BACKGROUND/OBJECTIVES: The aim of this work is to validate the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire in a Latin American (Peru) AAV cohort. METHODS: We included patients from the Alm...BACKGROUND/OBJECTIVES: The aim of this work is to validate the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire in a Latin American (Peru) AAV cohort. METHODS: We included patients from the Almenara vasculitis cohort who had at least 1 visit between December 2022 and June 2024. Sociodemographic features, disease activity (Birmingham Vasculitis Activity Score version 3 [BVASv3] score), damage (Vasculitis Damage Index [VDI] score), the AAV-PRO (Spanish version), and the Short Form 36 (SF-36) were obtained. The AAV-PRO includes 6 domains (organ-specific symptoms, systemic symptoms, treatment side effects, social and emotional impact, concerns about the future, and physical function); the score ranges from 0 to 100: the higher the value, the worse the health-related quality of life. Correlations between domains of the AAV-PRO and clinical and sociodemographic variables were evaluated using Spearman correlation. RESULTS: Eighty-two patients were included; 60 (73.2%) of them were female. Their age and disease duration were 55.3 (14.3) and 5.7 (5.2) years, respectively. The BVASv3 and the VDI scores were 6.1 (9.0) and 2.4 (1.7), respectively. Overall, every domain of the AAV-PRO correlated strongly and inversely with the global scores of the SF-36 (physical component summary and mental component summary) (all r < -0.4 and p < 0.001). Physical function, role physical, role emotional, and physical component summary correlated inversely with the BVASv3, whereas the organ-specific symptoms score correlated positively with the VDI. CONCLUSIONS: The Spanish version of the AAV-PRO questionnaire correlated with the SF-36 in AAV patients from a Peruvian cohort. These findings may support the use of this instrument in other Latin American populations.
OBJECTIVE: Biological drugs have revolutionized the treatment of rheumatic diseases, but their high cost has contributed to increased prescription drug spending in the United States. The US Food and Drug Administration h...OBJECTIVE: Biological drugs have revolutionized the treatment of rheumatic diseases, but their high cost has contributed to increased prescription drug spending in the United States. The US Food and Drug Administration has approved the use of several biosimilars, medications that are like their reference biologics with comparable safety and effectiveness, for use in rheumatic diseases. We describe a cost reduction project at a large academic medical center aimed at increasing the use of biosimilars for rituximab and infliximab within rheumatology clinics. METHODS: We included patients aged 17 and older with rheumatologic conditions who were prescribed either infliximab or rituximab. A series of educational and electronic health record (EHR) interventions were implemented between 2018 and 2020 to encourage the use of infliximab-dyyb and rituximab-abbs, both biosimilar agents. We measured the change in utilization of these 2 biosimilars between onset of institutional approval through 2023. RESULTS: During the study period, the overall rate of use of these biosimilars increased from a baseline of <5.0% to 49.4% for infliximab-dyyb and <5.0% to 51.3% for rituximab-abbs. We estimated a total of greater than $3.2 million in cost savings, solely through 2 biosimilar substitutions within 1 specialty clinic at our institution. CONCLUSIONS: Biosimilar use among rheumatology providers in an academic setting can be increased through multimodal interventions including education and EHR modifications. This change has the potential for large cost savings.
OBJECTIVE: Previous studies have shown an association between chondrocalcinosis (CC) and vascular calcifications (VCs). This study aimed to investigate the association of VCs detected on joint radiographs (XRs) of older...OBJECTIVE: Previous studies have shown an association between chondrocalcinosis (CC) and vascular calcifications (VCs). This study aimed to investigate the association of VCs detected on joint radiographs (XRs) of older patients diagnosed with calcium pyrophosphate (CPP) arthritis compared with a control group with osteoarthritis (OA). METHODS: A medical records review study of joint radiographs (knee and wrist) was conducted. CPP crystal arthritis was diagnosed based on at least 1 documented episode of arthritis with synovial fluid analysis positive for CPP crystals or imaging showing CC at 1 or more sites, with no alternative inflammatory arthritis diagnosis. The control group comprised patients with OA and no CC, matched 1:1 for age and sex. All participants were over 60 years of age. XRs were reviewed for CC, OA, and VCs at the affected joint by 2 independent observers. RESULTS: A total of 98 patients were enrolled in both the CPP arthritis group and the OA group. VCs adjacent to the affected joint were detected in 69 patients of the CPP group and 19 patients of the control group (70.4% vs 19.4%, p < 0.001). Among patients aged 60 to 80 years, the presence of VCs on XRs was highly indicative of CPP, demonstrating a specificity of 89.2% (95% confidence interval: 79.1%-95.6%). In the CPP group, patients with VCs had a significantly higher prevalence of cardiovascular (CV) comorbidities. CONCLUSIONS: The detection of VCs on XRs was strongly associated with CPP crystal arthritis. The presence of VCs may further serve as a biomarker for an increased burden of CV comorbidities.
Systemic lupus erythematosus is considered a prototype of human autoimmune disease based on the appearance of multiple autoantibodies, some of which can have a direct pathogenic effect on tissues. Most therapeutic modali...Systemic lupus erythematosus is considered a prototype of human autoimmune disease based on the appearance of multiple autoantibodies, some of which can have a direct pathogenic effect on tissues. Most therapeutic modalities aim to check the enhanced humoral responses by targeting T and B cells with conventional or biologic drugs. However, in some cases, the clinical response is limited and frequently takes a high toll of toxicity in patients. The last 2 decades have brought up novel discoveries showing profound disturbances of innate immune cell function in systemic lupus erythematosus, including dysregulated NETosis, increased apoptosis, type 1 interferon, and granulopoiesis signatures that are grounded in basic cell biology abnormalities, including response to excessive oxidative stress, mitochondrial dysfunction, and upregulation of the cGAS-STING pathway. Whether the prominent autoimmunity component of lupus patients is sufficient to drive this chronic disease or follows a breakdown of innate immune homeostasis in response to the environmental factors triggering disease is the subject of this revision.
OBJECTIVE: Appreciative Inquiry (AIn) is a strengths-based organizational framework to promote engagement and change. It has shown promise in graduate medical education settings, but how, why, and for whom AIn may drive...OBJECTIVE: Appreciative Inquiry (AIn) is a strengths-based organizational framework to promote engagement and change. It has shown promise in graduate medical education settings, but how, why, and for whom AIn may drive educational outcomes is underexplored. This realist evaluation examines the causal relationships between contexts, mechanisms, and outcomes at a rheumatology fellowship program in a large tertiary care center that implemented a set of AIn-based interventions. We generate recommendations for leaders in rheumatology fellowship programs on the implementation of AIn-based interventions. METHODS: The realist evaluation was conducted in 3 phases. In phase 1, a scoping review informed the initial program theory. In phase 2, realist interviews were conducted to identify and refine causal relationships between contexts, mechanisms, and outcomes, yielding a final program theory. In phase 3, the final program theory was utilized to generate recommendations for implementation. RESULTS: The final program theory identified 15 contexts, 10 mechanisms, and 10 outcomes along with 43 context-mechanism-outcome configurations. Through analysis of the final program theory, 3 recommendations were generated: (1) programs must first create permission structures for critical self-reflection through strengths-based feedback, (2) programs must consistently and synergistically apply AIn principles at multiple levels, and (3) programs can sustain AIn-based interventions through the deliberate co-design of virtuous cycles. CONCLUSIONS: This realist evaluation has generated a theory on how AIn may be implemented into rheumatology fellowship programs to drive educational outcomes. Because of the intricate causal relationships, leaders are well-advised to tailor AIn-based interventions based on the context of their training programs.
OBJECTIVE: In the previous Spondyloarthritis EYE study, we confirmed the potential of a screening strategy for early axial spondyloarthritis (axSpA) detection using acute anterior uveitis (AAU) and chronic back pain (CBP...OBJECTIVE: In the previous Spondyloarthritis EYE study, we confirmed the potential of a screening strategy for early axial spondyloarthritis (axSpA) detection using acute anterior uveitis (AAU) and chronic back pain (CBP) as referral criteria. This follow-up study assessed changes in diagnostic categories (definite, suspected, and no axSpA) over 2 years and identified baseline factors predicting axSpA diagnosis at 24 months. METHODS: Patients with AAU and CBP were categorized into 3 groups: definite axSpA, suspected of axSpA, and no axSpA, based on clinical and radiographic data within 6 months after baseline. Suspected cases were monitored for 24 months, with the possibility of reclassification. A competing risk analysis was used to estimate the probability of transitioning from "suspected of axSpA" to "definite axSpA" or "no axSpA," and logistic regression analysis was employed to determine if baseline factors could predict definite axSpA at 24 months. RESULTS: Among 81 patients, 26 were classified as no axSpA, 36 as suspected of axSpA, and 19 as definite axSpA. At 24 months, suspected patients had an 18% probability to transition to definite axSpA (4 cases) and a 60% to no axSpA (15 cases). Significant predictors of axSpA diagnosis included the following: HLA-B27 positivity, good response to nonsteroidal anti-inflammatory drugs, inflammatory back pain, increasing C-reactive protein levels, buttock pain, and higher Bath Ankylosing Spondylitis Metrology Index scores. CONCLUSIONS: Our screening strategy identified approximately one third of previously undiagnosed axSpA cases among patients with AAU and CBP, mostly at baseline, with few additional cases at follow-up. The predictors revealed in this study could aid physicians in estimating axSpA disease probability.
OBJECTIVE: This study aims to evaluate the association between patient sex and discharge disposition as well as inpatient mortality following elective primary total hip arthroplasty (THA) for osteoarthritis (OA) in the U...OBJECTIVE: This study aims to evaluate the association between patient sex and discharge disposition as well as inpatient mortality following elective primary total hip arthroplasty (THA) for osteoarthritis (OA) in the United States. METHODS: This study used the 2016-2019 US National Inpatient Sample, a nationally representative dataset, to conduct a cross-sectional study. Adjusted odds ratios and 95% confidence intervals (CIs) were calculated to assess the association of sex with discharge disposition and in-hospital mortality after elective primary THA for OA, adjusting for demographics, comorbidity, social determinants of health (income, insurance payer), hospital characteristics (bed size, location/teaching status, region, control), and postprocedural complications (for mortality and discharge disposition). RESULTS: There were 1,507,085 elective primary THA hospitalizations for OA in the 2016-2019 National Inpatient Sample data. The mean age was 65.6 years, 55.7% were female, and the mean Deyo-Charlson comorbidity index score was 0.6. In multivariable-adjusted analysis, compared with male sex, female sex was associated with nonhome discharge, but not with in-hospital mortality following elective THA for OA; the adjusted odds ratios were 1.27 (95% CI, 1.25-1.29; p < 0.001) and 0.72 (95% CI, 0.46-1.13; p = 0.15), respectively. CONCLUSIONS: Female sex was a risk factor for nonhome discharge, but not in-hospital mortality after elective primary THA for OA. It remains to be seen whether better patient health optimization with clinical pathways and targeted interventions in females undergoing elective primary THA can reduce the complication rate.
OBJECTIVE: The study aims to evaluate the impact of patient-reported disease activity in other patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE) patients. METHODS: SLE patients from the Almenara Lupu...OBJECTIVE: The study aims to evaluate the impact of patient-reported disease activity in other patient-reported outcomes (PROs) in systemic lupus erythematosus (SLE) patients. METHODS: SLE patients from the Almenara Lupus Cohort were included, and visits were performed every 6 months. Disease activity was assessed with the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) PRO, health-related quality of life (HRQoL) with the LupusQoL, fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and work productivity impairment with the work productivity and activity impairment (WPAI). Generalized estimating equations were performed for each domain of the LupusQoL, the FACIT-F, and the WPAI. The LFA-REAL PRO measured at the previous visit; multivariable models were adjusted for possible confounders measured at the same visit as the LFA-REAL PRO. The Β (regression unstandardized coefficient) is reported per an increase of 10 units of the LFA-REAL PRO. RESULTS: A total of 316 patients and 1116 visits were included. Mean (SD) LFA-REAL PRO at baseline was 240.9 (182.1). LFA-REAL PRO predicted a worse HRQoL in all domains of the LupusQoL, the WPAI, and the FACIT-F, even after adjustment for confounders. CONCLUSIONS: A higher patient-reported disease activity predicted a worse HRQoL and fatigue as well as a higher work productivity impairment in SLE patients. Patient-reported disease activity should be included in the evaluation of SLE patients on a regular basis as such provides the patients' own perception of their disease. This may have an impact on their adherence to treatment and may result in better outcomes.
OBJECTIVE: Our hypothesis is that biopsy-positive giant cell arteritis (GCA) is infrequent among Black patients. To evaluate this, we compared the temporal artery biopsy (TAB) positivity rates among White and Black patie...OBJECTIVE: Our hypothesis is that biopsy-positive giant cell arteritis (GCA) is infrequent among Black patients. To evaluate this, we compared the temporal artery biopsy (TAB) positivity rates among White and Black patients. METHODS: This is a case-control study review from all patients who underwent TAB at our institution from 2012 until 2021. The main study outcome was the TAB positivity rate. The main independent variable was race/ethnicity. Clinical and demographic features of patients undergoing TAB were compared between those with positive and negative biopsies with t tests, Wilcoxon rank sum test, χ 2 test, or Fisher exact test where appropriate. A multiple logistic regression with Firth correction was performed with factors found to be significant in bivariate analysis to evaluate for independent associations with a positive biopsy. RESULTS: Three hundred eighty-five patients who underwent TAB for suspected GCA were included (290 White, 95 Black). Mean sedimentation rate was higher in Black patients, but otherwise, both groups had similar demographic and clinical characteristics. Positivity rate of TAB in White patients was 20.3% and 8.4% in Black patients. White race was associated with higher likelihood of TAB positivity compared with Black race (odds ratio, 3.47). Patients with positive TAB were more likely to have jaw claudication, constitutional symptoms, and higher inflammatory markers. Other factors significant in the logistic regression model included age, and inversely with decreased visual acuity. CONCLUSIONS: Our study results support the hypothesis that there is a discrepancy in the frequency of biopsy-confirmed GCA in patients referred for TAB, with Black patients having lower rates than their White counterparts.