single leg at a single time point per subject were included, and the latest available time point was used for children who had multiple scanograms made. Quantile regression analysis was used to fit the lengths of the tibia and femur and overall leg length separately for male patients and female patients. RESULTS Seven hundred patients (328 female and 372 male) met the inclusion criteria. On average, the reported 50th percentile tibial lengths from the GA study at each time point were shorter than the lengths in this study by 2.2 cm (range, 1.4 to 3.3 cm) for boys and 2 cm (range, 1.1 to 3.1 cm) for girls. The reported 50th percentile femoral lengths from the GA study at each time point were shorter than the lengths in this study by 1.8 cm (range, 1.1 to 2.5 cm) for boys and 1.7 cm (range, 0.8 to 2.3 cm) shorter for girls. CONCLUSIONS This study developed new growth charts for femoral and tibial lengths in a modern U.S. population of children. The new femoral and tibial lengths at nearly all time points are 1 to 3 cm longer than traditional GA data. The use of GA data for epiphysiodesis could result in underestimation of expected childhood growth. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chunho Chen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elham Babadi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephanie Q Duong
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Hocaoğlu M, Davis MDP, Osei-Onomah SA, Valenzuela-Almada MO, Dabit JY, Duong SQ, Yang JX, Helmick CG, Crowson C, Duarte-García A. Epidemiology of Cutaneous Lupus Erythematosus Among Adults Over Four Decades (1976-2018): A Lupus Midwest Network (LUMEN) Study. Mayo Clin Proc 2022; 97:2282-2290. [PMID: 36347648 PMCID: PMC10013735 DOI: 10.1016/j.mayocp.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To characterize the epidemiological trends and mortality of cutaneous lupus erythematosus (CLE) between 1976 and 2018 in Olmsted County, Minnesota. PATIENTS AND METHODS In this retrospective population-based cohort study, all incident and prevalent CLE cases among adult residents in Olmsted County, Minnesota, between January 1, 1976, and December 31, 2018, were identified and categorized by subtype through medical record review using the resources of the Rochester Epidemiology Project. RESULTS The overall incidence rate of CLE between 1976 and 2018 was 3.9 (95% CI, 3.4 to 4.5) per 100,000. The incidence of CLE was relatively stable, with no major trend across sexes or age groups. The age- and sex-adjusted prevalence of CLE was 108.9 per 100,000 on January 1, 2015. Mortality in CLE patients was similar to that of the general population, with a standardized mortality ratio of 1.23 (95% CI, 0.88 to 1.66) with no observed trends in mortality over time. CONCLUSION In the past 4 decades, the incidence of CLE remained stable. Patients with CLE have mortality comparable to that of the general population.
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Affiliation(s)
- Mehmet Hocaoğlu
- Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore
| | | | | | | | - Jesse Y Dabit
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Stephanie Q Duong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Charles G Helmick
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Cynthia Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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4
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Chevet B, Figueroa-Parra G, Yang JX, Hulshizer CA, Gunderson TM, Duong SQ, Putman MS, Barbour KE, Crowson CS, Duarte-García A. COVID-19 Vaccine Uptake Among Patients With Systemic Lupus Erythematosus in the American Midwest: The Lupus Midwest Network (LUMEN). J Rheumatol 2022; 49:1276-1282. [PMID: 35777817 PMCID: PMC9633343 DOI: 10.3899/jrheum.220220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) are at higher risk of poor outcomes from coronavirus disease 2019 (COVID-19). The vaccination rate among such patients is unknown. We aimed to assess COVID-19 vaccine uptake among patients with SLE. METHODS We included 342 patients with SLE from the Lupus Midwest Network (LUMEN) and 350 age-, sex-, race-, and county-matched comparators. Vaccination uptake for influenza, pneumococcal, and zoster vaccines before pandemic restrictions began (up to February 29, 2020) was assessed. First-dose COVID-19 vaccine uptake was electronically retrieved and manually ascertained (December 15, 2020, to July 31, 2021). Time to COVID-19 vaccination, demographics, SLE manifestations, medications, Charlson Comorbidity Index, Area Deprivation Index, and Rural-Urban Commuting Area codes were compared. RESULTS On July 31, 2021, 83.3% of patients with SLE and 85.5% of comparators were vaccinated against COVID-19. The COVID-19 vaccination rates were similar among SLE and comparators (hazard ratio 0.93, 95% CI 0.79-1.10). Unvaccinated patients with SLE were more likely than vaccinated patients to be men (27.3% vs 14.1%), younger (mean age 54.1 vs 58.8 yrs), have a shorter SLE duration (median 7.3 vs 10.7 yrs), and be less frequently vaccinated with influenza and pneumococcal vaccines. CONCLUSION Patients with SLE in the Lupus Midwest Network had similar COVID-19 vaccination uptake as matched comparators, most of whom were vaccinated early when the vaccine became available. One in 6 patients with SLE remain unvaccinated.
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Affiliation(s)
- Baptiste Chevet
- B. Chevet, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA, and Division of Rheumatology, Brest Teaching Hospital, LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | | | - Jeffrey X Yang
- J.X. Yang, MD, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassondra A Hulshizer
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie Q Duong
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael S Putman
- M.S. Putman, MD, MSci, Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kamil E Barbour
- K.E. Barbour, PhD, MPH, MS, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alí Duarte-García
- A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
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5
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Vassilaki M, Crowson CS, Davis III JM, Duong SQ, Jones DT, Nguyen A, Mielke MM, Vemuri P, Myasoedova E. Rheumatoid Arthritis, Cognitive Impairment, and Neuroimaging Biomarkers: Results from the Mayo Clinic Study of Aging. J Alzheimers Dis 2022; 89:943-954. [PMID: 35964191 PMCID: PMC9535562 DOI: 10.3233/jad-220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Observational studies suggested that dementia risk in patients with rheumatoid arthritis (RA) is higher than in the general population. OBJECTIVE To examine the associations of RA with cognitive decline and dementia, and neuroimaging biomarkers of aging, Alzheimer's disease, and vascular pathology in adult participants in the Mayo Clinic Study of Aging (MCSA). METHODS Participants with RA were matched 1:3 on age, sex, education, and baseline cognitive diagnosis to participants without RA. RA cases with MRI were also matched with non-cases with available MRI. All available imaging studies (i.e., amyloid and FDG PET, sMRI, and FLAIR) were included. The study included 104 participants with RA and 312 without RA (mean age (standard deviation, SD) 75.0 (10.4) years, 33% male and average follow-up (SD) 4.2 (3.8) years). RESULTS Groups were similar in cognitive decline and risk of incident dementia. Among participants with neuroimaging, participants with RA (n = 33) and without RA (n = 98) had similar amyloid burden and neurodegeneration measures, including regions sensitive to aging and dementia, but greater mean white matter hyperintensity volume relative to the total intracranial volume (mean (SD)% : 1.12 (0.57)% versus 0.76 (0.69)% of TIV, p = 0.01), and had higher mean (SD) number of cortical infarctions (0.24 (0.44) versus 0.05 (0.33), p = 0.02). CONCLUSION Although cognitive decline and dementia risk were similar in participants with and without RA, participants with RA had more abnormal cerebrovascular pathology on neuroimaging. Future studies should examine the mechanisms underlying these changes and potential implications for prognostication and prevention of cognitive decline in RA.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Correspondence to: Maria Vassilaki, MD, PhD, MPH, Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1 507 293 7472; Fax: +1 507 284 1516; E-mail:
| | - Cynthia S. Crowson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Stephanie Q. Duong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Aivi Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,
Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Elena Myasoedova
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,
Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
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6
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Hannon CP, Sheehan KP, Duong SQ, Yuan BJ, Lewallen DG, Berry DJ, Abdel MP. Modular Fluted Tapered Stems for Periprosthetic Femoral Fractures: Excellent Results in 171 Cases. J Bone Joint Surg Am 2022; 104:1188-1196. [PMID: 35793797 DOI: 10.2106/jbjs.21.01168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Modular fluted tapered (MFT) stems have advanced treatment of Vancouver B2 and B3 periprosthetic femoral fractures, but series to date have been limited with respect to cohort size and follow-up duration. The purpose of this study was to determine implant survivorship, radiographic results, complications, and clinical outcomes of Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems in a large series of patients. METHODS We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femoral fractures treated with an MFT stem between 2000 and 2018 using our institutional total joint registry. The mean age was 75 years, 50% were female, and the mean body mass index was 29 kg/m2. The median stem diameter was 18 mm and median stem length was 210 mm. The cumulative incidences of revision and reoperation with death as the competing risk were calculated, radiographs were reviewed, and clinical outcomes were evaluated using the Harris hip score (HHS). The mean follow-up was 5 years. RESULTS The 10-year cumulative incidence of any revision was 10%. There were 17 revisions, of which only 3 were for the distal fluted portion of the MFT stem. Revision indications included periprosthetic joint infection (PJI) (n = 6) and dislocation (n = 11). The 10-year cumulative incidence of any reoperation was 15%. In addition to the above 17 revisions, there were 7 reoperations for superficial wound complications (n = 4), Vancouver B1 periprosthetic femoral fracture (n = 1), vascular occlusion (n = 1), and acetabular cartilage degeneration requiring an acetabular component (n = 1). Radiographically, there was 1 fracture nonunion. All unrevised MFT stems were radiographically well fixed. Subsidence of ≥5 mm occurred in 11%, but all implants were stable at the most recent follow-up. The mean HHS was 75 at 2 years (n = 71). CONCLUSIONS In this large series of 171 Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems, we found that such constructs were associated with a high rate of fracture healing and provided extremely reliable and durable implant fixation, with no revisions for aseptic loosening. Dislocation and PJI were the most common complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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7
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Ryan SP, Couch CG, Duong SQ, Taunton MJ, Lewallen DG, Berry DJ, Abdel MP. Frank Stinchfield Award: Does Bariatric Surgery Prior to Primary Total Hip Arthroplasty Really Improve Outcomes? J Arthroplasty 2022; 37:S386-S390. [PMID: 35241319 DOI: 10.1016/j.arth.2022.01.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal management of morbid obesity before total hip arthroplasty (THA) remains debated. Recently, bariatric procedures have become more common with advancements in surgical techniques. We hypothesized that bariatric surgery prior to primary THA would mitigate acute postoperative complications and improve implant survivorship. METHODS A retrospective review from 1995 to 2020 identified 88 primary THA procedures in 71 unique patients who previously underwent bariatric surgery (73% Roux-en-Y). This cohort was matched 1:1:1 for age, gender, surgical year, American Society of Anesthesiologists score, and Charlson Comorbidity Index to cohorts of patients with body mass index (BMI) <40 kg/m2 and BMI ≥40 kg/m2. Revisions, reoperations, and acute complications were compared. Subgroup analysis then evaluated historical (pre-2012) relative to contemporary (2012 and after) bariatric procedures. RESULTS Revision rates for bariatric patients were higher relative to controls with low (hazard ratio [HR] 19, P < .01) and high BMI (HR 8, P < .01). Reoperation rates showed a similar increase for bariatric patients when compared to low (HR 9, P < .01) and high BMI (HR 4, P = .01) patients. Moreover, bariatric patients had an increased dislocation risk compared to the low (HR 7, P = .03) and high BMI (HR 17, P < .01) patients. Contemporary bariatric techniques had similar complications, revisions, and reoperations relative to historical procedures. CONCLUSION Morbidly obese patients undergoing THA have increased risks of certain complications, but it is unclear if bariatric surgery improves this risk. This study found that patients undergoing bariatric surgery have worse implant survivorship and higher dislocation rates compared to patients with naturally low and high BMIs. Further investigation into the post-bariatric metabolic state is warranted. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Sean P Ryan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cory G Couch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Stephanie Q Duong
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Duong SQ, Crowson CS, Athreya A, Atkinson EJ, Davis JM, Warrington KJ, Matteson EL, Weinshilboum R, Wang L, Myasoedova E. Clinical predictors of response to methotrexate in patients with rheumatoid arthritis: a machine learning approach using clinical trial data. Arthritis Res Ther 2022; 24:162. [PMID: 35778714 PMCID: PMC9248180 DOI: 10.1186/s13075-022-02851-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/15/2022] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methotrexate is the preferred initial disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA). However, clinically useful tools for individualized prediction of response to methotrexate treatment in patients with RA are lacking. We aimed to identify clinical predictors of response to methotrexate in patients with rheumatoid arthritis (RA) using machine learning methods. METHODS Randomized clinical trials (RCT) of patients with RA who were DMARD-naïve and randomized to placebo plus methotrexate were identified and accessed through the Clinical Study Data Request Consortium and Vivli Center for Global Clinical Research Data. Studies with available Disease Activity Score with 28-joint count and erythrocyte sedimentation rate (DAS28-ESR) at baseline and 12 and 24 weeks were included. Latent class modeling of methotrexate response was performed. The least absolute shrinkage and selection operator (LASSO) and random forests methods were used to identify predictors of response. RESULTS A total of 775 patients from 4 RCTs were included (mean age 50 years, 80% female). Two distinct classes of patients were identified based on DAS28-ESR change over 24 weeks: "good responders" and "poor responders." Baseline DAS28-ESR, anti-citrullinated protein antibody (ACPA), and Health Assessment Questionnaire (HAQ) score were the top predictors of good response using LASSO (area under the curve [AUC] 0.79) and random forests (AUC 0.68) in the external validation set. DAS28-ESR ≤ 7.4, ACPA positive, and HAQ ≤ 2 provided the highest likelihood of response. Among patients with 12-week DAS28-ESR > 3.2, ≥ 1 point improvement in DAS28-ESR baseline-to-12-week was predictive of achieving DAS28-ESR ≤ 3.2 at 24 weeks. CONCLUSIONS We have developed and externally validated a prediction model for response to methotrexate within 24 weeks in DMARD-naïve patients with RA, providing variably weighted clinical features and defined cutoffs for clinical decision-making.
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Affiliation(s)
- Stephanie Q Duong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.,Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arjun Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA. .,Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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9
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Duarte-García A, Hocaoglu M, Valenzuela-Almada M, Osei-Onomah SA, Dabit JY, Sanchez-Rodriguez A, Duong SQ, Giblon RE, Langenfeld HE, Alarcón GS, Helmick CG, Crowson CS. Rising incidence and prevalence of systemic lupus erythematosus: a population-based study over four decades. Ann Rheum Dis 2022; 81:annrheumdis-2022-222276. [PMID: 35577385 PMCID: PMC10481386 DOI: 10.1136/annrheumdis-2022-222276] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine the trends in incidence, prevalence and mortality of systemic lupus erythematosus (SLE) in a US population over four decades. METHODS We identified all the patients with SLE in Olmsted County, Minnesota who fulfilled the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for SLE during 1976-2018. Age-specific and sex-specific incidence and prevalence rates were adjusted to the standard 2000 projected US population. The EULAR/ACR score was used as a proxy for disease severity. Standardised mortality ratio (SMR) was estimated. RESULTS There were 188 incident SLE cases in 1976-2018 (mean age 46.3±SD 16.9; 83% women). Overall age-adjusted and sex-adjusted annual SLE incidence per 100 000 population was 4.77 (95% CI 4.09 to 5.46). Incidence was higher in women (7.58) than men (1.89). The incidence rate increased from 3.32 during 1976-1988 to 6.44 during 2009-2018. Incidence rates were higher among the racial and ethnic minority populations than non-Hispanic whites. The EULAR/ACR score did not change significantly over time. Overall prevalence increased from 30.6 in 1985 to 97.4 in 2015. During the study period, there was no improvement in SMR over time (p=0.31). CONCLUSIONS The incidence and prevalence of SLE are increasing in this US population. The increase in incidence may be at least partially explained by the rising ethnic/racial diversity of the population. There was no evidence that the severity of SLE has changed over time. The survival gap between SLE and the general population remains unchanged. As the US population grows more diverse, we might continue to see an increase in the incidence of SLE.
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Affiliation(s)
- Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
| | | | | | - Jesse Y Dabit
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stephanie Q Duong
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Hannah E Langenfeld
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
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Koster MJ, Ghaffar U, Duong SQ, Crowson CS, Burke MM, Viers BR, Potretzke AM, Bjarnason H, Warrington KJ. Incidence, prevalence and mortality of chronic periaortitis: a population-based study. Clin Exp Rheumatol 2021; 40:751-757. [PMID: 35200130 PMCID: PMC9468868 DOI: 10.55563/clinexprheumatol/0v8l4j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the epidemiology, presentation and outcomes of patients with chronic periaortitis from 1998 through 2018. METHODS An inception cohort of patients with incident chronic periaortitis from January 1, 1998 through December 31, 2018, in Olmsted County, Minnesota was identified based on comprehensive individual medical record review utilising the Rochester Epidemiology Project medical record linkage system. Inclusion required radiographic and/or histologic confirmation of periarterial soft tissue thickening around at least part of the infra-renal abdominal aorta or the common iliac arteries. Data were collected on demographic characteristics, clinical presentation, renal and radiographic outcomes, and mortality. Incidence rates were age and sex adjusted to the 2010 United States white population. RESULTS Eleven incident cases of chronic periaortitis were identified during the study period. Average age at diagnosis was 61.8±13.4 years. The cohort included 9 men (82%) and 2 women (18%). Age- and sex-adjusted incidence rates per 100,000 population were 0.26 for females, 1.56 for males and 0.87 overall. Overall prevalence on January 1, 2015 was 8.98 per 100,000 population. Median (IQR) length of follow-up was 10.1 (2.5, 13.8) years. Overall mortality was similar to the expected age, sex, and calendar estimates of the Minnesota population with standardised mortality ratio (95% CI) for the entire cohort 2.07 (0.67, 4.84). CONCLUSIONS This study reports the first epidemiologic data on chronic periaortitis in the United States. In this cohort of patients with chronic periaortitis, men were 4 times more commonly affected than women. Mortality was not increased compared to the general population.
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Affiliation(s)
- Matthew J. Koster
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Umar Ghaffar
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Stephanie Q. Duong
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cynthia S. Crowson
- Department of Medicine, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michelle M. Burke
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Boyd R. Viers
- Department of Urology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Aaron M. Potretzke
- Department of Urology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Haraldur Bjarnason
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kenneth J. Warrington
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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