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Venuturupalli S, Peck A, Jinka Y, Fortune N, Davuluri N, Nowell WB, Gavigan K, Cush J, Soares N, Grainger R, Curtis JR. Home-Based Telemedicine in Rheumatology-A Scoping Review. ACR Open Rheumatol 2024; 6:312-320. [PMID: 38456334 PMCID: PMC11089445 DOI: 10.1002/acr2.11660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE We performed a scoping review of the relevant literature on home-based telehealth in rheumatology to understand its appropriate application in rheumatology practice. METHODS We searched the Cochrane Library, PubMed, Web of Science, and scientific meeting abstracts to identify articles that specifically addressed telehealth suitability, barriers to telehealth, patient-reported outcomes (PROs) collected in telehealth settings, and telehealth satisfaction. From the initial search of 4,882 studies, 23 reports were included. In addition, 10 abstracts were also eligible for analysis, resulting in a total of 33 articles: 2 randomized clinical trials, 9 prospective cohort studies, and 22 retrospective studies. RESULTS We found that triage appointments or predictive models could be helpful in selecting patients for telehealth and that telehealth interventions were appropriate for follow-up of patients with systemic lupus erythematosus and inflammatory arthritis, but that conducting new patient visits over telehealth was not ideal. Barriers to telehealth include patient factors (age, technology access) and need for physician/process factors (eg, physical examinations). PROs collected in regular practice can be incorporated into telehealth. Several small, single-center studies suggest that telehealth does not lead to negative outcomes compared with in-person visits, and overall, patients report high patient satisfaction with telehealth. In several scenarios, home-based telehealth was equivalent to in-person visits with regard to patient outcomes and satisfaction. CONCLUSION The widespread potential of telehealth to manage and deliver care for people with rheumatic disease is significant. As such, further research in the form of randomized controlled trials can help contribute to growing evidence that shapes telehealth implementation for patients with rheumatic diseases.
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Affiliation(s)
- Swamy Venuturupalli
- Cedars Sinai Medical Center, University of California Los Angeles, and Attune HealthLos AngelesCalifornia
| | - Alexander Peck
- Cedars Sinai Medical Center and Pacific Arthritis Care CenterLos AngelesCalifornia
| | | | | | | | | | | | - John Cush
- Texas Christian University Burnett School of MedicineFort Worth
| | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of MedicineKalamazoo
| | - Rebecca Grainger
- Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley and University of Otago WellingtonWellingtonNew Zealand
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Lopez-Alcalde J, Susan Wieland L, Barth J, Grainger R, Baxter N, Heron N, Triantafyllidis A, Carrion C, Trecca EMC, Holl F, Maria Wägner A, Edney S, Yan Y, Campos-Asensio C, Villanueva G, Ramsey RR, Witt CM. Methodological challenges in systematic reviews of mHealth interventions: Survey and consensus-based recommendations. Int J Med Inform 2024; 184:105345. [PMID: 38309237 DOI: 10.1016/j.ijmedinf.2024.105345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Mobile Health (mHealth) refers to using mobile devices to support health. This study aimed to identify specific methodological challenges in systematic reviews (SRs) of mHealth interventions and to develop guidance for addressing selected challenges. STUDY DESIGN AND SETTING Two-phase participatory research project. First, we sent an online survey to corresponding authors of SRs of mHealth interventions. On a five-category scale, survey respondents rated how challenging they found 24 methodological aspects in SRs of mHealth interventions compared to non-mHealth intervention SRs. Second, a subset of survey respondents participated in an online workshop to discuss recommendations to address the most challenging methodological aspects identified in the survey. Finally, consensus-based recommendations were developed based on the workshop discussion and subsequent interaction via email with the workshop participants and two external mHealth SR authors. RESULTS We contacted 953 corresponding authors of mHealth intervention SRs, of whom 50 (5 %) completed the survey. All the respondents identified at least one methodological aspect as more or much more challenging in mHealth intervention SRs than in non-mHealth SRs. A median of 11 (IQR 7.25-15) out of 24 aspects (46 %) were rated as more or much more challenging. Those most frequently reported were: defining intervention intensity and components (85 %), extracting mHealth intervention details (71 %), dealing with dynamic research with evolving interventions (70 %), assessing intervention integrity (69 %), defining the intervention (66 %) and maintaining an updated review (65 %). Eleven survey respondents participated in the workshop (five had authored more than three mHealth SRs). Eighteen consensus-based recommendations were developed to address issues related to mHealth intervention integrity and to keep mHealth SRs up to date. CONCLUSION mHealth SRs present specific methodological challenges compared to non-mHealth interventions, particularly related to intervention integrity and keeping SRs current. Our recommendations for addressing these challenges can improve mHealth SRs.
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Affiliation(s)
- Jesus Lopez-Alcalde
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Unidad de bioestadística clínica, Hospital Universitario Ramón y Cajal, (CIBERESP), Madrid, Spain.
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Heron
- Centre for Public Health, Queen's University Belfast, Northern Ireland, School of Medicine, Keele University, Staffordshire, England, United Kingdom
| | - Andreas Triantafyllidis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Carme Carrion
- eHealth Lab Research Group, Universitat Oberta de Catalunya (UOC), Spain
| | - Eleonora M C Trecca
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ana Maria Wägner
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sarah Edney
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yuqian Yan
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kanagasabai P, Ormandy J, Filoche S, Henry C, Te Whaiti S, Willink R, Gladman T, Grainger R. Can storytelling of women's lived experience enhance empathy in medical students? A pilot intervention study. Med Teach 2024; 46:219-224. [PMID: 37542361 DOI: 10.1080/0142159x.2023.2243023] [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] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
PURPOSE This pilot study aimed to investigate the acceptability and efficacy of a patient storytelling intervention (live and recorded) on empathy levels of medical students. MATERIALS AND METHODS Medical students participated in a storytelling intervention that had three components: listening to live or recorded stories from women with abnormal uterine bleeding, reflective writing, and a debriefing session. Empathy scores of students pre- and post-intervention were measured using the Jefferson Scale of Empathy-student version (JSE-S). Students also completed a feedback survey. Descriptive and inferential statistics were used to analyse quantitative data and content analysis was used for text comments. RESULTS Both live and recorded storytelling interventions had positive effects on student's empathy scores post intervention. Overall, students were satisfied with the intervention and reported that it improved their understanding of life experiences of women. Suggestions were made for an in-person storytelling session and interactive discussion after listening to each story. CONCLUSION A storytelling intervention has the potential to improve medical students' empathy and understanding of lived experience of women with health conditions. This could be valuable when student-patient interactions are limited in healthcare settings, or to enable stories of small numbers of patient volunteers to reach students.
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Affiliation(s)
| | - Judy Ormandy
- University of Otago, Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | | | | | - Sarah Te Whaiti
- University of Otago, Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Robin Willink
- Biostatistics group, University of Otago, Wellington, New Zealand
| | - Tehmina Gladman
- Education unit, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
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Yazdany J, Ware A, Wallace ZS, Bhana S, Grainger R, Hachulla E, Richez C, Cacoub P, Hausmann JS, Liew JW, Sirotich E, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Ribeiro SLE, Al-Emadi S, Hasseli R, Müller-Ladner U, Specker C, Schulze-Koops H, Bernardes M, Fraga VM, Rodrigues AM, Sparks JA, Ljung L, Di Giuseppe D, Tidblad L, Wise L, Duarte-García A, Ugarte-Gil MF, Colunga-Pedraza IJ, Martínez-Martínez MU, Alpizar-Rodriguez D, Xavier RM, Isnardi CA, Pera M, Pons-Estel G, Izadi Z, Gianfrancesco MA, Carrara G, Scirè CA, Zanetti A, Machado PM. Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res (Hoboken) 2024; 76:274-287. [PMID: 37643903 DOI: 10.1002/acr.25220] [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] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. RESULTS Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell-depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell-depleting therapy was associated with worse outcomes. CONCLUSION Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
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Affiliation(s)
| | - Anna Ware
- National Center for Collaborative Healthcare Innovation, Palo Alto Department of Veterans Affairs Healthcare System, Palo Alto, California
| | | | | | - Rebecca Grainger
- University of Otago Wellington and Te Whatu Ora, Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire (CHU) de Lille, pour la Filière des maladies Auto-Immunes et Autoinflammatoires Rares, Lille, France
| | - Christophe Richez
- Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux, pour la Société Française de Rhumatologie, Bordeaux, France
| | - Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Société Nationale Française de Médecine Interne, Paris, France
| | - Jonathan S Hausmann
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center and Charité University Hospital, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European Alliance of Associations for Rheumatology, Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Rebecca Hasseli
- University Hospital Munster, Munster, Germany, and Justus Liebig University Giessen, Kerckhoff, Germany
| | | | | | | | - Miguel Bernardes
- University of Porto and Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Ana Maria Rodrigues
- Sociedade Portuguesa de Reumatologia and Comprehensive Health Research Centre, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lotta Ljung
- Karolinska Institutet and Academic Specialist Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Manuel F Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémica, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | | | | | | | - Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Mariana Pera
- Hospital Angel C. Padilla, San Miguel de Tucuman, Tucuman, Argentina
| | - Guillermo Pons-Estel
- Universidad Nacional de Rosario, Rosario, Argentina, and College of Physicians of the Province of Santa Fe 2nd, Santa Fe, Argentina
| | | | | | | | - Carlo Alberto Scirè
- Italian Society for Rheumatology and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Maheswaranathan M, Miller B, Ung N, Sinha R, Harrison C, Egeli BH, Degirmenci HB, Sirotich E, Liew JW, Grainger R, Chock EY. Patient perspectives on telemedicine use in rheumatology during the COVID-19 pandemic: survey results from the COVID-19 Global Rheumatology Alliance. Clin Rheumatol 2024; 43:543-552. [PMID: 37552351 DOI: 10.1007/s10067-023-06717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/15/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The COVID-19 pandemic resulted in rapid adoption of telemedicine in rheumatology. We described perspectives of patients with rheumatic diseases related to telemedicine use. METHODS An anonymous online survey for people with rheumatic diseases was launched in January 2021. We collected data on reasons for telemedicine use, perceived benefits, disadvantages and obstacles of telemedicine, perceived telemedicine effectiveness for different clinical tasks, level of satisfaction with telemedicine use, and future preferences for telemedicine. We summarized results with descriptive statistics and identified themes in free text responses to describe perspectives of telemedicine qualitatively. RESULTS We received 596 complete responses (85% female and 47% 41-60 years old). During the COVID-19 pandemic, 78% (467/596) of respondents used telemedicine, and 61% (283/467) of telemedicine users reported that telemedicine was as effective or more effective than an in-person visit. Younger participants and those in North America reported effectiveness and satisfaction with telemedicine at higher frequencies. Participants reported similar effectiveness to in-person visits for making medication changes and discussing disease symptoms or complications. CONCLUSION Most respondents found telemedicine at least as effective as in-person visits. Participants found telemedicine to be effective for specific scenarios, such as making medication changes and discussion of disease activity. Telemedicine may continue to be of importance in the care of patients with rheumatic diseases post pandemic, but likely for specific subsets of patients for specific visit indications. Key Points • Most patients with rheumatic disease found telemedicine as effective as in-person visits, particularly for some indications.
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Affiliation(s)
- Mithu Maheswaranathan
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Bruce Miller
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, San Diego, CA, USA
| | - Natasha Ung
- NSW Health, St Leonards, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | | | - Carly Harrison
- LupusChat, New York, NY, USA
- COVID-19 Global Rheumatology Alliance, New York, NY, USA
| | - Bugra Han Egeli
- Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Huseyin Berk Degirmenci
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Emily Sirotich
- COVID-19 Global Rheumatology Alliance, New York, NY, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Jean W Liew
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Eugenia Y Chock
- Section of Rheumatology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Grainger R, Liu Q, Gladman T. Learning technology in health professions education: Realising an (un)imagined future. Med Educ 2024; 58:36-46. [PMID: 37555302 DOI: 10.1111/medu.15185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023]
Abstract
CONTEXT Technology is being introduced, used and studied in almost all areas of health professions education (HPE), often with a claim of making HPE better in one way or another. However, it remains unclear if technology has driven real change in HPE. In this article, we seek to develop an understanding of the transformative capacity of learning technology in HPE. METHODS AND OUTCOMES We first consider the wider scholarship highlighting the intersection between technology and pedagogy, articulating what is meant by transformation and the role of learning technology in driving educational transformation. We then undertake a synthesis of the current high visibility HPE-focused research. We sampled the literature in two ways-for the five highest impact factor health professional education journals over the past decade and for all PubMed indexed journals for the last 3 years-and categorised the extant research against the Substitution, Augmentation, Modification, Redefinition model. We found that the majority of research we sampled focussed on substituting or augmenting learning through technology, with relatively few studies using technology to modify or redefine what HPE is through the use of technology. Of more concern was the lack of theoretical justification for pedagogical improvement, including transformation, underpinning the majority of studies. CONCLUSIONS While all kinds of technology use in learning have their place, the next step for HPE is the robust use of technology aiming to lead transformation. This should be guided by transformational educational theory and aligned with pedagogical context. We challenge HPE practitioners and scholars to work thoughtfully and with intent to enable transformation in education for future health professionals.
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Affiliation(s)
- Rebecca Grainger
- Education Unit Te Pou Whirinaki, University of Otago Wellington, Wellington, New Zealand
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Qian Liu
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand
| | - Tehmina Gladman
- Education Unit Te Pou Whirinaki, University of Otago Wellington, Wellington, New Zealand
- Otago Medical School, University of Otago, Dunedin, New Zealand
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Mongkolporn A, Satpanich P, Grainger R, Jatuworapruk K. GOUT-36 prediction rule is sensitive in predicting gout flare during COVID-19 hospitalization. Int J Rheum Dis 2024; 27:e15010. [PMID: 38140784 DOI: 10.1111/1756-185x.15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Ariya Mongkolporn
- Department of Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Thailand
| | - Panchalee Satpanich
- Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kanon Jatuworapruk
- Department of Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Thailand
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Hsieh E, Dey D, Grainger R, Li M, Machado PM, Ugarte-Gil MF, Yazdany J. Global Perspective on the Impact of the COVID-19 Pandemic on Rheumatology and Health Equity. Arthritis Care Res (Hoboken) 2024; 76:22-31. [PMID: 37277949 DOI: 10.1002/acr.25169] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
Although the public health emergency associated with the COVID-19 pandemic has ended, challenges remain, especially for individuals with rheumatic diseases. We aimed to assess the historical and ongoing effects of COVID-19 on individuals with rheumatic diseases and rheumatology practices globally, with specific attention to vulnerable communities and lessons learned. We reviewed literature from several countries and regions, including Africa, Australia and New Zealand, China, Europe, Latin America, and the US. In this review, we summarize literature that not only examines the impact of the pandemic on individuals with rheumatic diseases, but also research that reports the lasting changes to rheumatology patient care and practice, and health service use. Across countries, challenges faced by individuals with rheumatic diseases during the pandemic included disruptions in health care and medication supply shortages. These challenges were associated with worse disease and mental health outcomes in some studies, particularly among those who had social vulnerabilities defined by socioeconomic, race, or rurality. Moreover, rheumatology practice was impacted in all regions, with the uptake of telemedicine and changes in health care utilization. While many regions developed rapid guidelines to disseminate scientific information, misinformation and disinformation remained widespread. Finally, vaccine uptake among individuals with rheumatic diseases has been uneven across the world. As the acute phase of the pandemic wanes, ongoing efforts are needed to improve health care access, stabilize rheumatology drug supplies, improve public health communication, and implement evidence-based vaccination practices to reduce COVID-19 morbidity and mortality among individuals with rheumatic diseases.
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Affiliation(s)
- Evelyn Hsieh
- Yale School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Dzifa Dey
- Korle-bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | | | - Mengtao Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, and London North West University Healthcare NHS Trust, London, UK
| | - Manuel F Ugarte-Gil
- Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Perú
| | - Jinoos Yazdany
- San Francisco General Hospital and University of California, San Francisco
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9
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Darlow B, Brown M, Stanley J, Abbott JH, Briggs AM, Clark J, Frew G, Grainger R, Hood F, Hudson B, Keenan R, Marra C, McKinlay E, Pask A, Pierobon A, Simmonds S, Vincent L, Wilson R, Dean S. Reducing the burden of knee osteoarthritis through community pharmacy: Protocol for a randomised controlled trial of the Knee Care for Arthritis through Pharmacy Service. Musculoskeletal Care 2023; 21:1053-1067. [PMID: 37212721 DOI: 10.1002/msc.1785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/02/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Knee osteoarthritis (OA) negatively impacts the health outcomes and equity, social and employment participation, and socio-economic wellbeing of those affected. Little community-based support is offered to people with knee OA in Aotearoa New Zealand. Identifying Māori and non-Māori with knee OA in community pharmacy and providing co-ordinated, evidence- and community-based care may be a scalable, sustainable, equitable, effective and cost-effective approach to improve health and wellbeing. AIM Assess whether the Knee Care for Arthritis through Pharmacy Service (KneeCAPS) intervention improves knee-related physical function and pain (co-primary outcomes). Secondary aims assess impacts on health-related quality of life, employment participation, medication use, secondary health care utilisation, and relative effectiveness for Māori. METHODS AND ANALYSIS A pragmatic randomised controlled trial will compare the KneeCAPS intervention to the Pharmaceutical Society of New Zealand Arthritis Fact Sheet and usual care (active control) at 12 months for Māori and non-Māori who have knee OA. Participants will be recruited in community pharmacies. Knee-related physical function will be measured using the function subscale of the Short Form of the Western Ontario and McMaster Universities Osteoarthritis Index. Knee-related pain will be measured using an 11-point numeric pain rating scale. Primary outcome analyses will be conducted on an intention-to-treat basis using linear mixed models. Parallel within-trial health economic analysis and process evaluation will also be conducted. ETHICS AND TRIAL DISSEMINATION Ethical approval was obtained from the Central Health and Ethics Committee (2022-EXP-11725). The trial is registered with ANZCTR (ACTRN12622000469718). Findings will be submitted for publication and shared with participants.
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Affiliation(s)
- Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Melanie Brown
- University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- University of Otago Wellington, Wellington, New Zealand
| | | | | | - Jane Clark
- Consumer Research Partner, Wellington, New Zealand
| | - Gareth Frew
- Canterbury Community Pharmacy Group, Christchurch, New Zealand
| | | | - Fiona Hood
- University of Otago Wellington, Wellington, New Zealand
| | - Ben Hudson
- University of Otago Christchurch, Christchurch, New Zealand
| | - Rāwiri Keenan
- University of Otago Wellington, Wellington, New Zealand
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10
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Jatuworapruk K, Grainger R. Technology, COVID-19, and approaching the insoluble problems of gout care. Lancet Rheumatol 2023; 5:e570-e571. [PMID: 38251478 DOI: 10.1016/s2665-9913(23)00217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington 6242, New Zealand; Te Whatu Ora | Health New Zealand Capital Coast and Hutt Valley, Wellington, New Zealand.
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11
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Conway R, Nikiphorou E, Demetriou CA, Low C, Leamy K, Ryan JG, Kavanagh R, Fraser AD, Carey JJ, O'Connell P, Flood RM, Mullan RH, Kane DJ, Stafford F, Robinson PC, Liew JW, Grainger R, McCarthy GM. Outcomes of COVID-19 in people with rheumatic and musculoskeletal disease in Ireland over the first 2 years of the pandemic. Ir J Med Sci 2023; 192:2495-2500. [PMID: 36622628 PMCID: PMC9827440 DOI: 10.1007/s11845-022-03265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Poor COVID-19 outcomes occur with higher frequency in people with rheumatic and musculoskeletal diseases (RMD). Better understanding of the factors involved is crucial to informing patients and clinicians regarding risk mitigation. AIM To describe COVID-19 outcomes for people with RMD in Ireland over the first 2 years of the pandemic. METHODS Data entered into the C19-GRA provider registry from Ireland between 24th March 2020 and 31st March 2022 were analysed. Differences in the likelihood of hospitalisation and mortality according to demographic and clinical variables were investigated. RESULTS Of 237 cases included, 59.9% were female, 95 (41.3%) were hospitalised, and 22 (9.3%) died. Hospitalisation was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular and pulmonary disease, and cancer. Hospitalisation was less frequent in people with inflammatory arthritis and conventional synthetic or biologic disease-modifying antirheumatic drug use. Hospitalisation had a U-shaped relationship with disease activity, being more common in both high disease activity and remission. Mortality was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular disease, pulmonary disease, and obesity. Inflammatory arthritis was less frequent in those who died. CONCLUSION Hospitalisation or death were more frequently experienced by RMD patients with increasing age, certain comorbidities including potentially modifiable ones, and certain medications and diagnoses amongst other factors. These are important 'indicators' that can help risk-stratify and inform the management of RMD patients.
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Affiliation(s)
- Richard Conway
- Department of Rheumatology, St. James's Hospital, James Street, Dublin 8, Ireland.
- Trinity College Dublin, Dublin, Ireland.
| | - Elena Nikiphorou
- Department of Rheumatology, King's College Hospital, London, UK
- Centre for RMDs, King's College London, London, UK
| | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Candice Low
- Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Kelly Leamy
- Department of Rheumatology, Mater Misericordiae Hospital, Dublin 1, Ireland
| | - John G Ryan
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Alexander D Fraser
- Department of Rheumatology, University Hospitals Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - John J Carey
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
- National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connell
- Department of Rheumatology, Beaumont Hospital, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachael M Flood
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Ronan H Mullan
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - David J Kane
- Trinity College Dublin, Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | | | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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12
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Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Nikpour M, Grainger R, Barnabe C, Lin I. What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines. Clin Rheumatol 2023; 42:2267-2278. [PMID: 37291382 PMCID: PMC10412487 DOI: 10.1007/s10067-023-06654-0] [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: 02/15/2023] [Revised: 05/10/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. TRIAL REGISTRATION: The protocol for this review was registered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/UB3Y7 ).
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Affiliation(s)
- Brooke Conley
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
| | - Samantha Bunzli
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | | | - Penny O’Brien
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Melbourne, VIC Australia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia, Perth, WA Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Tilini Gunatillake
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Melbourne, VIC Australia
| | - Mandana Nikpour
- Departments of Medicine and Rheumatology Melbourne, The University of Melbourne at St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Health New Zealand – Capital Coast and Hutt Valley, Wellington, New Zealand
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, WA Australia
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13
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Denecke K, Romero OR, Petersen C, Benham-Hutchins M, Cabrer M, Davies S, Grainger R, Hussein R, Lopez-Campos G, Martin-Sanchez F, McKillop M, Merolli M, Miron-Shatz T, Trigo JD, Wright G, Wynn R, Hullin Lucay Cossio C, Gabarron E. Defining and Scoping Participatory Health Informatics: An eDelphi Study. Methods Inf Med 2023; 62:90-99. [PMID: 36787885 PMCID: PMC10462430 DOI: 10.1055/a-2035-3008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/22/2022] [Accepted: 10/08/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Health care has evolved to support the involvement of individuals in decision making by, for example, using mobile apps and wearables that may help empower people to actively participate in their treatment and health monitoring. While the term "participatory health informatics" (PHI) has emerged in literature to describe these activities, along with the use of social media for health purposes, the scope of the research field of PHI is not yet well defined. OBJECTIVE This article proposes a preliminary definition of PHI and defines the scope of the field. METHODS We used an adapted Delphi study design to gain consensus from participants on a definition developed from a previous review of literature. From the literature we derived a set of attributes describing PHI as comprising 18 characteristics, 14 aims, and 4 relations. We invited researchers, health professionals, and health informaticians to score these characteristics and aims of PHI and their relations to other fields over three survey rounds. In the first round participants were able to offer additional attributes for voting. RESULTS The first round had 44 participants, with 28 participants participating in all three rounds. These 28 participants were gender-balanced and comprised participants from industry, academia, and health sectors from all continents. Consensus was reached on 16 characteristics, 9 aims, and 6 related fields. DISCUSSION The consensus reached on attributes of PHI describe PHI as a multidisciplinary field that uses information technology and delivers tools with a focus on individual-centered care. It studies various effects of the use of such tools and technology. Its aims address the individuals in the role of patients, but also the health of a society as a whole. There are relationships to the fields of health informatics, digital health, medical informatics, and consumer health informatics. CONCLUSION We have proposed a preliminary definition, aims, and relationships of PHI based on literature and expert consensus. These can begin to be used to support development of research priorities and outcomes measurements.
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Affiliation(s)
- Kerstin Denecke
- Bern University of Applied Sciences, Department Engineering and Computer Science, Institute for Medical Informatics, Bern, Switzerland
| | - Octavio Rivera Romero
- Instituto de Ingeniería Informática (I3US), Universidad de Sevilla, Sevilla, Spain
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | | | - Marge Benham-Hutchins
- College of Nursing and Health Sciences, Texas A&M University Corpus Christi, Texas, Corpus Christi, United States
| | | | - Shauna Davies
- Faculty of Nursing, University of Regina, Regina, SK, Canada
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Rada Hussein
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Guillermo Lopez-Campos
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Mark Merolli
- Department of Physiotherapy, School of Health Sciences, the University of Melbourne, Melbourne, Australia
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Talya Miron-Shatz
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Jesús Daniel Trigo
- Department of Electrical, Electronic and Communications Engineering, Public University of Navarra, Institute of Smart Cities (ISC), Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Graham Wright
- Department of Information Systems, Rhodes University, Grahamstown, South Africa
| | - Rolf Wynn
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Carol Hullin Lucay Cossio
- Data Governance Manager, Victoria Legal Aid, Melbourne, Australia
- College Economy & Business, The University of Tasmania, Tasmania, Australia
- Digital Innovation Centre for Latinoamerican Region, Temuco, Chile
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
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14
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Brooks J, Montgomery A, Dalbeth N, Sapsford M, Ngan Kee R, Cooper A, Quincey V, Bhana S, Gore-Massy M, Hausmann J, Liew J, Machado PM, Sufka P, Sirotich E, Robinson P, Wallace Z, Yazdany J, Grainger R. Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand. Lancet Reg Health West Pac 2023; 38:100843. [PMID: 37520279 PMCID: PMC10372177 DOI: 10.1016/j.lanwpc.2023.100843] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
Background Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting. Methods This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death. Findings Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old. Interpretation In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable. Funding Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.
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Affiliation(s)
- Jonathon Brooks
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Anna Montgomery
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, New Zealand
| | - Mark Sapsford
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Rachel Ngan Kee
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Amy Cooper
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Vicki Quincey
- Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | | | | | - Jonathan Hausmann
- Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M. Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | | | - Philip Robinson
- University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Zachary Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital Coast and Hutt, Wellington, New Zealand
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15
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Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PF, Nikpour M, Grainger R, Lin I. What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines. BMC Rheumatol 2023; 7:15. [PMID: 37316871 PMCID: PMC10268528 DOI: 10.1186/s41927-023-00335-w] [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: 11/17/2022] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs. METHODS Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched. RESULTS Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan. CONCLUSION Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care. TRIAL REGISTRATION The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).
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Affiliation(s)
- Brooke Conley
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
| | - Samantha Bunzli
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | | | - Penny O’Brien
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia, Perth, WA Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Tilini Gunatillake
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Mandana Nikpour
- Departments of Medicine and Rheumatology, The University of Melbourne at St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Health New Zealand – Capital Coast and Hutt Valley, Wellington, New Zealand
| | - Ivan Lin
- The University of Western Australia, Western Australian Centre for Rural Health, Geraldton, WA Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, WA Australia
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16
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O'Brien DW, Norman S, Grainger R, Ellis R, Hudson B, Nakarada-Kordic I, Abbott JH. Exploring the current and future osteoarthritis health service delivery needs in Aotearoa New Zealand. N Z Med J 2023; 136:55-66. [PMID: 37054455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
AIM Osteoarthritis (OA) affects the wellbeing of one in 10 people in Aotearoa New Zealand, yet current healthcare delivery for these people is fragmented, un-coordinated and inconsistent. How current and future needs should be addressed has not been systematically explored. This study aimed to describe the views of interested people from the health sector regarding current and future OA health service delivery in the public health system in Aotearoa New Zealand. METHOD Data were collected via a co-design approach within an interprofessional workshop at the Taupuni Hao Huatau Kaikōiwi: Osteoarthritis Aotearoa New Zealand Basecamp symposium and analysed using direct qualitative content analysis. RESULTS The results highlighted several promising current healthcare delivery initiatives. Health literacy and obesity prevention policies featured in the thematic analysis suggesting a lifespan or systemwide approach is needed. Data highlighted a need for reformed systems that enhances hauora/wellbeing, promotes physical activity, facilitates interprofessional service delivery and collaborates across care settings. CONCLUSION Participants identified several promising healthcare delivery initiatives for people with OA in Aotearoa New Zealand. Public health policy initiatives are needed to reduce osteoarthritis risk factors. Developing future care pathways should support the diverse needs within Aotearoa New Zealand, coordinate and stratify care, value interprofessional collaboration and practice, and improve health literacy and self-management.
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Affiliation(s)
- Daniel W O'Brien
- Senior Lecturer, Department of Physiotherapy, Auckland University of Technology, Auckland
| | - Sam Norman
- Teaching Assistant, Department of Physiotherapy, Auckland University of Technology, Auckland
| | | | - Richard Ellis
- Associate Professor, Department of Physiotherapy, Auckland University of Technology, Auckland
| | - Ben Hudson
- Head of Department, Department of Primary Care and Clinical Simulation, University of Otago, Christchurch
| | | | - J Haxby Abbott
- Professor, Department of Surgical Sciences, University of Otago, Dunedin
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17
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Morillon MB, Nørup A, Singh JA, Dalbeth N, Taylor WJ, Kennedy MA, Pedersen BM, Grainger R, Tugwell P, Perez-Ruiz F, Diaz-Torne C, Edwards NL, Shea B, Ellingsen TJ, Christensen R, Stamp LK. Outcome reporting in randomized trials in gout: A systematic scoping review from the OMERACT gout working group assessing the uptake of the core outcome set. Semin Arthritis Rheum 2023; 60:152191. [PMID: 36963128 DOI: 10.1016/j.semarthrit.2023.152191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE The selection and reporting of core outcome measures in clinical trials is essential for patients, researchers, and healthcare providers for clinical research to have an impact on healthcare. In this systematic scoping review, we aimed to quantify the extent to which gout clinical trials are collecting and reporting data in accordance with the core outcome domains from Outcome Measures in Rheumatology (OMERACT) published in 2009 applicable for both acute and chronic trials and evaluate the reporting according to the core domains before and after the 2009 OMERACT endorsement. METHODS We searched multiple databases PubMed, EMBASE, the Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) and www. CLINICALTRIALS gov for randomized controlled trials (RCTs) allocating people with gout versus an active pharmacological gout treatment or a control comparator (no date limitation). We extracted the data in accordance with the core outcome sets, focusing individually on core outcome domains and the core outcome measurements for acute and chronic trials, respectively. In this study 'Acute trials' reflect studies that describe interventions for short term management of gout flares, and 'chronic trials' describe interventions for long-term urate lowering therapy in the management of gout. RESULTS From 8,522 records identified in the database search, 134 full text papers were reviewed, and 71 trials were included, of which 36 were acute and 35 were chronic. Only 3 of 36 (8%) acute trials reported all five core domains and none of the 35 included chronic trials reported all 7 core domains. In the acute trials, twenty-seven unique measurement instruments across the 5 core domains were identified. For chronic trials there were 31 unique measurement instruments used across the 7 core domains. Serum urate was reported in 100% of the chronic trials and gout flares in 80%. However, other core domains were reported in <30% of chronic trials. In particular the patient-important domains such as HR-QOL, patient global assessment and activity limitations were rarely reported. A broad variety of different measurement instruments were used to assess each endorsed core domain, a minority of trials used the OMERACT endorsed instruments. For acute trials, the number reporting on all core domains was consistently low and no change was detected before and after the endorsement of the core domains in 2009. None of the included chronic trials reported on all 7 endorsed core domains at any time. CONCLUSION In this study we found a low adherence with the intended endorsed (i.e., core) outcome domains for acute and chronic gout studies which represents a poor uptake of the global OMERACT efforts for the minimum of what should be measured in clinical trials. In addition, there is a significant variation in how the OMERACT endorsed outcome domains have been measured. This systematic review demonstrates the need for continuous encouragement among gout researchers to adhere to OMERACT core domains as well as further guidance on outcome measurements reporting. REGISTRATION Prospero: CRD42019151316.
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Affiliation(s)
- Melanie B Morillon
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Department of Internal Medicine, Odense University Hospital, Svendborg, Denmark
| | - Alexander Nørup
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Jasvinder A Singh
- Birmingham Veterans Affairs (VA) Medical Center and University of Alabama, Birmingham, AL, United States
| | | | | | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, Christchurch, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fernando Perez-Ruiz
- Rheumatology Division, Osakidetza, OSI-EE Cruces, Cruces University Hospital, Barakaldo, Spain
| | - Cesar Diaz-Torne
- Rheumatology Department. Hospital de la Sant Pau. Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Beverley Shea
- Clinical Epidemiology program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Torkell J Ellingsen
- Department of Clinical Research, University of Southern Denmark; the Department of Rheumatology, Odense University Hospital, the Faculty of Health Sciences, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
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18
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Darlow B, Brown M, Hudson B, Frew G, Clark J, Vincent L, Grainger R, Marra C, McKinlay E, Abbott JH, Briggs AM. Knee osteoarthritis and the knowledgeable, trustworthy pharmacist: Patient and pharmacist perceptions of community pharmacy-based education and support. Musculoskeletal Care 2023; 21:3-15. [PMID: 35615979 DOI: 10.1002/msc.1660] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Osteoarthritis (OA) clinical guidelines recommend self-management education, but education is often not included in primary care consultations. OBJECTIVE To explore pharmacists' and patients' perceptions of a pharmacist-led model of service delivery for knee OA that was integrated within pharmacies' day-to-day workflow. METHODS Cross-sectional qualitative design using Thematic Analysis. Community pharmacies were recruited in New Zealand and Australia. Pharmacy patients were screened for knee OA and offered tailored explanations, self-management information and referral for further support. Pharmacist focus groups and patient 1:1 interviews explored perceptions of the service delivery model. RESULTS Nineteen pharmacists and 12 patients with knee OA participated. Pharmacist and patient data were analysed separately, with themes compared and contrasted to derive three meta-themes. Meta-theme 1: 'Welcome Engagement' included two pharmacist themes ('putting my broad skill set to use' and 'we're here and happy to help') and two patient themes ('information delivered well' and 'a welcome offer of help'). Meta-theme 2: 'The Knowledgeable and Trustworthy Pharmacist' included two pharmacist themes ('professional knowledge to help all sorts of patients' and 'managing time to help my patients') and one patient theme ('the accessible professional who I know and trust'). Meta-theme 3: 'The Opportunity for More Support' included one pharmacist theme ('this is not the end of the story') and one patient theme ('more help is available'). CONCLUSION Community pharmacists are well-positioned to provide information and support to people with knee OA. Pharmacists appreciate the opportunity to better use their skills and accessibility for OA care, and patients welcome this engagement.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Gareth Frew
- Canterbury Community Pharmacy Group, Christchurch, New Zealand
| | - Jane Clark
- Consumer Research Partner, Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Carlo Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - J Haxby Abbott
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Australia
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19
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Machado PM, Schäfer M, Mahil SK, Liew J, Gossec L, Dand N, Pfeil A, Strangfeld A, Regierer AC, Fautrel B, Alonso CG, Saad CGS, Griffiths CEM, Lomater C, Miceli-Richard C, Wendling D, Alpizar Rodriguez D, Wiek D, Mateus EF, Sirotich E, Soriano ER, Ribeiro FM, Omura F, Rajão Martins F, Santos H, Dau J, Barker JN, Hausmann J, Hyrich KL, Gensler L, Silva L, Jacobsohn L, Carmona L, Pinheiro MM, Zelaya MD, Severina MDLÁ, Yates M, Dubreuil M, Gore-Massy M, Romeo N, Haroon N, Sufka P, Grainger R, Hasseli R, Lawson-Tovey S, Bhana S, Pham T, Olofsson T, Bautista-Molano W, Wallace ZS, Yiu ZZN, Yazdany J, Robinson PC, Smith CH. Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries. Ann Rheum Dis 2023; 82:698-709. [PMID: 36787993 PMCID: PMC10176347 DOI: 10.1136/ard-2022-223499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS Demographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression. RESULTS Of 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39-2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42-0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19. CONCLUSION Older age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.
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Affiliation(s)
- Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Martin Schäfer
- Epidemiology and Health Services Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France.,AP-HP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany.,Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Anne Constanze Regierer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Bruno Fautrel
- Rheumatology, Pitié-Salpêtrière hospital, AP - HP, Paris, France
| | | | - Carla G S Saad
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Claudia Lomater
- Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy
| | - Corinne Miceli-Richard
- Assistance Publique, Hôpital Cochin, Hôpitaux de Paris & Université de Paris, Paris, France.,Unité Mixte AP-HP/ Institut Pasteur, Institut Pasteur, Paris, France
| | - Daniel Wendling
- Rheumatology, Franche-Comté University and University Teaching Hospital (CHRU), Besançon, France
| | | | - Dieter Wiek
- People with Arthritis and Rheumatism (PARE), EULAR, Zurich, Switzerland
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.,European Alliance of Associations for Rheumatology (EULAR), Kilchberg, Switzerland
| | - Emily Sirotich
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Francinne Machado Ribeiro
- Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | | | - Helena Santos
- Instituto Português de Reumatologia, Lisbon, Portugal.,EpiDoC Unit, CEDOC, Nova Medical School, Lisbon, Portugal
| | - Jonathan Dau
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jonathan Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimme L Hyrich
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Gensler
- University of California, San Francisco, California, USA
| | - Ligia Silva
- Rheumatology, Centro Hospitalar de Trás-os-montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Marcelo M Pinheiro
- Rheumatology, Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - María de Los Ángeles Severina
- Centro Privado de Medicina Nuclear and Clinica Villa Dalcar, Córdoba, Argentina.,Clinica Villa Dalcar, Río Cuarto, Córdoba, Argentina
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Maureen Dubreuil
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Nigil Haroon
- Rheumatology, University Health Network, Toronto, Ontario, Canada.,Senior Scientist, Schroder Arthritis Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Sufka
- Healthpartners, St. Paul, Minnesota, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Hasseli
- Department of Internal Medicine II, University Hospitals Giessen, Giessen, Germany.,Justus Liebig University Giessen, Giessen, Germany
| | - Saskia Lawson-Tovey
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | | | - Thao Pham
- Rheumatology, Aix-Marseille-University, Marseille, France.,Rheumatology, APHM, Marseille, France
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Wilson Bautista-Molano
- Rheumatology Division, University Hospital Fundación Santa Fé de Bogotá, Bogota, Colombia.,School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Zenas Z N Yiu
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | - Philip C Robinson
- School of Clinical Medicine, University of Queensland, Herston, Queensland, Australia.,Rheumatology, Royal Brisbane and Woman's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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20
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Ngan Kee R, Milne V, Dalbeth N, Grainger R. Patient participation in defining best-practice rheumatology service provision in Aotearoa New Zealand: a qualitative study with service consumers. BMC Rheumatol 2023; 7:1. [PMID: 36694263 PMCID: PMC9872402 DOI: 10.1186/s41927-022-00319-2] [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: 03/30/2022] [Accepted: 11/02/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Aotearoa New Zealand (AoNZ) has no agreed models for rheumatology service provision in government-funded health care. We aimed to describe what people with inflammatory rheumatic diseases who have used rheumatology services view as being important in those services, and map these views to previously collated statements describing best practice components of rheumatology services from international recommendations. If these statements did not capture all service aspects that people with inflammatory rheumatic diseases considered important, we aimed to co-create new statements with our patient-participants. METHODS We conducted one focus group and an interview with people with inflammatory rheumatic disease who had used a government-funded rheumatology service in the previous 5 years (patient-participants) and analysed data using thematic analysis. The research team mapped subthemes to previously collated best practice recommendations that had been included in a Delphi consensus exercise with rheumatologists in AoNZ and proposed new statements, based on patient-participant data. Patient-participant feedback on thematic analysis and the new statements led to a refining of statements. A patient-partner in the research team informed research design and data analysis. RESULTS Patient-participants viewed it as highly valuable for rheumatology services to respect and value their experiences as people and patients, and those of their whānau (Māori word for family). They expected rheumatology services to provide the right care, at the right time. Many of the subthemes mapped to the best-practice statements. However, three new principles and three new statements were developed and refined by patient-participants. The three principles addressed valuing individuals, and their whānau (family) and their experiences, and providing a patient-focused health system that supports patient participation in decision-making and self-management, and patient education. New statements related to having a specific rheumatologist and other staff for comprehensive care, having adequate nurse staffing, and active provision of outside services and support. CONCLUSION It was important to patients that rheumatology services demonstrated that patients and their whānau (family) were valued. The inclusion of people with rheumatic diseases who are users of rheumatology services in service development can provide valuable insights to inform how services should be delivered.
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Affiliation(s)
- Rachel Ngan Kee
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand
| | | | - Nicola Dalbeth
- grid.9654.e0000 0004 0372 3343Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand ,grid.414057.30000 0001 0042 379XDepartment of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Rebecca Grainger
- grid.29980.3a0000 0004 1936 7830Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Newtown, Wellington South 6242 New Zealand ,grid.413663.50000 0001 0842 2548Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
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21
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Donskov AO, Mackie SL, Hauge EM, Toro-Gutiérrez CE, Hansen IT, Hemmig AK, Van der Maas A, Gheita T, Nielsen BD, Douglas KMJ, Conway R, Rezus E, Dasgupta B, Monti S, Matteson EL, Sattui SE, Matza M, Ocampo V, Gromova M, Grainger R, Bran A, Appenzeller S, Goecke A, Colman N, Keen HI, Kuwana M, Gupta L, Salim B, Harifi G, Erraoui M, Ziade N, Al-Ani NA, Ajibade A, Knitza J, Frølund L, Yates M, Pimentel-Quiroz VR, Lyrio AM, Sandovici M, Van der Geest KSM, Helliwell T, Brouwer E, Dejaco C, Keller KK. An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists. Rheumatology (Oxford) 2023:6986973. [PMID: 36637182 DOI: 10.1093/rheumatology/keac713] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To explore current management practices for polymyalgia rheumatica (PMR) by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment. METHODS An English language questionnaire was constructed by a working group of rheumatologists and GPs from 6 countries. The questionnaire focused on: 1: Respondent characteristics, 2: Referral practices, 3: Treatment with glucocorticoids, 4: Diagnostics, 5: Comorbidities, and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/giant cell arteritis Study Group. RESULTS In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR >2 weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing >25 mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials. CONCLUSION This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment naïve patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.
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Affiliation(s)
| | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ellen Margrethe Hauge
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Ib Tønder Hansen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Tamer Gheita
- Rheumatology and Clinical Immunology, Cairo University, Cairo, Egypt
| | | | - Karen M J Douglas
- Department of Rheumatology, Dudley Group NHS FT, Dudley, United Kingdom
| | - Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Elena Rezus
- Department of Rheumatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital, Southend, United Kingdom
| | - Sara Monti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia.,Department of Internal Medicine and Therapeutics, Università di Pavia
| | - Eric L Matteson
- Mayo Clinic College of Medicine and Science, Division of Rheumatology, Rochester, United States of America
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Matza
- Rheumatology Unit, Massachusetts General Hospital, Boston, United States of America
| | - Vanessa Ocampo
- University of Toronto - Center for Prognosis studies in Rheumatic Diseases, Toronto Western Hospital. Rheumatology Department -Scarborough Health Network and Kensington Eye Institute. Toronto, Canada
| | - Margarita Gromova
- Faculty therapy, Pirogov National Russian Research Medical University, Moscow, Russian Federation
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Andrea Bran
- Department of medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology-School of Medical Science, University of Campinas, Campinas, Brazil
| | - Annelise Goecke
- Rheumatology Section, Department of Medicine, University of Chilés Clinical Hospital, Santiago, Chile
| | - Nelly Colman
- Universidad Nacional de Asunción, Hospital de Clinicas, Asunción, Paraguay
| | - Helen I Keen
- Medical School, UWA, Perth Australia, Rheumatology Department, Fiona Stanley Hospital, Perth, Australia
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, United Kingdom.,Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Babur Salim
- Fauji Foundation Hospital Rawalpindi, Rheumatology, Rawalpindi, Pakistan
| | - Ghita Harifi
- Mediclinic Parkview Hospital, Dubai Health Authority, Rheumatology, Dubai, United Arab Emirates
| | - Mariam Erraoui
- Ibn Zohr University, Faculty of Medicine and Pharmacy, Department of Rheumatology, Agadir, Morocco
| | - Nelly Ziade
- Rheumatology, Saint-Joseph University, Beirut, Lebanon
| | | | - Adeola Ajibade
- Department of Rheumatology, Royal Wolverhampton Hospital NHS Trust, Wolverhampton, United Kingdom.,Rheumatology Unit, Internal Medicine Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Johannes Knitza
- Friedrich-Alexander-University ErlangenNürnberg (FAU) and Universitätsklinikum Erlangen, Medizinische Klinik 3, Erlangen, Germany
| | - Line Frølund
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
| | - Max Yates
- Centre for Epidemiology, Norwich Medical School, University of East Anglia, NR4 7UQ, United Kingdom.,Department of Rheumatology, Norfolk and Norwich University Hospital, NR4 7UY, United Kingdom
| | - Victor R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.,Universidad Científica del Sur, Lima, Perú
| | - Andre Marun Lyrio
- Department of general medicine/Rheumatology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kornelis S M Van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Toby Helliwell
- Staffordshire, University of Staffordshire, School of Medicine, United Kingdom
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck (SABES-ASAA), Bruneck, Italy
| | - Kresten Krarup Keller
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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22
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Kanagasabai PS, Filoche S, Grainger R, Henry C, Hay-Smith J. Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review. Int J Gynaecol Obstet 2023; 160:38-48. [PMID: 35429335 PMCID: PMC10084285 DOI: 10.1002/ijgo.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with abnormal uterine bleeding (AUB) experience barriers to accessing healthcare services. OBJECTIVES To identify and describe the evidence on interventions to improve healthcare access of women with AUB. SEARCH STRATEGY A systematic search of databases including Medline, CINAHL, EMBASE, Scopus, and Cochrane register for clinical trials on February 26, 2021. SELECTION CRITERIA Studies including women with AUB and investigating an intervention to improve access at the levels of individual patient, community, organization, health system, or medical education. DATA COLLECTION AND ANALYSIS Data extraction and descriptive analysis of the country, study design, settings, participant characteristics, intervention, outcome measures, and key findings. MAIN RESULTS We identified 20 studies and most interventions (13 studies) targeted organizational changes. Creating a multidisciplinary team, bringing services together and developing a care pathway improved the availability of services. Management of AUB in an outpatient setting improved the affordability. The use of decision aids improved patient engagement in consultations. There is a lack of interventions at an individual or community level targeting health literacy, health beliefs, social acceptability, and opportunity to reach and pay for services. CONCLUSIONS Community-based culturally-adapted interventions focusing on access to women with different socio-economic and cultural backgrounds should be investigated.
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Affiliation(s)
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Institute, University of Otago Wellington, Wellington, New Zealand
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23
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Ugarte-Gil MF, Alarcón GS, Seet AM, Izadi Z, Montgomery AD, Duarte-García A, Gilbert EL, Valenzuela-Almada MO, Wise L, Sparks JA, Hsu TYT, D'Silva KM, Patel NJ, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Wallace Z, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Machado PM, Robinson PC, Gianfrancesco M, Yazdany J. Association Between Race/Ethnicity and COVID-19 Outcomes in Systemic Lupus Erythematosus Patients From the United States: Data From the COVID-19 Global Rheumatology Alliance. Arthritis Care Res (Hoboken) 2023; 75:53-60. [PMID: 36239292 PMCID: PMC9874592 DOI: 10.1002/acr.25039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the association between race/ethnicity and COVID-19 outcomes in individuals with systemic lupus erythematosus (SLE). METHODS Individuals with SLE from the US with data entered into the COVID-19 Global Rheumatology Alliance registry between March 24, 2020 and August 27, 2021 were included. Variables included age, sex, race, and ethnicity (White, Black, Hispanic, other), comorbidities, disease activity, pandemic time period, glucocorticoid dose, antimalarials, and immunosuppressive drug use. The ordinal outcome categories were: not hospitalized, hospitalized with no oxygenation, hospitalized with any ventilation or oxygenation, and death. We constructed ordinal logistic regression models evaluating the relationship between race/ethnicity and COVID-19 severity, adjusting for possible confounders. RESULTS We included 523 patients; 473 (90.4%) were female and the mean ± SD age was 46.6 ± 14.0 years. A total of 358 patients (74.6%) were not hospitalized; 40 patients (8.3%) were hospitalized without oxygen, 64 patients (13.3%) were hospitalized with any oxygenation, and 18 (3.8%) died. In a multivariable model, Black (odds ratio [OR] 2.73 [95% confidence interval (95% CI) 1.36-5.53]) and Hispanic (OR 2.76 [95% CI 1.34-5.69]) individuals had higher odds of more severe outcomes than White individuals. CONCLUSION Black and Hispanic individuals with SLE experienced more severe COVID-19 outcomes, which is consistent with findings in the US general population. These results likely reflect socioeconomic and health disparities and suggest that more aggressive efforts are needed to prevent and treat infection in this population.
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Affiliation(s)
- Manuel F Ugarte-Gil
- Universidad Cientifica del Sur and Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Heersink School of Medicine, University of Alabama at Birmingham, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | | | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristin M D'Silva
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Naomi J Patel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emily Sirotich
- McMaster University, Hamilton, and Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Jean W Liew
- Boston University School of Medicine, Boston, Massachusetts
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Zachary Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European League Against Rheumatism Standing Committee of People with Arthritis/Rheumatism in Europe, Kilchberg, Switzerland
| | - Kimme L Hyrich
- University of Manchester, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | - Saskia Lawson-Tovey
- University of Manchester, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | | | - Pedro M Machado
- University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Herston, and Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
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24
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Grainger R, Milne V. COVID-19 Disrupts Rheumatology Care: An Opportunity for Innovation? J Rheumatol 2022:jrheum.221122. [PMID: 36521925 DOI: 10.3899/jrheum.221122] [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: 06/17/2023]
Abstract
Pandemics are disruptive. Transport, commerce, education, recreation, and health are all affected. As a rheumatology community, we should be particularly considering the effects on rheumatology care and patient outcomes.
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Affiliation(s)
- Rebecca Grainger
- R. Grainger, PhD, Professor, Department of Medicine, University of Otago Wellington, and Rheumatologist, Te Whatu Ora|Health New Zealand, Capital Coast and Hutt; V. Milne, Research Fellow, PhD, Department of Medicine, University of Otago Wellington, Wellington, New Zealand. RG reports personal fees from AbbVie, Janssen, Cornerstones, Novartis; and meeting attendance support from Pfizer. VM declares no conflicts of interest relevant to this article. Address correspondence to Dr. R. Grainger, Department of Medicine, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand.
| | - Valerie Milne
- R. Grainger, PhD, Professor, Department of Medicine, University of Otago Wellington, and Rheumatologist, Te Whatu Ora|Health New Zealand, Capital Coast and Hutt; V. Milne, Research Fellow, PhD, Department of Medicine, University of Otago Wellington, Wellington, New Zealand. RG reports personal fees from AbbVie, Janssen, Cornerstones, Novartis; and meeting attendance support from Pfizer. VM declares no conflicts of interest relevant to this article. Address correspondence to Dr. R. Grainger, Department of Medicine, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand.
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25
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Machado PM, Verschueren P, Grainger R, Jones H, Piercy J, van Beneden K, Caporali R, Dejaco C, Fautrel B. Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries. Rheumatol Adv Pract 2022; 7:rkac108. [PMID: 36601518 PMCID: PMC9800854 DOI: 10.1093/rap/rkac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.
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Affiliation(s)
- Pedro M Machado
- Correspondence to: Pedro M. Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10–12 Russell Square, London WC1B 5EH, UK. E-mail:
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hannah Jones
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - James Piercy
- Health Economics and Outcomes Research, Adelphi Real World, Bollington, UK
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy
| | | | - Bruno Fautrel
- Service de Rhumatologie, Sorbonne Université-Assistance Publique-Hôpitaux de Paris, Paris, France
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26
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Liu Q, Geertshuis S, Gladman T, Grainger R. Student video production within health professions education: A scoping review. Med Educ Online 2022; 27:2040349. [PMID: 35180045 PMCID: PMC8865118 DOI: 10.1080/10872981.2022.2040349] [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] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recent technological developments have influenced a shift in the use of videos in Health Professions Education (HPE). Rather than casting students in the role of observers of videos, educators have been asking students to produce videos as a learning activity. The assumption is that video production is often an active and collaborative exercise, therefore could engage students and enhance learning. However, applications of this emerging pedagogical approach vary, and there has not been a knowledge synthesis to guide future research and practice. METHODS With a view to mapping existing knowledge, identifying avenues for further research, and informing practice, we conducted a scoping review to establish current understanding of video production in HPE. We undertook a literature search of seven databases and identified thirty-six studies. RESULTS The findings showed considerable variation in purposes and implementation approaches, consequences and challenges associated with video production. In particular, the assumption that creating a video automatically promotes student engagement was not well supported, especially when the intended learning was not made apparent to students. CONCLUSION Overall, the review suggests that despite the increasing adoption of video production in HPE, the purposes are often unclear; pedagogical considerations underlying project design are limited, which risks undermining the intended learning. To optimise educational benefits, future video production projects should be explicit in their intention and approach, draw upon pedagogical theories, anticipate and address implementation issues, and be robust in their formative and summative assessment processes. Future research should more explicitly show the relationship between the intended learning and the underlying pedagogy and thoroughly evaluate the effectiveness and feasibility of video production projects.
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Affiliation(s)
- Qian Liu
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand
| | - Susan Geertshuis
- Department of Management and International Business, University of Auckland, Auckland, New Zealand
| | - Tehmina Gladman
- Education Unit, University of Otago, Wellington, New Zealand
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27
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA, Hill C, Ranganathan D, Kronbichler A, Blockmans D, Barra L, Carette S, Pagnoux C, Dhindsa N, Fifi‐Mah A, Khalidi N, Liang P, Milman N, Pineau C, Tian X, Wang G, Wang T, Zhao M, Tesar V, Baslund B, Hammam N, Shahin A, Pirila L, Putaala J, Hellmich B, Henes J, Holle J, Lamprecht P, Moosig F, Neumann T, Schmidt W, Sunderkoettey C, Szekanecz Z, Danda D, Das S, Gupta R, Rajasekhar L, Sharma A, Wagh S, Clarkson M, Molloy E, Salvarani C, Schiavon F, Tombetti E, Vaglio A, Amano K, Arimura Y, Dobashi H, Fujimoto S, Harigai M, Hirano F, Hirahashi J, Honma S, Kawakami T, Kobayashi S, Kono H, Makino H, Matsui K, Muso E, Suzuki K, Ikeda K, Takeuchi T, Tsukamoto T, Uchida S, Wada T, Yamada H, Yamagata K, Yumura W, Lai KS, Flores‐Suarez LF, Hinojosa‐Azaola A, Rutgers B, Tak P, Grainger R, Quincey V, Stamp L, Suppiah R, Besada E, Diamantopoulos A, Sznajd J, Azevedo E, Geraldes R, Rodrigues M, Santos E, Song Y, Moiseev S, Hočevar A, Cid MC, Moreno XS, Atukorala I, Berglin E, Mohammed A, Segelmark M, Daikeler T, Direskeneli H, Hatemi G, Kamali S, Karadağ Ö, Pehlevan S, Adler M, Basu N, Bruce I, Chakravarty K, Dasgupta B, Flossmann O, Gendi N, Hassan A, Hoyles R, Jayne D, Jones C, Klocke R, Lanyon P, Laversuch C, Luqmani R, Robson J, Magliano M, Mason J, Maw WW, McInnes I, Mclaren J, Morgan M, Morgan A, Mukhtyar C, O'Riordan E, Patel S, Peall A, Robson J, Venkatachalam S, Vermaak E, Menon A, Watts R, Yee C, Albert D, Calabrese L, Chung S, Forbess L, Gaffo A, Gewurz‐Singer O, Grayson P, Liang K, Matteson E, Merkel PA, Rhee R, Springer J, Sreih A. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol 2022; 74:1872-1880. [PMID: 36349501 DOI: 10.1002/art.42324] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for Takayasu arteritis (TAK). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. RESULTS The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94-0.99) with a sensitivity of 93.8% (95% CI 88.6-97.1%) and specificity of 99.2% (95% CI 96.7-100.0%). CONCLUSION The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Acadámico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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Jatuworapruk K, Satpanich P, Robinson PC, Grainger R. Prevalence, Risk Factors, and Outcomes of Gout Flare in Patients Hospitalized for PCR-Confirmed COVID-19: A Multicenter Retrospective Cohort Study. J Rheumatol Suppl 2022; 50:556-563. [PMID: 36379566 DOI: 10.3899/jrheum.220762] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study aimed to describe the prevalence and outcomes of gout flare in patients with comorbid gout hospitalized for coronavirus disease 2019 (COVID-19). Factors associated with gout flare and hospital length of stay were explored. METHODS This retrospective cohort study included adults with comorbid gout who were hospitalized for PCR-confirmed COVID-19 between March 2020 and December 2021 in 3 hospitals in Thailand. Prevalence, characteristics, and outcomes of gout flare were described. Factors associated with gout flare were explored using least absolute shrinkage and selection operator selection and multivariate logistic regression. The association between gout flare and hospital length of stay was explored using multivariate linear regression. RESULTS Among 8697 patients hospitalized for COVID-19, 146 patients with comorbid gout were identified and gout flare occurred in 26 (18%). Compared to those without flare, patients with gout flare had higher baseline serum urate and lower prevalence of use of urate-lowering therapy (ULT) and gout flare prophylaxis medications. One-third of gout flare episodes were treated with ≥ 2 antiinflammatory medications. Logistic regression identified GOUT-36 rule ≥ 2, a predictive index for inpatient gout flare, as the only factor associated with gout flare (odds ratio 5.46, 95% CI 1.18-25.37). Gout flare was found to be independently associated with hospital length of stay and added 3 days to hospital course. CONCLUSION Gout flare occurred in 18% of patients with comorbid gout hospitalized for COVID-19 and added up to 3 days to hospital length of stay. Patients with suboptimal ULT appeared to be at high risk for gout flare during COVID-19 hospitalization.
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Affiliation(s)
- Kanon Jatuworapruk
- K. Jatuworapruk, MD, PhD, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Panchalee Satpanich
- P. Satpanich, MD, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Philip C Robinson
- P.C. Robinson, MBChB, PhD, Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital & Health Service, and Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Rebecca Grainger
- R. Grainger, MBChB, PhD, Department of Medicine, University of Otago, Wellington, New Zealand
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29
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Gladman T, Grainger R. Cultural historical activity and the complexity of health professions education. Med Educ 2022; 56:1058-1060. [PMID: 35953689 PMCID: PMC9804292 DOI: 10.1111/medu.14913] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Commenting on Hu et al., Grainger and Gladman comment on how the purpose of student‐led community learning can change focus from the development of technical and professional skills to the aspirations and goals of the community in which students work.
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Affiliation(s)
- Tehmina Gladman
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
| | - Rebecca Grainger
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
- Te Whatu Ora Health New Zealand—Capital, Coast and Hutt ValleyWellingtonNew Zealand
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Donnelly S, Ersoy Y, Grainger R. Doctors' views on the impact of the absence of an in-person rheumatology service at a major New Zealand hospital. N Z Med J 2022; 135:19-30. [PMID: 36302239] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM To describe the views of doctors in one hospital service about the impact of the lack of an in-person rheumatology consultation service and to identify service improvements informed by those views and services at comparable district health boards (DHB). METHODS Qualitative study using focus groups of resident and senior medical officers (RMOs and SMOs) from the general medical service at Wellington Regional Hospital. A national survey of DHB heads of rheumatology was also used. RESULTS Three major categories emerged from the focus groups with 16 RMOs and 15 SMOs: 1) a negative impact on quality of patient care, which is inequitable to other nearby DHBs; 2) workarounds are found; and 3) doctors' knowledge of rheumatology and education opportunities suffer. Best practice was considered to be an in-person rheumatology consultation service, as offered at the six DHBs surveyed. CONCLUSIONS Lack of an in-person rheumatology consultation service in this large hospital had perceived negative impacts on patient care and doctors' education and competence. Providing an in-person consultation service seems highly desirable but would need more rheumatology capacity regionally. The themes identified may also be relevant to other hospital or specialist services that are not equitably accessible in other parts of the New Zealand health system and thus inform the transformation of the health system required by the Pae Ora (Healthy Futures) Bill 2022.
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Affiliation(s)
- Sinead Donnelly
- Physician, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Yesim Ersoy
- At the time of data collection was employed as a physician at Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Rebecca Grainger
- Professor, University of Otago Wellington, Wellington, New Zealand. Rheumatologist, Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
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31
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Izadi Z, Gianfrancesco MA, Aguirre A, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson‐Tovey S, Kearsley‐Fleet L, Schaefer M, Seet AM, Schmajuk G, Jacobsohn L, Katz P, Rush S, Al‐Emadi S, Sparks JA, Hsu TY, Patel NJ, Wise L, Gilbert E, Duarte‐García A, Valenzuela‐Almada MO, Ugarte‐Gil MF, Ribeiro SLE, de Oliveira Marinho A, de Azevedo Valadares LD, Giuseppe DD, Hasseli R, Richter JG, Pfeil A, Schmeiser T, Isnardi CA, Reyes Torres AA, Alle G, Saurit V, Zanetti A, Carrara G, Labreuche J, Barnetche T, Herasse M, Plassart S, Santos MJ, Rodrigues AM, Robinson PC, Machado PM, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Costello W, Wallace ZS, Yazdany J. Development of a Prediction Model for COVID-19 Acute Respiratory Distress Syndrome in Patients With Rheumatic Diseases: Results From the Global Rheumatology Alliance Registry. ACR Open Rheumatol 2022; 4:872-882. [PMID: 35869686 PMCID: PMC9350083 DOI: 10.1002/acr2.11481] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Some patients with rheumatic diseases might be at higher risk for coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). We aimed to develop a prediction model for COVID-19 ARDS in this population and to create a simple risk score calculator for use in clinical settings. METHODS Data were derived from the COVID-19 Global Rheumatology Alliance Registry from March 24, 2020, to May 12, 2021. Seven machine learning classifiers were trained on ARDS outcomes using 83 variables obtained at COVID-19 diagnosis. Predictive performance was assessed in a US test set and was validated in patients from four countries with independent registries using area under the curve (AUC), accuracy, sensitivity, and specificity. A simple risk score calculator was developed using a regression model incorporating the most influential predictors from the best performing classifier. RESULTS The study included 8633 patients from 74 countries, of whom 523 (6%) had ARDS. Gradient boosting had the highest mean AUC (0.78; 95% confidence interval [CI]: 0.67-0.88) and was considered the top performing classifier. Ten predictors were identified as key risk factors and were included in a regression model. The regression model that predicted ARDS with 71% (95% CI: 61%-83%) sensitivity in the test set, and with sensitivities ranging from 61% to 80% in countries with independent registries, was used to develop the risk score calculator. CONCLUSION We were able to predict ARDS with good sensitivity using information readily available at COVID-19 diagnosis. The proposed risk score calculator has the potential to guide risk stratification for treatments, such as monoclonal antibodies, that have potential to reduce COVID-19 disease progression.
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Affiliation(s)
| | | | | | | | - Elsa F. Mateus
- Portuguese League Against Rheumatic DiseasesLisbonPortugal
| | - Kimme L. Hyrich
- The University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University and NHS Foundation TrustManchesterUK
| | - Laure Gossec
- INSERM, Sorbonne Universite and Hopital Universitaire Pitie Salpetriere, AP‐HPParisFrance
| | | | - Saskia Lawson‐Tovey
- The University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and Manchester Academic Health Science CentreManchesterUK
| | - Lianne Kearsley‐Fleet
- The University of Manchester and Manchester Academic Health Science CentreManchesterUK
| | | | | | - Gabriela Schmajuk
- University of CaliforniaSan Francisco and San Francisco Department of Veterans Affairs Medical Center
| | | | | | | | | | - Jeffrey A. Sparks
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Tiffany Y‐T Hsu
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Naomi J. Patel
- Massachusetts General Hospital and Harvard Medical SchoolBoston
| | - Leanna Wise
- University of Southern CaliforniaLos Angeles
| | | | | | | | - Manuel F. Ugarte‐Gil
- Universidad Científica del Sur and Hospital Nacional Guillermo Almenara IrigoyenEsSalud, LimaPeru
| | | | | | | | | | - Rebecca Hasseli
- Justus‐Liebig University Giessen, Campus KerckhoffGiessenGermany
| | | | - Alexander Pfeil
- Jena University Hospital and Friedrich Schiller University JenaJenaGermany
| | - Tim Schmeiser
- Rheumatology im Veedel (Private Practice)CologneGermany
| | | | | | | | | | - Anna Zanetti
- Italian Society for Rheumatology and University of Milano‐BicoccaMilanItaly
| | - Greta Carrara
- Italian Society for Rheumatology and University of Milano‐BicoccaMilanItaly
| | | | - Thomas Barnetche
- FHU ACRONIM, Centre for Autoimmune Systemic Rare Diseases, Bordeaux University HospitalBordeauxFrance
| | - Muriel Herasse
- Filière des Maladies Autoimmunes et Autoinflammatoires Rares, Hôpital Huriez, Centre Hospitalier Universitaire de LilleLilleFrance
| | - Samira Plassart
- Filière des Maladies Autoimmunes et Autoinflammatoires Rares, Hôpital Huriez, Centre Hospitalier Universitaire de LilleLilleFrance
| | - Maria José Santos
- Hospital Garcia de Orta, Almada, Portugal, and Instituto de Medicina Molecular Faculdade Medicina and Rheumatic Diseases Portuguese RegisterLisbonPortugal
| | - Ana Maria Rodrigues
- Rheumatic Diseases Portuguese Register, Sociedade Portuguesa de Reumatologia, Nova Medical School, and Hospital dos LusiadasLisbonPortugal
| | - Philip C. Robinson
- The University of Queensland, Brisbane, Queensland, Australia, and Royal Brisbane and Women's Hospital, Metro North Hospital and Health ServiceHerstonQueenslandAustralia
| | - Pedro M. Machado
- University College London, University College London Hospitals NHS Foundation Trust and Northwick Park Hospital, London North West University Healthcare NHS TrustLondonUK
| | - Emily Sirotich
- McMaster University, Hamilton, Ontario, Canada, and Canadian Arthritis Patient AllianceTorontoOntarioCanada
| | - Jean W. Liew
- Boston University School of MedicineBostonMassachusetts
| | - Jonathan S. Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School and Boston Children's HospitalBostonMassachusetts
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32
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Maguire S, Al-Emadi S, Alba P, Aguiar MC, Lawati TA, Alle G, Bermas B, Bhana S, Branimir A, Bulina I, Clowse M, Cogo K, Colunga I, Cook C, Cortez KJ, Dao K, Gianfrancesco M, Gore-Massey M, Gossec L, Grainger R, Hausman J, Hsu TYT, Hyrich K, Isnardi C, Kawano Y, Kilding R, Kusevich DA, Lawson-Tovey S, Liew J, McCarthy E, Montgumery A, Moyano S, Nasir N, Padjen I, Papagoras C, Patel NJ, Pera M, Pisoni C, Pons-Estel G, Quiambao AL, Quintana R, Ruderman E, Sattui S, Savio V, Sciascia S, Sencarova M, Morales RS, Siddique F, Sirotich E, Sparks J, Strangfeld A, Sufka P, Tanner H, Tissera Y, Wallace Z, Werner ML, Wise L, Worthing AB, Zell J, Zepa J, Machado PM, Yazdany J, Robinson P, Conway R. Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status. Rheumatology (Oxford) 2022; 62:1621-1626. [PMID: 36124987 DOI: 10.1093/rheumatology/keac534] [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: 06/11/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi -square or Fisher's exact test. RESULTS There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2%(n = 2). CONCLUSION In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Samar Al-Emadi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Paula Alba
- Hospital Cordoba, Rheumatology Unit, Cordoba, Argentina.,Universidad Nacional de Cordoba, School of Medicine, Cordoba, Argentina
| | | | - Talal Al Lawati
- Department of Rheumatology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Suleman Bhana
- Department of Rheumatology, Crystal Run Healthcare, Middleton, New York, USA
| | - Anic Branimir
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Inita Bulina
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia.,Department of Internal Diseases, Riga Stradins University, Riga, Latvia
| | - Megan Clowse
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Karina Cogo
- Department of Rheumatology, Hospital Interzonal Luis Guemes, Buenos Aires, Argentina.,Hospital San Juan De Dios, Department of Rheumatology, Buenos Aires, Argentina
| | - Iris Colunga
- Hospital Universitario Dr Jose Eleuterio Gonzalez, Department of Rheumatology, Monterrey, Mexico
| | - Claire Cook
- Division of Rheumatology, Massachusetts General Hospital, Allergy & Immunology, Boston, Massachusetts, USA
| | - Karen J Cortez
- Baguio General Hospital and Medical Center, Department of Rheumatology, Baguio City, Philippines
| | - Kathryn Dao
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Laure Gossec
- Sorbonne Universite, Paris, France.,Pitie-Salpetriere Hospital, Paris, France
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathon Hausman
- Department of Pediatric Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Rheumatology and Clinical Immunology, Beth Isreal Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tiffany Y T Hsu
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kimme Hyrich
- The University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UK.,Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,Department of Biomedical Research, UK and National Institute of Health Research Manchester, Manchester, UK
| | - Carolina Isnardi
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Yumeko Kawano
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA
| | - Rachael Kilding
- Department of Rheumatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Daria A Kusevich
- Nasonova Research Institute of Rheumatology, Department of Rheumatology, Vidnoe, Russia
| | - Saskia Lawson-Tovey
- Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,UK and National Institute of Health Research Manchester, Department of Biomedical Research, Manchester, UK.,University of Manchester, Centre for Musculoskeletal Research, Centre for Genetics and Genomics Versus Arthritis, Manchester, UK.,Department of Biomedical Research, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jean Liew
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eoghan McCarthy
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Anna Montgumery
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA.,VA Medical Center, Department of Health Research, San Francisco, California, USA
| | - Sebastian Moyano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Noreen Nasir
- The Aga Khan University Hospital, Section of Internal Medicine, Department of Medicine, Karachi, Pakistan
| | - Ivan Padjen
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Charalampos Papagoras
- Democritus University of Thrace, First Department of Internal Medicine, Alexandroupolis, Greece
| | - Naomi J Patel
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA
| | - Mariana Pera
- Hospital Angel C Padilla, Department of Rheumatology, Tucuman, Argentina
| | - Cecilia Pisoni
- CEMIC, Rheumatology and Immunology Section, Department of Internal Medicine, Buenos Aires, Argentina
| | - Guillermo Pons-Estel
- Sheffield Teaching Hospitals, NHS Foundation Trust, Department of Rheumatology, Sheffield, UK
| | - Antonio L Quiambao
- East Avenue Medical Center, Department of Rheumatology, Quezon City, Philippines
| | - Rosana Quintana
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Eric Ruderman
- Northwestern University Feinberg School of Medicine, Department of Medicine/Rheumatology, Chicago, Illinois, USA
| | - Sebastian Sattui
- University of Pittsburgh, Department of Rheumatology, Pittsburgh, Pennsylvania, USA
| | | | - Savino Sciascia
- Osedale San Giovanni Bosco, Centro Multidisciplinare de Recerche di Immunopatologia e Documentazione su Malattie Rare (C.M.I.D.), Turin, Italy
| | - Marieta Sencarova
- Univerzitna Nemocnica L Pasteura, Department of Rheumatology, Slovakia
| | - Rosa Serrano Morales
- Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Faizah Siddique
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Emily Sirotich
- McMaster University, Department of Health Research, Evidence and Impact, Hamilton, Ontario, Canada
| | - Jeffrey Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Paul Sufka
- Healthcare Partners, St Paul, Minnesota, USA
| | - Helen Tanner
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia
| | | | - Zachary Wallace
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marina L Werner
- Hospital Nacional de Clinicas, Department of Rheumatology, Cordoba, Argentina
| | - Leanna Wise
- University of Southern California, Keck School of Medicine, Los Angelos, California, USA
| | - Angus B Worthing
- Department of Rheumatology, Arthritis and Rheumatism Associates PC, Washington, DC, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - JoAnn Zell
- Division of Rheumatology, University of Colorado Health, Aurora, Colorado, USA
| | - Julija Zepa
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Latvia, Riga.,Riga Stradins University, School of Medicine, Latvia, Riga
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK.,Department of Rheumatology, Northwick Park Hospital, London, UK
| | - Jinoos Yazdany
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA
| | - Philip Robinson
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia.,Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
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Yeoh SA, Gianfrancesco M, Lawson-Tovey S, Hyrich KL, Strangfeld A, Gossec L, Carmona L, Mateus EF, Schäfer M, Richez C, Hachulla E, Holmqvist M, Scirè CA, Lorenz HM, Voll RE, Hasseli R, Jayatilleke A, Hsu TYT, D'Silva KM, Pimentel-Quiroz VR, Vasquez Del Mercado M, Shinjo SK, Neto ETDR, Junior LFDR, de Oliveira E Silva Montandon AC, Pons-Estel GJ, Ornella S, D'Angelo Exeni ME, Velozo E, Jordan P, Sirotich E, Hausmann JS, Liew JW, Jacobsohn L, Gore-Massy M, Sufka P, Grainger R, Bhana S, Wallace Z, Robinson PC, Yazdany J, Machado PM. Factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. RMD Open 2022; 8:rmdopen-2022-002508. [PMID: 36100295 PMCID: PMC9471207 DOI: 10.1136/rmdopen-2022-002508] [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] [Received: 06/10/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives To investigate factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy (IIM). Methods Demographic data, clinical characteristics and COVID-19 outcome severity of adults with IIM were obtained from the COVID-19 Global Rheumatology Alliance physician-reported registry. A 3-point ordinal COVID-19 severity scale was defined: (1) no hospitalisation, (2) hospitalisation (and no death) and (3) death. ORs were estimated using multivariable ordinal logistic regression. Sensitivity analyses were performed using a 4-point ordinal scale: (1) no hospitalisation, (2) hospitalisation with no oxygen (and no death), (3) hospitalisation with oxygen/ventilation (and no death) and 4) death. Results Of 348 patients, 48% were not hospitalised, 39% were hospitalised (and did not die) and 13% died. Older age (OR=1.59/decade, 95% CI 1.31 to 1.91), high disease activity (OR=3.50, 95% CI 1.25 to 9.83; vs remission), ≥2 comorbidities (OR=2.63, 95% CI 1.39 to 4.98; vs none), prednisolone-equivalent dose >7.5 mg/day (OR=2.40, 95% CI 1.09 to 5.28; vs no intake) and exposure to rituximab (OR=2.71, 95% CI 1.28 to 5.72; vs conventional synthetic disease-modifying antirheumatic drugs only) were independently associated with severe COVID-19. In addition to these variables, in the sensitivity analyses, male sex (OR range: 1.65–1.83; vs female) was also significantly associated with severe outcomes, while COVID-19 diagnosis after 1 October 2020 (OR range: 0.51–0.59; vs on/before 15 June 2020) was significantly associated with less severe outcomes, but these associations were not significant in the main model (OR=1.57, 95% CI 0.95 to 2.59; and OR=0.61, 95% CI 0.37 to 1.00; respectively). Conclusions This is the first large registry data on outcomes of COVID-19 in people with IIM. Older age, male sex, higher comorbidity burden, high disease activity, prednisolone-equivalent dose >7.5 mg/day and rituximab exposure were associated with severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with IIM.
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Affiliation(s)
- Su-Ann Yeoh
- Centre for Rheumatology, University College London, London, UK.,Department of Rheumatology, University College London University Hospitals NHS Foundation Trust, London, UK
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Kimme L Hyrich
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK.,Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anja Strangfeld
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Department of Rheumatology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
| | - Martin Schäfer
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Christophe Richez
- Département de Rhumatologie, Referral Center for Rare Systemic Autoimmune Diseases RESO, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Eric Hachulla
- Lille Inflammation Research International Center (LIRIC), University of Lille, Lille, France.,Département de Médecine Interne et Immunologie Clinique, Referral Center for Rare Systemic Autoimmune Diseases North and Northwest of France (CeRAINO), INSERM U995, CHU Lille, Lille, France
| | - Marie Holmqvist
- Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
| | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | - Rebecca Hasseli
- Department of Internal Medicine II, University Hospitals Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Arundathi Jayatilleke
- Section of Rheumatology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Victor R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.,Universidad Cientifica del Sur, Lima, Peru
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Sofía Ornella
- Hospital Interzonal General de Agudos (HIGA) San Martin, La Plata, Buenos Aires, Argentina
| | | | - Edson Velozo
- Sanatorio y Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
| | | | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, MA, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Zachary Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, Australia.,Department of Rheumatology, Royal Brisbane and Woman's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK .,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Neuromuscular Diseases, University College London, London, UK
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DiIorio M, Kennedy K, Liew JW, Putman MS, Sirotich E, Sattui SE, Foster G, Harrison C, Larché MJ, Levine M, Moni TT, Thabane L, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Gore-Massy M, Howard RA, Kodhek MA, Lalonde N, Tomasella LA, Wallace J, Akpabio A, Alpízar-Rodríguez D, Beesley RP, Berenbaum F, Bulina I, Chock EY, Conway R, Duarte-García A, Duff E, Gheita TA, Graef ER, Hsieh E, El Kibbi L, Liew DF, Lo C, Nudel M, Singh AD, Singh JA, Singh N, Ugarte-Gil MF, Hausmann JS, Simard JF, Sparks JA. Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2022; 8:e002587. [PMID: 36104117 PMCID: PMC9475962 DOI: 10.1136/rmdopen-2022-002587] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). METHODS We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021-15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression. RESULTS We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81). CONCLUSION Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.
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Affiliation(s)
- Michael DiIorio
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Kennedy
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael S Putman
- Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact (HEI); Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Maggie J Larché
- Divisions of Clinical Immunology and Allergy/Rheumatology, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tarin T Moni
- Department of Biochemistry & Biomedical Sciences, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Suleman Bhana
- Rheumatology, Crystal Run Healthcare, Middletown, New York, USA
| | - Wendy Costello
- N/A, Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Paul Sufka
- Rheumatology, HealthPartners, St Paul, Minnesota, USA
| | - Zachary S Wallace
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | | | | | | | - Nadine Lalonde
- Patient Board, Covid-19 Global Rheumatology Alliance, London, Ontario, Canada
| | | | - John Wallace
- Rheumatology, Autoinflammatory UK, Edinburgh, UK
| | - Akpabio Akpabio
- Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | | | - Richard P Beesley
- Juvenile Arthritis Research, European Network for Childhood Arthritis (ENCA), Tonbridge, UK
| | | | - Inita Bulina
- Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Eugenia Yupei Chock
- Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard Conway
- Department of Rheumatology, Saint James's Hospital, Dublin, Ireland
| | | | - Eimear Duff
- Rheumatology, Saint James's Hospital, Dublin, Ireland
| | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elizabeth R Graef
- Rheumatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evelyn Hsieh
- Division of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA
- Rheumatology, VA Connecticut Healthcare System-West Haven Campus, West Haven, Connecticut, USA
| | - Lina El Kibbi
- Internal Medicine Department, Division of Rheumatology, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | - David Fl Liew
- Rheumatology, Austin Health, Heidelberg West, Victoria, Australia
- Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Chieh Lo
- Rheumatology, I-Shou University College of Medicine, Yanchau Sheng, Taiwan
| | - Michal Nudel
- N/A, The Israeli Association for RMDs patients "Mifrakim Tz'eirim", Haifa, Israel
| | - Aman Dev Singh
- Department of Community Medicine, Government Medical College Amritsar, Amritsar, Punjab, India
- Rajindra Hospital Patiala, Patiala, Punjab, India
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Namrata Singh
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Cientifica del Sur, Lima, Peru
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Jonathan S Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia F Simard
- Epidemiology and Population Health and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Department of Medicine, Clinical Epidemiology Unit, Sweden
| | - Jeffrey A Sparks
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Izadi Z, Gianfrancesco MA, Schmajuk G, Jacobsohn L, Katz P, Rush S, Ja C, Taylor T, Shidara K, Danila MI, Wysham KD, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Al-Emadi S, Sparks JA, Hsu TYT, Patel NJ, Wise L, Gilbert E, Duarte-García A, Valenzuela-Almada MO, Ugarte-Gil MF, Ljung L, Scirè CA, Carrara G, Hachulla E, Richez C, Cacoub P, Thomas T, Santos MJ, Bernardes M, Hasseli R, Regierer A, Schulze-Koops H, Müller-Ladner U, Pons-Estel G, Tanten R, Nieto RE, Pisoni CN, Tissera YS, Xavier R, Lopes Marques CD, Pileggi GCS, Robinson PC, Machado PM, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Gore-Massy M, Wallace ZS, Yazdany J. Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study. Lancet Rheumatol 2022; 4:e603-e613. [PMID: 35909441 PMCID: PMC9313519 DOI: 10.1016/s2665-9913(22)00192-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. Funding American College of Rheumatology and European Alliance of Associations for Rheumatology.
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Affiliation(s)
- Zara Izadi
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Milena A Gianfrancesco
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Gabriela Schmajuk
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Patricia Katz
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Stephanie Rush
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Clairissa Ja
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Tiffany Taylor
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Kie Shidara
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine D Wysham
- VA Puget Sound Health Care System and Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- INSERM, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Rheumatology Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, UK
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Martin Schaefer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leanna Wise
- University of Southern California, Los Angeles, CA, USA
| | - Emily Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Científica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Lotta Ljung
- Department of Public Health and Clinical Medicine and Department of Rheumatology, Umeå University, Umeå, Sweden
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Carlo A Scirè
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Eric Hachulla
- INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France, U1286-INFINITE-Institute for Translational Research in Inflammation, Université de Lille, Lille, France
| | - Christophe Richez
- Department of Rheumatology, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeux, France
- UMR-CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Patrice Cacoub
- INSERM 959, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
| | - Thierry Thomas
- Département de Médecine Interne et Immunologie Clinique, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Centre National de Références Maladies Autoimmunes systémiques rares, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Inflammation-Immunopathology-Biotherapy Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire Saint-Etienne, INSERM U1059, Lyon University, Saint-Etienne, France
| | - Maria J Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
- Instituto de Medicina Molecular, Faculdade Medicina Lisboa, University of Lisbon, Lisbon, Portugal
| | - Miguel Bernardes
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Rheumatology Department, Centro Hospitalar-Universitário de São João, Porto, Portugal
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
| | - Anne Regierer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
| | | | - Romina Tanten
- Hospital Francisco Lopez Lima, General Roca, Argentina
| | - Romina E Nieto
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Santa Fe, Argentina
| | - Cecilia N Pisoni
- Rheumatology and Immunology Section, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno", Buenos Aires, Argentina
| | - Yohana S Tissera
- Servicio de Clínica Médica, Unidad de Reumatología del Hospital Córdoba and Sanatorio Parque de Córdoba, Córdoba, Argentina
| | - Ricardo Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Philip C Robinson
- University of Queensland Medical School, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Pedro M Machado
- University College London, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, London North-West University Healthcare NHS Trust, London, UK
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jean W Liew
- Boston University School of Medicine, Boston, MA, USA
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | | | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
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Jatuworapruk K, Montgomery A, Gianfrancesco M, Conway R, Durcan L, Graef ER, Jayatilleke A, Keen H, Kilian A, Young K, Carmona L, Cogo AK, Duarte‐García A, Gossec L, Hasseli R, Hyrich KL, Langlois V, Lawson‐Tovey S, Malcata A, Mateus EF, Schafer M, Scirè CA, Sigurdardottir V, Sparks JA, Strangfeld A, Xavier RM, Bhana S, Gore‐Massy M, Hausmann J, Liew JW, Sirotich E, Sufka P, Wallace Z, Machado PM, Yazdany J, Grainger R, Robinson PC. Characteristics and Outcomes of People With Gout Hospitalized Due to
COVID
‐19: Data From the
COVID
‐19 Global Rheumatology Alliance
Physician‐Reported
Registry. ACR Open Rheumatol 2022; 4:948-953. [PMID: 36000538 PMCID: PMC9539246 DOI: 10.1002/acr2.11495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To describe people with gout who were diagnosed with coronavirus disease 2019 (COVID‐19) and hospitalized and to characterize their outcomes. Methods Data on patients with gout hospitalized for COVID‐19 between March 12, 2020, and October 25, 2021, were extracted from the COVID‐19 Global Rheumatology Alliance registry. Descriptive statistics were used to describe the demographics, comorbidities, medication exposures, and COVID‐19 outcomes including oxygenation or ventilation support and death. Results One hundred sixty‐three patients with gout who developed COVID‐19 and were hospitalized were included. The mean age was 63 years, and 85% were male. The majority of the group lived in the Western Pacific Region (35%) and North America (18%). Nearly half (46%) had two or more comorbidities, with hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%) being the most common. Glucocorticoids and colchicine were used pre‐COVID‐19 in 11% and 12% of the cohort, respectively. Over two thirds (68%) of the cohort required supplemental oxygen or ventilatory support during hospitalization. COVID‐19‐related death was reported in 16% of the overall cohort, with 73% of deaths documented in people with two or more comorbidities. Conclusion This cohort of people with gout and COVID‐19 who were hospitalized had high frequencies of ventilatory support and death. This suggests that patients with gout who were hospitalized for COVID‐19 may be at risk of poor outcomes, perhaps related to known risk factors for poor outcomes, such as age and presence of comorbidity.
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Affiliation(s)
| | | | | | | | - Laura Durcan
- Beaumont Hospital and Royal College of Surgeons of Ireland Dublin
| | | | - Aruni Jayatilleke
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania
| | - Helen Keen
- The University of Western Australia Western Australia
| | - Adam Kilian
- Saint Louis University School of Medicine St. Louis Missouri
| | | | | | - Adriana Karina Cogo
- Hospital Interzonal Luis Guemes, Haedo, and Hospital San Juan de Dios Castelar, Buenos Aires Argentina
| | | | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and AP‐HP, Pitié‐Salpêtrière Hospital Paris France
| | - Rebecca Hasseli
- University Hospital Giessen, Justus‐Liebig‐University Giessen Germany
| | - Kimme L. Hyrich
- The University of Manchester and National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester UK
| | | | | | - Armando Malcata
- Serviço de reumatologia do Centro Hospitalar e Universitário de Coimbra, and Reuma.pt, Sociedade Portuguesa de Reumatologia Lisbon Portugal
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR) Lisbon Portugal
| | - Martin Schafer
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin (DRFZ) Berlin Germany
| | | | | | - Jeffrey A. Sparks
- Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin (DRFZ) Berlin Germany
| | - Ricardo M. Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
| | | | | | - Jonathan Hausmann
- Boston Children's Hospital, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Jean W. Liew
- Boston University School of Medicine Boston Massachusetts
| | - Emily Sirotich
- McMaster University, Hamilton, Ontario, Canada; Canadian Arthritis Patient Alliance
| | | | - Zach Wallace
- Massachusetts General Hospital and Harvard Medical School Boston
| | - Pedro M. Machado
- University College London; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust; and Northwick Park Hospital, London North West University Healthcare NHS Trust London UK
| | | | | | - Philip C. Robinson
- Royal Brisbane & Women's Hospital and University of Queensland School of Clinical Medicine Herston Queensland Australia
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37
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Grainger R. Transforming rheumatology practice with technology - products, processes, people, and purpose. Arthritis Rheumatol 2022; 74:1730-1732. [PMID: 35696331 DOI: 10.1002/art.42259] [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: 05/19/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Grainger
- Department of Medicine, University of Otago Wellington PO Box 7343, 23a Mein St, Newtown, Wellington South 6242, New Zealand
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Stamp LK, Grainger R, Frampton C, Drake J, Hill CL. Effect of omega-three supplementation on serum urate and gout flares in people with gout; a pilot randomized trial. BMC Rheumatol 2022; 6:31. [PMID: 35672866 PMCID: PMC9175343 DOI: 10.1186/s41927-022-00263-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To determine the effect of omega-three supplementation with fish oil on serum urate, weight and body mass index (BMI) in people with gout. Methods A pilot 6-month, randomized, open-label clinical trial was undertaken in people with gout with serum urate ≥ 0.36 mmol/l. Forty participants were randomized to receive 6.2 g omega-3 fish oil daily or no fish oil for 24 weeks. Blood was obtained monthly for serum urate and red cell EPA (20:5n-3) DHA (22:6n-3) were measured using a blood spot collection system.
Results There was no statistically significant difference in the mean (SEM) decrease in serum urate between baseline and week 24 between randomized groups: fish oil − 0.021 (0.02) mmol/l versus control − 0.006 (0.02) mmol/l. There was no significant difference in change in weight or BMI between baseline and week 24 between randomized groups. There was a statistically significant correlation between red cell omega-three concentrations and the total number of flares per participant between week 12 and week 24; total omega-three r = − 0.75 (p ≤ 0.001), EPA r = − 0.75 (p ≤ 0.001) and DHA r = -0.76 (p ≤ 0.001). In the omega-three fish oil group four participants reported gastrointestinal adverse effects definitely or probably related to the omega-three supplementation. Conclusions The lack of untoward effect of omega three fish oil supplementation on serum urate and BMI together with the relationship between higher omega-three concentrations and lower gout flares supports the development of further adequately powered clinical trials to determine the role of omega-three supplements as prophylaxis against gout flares in people starting urate lowering therapy. Clinical trial registration ACTRN12617000539336p Registered 13/04/2017.
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Walker TA, Grainger R, Quirke T, Roos R, Sherwood J, Mackereth G, Kiedrzynski T, Eyre R, Paine S, Wood T, Jagroop A, Baker MG, Jones N. Reactive arthritis incidence in a community cohort following a large waterborne campylobacteriosis outbreak in Havelock North, New Zealand. BMJ Open 2022; 12:e060173. [PMID: 35667727 PMCID: PMC9171216 DOI: 10.1136/bmjopen-2021-060173] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/16/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES In August 2016, Campylobacter spp contaminated an untreated reticulated water supply resulting in a large-scale gastroenteritis outbreak affecting an estimated 8320 people. We aimed to determine the incidence of probable reactive arthritis (ReA) cases in individuals with culture-confirmed campylobacteriosis (CC), self-reported probable campylobacteriosis (PC) and those reporting no diarrhoea (ND). DESIGN We conducted a retrospective cohort study to identify incidence of probable ReA cases. We identified cases with new ReA symptoms using an adapted acute ReA (AReA) telephone questionnaire. Those reporting ≥1 symptom underwent a telephone interview with the study rheumatologist. Probable ReA was defined as spontaneous onset of pain suggestive of inflammatory arthritis in ≥1 previously asymptomatic joint for ≥3 days occurring ≤12 weeks after outbreak onset. SETTING Population-based epidemiological study in Havelock North, New Zealand. PARTICIPANTS We enrolled notified CC cases with gastroenteritis symptom onsets 5 August 2016-6 September 2016 and conducted a telephone survey of households supplied by the contaminated water source to enrol PC and ND cases. RESULTS One hundred and six (47.3%) CC, 47 (32.6%) PC and 113 (34.3%) ND cases completed the AReA telephone questionnaire. Of those reporting ≥1 new ReA symptom, 45 (75.0%) CC, 13 (68.4%) PC and 14 (82.4%) ND cases completed the rheumatologist telephone interview. Nineteen CC, 4 PC and 2 ND cases developed probable ReA, resulting in minimum incidences of 8.5%, 2.8% and 0.6% and maximum incidences of 23.9%, 12.4% and 2.15%. DISCUSSION We describe high probable ReA incidences among gastroenteritis case types during a very large Campylobacter gastroenteritis outbreak using a resource-efficient method that is feasible to employ in future outbreaks.
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Affiliation(s)
- Tiffany A Walker
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, The New Zealand
| | - Terence Quirke
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Rebekah Roos
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Jill Sherwood
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Graham Mackereth
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | | | - Rachel Eyre
- Hawke's Bay District Health Board, Napier, The New Zealand
| | - Shevaun Paine
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Anita Jagroop
- School of Health and Sport Science, Eastern Institute of Technology, Napier, The New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Dunedin, The New Zealand
| | - Nicholas Jones
- Hawke's Bay District Health Board, Napier, The New Zealand
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Darlow B, Brown M, Hudson B, Frew G, Clark J, Vincent L, Abbott J, Briggs AM, Grainger R, Marra C, McKinlay E, Stanley J. Feasibility of a randomised controlled trial of two types of written information for people with knee osteoarthritis. Osteoarthritis and Cartilage Open 2022; 4:100254. [DOI: 10.1016/j.ocarto.2022.100254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
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Overgaard Donskov A, Mackie S, Hauge EM, Toro Gutiérrez C, Hemmig A, Van der Maas A, Dalsgaard Nielsen B, Hansen I, Yates M, Frølund L, Douglas K, Van der Geest K, Rezus E, Monti S, Gromova M, Ocampo V, Appenzeller S, Erraoui M, Ajibade A, Marun Lyrio A, Grainger R, Sandovici M, Helliwell T, Brouwer E, Dejaco C, Keller K. AB0583 REFERRAL PATTERN AND TREATMENT OF POLYMYALGIA RHEUMATICA IN GENERAL PRACTICE: AN INTERNATIONAL QUESTIONNAIRE BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1380] [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
BackgroundIn most countries polymyalgia rheumatica (PMR) is diagnosed and managed by both general practitioners (GP) and rheumatologists. However, the referral pattern from GP’s to specialist around the world has not been described. The initial prednisolone dose recommended by EULAR/ACR is between 12.5 and 25 mg1, but little is known about whether these guidelines are followed everywhere by GP’s in clinical practice2.ObjectivesThis study aims to describe the refererral pattern and treatment strategy for PMR in general practice in several countries worldwide.MethodsAn English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. The questionnaire contained questions on: 1: Respondent, 2: Referral pattern and 3: Prednisolone. Questionnaires were distributed to GP’s via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 3rd of November 2021 to 27th of January 2022. Countries with more than 15 responders to the questionnaire were included in the analysis.ResultsData from 11 countries were analysed. Referral patterns differed widely among countries (Table 1). Almost all patients initially seen by rheumatologists were returned to GP’s for treatment. In all countries a proportion of the GP’s prescribed higher initial prednisolone doses than recommended, with a large variation between countries (Table 1).Table 1.Characteristics of responders, referral pattern, and treatment strategyAustriaCanadaColombiaDenmarkItalyNether-landsNew ZealandRomaniaRussiaSwitzer-landUnited KingdomRespondersResponders (n), Completed questionnaire (total)26 (29)15 (15)17 (23)53 (53)36 (41)22 (22)17 (17)37 (43)42 (49)26 (26)34 (35)Experience (years)20 (12-34)8 (4-10)6 (4-9)12 (10-17)15 (5-27)23 (17-30)14 (9-27)21 (16-30)6 (5-9)26 (15-32)16 (11-24)Available PMR/GCA guideline, n (%)26 (100)15(100)17 (100)53 (100)36 (100)22 (100)17 (100)37 (100)42 (100)26 (100)34 (100)Adherence to guideline, n (%)21 (82)15 (100)17 (100)51 (97)34 (94)21 (95)17 (100)37 (100)42 (100)26 (100)34 (100)ReferralsNew PMR patients referred for diagnose (%)58 (10-100)50 (2-100)100 (13-100)50-(20-100)60 (28-100)20 (10-50)10 (10-20)60 (10-88)1 (1-2)28 (10-50)10 (1-25)Patients returned to GP for treatment (%)100 (50-100)50 (2-100)8 (0-50)85 (40-100)50 (0-100)50 (10-90)100 (90-100)80 (50-98)1 (1-1)80 (10-100)100 (100-100)Patients referred during treatment (%)50 (25-90)50 (10-100)100 (50-100)20 (10-33)50 (15-80)15 (10-30)20 (10-25)30 (10-80)1(1-1)20 (10-30)10 (10-20)PrednisoloneInitial dose (mg)38 (25-50)20 (20-50)20 (10-30)25 (15-40)25 (25-25)15 (15-15)20 (15-40)15 (12-20)15 (15-15)50 (25-50)15 (15-20)Initial dose > 25 mg, n (%)12 (47)4 (25)7 (40)14 (26)9 (25)1 (5)6 (38)7 (20)3 (8)22 (83)3 (9)Duration of treatment (months)9 (6-12)6 (2-9)6 (4-24)12 (8-18)5 (3-12)11 (6-12)12 (10-18)2 (2-5)6 (6-6)12 (12-14)15 (12-24)Data are presented as weighted median (interquartile range) unless otherwise stated. GP: general practitioner, PMR: polymyalgia rheumatica, GCA: great cell arteritis.ConclusionAlthough many patients were referred to the hospital for initial PMR diagnosis or during the disease course, a large proportion of patients received treatment in general practice worldwide. GPs frequently use a higher starting dose of prednisolone and shorter treatment duration than recommended by EULAR/ACR.References[1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74(10): 1799-807.[2]Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. The British journal of general practice: the journal of the Royal College of General Practitioners 2013; 63(610): e361-6.AcknowledgementsThis study was endorsed by the international PMR/GCA study group.Disclosure of InterestsAgnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis,Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Ib Hansen: None declared, Max Yates: None declared, Line Frølund: None declared, Karen Douglas: None declared, Kornelis van der Geest Speakers bureau: Roche, Elena Rezus: None declared, Sara Monti: None declared, Margarita Gromova: None declared, Vanessa Ocampo Speakers bureau: Abvie, Simone Appenzeller Speakers bureau: Janssen, UCB, Lilly and Pfizer, Mariama Erraoui: None declared, Adeola Ajibade: None declared, Andre Marun Lyrio: None declared, Rebecca Grainger: None declared, Maria Sandovici: None declared, Toby Helliwell: None declared, Elisabeth Brouwer Speakers bureau: Roche, Consultant of: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared
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Yeoh SA, Gianfrancesco M, Lawson-Tovey S, Hyrich K, Strangfeld A, Gossec L, Carmona L, Mateus E, Schaefer M, Richez C, Hachulla E, Holmqvist M, Scirè CA, Hasseli R, Jayatilleke A, Hsu T, D’Silva K, Pimentel-Quiroz V, Vasquez del Mercado M, Katsuyuki Shinjo S, Reis Neto E, Rocha L, Montandon ACDOES, Jordan P, Sirotich E, Hausmann J, Liew J, Jacobsohn L, Gore-Massy M, Sufka P, Grainger R, Bhana S, Wallace Z, Robinson P, Yazdany J, Machado P. OP0252 FACTORS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHY: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3235] [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
BackgroundThere is a paucity of data in the literature about the outcome of patients with idiopathic inflammatory myopathy (IIM) who have been infected with SARS-CoV-2.ObjectivesTo investigate factors associated with severe COVID-19 outcomes in patients with IIM.MethodsData on demographics, number of comorbidities, region, COVID-19 time period, physician-reported disease activity, anti-rheumatic medication exposure at the clinical onset of COVID-19, and COVID-19 outcomes of IIM patients were obtained from the voluntary COVID-19 Global Rheumatology Alliance physician-reported registry of adults with rheumatic disease (from 17 March 2020 to 27 August 2021). An ordinal COVID-19 severity scale was used as primary outcome of interest, with each outcome category being mutually exclusive from the other:a) no hospitalization, b) hospitalization (and no death), or c) death. Odds ratios (OR) were estimated using multivariable ordinal logistic regression. In ordinal logistic regression, the effect size of a categorical predictor can be interpreted as the odds of being one level higher on the ordinal COVID-19 severity scale than the reference category.ResultsComplete hospitalization and death outcome data was available in 348 IIM cases. Mean age was 53 years, and 223 (64.1%) were female. Overall, 167/348 (48.0%) people were not hospitalized, 136/348 (39.1%) were hospitalized (and did not die), and 45/348 (12.9%) died. Older age (OR=1.59 per decade of life, 95%CI 1.32-1.93), male sex (OR=1.63, 95%CI 1.004-2.64; versus female), high disease activity (OR=4.05, 95%CI 1.29-12.76; versus remission), presence of two or more comorbidities (OR=2.39, 95%CI 1.22-4.68; versus none), prednisolone-equivalent dose >7.5 mg/day (OR=2.37, 95%CI 1.27-4.44; versus no glucocorticoid intake), and exposure to rituximab (OR=2.60, 95%CI 1.23-5.47; versus csDMARDs only) were associated with worse COVID-19 outcomes (Table 1).Table 1.Multivariable logistic regression analysis of factors associated with the ordinal COVID-19 severity outcomes. AZA, azathioprine; CI, confidence interval; combo, combination; CSA, ciclosporin; CYC, cyclophosphamide; DMARD, disease-modifying anti-rheumatic drug; b/tsDMARD, biologic/targeted synthetic DMARD, csDMARD, conventional synthetic DMARD; HCQ, hydroxychloroquine; IVIg, intravenous immunoglobulin; LEF, leflunomide; MMF, mycophenolate mofetil; mono, monotherapy; MTX, methotrexate; OR, odds ratio; Ref, reference; RTX, rituximab; SSZ, sulfasalazine; TAC, tacrolimus.VariableOR (95%CI)P-valueVariableOR (95%CI)P-valueAge (per decade)1.59 (1.32-1.93)<0.001ComorbiditiesMale sex1.63 (1.004-2.64)0.048NoneRefNAPrednisolone-equivalent doseOne1.46 (0.79-2.72)0.228NoneRefNATwo or more2.39 (1.22-4.68)0.011>0 to 7.5mg/day1.10 (0.57-2.11)0.779Physician-reported disease activity>7.5mg/day2.37 (1.27-4.44)0.007RemissionRefNAIVIg0.41 (0.15-1.16)0.093Low/moderate1.23 (0.67-2.28)0.504DMARDsHigh4.05 (1.29-12.76)0.018csDMARD only (mono or combi - HCQ, MTX, LEF, SSZ)RefNARegionNo DMARD1.84 (0.90-3.75)0.094EuropeRefNAb/tsDMARD mono or combi (except RTX)1.60 (0.49-5.26)0.435North America0.89 (0.49-1.61)0.694CSA/CYC/TAC mono or combi (except RTX or b/tsDMARDs)1.55 (0.52-4.58)0.429Other4.25 (2.21-8.16)<0.001AZA mono1.70 (0.69-4.19)0.249Time periodMMF mono1.22 (0.53-2.82)0.634Before 15 June 2020RefNAAZA/MMF combi (except RTX or b/tsDMARDs)0.71 (0.25-2.00)0.51716 June - 30 September 20200.58 (0.26-1.27)0.171RTX mono or combi2.60 (1.23-5.47)0.012After 1 October 20200.58 (0.35-0.95)0.032ConclusionThese are the first global registry data on the impact of COVID-19 on IIM patients. Older age, male gender, higher comorbidity burden, higher disease activity, higher glucocorticoid intake and rituximab exposure were associated with worse outcomes. These findings will inform risk stratification and management decisions for IIM patients.ReferencesNoneDisclosure of InterestsSu-Ann Yeoh: None declared, Milena Gianfrancesco: None declared, Saskia Lawson-Tovey: None declared, Kimme Hyrich Speakers bureau: AbbVie unrelated to this work, Grant/research support from: Pfizer, BMS, both unrelated to this work, Anja Strangfeld Speakers bureau: AbbVie, Celltrion, MSD, Janssen, Lilly, Roche, BMS, Pfizer, all unrelated to this work, Laure Gossec Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, all unrelated to this work, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz, all unrelated to this work, Loreto Carmona: None declared, Elsa Mateus Consultant of: Boehringer Ingelheim Portugal, not related to this work, Martin Schaefer: None declared, Christophe Richez Speakers bureau: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this abstract, Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly, Galapagos, GSK, MSD, Novartis, and Pfizer, all unrelated to this abstract, Eric Hachulla Speakers bureau: Johnson & Johnson, GlaxoSmithKline, Roche-Chugai, all unrelated to this work, Consultant of: Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, all unrelated to this work, Grant/research support from: CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, all unrelated to this work, Marie Holmqvist: None declared, Carlo Alberto Scirè Grant/research support from: AbbVie, Lilly, both unrelated to this work, Rebecca Hasseli: None declared, Arundathi Jayatilleke: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Victor Pimentel-Quiroz: None declared, Monica Vasquez del Mercado: None declared, Samuel Katsuyuki Shinjo: None declared, Edgard Reis Neto: None declared, Laurindo Rocha Jr: None declared, Ana Carolina de Oliveira e Silva Montandon Speakers bureau: GSK, not related to this work, Paula Jordan: None declared, Emily Sirotich: None declared, Jonathan Hausmann Speakers bureau: Novartis, Biogen, Pfizer, not related to this work, Consultant of: Novartis, Biogen, Pfizer, not related to this work, Jean Liew Grant/research support from: Pfizer research grant, completed in 2021, not related to this work, Lindsay Jacobsohn: None declared, Monique Gore-Massy Speakers bureau: Aurinia Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, not related to this work, Consultant of: Aurinia Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, not related to this work, Paul Sufka: None declared, Rebecca Grainger Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and Cornerstones, all unrelated to this work, Consultant of: AbbVie, Novartis, both unrelated to this work, Suleman Bhana Shareholder of: Pfizer, Inc, Speakers bureau: AbbVie, Horizon, Novartis, and Pfizer, all unrelated to this work, Consultant of: AbbVie, Horizon, Novartis, and Pfizer, all unrelated to this work, Employee of: Pfizer, Inc, Zachary Wallace: None declared, Philip Robinson Speakers bureau: Abbvie, Janssen, Roche, GSK, Novartis, Lilly, UCB, all unrelated to this work, Paid instructor for: Lilly, unrelated to this work, Consultant of: GSK, Kukdong, Atom Biosciences, UCB, all unrelated to this work, Grant/research support from: Janssen, Pfizer, UCB and Novartis, all unrelated to this work, Jinoos Yazdany Consultant of: Aurinia, Astra Zeneca, Pfizer, all unrelated to this work, Grant/research support from: Astra Zeneca, Gilead, BMS Foundation, all unrelated to this work, Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this work., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this work.
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Machado PM, Schaefer M, Mahil S, Dand N, Gianfrancesco M, Lawson-Tovey S, Yiu Z, Yates M, Hyrich K, Gossec L, Carmona L, Mateus E, Wiek D, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sufka P, Sirotich E, Wallace Z, Olofsson T, Lomater C, Romeo N, Wendling D, Pham T, Miceli Richard C, Fautrel B, Silva L, Santos H, Martins FR, Hasseli R, Pfeil A, Regierer A, Isnardi C, Soriano E, Quintana R, Omura F, Machado Ribeiro F, Pinheiro M, Bautista-Molano W, Alpizar-Rodriguez D, Saad C, Dubreuil M, Haroon N, Gensler LS, Dau J, Jacobsohn L, Liew J, Strangfeld A, Barker J, Griffiths CEM, Robinson P, Yazdany J, Smith C. OP0249 CHARACTERISTICS ASSOCIATED WITH POOR COVID-19 OUTCOMES IN PEOPLE WITH PSORIASIS AND SPONDYLOARTHRITIS: DATA FROM THE COVID-19 PsoProtect AND GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSome factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.ObjectivesTo determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.MethodsThis study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.ResultsA total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).ConclusionMore severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.AcknowledgementsWe thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.Disclosure of InterestsNone declared
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Chock YPE, Putman M, Conway R, Danila MI, Hoyer B, Hsieh E, Jayatilleke A, Kilian A, Leipe J, Liew JW, Machado PM, Robinson PC, Singh N, Ung N, Yeoh SA, Wallace ZS, Grainger R, Cappelli LC. Experience with telemedicine amongst rheumatology clinicians during the COVID-19 pandemic: an international survey. Rheumatol Adv Pract 2022; 6:rkac039. [PMID: 35669677 PMCID: PMC9154733 DOI: 10.1093/rap/rkac039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The aim was to assess rheumatology clinicians’ perceptions of telemedicine and their experiences before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods We conducted a cross-sectional online survey and collected responses from rheumatology clinicians worldwide, between November 2020 and February 2021, regarding use and perceptions of telemedicine in rheumatology. We summarized data with descriptive statistics and qualitative analysis for free-text responses. Results The survey was completed by 349 rheumatology clinicians from 49 countries; 59% were female and about two-thirds were in the 30–50 years age group. Academic affiliations were held by 55% of participants, and 44% were from North America. Before the pandemic, 24% of participants had experience with telemedicine, whereas about three-quarters used telemedicine for the first time during the pandemic. Overall, 56% thought they provided less adequate care with telemedicine. More than half of clinicians felt that telemedicine was adequate for evaluating crystalline arthritis, inflammatory arthritis and lupus flares. Telemedicine was felt to be inadequate for flares of myositis, vasculitis and scleroderma. Technical problems were reported in 29% of telemedicine encounters and were most commonly related to patient-encountered difficulties. Conclusion Most rheumatology clinicians used telemedicine for the first time during the pandemic. The quality of care provided was thought to be inferior to that provided in person for specific clinical situations. Additional efforts are needed to address barriers to effective telemedicine, such as patient-related technology issues, challenges with building rapport and performing a physical examination, and to define the appropriate scope of clinical scenarios conducive to telemedicine.
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Affiliation(s)
| | - Michael Putman
- Division of Rheumatology, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard Conway
- Department of Rheumatology, University College Dublin, Dublin, Ireland
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bimba Hoyer
- Department of Rheumatology and Clinical Immunology, Medical Department, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy and Immunology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Section of Rheumatology, Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Arundathi Jayatilleke
- Section of Rheumatology, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Adam Kilian
- Saint Louis University School of Medicine, Division of Rheumatology St. Louis, MO, USA
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, HERSTON, Queensland, Australia
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington, WA, USA., Seattle
| | | | - Su-Ann Yeoh
- Rheumatology, Division of Medicine, University College London, United Kingdom
| | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Laura C Cappelli
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
The COVID-19 pandemic has brought challenges for people with rheumatic disease in addition to those faced by the general population, including concerns about higher risks of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poor outcomes of COVID-19. The data that are now available suggest that rheumatic disease is associated with a small additional risk of SARS-CoV-2 infection, and that outcomes of COVID-19 are primarily influenced by comorbidities and particular disease states or treatments. Despite considerable advances in our knowledge of which therapeutic agents provide benefits in COVID-19, and of what constitutes effective vaccination strategies, the specific considerations that apply to people with rheumatic disease are yet to be definitively addressed. An overview of the most important COVID-19 studies to date that relate to people with rheumatic disease can contribute to our understanding of the clinical-care requirements of this population.
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Affiliation(s)
- Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Herston, Queensland, Australia.
- Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston Road, Herston, Queensland, Australia.
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Liew J, Gianfrancesco M, Harrison C, Izadi Z, Rush S, Lawson-Tovey S, Jacobsohn L, Ja C, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Schäfer M, Frãzao-Mateus E, Bulina I, Stafford F, Tufan A, Graver C, Yardımcı GK, Zepa J, Al Emadi S, Cook C, Abutiban F, Dey D, Katigbak G, Kaufman L, Kowalski E, Martínez-Martínez MU, Patel NJ, Reyes-Cordero G, Salido E, Smith E, Snow D, Sparks J, Wise L, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sirotich E, Sufka P, Wallace Z, Machado PM, Robinson PC, Yazdany J. SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry. RMD Open 2022; 8:e002187. [PMID: 35387864 PMCID: PMC8987210 DOI: 10.1136/rmdopen-2021-002187] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. METHODS We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. RESULTS SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. CONCLUSION More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.
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Affiliation(s)
- Jean Liew
- Medicine, Section of Rheumatology, Boston University, Boston, Massachusetts, USA
| | - Milena Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | | | - Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
| | - Clairissa Ja
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Martin Schäfer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | | | - Inita Bulina
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | | | - Gözde Kübra Yardımcı
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe University, Ankara, Turkey
| | - Julija Zepa
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Claire Cook
- Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Dfiza Dey
- University of Ghana Medical School, Accra, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Lauren Kaufman
- Rheumatology Associates Louisville, Louisville, Kentucky, USA
| | - Emily Kowalski
- Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco Ulises Martínez-Martínez
- Rheumatology, Hospital Central "Dr Ignacio Morones Prieto", San Luis Potosí, Mexico
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis, Mexico
| | - Naomi J Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Evelyn Salido
- University of the Philippines Manila, Manila, Philippines
| | - Ellison Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Asheville Arthritis & Osteoporosis Center, Asheville, North Carolina, USA
| | - David Snow
- Cape Fear Arthritis Care, Leland, North Carolina, USA
| | - Jeffrey Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leanna Wise
- Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
| | | | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
- University Of Otago, Wellington, New Zealand
| | - Jonathan Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Zachary Wallace
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital Health Service District, Herston, Queensland, Australia
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
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47
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Gibbs HN, Grainger R. A Delphi exercise with rheumatologists to identify consensus on essential components of a rheumatology service in district health boards of Aotearoa New Zealand. N Z Med J 2022; 135:27-36. [PMID: 35728182] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM To identify consensus of rheumatologists on components of best practice rheumatology service in district health boards (DHB) in Aotearoa New Zealand (AoNZ). METHODS A consensus survey of rheumatologists in AoNZ was informed by an initial survey inviting modifications to statements about best practice rheumatology from international literature and requested additional statements. The three-round consensus email exercise asked rheumatologists to indicate their level of agreement with each statement for a DHB serving a small or large population. Consensus for each statement was achieved when ≥80% of participants' votes were within a pre-determined category (essential, potentially desirable, to be avoided). RESULTS Ten rheumatologists reviewed the 19 initial statements with three additional statements offered-the consensus survey had 22 statements. Twenty-six rheumatologists responded in the first consensus round, with 21/26 (81%) responding in rounds two and three. After three rounds, 16 statements met consensus as essential for both small and large DHB rheumatology services. One statement met consensus as potentially desirable for a large rheumatology service. Five statements did not reach consensus. CONCLUSIONS The component statements identified by consensus can inform policy and implementation of rheumatology services in the AoNZ health system reforms and be used for benchmarking.
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Affiliation(s)
- Hamish Nigel Gibbs
- Physician and Rheumatologist, Hawke's Bay District Health Board, Hastings
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington; Rheumatologist, Hutt Valley District Health Board
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48
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Putman M, Kennedy K, Sirotich E, Liew JW, Sattui SE, Moni TT, Akpabio AA, Alpizar-Rodriguez D, Angevare S, Beesley RP, Berenbaum F, Bulina I, Chock YPE, Conway R, Duarte-García A, Singh AD, Duff E, Durrant KL, Gheita TA, Hill CL, Howard R, Hoyer BF, Hsieh E, El Kibbi L, Kilian A, Kim AHJ, Liew DFL, Lo C, Mateus EF, Miller B, Mingolla S, Nudel M, Singh JA, Singh N, Ugarte-Gil MF, Wallace J, Young KJ, Zamora-Tehozol EA, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Harrison C, Larché MJ, Levine M, Foster G, Thabane L, Hausmann JS, Sparks JA, Simard JF. COVID-19 vaccine perceptions and uptake: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. Lancet Rheumatol 2022; 4:e237-e240. [PMID: 35156060 PMCID: PMC8824526 DOI: 10.1016/s2665-9913(22)00001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kevin Kennedy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Tarin T Moni
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Akpabio A Akpabio
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - Saskya Angevare
- Stichting KAISZ, Amsterdam, The Netherlands
- ENCA, Paris, France
- Autoinflammatory Alliance, Amsterdam, The Netherlands
| | | | - Francis Berenbaum
- Sorbonne University, INSERM, AP-HP Saint-Antoine hospital, Paris, France
| | - Inita Bulina
- Center of Rheumatology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Yu Pei Eugenia Chock
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Ali Duarte-García
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aman Dev Singh
- Department of Community Medicine, GMC Patiala, Punjab, India
| | - Eimear Duff
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | | | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | | | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Section of Rheumatology, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, University of Washington, St Louis, MO, USA
| | - David F L Liew
- Department of Rheumatology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Chieh Lo
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Comprehensive Health Research Centre, Lisbon, Portugal
| | - Bruce Miller
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Serena Mingolla
- Associazione Nazionale Persone con Malattie Reumatologiche e Rare APMARR APS, Lecca, Italy
| | | | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, University of Washington, St Louis, MO, USA
| | - Manuel F Ugarte-Gil
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud and School of Medicine, Universidad Cientifica del Sur, Lima, Peru
| | | | - Kristen J Young
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Maggie J Larché
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, ON, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital and Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, and Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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49
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Young K, Yeoh SA, Putman M, Sattui S, Conway R, Graef E, Kilian A, Konig M, Sparks J, Ugarte-Gil M, Upton L, Berenbaum F, Bhana S, Costello W, Hausmann J, Machado P, Robinson P, Sirotich E, Sufka P, Yazdany J, Liew J, Grainger R, Wallace Z, Jayatilleke A. The Impact of Covid-19 on rheumatology training - Results from the COVID-19 Global Rheumatology Alliance trainee survey. Rheumatol Adv Pract 2022; 6:rkac001. [PMID: 35392427 PMCID: PMC8982766 DOI: 10.1093/rap/rkac001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical experiences, research opportunities and well-being of rheumatology trainees. Methods A voluntary, anonymous, Web-based survey was administered in English, Spanish or French from 19 August 2020 to 5 October 2020. Adult and paediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the perceptions of trainees regarding the impact of the COVID-19 pandemic on patient care and redeployment, learning and supervision, research and well-being were assessed. Results There were 302 respondents from 33 countries, with 83% in adult rheumatology training. An increase in non-rheumatology clinical work was reported by 45%, with 68% of these having been redeployed to COVID-19. Overall, trainees reported a negative impact on their learning opportunities during rheumatology training, including outpatient clinics (79%), inpatient consultations (59%), didactic teaching (55%), procedures (53%), teaching opportunities (52%) and ultrasonography (36%). Impacts on research experiences were reported by 46% of respondents, with 39% of these reporting that COVID-19 negatively affected their ability to continue their pre-pandemic research. Burnout and increases in stress were reported by 50% and 68%, respectively. Physical health was negatively impacted by training programme changes in 25% of respondents. Conclusion The COVID-19 pandemic has had a substantial impact on rheumatology training and trainee well-being. Our study highlights the extent of this impact on research opportunities and clinical care, which are highly relevant to future curriculum planning and the clinical learning environment.
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Affiliation(s)
- Kristen Young
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Su-Ann Yeoh
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Michael Putman
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Sebastian Sattui
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Richard Conway
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Elizabeth Graef
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Adam Kilian
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Maximilian Konig
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jeffrey Sparks
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Manuel Ugarte-Gil
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Laura Upton
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Francis Berenbaum
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Suleman Bhana
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Wendy Costello
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jonathan Hausmann
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Pedro Machado
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Philip Robinson
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Emily Sirotich
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Paul Sufka
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jinoos Yazdany
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jean Liew
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Rebecca Grainger
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Zachary Wallace
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Arundathi Jayatilleke
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
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50
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Ugarte-Gil MF, Alarcón GS, Izadi Z, Duarte-García A, Reátegui-Sokolova C, Clarke AE, Wise L, Pons-Estel GJ, Santos MJ, Bernatsky S, Ribeiro SLE, Al Emadi S, Sparks JA, Hsu TYT, Patel NJ, Gilbert EL, Valenzuela-Almada MO, Jönsen A, Landolfi G, Fredi M, Goulenok T, Devaux M, Mariette X, Queyrel V, Romão VC, Sequeira G, Hasseli R, Hoyer B, Voll RE, Specker C, Baez R, Castro-Coello V, Maldonado Ficco H, Reis Neto ET, Ferreira GAA, Monticielo OAA, Sirotich E, Liew J, Hausmann J, Sufka P, Grainger R, Bhana S, Costello W, Wallace ZS, Jacobsohn L, Taylor T, Ja C, Strangfeld A, Mateus EF, Hyrich KL, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schäfer M, Machado PM, Robinson PC, Gianfrancesco M, Yazdany J. Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance. Ann Rheum Dis 2022; 81:970-978. [PMID: 35172961 PMCID: PMC8882632 DOI: 10.1136/annrheumdis-2021-221636] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Abstract
Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab. Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
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Affiliation(s)
- Manuel Francisco Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru .,Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ali 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, MN, USA
| | - Cristina Reátegui-Sokolova
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, LimaPeru
| | - Ann Elaine Clarke
- Division of Rheumatology Department of Medicine. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leanna Wise
- Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
| | - Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.,Research Unit, Argentine Society of Rheumatology, Buenos Aires, Argentina
| | - Maria Jose Santos
- Rheumatology, Hospital Garcia de Orta, Almada, Portugal.,Rheumatology Research Unit. Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Samar Al Emadi
- Rheumatology Department, Hamad Medical Corp, Doha, Qatar
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital. Harvard Medical School, Boston, Massachusetts, USA
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Gianpiero Landolfi
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tiphaine Goulenok
- Internal Medicine Department, Bichat Claude Bernard Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Mathilde Devaux
- Internal Medicine Department, Poissy Saint-Germain-en-Laye Hospital, Poissy, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Viviane Queyrel
- Department of Rheumatology, Pasteur 2 Hospital, University of Nice -Sophia- Antipolis, Nice, France
| | - Vasco C Romão
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Graca Sequeira
- Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology. Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Bimba Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
| | - Roberto Baez
- Hospital Francisco Lopez Lima, General Roca, Argentina
| | | | | | | | | | - Odirlei Andre André Monticielo
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center. Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital. Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tiffany Taylor
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Clairissa Ja
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anja Strangfeld
- Epidemiology and Health Services, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.,European League Against Rheumatism (EULAR) Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Saskia Lawson-Tovey
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Martin Schäfer
- Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals, London, UK.,Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia.,Department of Rheumatology. Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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