Rheumatology Commons^™

Adipocytes And Innate Immunity In Systemic Sclerosis, Nancy Wareing

Dissertations & Theses (Open Access)

Systemic sclerosis (SSc; scleroderma) is a chronic systemic autoimmune and connective tissue disorder characterized by vasculopathy, autoimmune phenomena, and widespread fibrosis. Skin thickening and tightening is the cardinal feature of SSc and is responsible, in part, for the considerable morbidity of this disease. There are currently no targeted treatments for skin manifestations in SSc, primarily due to our fragmented understanding of its pathophysiologic mechanisms. In PART I, we report a previously unappreciated link between aberrant expression of the developmental gene sine oculis homeobox homolog 1 (SIX1) in skin-associated adipocytes in SSc skin and the early loss of dermal white adipose …

Enhancing Physician Perspectives Of Skilled Occupational Therapy Services For Patients With Rheumatoid Arthritis, Valerie S. Trinidad

Department of Occupational Therapy Entry-Level Capstone Projects

This Capstone Project, with a focus in research, sought to identify a relationship between self-reported functional performance and participation restriction as described by satisfaction with one’s execution or participation in a described occupation. A correlational study design was employed under the mentorship of Dr. Thomas Decker, EdD, OTD, OTR/L who oversaw all IRB processes, documentation, study development and deployment, as well as co-authored and provided mentorship for creation of a publishable manuscript of this project. The established Health Assessment Questionnaire Disability Index (HAQ-DI) and the newer Keele Assessment of Participation (KAP) were the two outcome measures of focus for surveying …

Biomechanical Loading As A Driver Of Synovial Neovascularization And Microvascular Dysfunction In Knee Osteoarthritis, Mckenzie Carter

Electronic Thesis and Dissertation Repository

Synovial inflammation and biomechanical loading are independent risk factors for knee osteoarthritis (OA). However, the relationship between inflammatory and biomechanical factors, specifically if increased biomechanical loading causes synovial inflammation in OA (mechanoinflammation), is not well understood. The purpose of this thesis was to explore the associations of knee load during walking with features of synovial inflammation in knee OA. The knee adduction moment magnitude was associated with increased synovial vascularization and perivascular edema. Synovial fluid from OA patients with high knee adduction moments promoted endothelial cell migration in vitro. Late-stage knee OA synovial fluid caused endothelial monolayer hyperpermeability in …

The Natural History Of Modic Changes - A 5- And 15-Year Follow-Up Study, Parnian Saremi

Electronic Thesis and Dissertation Repository

Modic changes (MCs), defined as bone marrow lesions adjacent to the vertebral endplate seen on MRI, have been associated with back pain. There are different types of MCs, with different histopathological correlates. This community-based study sample comprised 110 men from the Twin Spine Study, with baseline, 5-year, and 15-year follow-up MRIs. Following training and reliability testing, 1320 endplates (T12-S1) were evaluated for MC presence, type, and dimensions at each time point. Results demonstrated that Type 2 Modic Changes (MC2) were the most common type, with approximately half located at the two lowest disc levels. However, Type 1 Modic Changes (MC1) …

Potential Therapeutic Effects Of Snake Venom Components On Pain Management In Rheumatoid Arthritis Patients, Maggie Metzger

University Honors Theses

This paper reviews the existing literature on the uses of snake venom in the treatment of rheumatoid arthritis and pain management. Venom from the families Elapidae and Viperidae have been shown to have anti-inflammatory and analgesic effects. The analgesic findings of research on arthritis murine models are discussed, and the existing uses of snake venom in medicine to suggest the therapeutic potential of venom in the pain management of rheumatoid arthritis are taken into account. Snake venom has anti-inflammatory effects by reducing levels of pro-inflammatory cytokines and increasing levels of anti-inflammatory cytokines. Additionally, snake venom can reduce structural damage from …

Joint Protection Programs For People With Hand Arthritis, Pavlos Bobos

Electronic Thesis and Dissertation Repository

The fact that Joint Protection Programs (JPP) can reduce pain and improve function is based on small, but definitive Randomized Controlled Trials (RCTs), conducted in the 1980s. However, changes over time in the nature of hand use, the rapid expansion of technology, and improvements in our understanding of health literacy mean that these programs are now outdated. Further, problems with adherence to JPP are well documented. The purpose of this thesis was 1) to conduct a scoping review to map all the available evidence around joint protection programs in published and unpublished studies 2) to evaluate the effectiveness of joint …

Correlation Of Inflammation In Arthritis With The Myelination In The Brain, Anna Spears

Honors Theses

This study was conducted to investigate whether the influence of arthritis has an effect on the cerebral white matter. The project was performed at the South Oxford Campus, where diffusion tensor imaging (DTI) data was obtained from the Nathan Kline Institute-Rockland Sample (NKI- RS). Image processing was conducted using Functional Magnetic Resonance Imaging of Brain Software Library in which we obtained raw data to formulate Apparent Diffusion Coefficient (ADC), Axial Diffusivity (AD), Radial Diffusivity (RD), and Fractional Anisotropy. A one way Analysis of Covariance (ANCOVA) was performed to determine the significant difference between the history of arthritis on each of …

The Effectiveness Of Cannabidiol In Rheumatic Disease Pain: A Systematic Review, Mary C. Wiczek

All Graduate Theses, Dissertations, and Other Capstone Projects

Cannabinoids have long been a part of human culture and medicine, and more recently have been rediscovered for their potential use in the management of rheumatic disease pain. The objective of this review was to evaluate the known clinical effectiveness of cannabidiol treatment for rheumatic disease related pain. The legality and current regulation of these products was also reviewed to establish the current status of federal and state rules regarding their clinical use. Basic definitions of the terms used to differentiate cannabidiol from other cannabinoid products was also outlined. A systematic literature search was then conducted to explore the current …

Enhancing The Identification Of Rheumatoid Arthritis-Associated Lung Disease, Bryant England

Theses & Dissertations

Rheumatoid arthritis (RA) is a systemic autoimmune disease that predisposes afflicted individuals to reduced quality of life, physical disability, and premature mortality. While joint involvement is the primary manifestation of RA, extra-articular features including lung disease are responsible for a significant portion of the excess mortality. In this dissertation I demonstrate the contribution of chronic lung diseases to premature mortality in RA, contrasting with the more widely recognized comorbidity in RA of cardiovascular disease. Then, I establish that a novel serum biomarker, anti-malondialdehyde-acetaldehyde adduct (MAA) antibody, is associated with the presence of interstitial lung disease (ILD) in RA subjects. Further …

Improving Adolescent Health Care Transition: Piloting The Transition Readiness Assessment Questionnaire, Meghan D. Foster Msn, Rn-Bc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Successful adolescent health care transition (HCT) is a vital process in providing developmentally appropriate care and minimizing negative outcomes, especially in adolescents with special health care needs. The purpose of this mixed-methods quality improvement project was to pilot the Transition Readiness Assessment Questionnaire (TRAQ) tool in a pediatric rheumatology clinic and assess its utility as a transition tool as well as to inquire about specific patient and family-based transition needs.

Methods. The TRAQ tool and follow-up survey were administered in dyads to all established pediatric rheumatology patients between the ages of 12-18, and one caregiver, who presented to the …

Does Secukinumab Improve Self-Reported Quality Of Life In Patients With Moderate-To-Severe Ankylosing Spondylitis When Taken Regularly?, Ryan Yenovkian

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not secukinumab improves self-reported quality of life in patients with moderate-to-severe ankylosing spondylitis when taken regularly.

Study design: A systematic review of three randomized placebo-controlled trials (RCTs), published in peer-reviewed journals between 2013 and 2015, all in the English language. Data sources: All three studies were found and accessed on PubMed.

Outcomes measured: Patient quality of life was assessed in all three studies using the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and reported as mean change from baseline. ASQoL is scored from 0-18 with a higher …

Is Hyaluronic Acid Intra-Articular Injection Better Than Corticosteroid Intra Articular Injection At Reducing Pain In Patients With Knee Osteoarthritis?, Madison Cohen

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Hyaluronic Acid intra articular injection is better than Corticosteroid intra articular injection at reducing pain in patients with knee osteoarthritis.”

STUDY DESIGN: Review of three double-blind, randomized control trials published between 2014 and 2016. All studies were published in English language in peer reviewed journals.

DATA SOURCES: All three randomized control trials were found via PubMed.

OUTCOMES MEASURED: The primary outcomes measured by the patient and investigator being improvement of knee pain severity, knee function, and range of motion after hyaluronic acid intra articular (IA) injection …

Does Adjuvant Therapy With Omega-3 Fatty Acids (Fish Oil) Improve Joint Tenderness In Patients With Rheumatoid Arthritis?, Eileen Fauteux

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not adjuvant therapy with Omega-3 fatty acids (fish oil) improves joint tenderness in patients with Rheumatoid Arthritis.

STUDY DESIGN: Review of 3 double-blind, randomized controlled trials from 2010- 2017.

DATA SOURCES: Three peer-reviewed journal articles written in English were found using PubMed. Articles were selected based on their relevance to the question and whether the outcome measured was patient-oriented evidence that matters.

OUTCOME(S) MEASURED: All articles analyzed the effectiveness of adjunctive treatment with omega-3 fatty acids on the improvement of joint tenderness in patients with rheumatoid arthritis. …

Can Yoga Therapy Help To Decrease Osteoarthritis-Related Pain In Adults With Knee Osteoarthritis?, Justin Mahr

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not yoga therapy can help to decrease osteoarthritis-related pain in adults with knee osteoarthritis.

Study Design: A review of two randomized controlled trials and one randomized control trial pilot study that were published in English in peer-reviewed journals after 2007.

Data Sources: All articles were selected from peer-reviewed journals and found via PubMed.

Outcome(s) Measured: Patient perception of pain using either a Walking Numerical Rating Scale (WNRS) and/or a Western Ontario and McMaster Universities OA Index scale (WOMAC).

Results: All three studies …

Does Probiotic Supplementation Help Decrease Pain And Number Of Tender Joints In Adults With Rheumatoid Arthritis?, Brittany Snyder

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “probiotic supplementation helps decrease pain and number of tender joints in adults with rheumatoid arthritis?”

STUDY DESIGN: Review of three double-blind, randomized control trials published between 2008 and 2018. All studies were published in English in peer reviewed journals.

DATA SOURCES: Three double-blind, randomized control trials were found via PubMed.

OUTCOMES MEASURED: The outcomes measured included number of tender joints from baseline to end of study counted by an investigator, visual analog scale (VAS) for pain severity, and a Stanford Health Assessment Questionnaire visual analog scale …

Factors Associated With Participant Attrition In A Longitudinal, Survey-Based Rheumatic Disease Databank, Kathryn A. Grafel

Capstone Experience

Introduction: Participant attrition is a problem common to many longitudinal studies, and when it occurs nonrandomly, it can impact the study’s validity and generalizability. Identifying factors associated with attrition can help to detect bias and aid in developing targeted interventions to reduce attrition. Methods: Logistic regression and Cox proportional hazards regression models were constructed separately for patients with rheumatoid arthritis, systemic lupus erythematosus, and other rheumatic diseases who participated in the FORWARD study between 1998 and 2018. Results: Patient characteristics associated with attrition included male sex, younger age, non-White race, and less education, each of which was identified in multiple …

Viral Etiology Of Rheumatoid Arthritis, Fatima Kudaeva

Electronic Thesis and Dissertation Repository

Viruses can trigger rheumatoid arthritis (RA) or inflammatory arthritis (IA). Our study provides insight into etiology of RA/IA. We analyzed the evidence relating to the risk of RA after viral infections; estimated the distribution of IA onsets over time; quantified the effect of influenza on the risk of IA.

Results of systematic review and meta-analysis showed that the risk of RA/IA is increased after parvovirus B19 and chikungunya virus. There seems to be a risk of RA after chronic hepatitis C (HCV), but whether it is a true RA or HCV-associated arthritis is not clear.

We estimated the distribution of …

Are Hylan Injections More Effective In Reducing Stiffness In Primary Knee Osteoarthritis Compared To Hyaluronic Acid Derivative Injections?, Jordan S. Hood

PCOM Physician Assistant Studies Student Scholarship

No abstract provided.

Is Weight Loss An Effective Treatment Of Pain Symptoms Related To Knee Joint Osteoarthritis In Obese Adults?, Samantha Sokol

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not weight loss is an effective treatment of pain symptoms related to knee joint osteoarthritis in obese adults.

Study Design: Systematic review of 2 randomized-controlled trials and 1 cohort study. All three articles were published in English between 2011-2015.

Data Sources: Two randomized, un-blinded, controlled studies and one cohort found using Pubmed.

Outcomes Measured: Each study evaluated change in pain symptoms related to knee osteoarthritis in obese adults as compared to weight loss.

Results: Studies showed that weight loss lead to a …

Are Antibiotics, Other Than Roxithromycin, An Effective Way To Manage Joint Pain In Rheumatoid Arthritis?, Kelly A. Hoffman

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine “Are antibiotics, other than roxithromycin, an effective way to manage joint pain in rheumatoid arthritis?”

STUDY DESIGN: Review of three double-blind, randomized-controlled studies published in English between 2001-2007.

DATA SOURCES: Three randomized controlled trials published between 2001 and 2007 were found using PubMed/MEDLINE and Cochrane databases.

OUTCOMES MEASURED: Clinical outcome for all three studies used American College of Rheumatology (ACR) criteria, which assesses joints for swelling and tenderness.

RESULTS: In the Odell et al.1 study, at 24 months 28 participants did meet the ACR50 …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Use Of Dietary And Herbal Supplements In Older Adults With Osteoarthritis, Sharon Denise Mcdonald

Dissertations

Over the past several decades, older adults with Osteoarthritis (OA) have increasingly used more natural products in an effort to manage chronic pain. The theoretical framework for this study was the Lazarus and Folkman transactional theory of stress and coping. This framework was chosen based on the belief that older adults with OA are taking natural products as an active problem solving coping strategy to manage the pain, disability, and alterations they experience in their health related quality life including functional status, physical symptoms, emotional health, and social functioning. Older adults also take prescription medications for Osteoarthritis and a variety …

Methotrexate And Cardiovascular Events, Alpesh Shah

Electronic Thesis and Dissertation Repository

We conducted a systematic review and meta-analysis to assess the association of MTX with cardiovascular morbidity, cardiovascular mortality and all-cause mortality in patients with autoimmune disease. Our primary outcome was incident cardiovascular events. After screening 13,479 citations, we identified a total of 30 eligible studies. We synthesized adjusted risk estimates using a random effects model. MTX was significantly associated with a 25% reduction in cardiovascular events (pooled RR: 0.75, 95% CI: 0.65, 0.86, I²: 11%), a 55% reduction in cardiovascular mortality (0.45, 95% CI: 0.26, 0.80, I²: 33%) and a 40% reduction in all-cause mortality (0.60, …

The Role Of Occupational Therapy In Primary Care, Priti Patel

Occupational Therapy Doctorate Capstone Projects

The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …

Sympathetic Nerve Modulation Of Joint Pathology In Adjuvant-Induced Arthritis, Carlo Anthony Wood

Loma Linda University Electronic Theses, Dissertations & Projects

Background: There is increasing data suggesting a net increase in sympathetic tone plays an important role in rheumatoid arthritis. Several studies have reported altered distribution and density of autonomic nerves in patients with rheumatoid arthritis and animal models for the disease. This provides anatomical evidence that supports a neurally-mediated drive in inflammation and joint destruction. Methods: Adult rats were injected with complete Freund’s adjuvant. At 12 days post immunization, animals were randomly placed into a drug treatment group (SH1293, which interacts with - and ß2-ARs), an adjuvant arthritic group, or a control group. These animals were sacrificed at 14, 21, …

Is Etanercept A Safe And Effective Treatment For Ankylosing Spondylitis?, Robyn M. Albert

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not etanercept is a safe and effective treatment for ankylosing spondylitis (AS).

Study Design: Review of three English language randomized control trials published in 2007, 2008, and 2010.

Data Sources: Two double-blind placebo-controlled randomized controlled trials and one placebo-controlled randomized control trial comparing etanercept to placebo were found using PubMed.

Outcomes Measured: Work instability was measured through the Ankylosing Spondylitis Work Instability Scale (AS-WIS) based on scores of 1-20. Quality of life was measured through the EuroQOL-5D (EQ-5D), which assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. …

Is Actemra (Tocilizumab) In Combination With Methotrexate An Effective Treatment For Rheumatoid Arthritis In Patients Who Had An Inadequate Response To Methotrexate Alone?, Jennifer Nagle

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not Actemra (tocilizumab) in combination with methotrexate is an effective treatment for rheumatoid arthritis in patients who had an inadequate response to methotrexate alone. Previous studies have shown other biologic agents and disease modifying antirheumatic drugs (DMARDs) to have some efficacy in treating rheumatoid arthritis. However, tocilizumab is a newly approved FDA drug and therefore, its efficacy in treating RA has yet to be determined.

Are Antinuclear Antibodies And Rheumatiod Factor Positivity More Prevalent In Apparently Healthy Smokers Compared To Ex-Smokers And Never Smokers?, Susan Nyanzi

Loma Linda University Electronic Theses, Dissertations & Projects

Context: There is now consistent evidence from population and epidemiological studies that cigarette smoking is an independent risk factor for Rheumatoid Arthritis (RA), via Rheumatoid Factor (RF) production (Deighton, 1997; Saag, 1997; Silman, 1996; Uhlig, 1999; Wolfe, 2000). Antinuclear Antibodies (ANA) are another collection of autoantibodies that are being associated with smoking and RA initiation. To our knowledge, no studies have examined the effects of smoking on both ANA and RF simultaneously in healthy subjects.

Objectives: To determine whether cigarette smoking has an effect on ANA and RF positivity in healthy blood donors.

Design, Setting, Participants: This was a cross-sectional, …

The Role Of Meat, Poultry, And Fish Consumption In The Occurrence Of Rheumatoid And Other Forms Of Arthritis, Asnake Hailu

Loma Linda University Electronic Theses, Dissertations & Projects

Rheumatoid arthritis and other forms of arthritis or rheumatism are now the leading cause of disability in the United States. The etiology and pathogenesis are less understood and available treatment options are not always satisfactory. This dissertation measures the prevalence and cumulative incidence of rheumatoid arthritis and other forms of arthritis or rheumatism, and examines any associations with current and lifetime consumption of meat, poultry, and fish (meat) using the Adventist Health Study and the Adventist Mortality Study databases. From these databases, it was possible to reconstruct a prospective cohort, obtain self-reported information on demographic characteristics, arthritis, rheumatoid arthritis, other …