Musculoskeletal Diseases Commons^™

Detection Of Igg4-Specific Autoantibodies In Rheumatoid Arthritis Serum Samples, Azra Borogovac, Youmna Lahoud, Janice Weaver, Sheldon M. Cooper, Mercedes Rincon, Jonathan Kay, Ellen M. Gravallese

Ellen M. Gravallese

Background: Rheumatoid arthritis (RA) is a chronic multi-system autoimmune disease characterized by inflammatory synovitis. Autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) have been implicated in the pathogenesis of RA, and are currently important criteria for diagnosis within the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria.1 Yet, many patients diagnosed with RA do not have measurable circulating ACPA or RF which may result in delayed diagnosis and treatment. After IgG1, IgG4 is the second most predominant isotype among ACPA and RF; however it is not detected in currently available diagnostic assays. Recent …

Detection Of Igg4-Specific Autoantibodies In Rheumatoid Arthritis Serum Samples, Azra Borogovac, Youmna Lahoud, Janice Weaver, Sheldon M. Cooper, Mercedes Rincon, Jonathan Kay, Ellen M. Gravallese

Jonathan Kay

Background: Rheumatoid arthritis (RA) is a chronic multi-system autoimmune disease characterized by inflammatory synovitis. Autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) have been implicated in the pathogenesis of RA, and are currently important criteria for diagnosis within the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria.1 Yet, many patients diagnosed with RA do not have measurable circulating ACPA or RF which may result in delayed diagnosis and treatment. After IgG1, IgG4 is the second most predominant isotype among ACPA and RF; however it is not detected in currently available diagnostic assays. Recent …

Osteopontin: A Bridge Between Bone And The Immune System, Ellen M. Gravallese

Ellen M. Gravallese

The molecular mechanisms underlying the putative role of osteopontin in the chronic inflammatory disease rheumatoid arthritis are unclear. A study in a murine model of arthritis now demonstrates that a specific antibody directed against the exposed osteopontin epitope SLAYGLR is capable of preventing inflammatory cell infiltration in arthritic joints.

The Role Played By Cell-Substrate Interactions In The Pathogenesis Of Osteoclast-Mediated Peri-Implant Osteolysis, Zhenxin Shen, Tania N. Crotti, Kevin P. Mchugh, Kenichiro Matsuzaki, Ellen M. Gravallese, Benjamin E. Bierbaum, Steven R. Goldring

Ellen M. Gravallese

Prosthetic wear debris-induced peri-implant osteolysis is a major cause of aseptic loosening after total joint replacement. In this condition, wear particles released from the implant components induce a granulomatous inflammatory reaction at the interface between implant and adjacent bone, leading to progressive bone resorption and loss of fixation. The present study was undertaken to characterize definitively the phenotype of osteoclast-like cells associated with regions of peri-implant focal bone resorption and to compare the phenotypic features of these cells with those of mononucleated and multinucleated cells associated with polyethylene wear particles. Peri-implant tissues were obtained from patients undergoing hip revision surgery …

The Role Of Tnf-Receptor Family Members And Other Traf-Dependent Receptors In Bone Resorption, Ellen M. Gravallese, Deborah L. Galson, Steven R. Goldring, Philip E. Auron

Ellen M. Gravallese

The contribution of osteoclasts to the process of bone loss in inflammatory arthritis has recently been demonstrated. Studies in osteoclast biology have led to the identification of factors responsible for the differentiation and activation of osteoclasts, the most important of which is the receptor activator of NF-kappa B ligand/osteoclast differentiation factor (RANKL/ODF), a tumor necrosis factor (TNF)-like protein. The RANKL/ODF receptor, receptor activator of NF-kappa B (RANK), is a TNF-receptor family member present on both osteoclast precursors and mature osteoclasts. Like other TNF-family receptors and the IL-1 receptor, RANK mediates its signal transduction via TNF receptor-associated factor (TRAF) proteins, suggesting …

Critical Roles For Interleukin 1 And Tumor Necrosis Factor Alpha In Antibody-Induced Arthritis, Hong Ji, Allison Pettit, Koichiro Ohmura, Adriana Ortiz-Lopez, Veronique Duchatelle, Claude Degott, Ellen M. Gravallese, Diane Mathis, Christophe Benoist

Ellen M. Gravallese

In spontaneous inflammatory arthritis of K/BxN T cell receptor transgenic mice, the effector phase of the disease is provoked by binding of immunoglobulins (Igs) to joint surfaces. Inflammatory cytokines are known to be involved in human inflammatory arthritis, in particular rheumatoid arthritis, although, overall, the pathogenetic mechanisms of the human affliction remain unclear. To explore the analogy between the K/BxN model and human patients, we assessed the role and relative importance of inflammatory cytokines in K/BxN joint inflammation by transferring arthritogenic serum into a panel of genetically deficient recipients. Interleukin (IL)-1 proved absolutely necessary. Tumor necrosis factor (TNF)-alpha was also …

Mechanisms Of Bone Loss In Inflammatory Arthritis: Diagnosis And Therapeutic Implications, Steven R. Goldring, Ellen M. Gravallese

Ellen M. Gravallese

Rheumatoid arthritis represents an excellent model in which to gain insights into the local and systemic effects of joint inflammation on skeletal tissues. Three forms of bone disease have been described in rheumatoid arthritis. These include: focal bone loss affecting the immediate subchondral bone and bone at the joint margins; periarticular osteopenia adjacent to inflamed joints; and generalized osteoporosis involving the axial and appendicular skeleton. Although these three forms of bone loss have several features in common, careful histomorphometric and histopathological analysis of bone tissues from different skeletal sites, as well as the use of urinary and serum biochemical markers …

The Role Of Occupational Therapy In The Prevention Of Infant Torticollis & Plagiocephaly, Anne H. Zachry

Faculty Presentations

AOTA includes health promotion as an Intervention approach in the Occupational Therapy Practice Framework: Domain and Process. As health care professionals, occupational therapy practitioners are responsible for promoting public health and wellness. Occupational therapists need to educate parents and caregivers about the importance of varying infant positions, providing tummy time, and limiting infant time spent in baby gear.

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, …

Fibromyalgia Syndrome: Considerations For Dental Hygienists, Amber Walters, Susan L. Tolle, Gayle M. Mccombs

Dental Hygiene Faculty Publications

PURPOSE: Fibromyalgia syndrome (FMS) is a neurosensory disorder characterized by widespread musculoskeletal pain. Typically persistent fatigue, depression, limb stiffness, non-refreshing sleep and cognitive deficiencies are also experienced. Oral symptoms and pain are common, requiring adaptations in patient management strategies and treatment interventions. Appropriate dental hygiene care of patients suffering with this disorder is contingent upon an understanding of disease epidemiology, pathophysiology, clinical characteristics, oral signs and symptoms, as well as treatment approaches. With this information dental hygienists will be better prepared to provide appropriate and effective treatment to patients with FMS.

Clinical Disease Activity And Acute Phase Reactant Levels Are Discordant Among Patients With Active Rheumatoid Arthritis: Acute Phase Reactant Levels Contribute Separately To Predicting Outcome At One Year, Jonathan Kay, Olga Morgacheva, Susan P. Messing, Joel M. Kremer, Jeffrey D. Greenberg, George W. Reed, Ellen M. Gravallese, Daniel E. Furst

Ellen M. Gravallese

INTRODUCTION: Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by …

Clinical Disease Activity And Acute Phase Reactant Levels Are Discordant Among Patients With Active Rheumatoid Arthritis: Acute Phase Reactant Levels Contribute Separately To Predicting Outcome At One Year, Jonathan Kay, Olga Morgacheva, Susan P. Messing, Joel M. Kremer, Jeffrey D. Greenberg, George W. Reed, Ellen M. Gravallese, Daniel E. Furst

Jonathan Kay

INTRODUCTION: Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by …

Effect Of Monophasic Pulsed Current On Heel Pain And Functional Activities Caused By Plantar Fasciitis, Abdullah K. Alotaibi, Jerrold S. Petrofsky, Noha S. Daher, Everett Lohman, Michael S. Laymon, Hasan M. Syed

College of Health & Human Services (TUN) Publications and Research

Background: Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF.

Material and Methods: Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; …

Is Regenerative Injection Therapy (Prolotherapy) Effective At Reducing Pain Associated With Knee Osteoarthritis?, Ashley Aloi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Is regenerative injection therapy (prolotherapy) effective at reducing pain associated with knee osteoarthritis?”

Study Design: Review of all English language primary studies published in 2012 and 2013.

Data Sources: One randomized control trial, one randomized crossover study and one single-arm uncontrolled study were found using PubMed and Ebscohost.

Outcomes Measured: Clinical outcome for all three articles was measured using the Western Ontario McMaster University Osteoarthritis Index (WOMAC); which specifically focuses on quality of life, function, and pain reduction after the use of prolotherapy versus the saline …

Is Treatment With Topical Glyceryl Trinitrate Effective In Reducing Elbow Pain In Patients With Lateral Epicondylitis?, Benjamin Chartier

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not treatment with topical glyceryl trinitrate is effective in reducing elbow pain in patients with lateral epicondylitis.

Study Design: Review of two English language randomized controlled trials and one primary study published 2003, 2009, 2011.

Data Sources: Two double blind randomized controlled and one prospective comparison study comparing the effectiveness of gylceryl trinitrate to placebo in the treatment of pain related to lateral epicondylitis, found using PubMed, EBSCOhost, and CINAHL Plus.

Outcome(s) Measured: The outcome studied was patient self-rated elbow pain at rest, pain with activity, pain …

In The Treatment Of Patients With Knee Joint Osteoarthritis, Are Platelet Rich Plasma Injections More Effective Than Hyaluronic Acid Injections?, Darshit Gandhi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not "In the treatment of patients with knee joint osteoarthritis, are Platelet Rich Plasma injections more effective than Hyaluronic acid injections?"

Study Design: Review of one randomized double-blind trial, one randomized cohort study, and one randomized control trial published in the English language in the year 2012.

Data Sources: All studies were published in peer-reviewed journals found via the use of PubMed.

Outcome(s) Measured: Patients were divided into two groups: those who received platelet rich plasma injections (PRP) and those who received hyaluronic injections (HA). Efficacy of …

Is Ayurvedic Effective In Reducing Osteoarthritis Pain In Adults?, Reja Khan

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not Ayurvedic is effective in reducing osteoarthritis pain in adults.

Study Design: Review of three English language randomized controlled trials published between from 2004-2013.

Data Sources: Two double blind randomized controlled trials and one open label randomized controlled clinical trial were found using PubMed and Cochrane Library databases.

Outcomes Measured: To measure the effectiveness, the following parameters were utilized visual analog scale (VAS) reported by the patient to assess reduction in pain symptoms of osteoarthritis.

Results: Three randomized controlled studies results found that Ayurvedic medicine was beneficial …

Is Ginger Effective In Reducing Knee Pain In Adults With Osteoarthritis?, Joseph Heng

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this evidence based medicine review is to determine whether ginger is effective in reducing knee pain in adults with osteoarthritis.

Study Design: Three double blind, randomized controlled trials were reviewed and selected based on their relevance to the clinical question and their inclusion of patient oriented outcomes (POEMS).

Data Sources: Each study was obtained by searching Cochrane and PubMed database.

Outcomes Measured: The outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) via Likert scale and Knee Pain rated via Knee injury and knee Osteoarthritis Outcome score (KOOS) questionnaire which is a …

Is Red Yeast Rice Tolerable In Treating Patients With Dyslipidemia Who Have Statin-Associated Myalgia?, Carie Lam

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not patients who have statin-associated myalgia have improved tolerability for red yeast rice (RYR) as an alternative treatment.

Study Design: This review consists of three double blinded randomized controlled trials published in English in 2009, 2010, 2013.

Data Sources: Three randomized, controlled, double blinded clinical trials on the tolerability of red yeast rice were found on PubMed and Ebsco Host. Two trials comparing red yeast rice to placebo and the third trial comparing red yeast rice to pravastatin.

Outcomes Measured: Each of the three articles analyzed whether …

Acupuncture: A Comparison Study Of Sham Acupuncture, Traditional Chinese Acupuncture And Current Practice Guidelines For The Treatment Of Chronic Musculoskeletal Pain In Adults, Kayla Olson

Physician Assistant Scholarly Project Posters

• Chronic pain is one of the most difficult conditions to treat.

---Close monitoring of controlled medications

---Unnecessary, expensive surgeries

• Alternatives to medication is increasingly necessary.

• Integrative medicine incorporates traditional western medicine with unconventional therapies, such as acupuncture.

---Evaluate the treatments’ efficacy for chronic neck and back pain by evaluating meta-analysis studies and randomized controlled trials.

• Physiology is a large component of understanding how and if the acupuncture works.

---Non-invasive functional magnetic resonance imaging

---Neurotransmitters and their response to acupuncture

• Acupuncture therapy for improvement of chronic musculoskeletal pain