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A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, MD, Lily Ackermann, MD 2018 Thomas Jefferson University

A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, Md, Lily Ackermann, Md

The Medicine Forum

INTRODUCTION

Eosinophilic granulomatosis with polyangiitis (eGPA) is a small- and medium-sized-vessel vasculitis with multi-organ manifestations. Given the rarity of eGPA, patients are often misdiagnosed for decades and may initially present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its associated signs and symptoms. This case report serves to describe a classic presentation of a patient with eGPA, as well as to delineate the diagnostic workup, acute management, and early outpatient follow-up required.

KEY POINTS

Given the life-threatening complications of this rare condition, it is important to raise awareness about eGPA. This ...


Frequency Of Cd19, Qianzi Zhao, Lawrence K Jung 2018 George Washington University

Frequency Of Cd19, Qianzi Zhao, Lawrence K Jung

Medicine Faculty Publications

BACKGROUND: To understand the relationship between regulatory B cells (Bregs) and juvenile idiopathic arthritis (JIA), we analyzed the percentages of Bregs and their function in peripheral blood (PB) and synovial fluid (SF) of JIA patients.

METHODS: Twenty-one JIA patients and 11 children with growing pain but without known rheumatic diseases as controls were included. The B cell phenotype and intracellular production of IL-10 of Bregs were assessed by flow cytometry. Mononuclear cells from PB and SF were stimulated to produce IL-10 in vitro for the identification of IL-10- producing regulatory B cells.

RESULTS: The percentage of CD24

CONCLUSIONS: The inability ...


Assistive Utensil: A Spork For Hand Tremors And Spatial Awareness, Ana Font Hernandez, Jacob Kabariti, Troy Taylor 2018 City University of New York (CUNY)

Assistive Utensil: A Spork For Hand Tremors And Spatial Awareness, Ana Font Hernandez, Jacob Kabariti, Troy Taylor

Publications and Research

In this poster, we present a 3D printed solution for hand tremors and special awareness. Our spork is an assistive device designed and 3D printed for patients suffering from scleroderma, systemic sclerosis, Parkinson's, multiple sclerosis, drug withdrawal, etc. The scale-based handle will act as a counterweight to offset the contents on the other end and reduce shakiness. The larger grip allows an easy and comfortable hold. The product will be 3D printed for a customizable fit and at an affordable price. Lastly, the product will include a haptic feedback sensor to assist the visually impaired in locating food contents ...


Towards An Arthritis Flare-Responsive Drug Delivery System, Nitin Joshi, Ellen M. Gravallese, Joerg Ermann, Jeffrey M. Karp 2018 Massachusetts Institute of Technology

Towards An Arthritis Flare-Responsive Drug Delivery System, Nitin Joshi, Ellen M. Gravallese, Joerg Ermann, Jeffrey M. Karp

Open Access Articles

Local delivery of therapeutics for the treatment of inflammatory arthritis (IA) is limited by short intra-articular half-lives. Since IA severity often fluctuates over time, a local drug delivery method that titrates drug release to arthritis activity would represent an attractive paradigm in IA therapy. Here we report the development of a hydrogel platform that exhibits disassembly and drug release controlled by the concentration of enzymes expressed during arthritis flares. In vitro, hydrogel loaded with triamcinolone acetonide (TA) releases drug on-demand upon exposure to enzymes or synovial fluid from patients with rheumatoid arthritis. In arthritic mice, hydrogel loaded with a fluorescent ...


Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju 2018 Craiova University of Medicine and Pharmacy, Department of Cardiology

Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju

Journal of Mind and Medical Sciences

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established.

We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation.

The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis ...


Cluster-Randomized Trial Of A Behavioral Intervention To Incorporate A Treat-To-Target Approach To Care Of Us Patients With Rheumatoid Arthritis, Leslie R. Harrold, George W. Reed, Ani John, Christine J. Barr, Kevin Soe, Robert P. Magner, Katherine C. Saunders, Eric M. Ruderman, Tmirah Haselkorn, Jeffrey D. Greenberg, Allan Gibofsky, J. Timothy Harrington, Joel M. Kremer 2018 University of Massachusetts Medical School

Cluster-Randomized Trial Of A Behavioral Intervention To Incorporate A Treat-To-Target Approach To Care Of Us Patients With Rheumatoid Arthritis, Leslie R. Harrold, George W. Reed, Ani John, Christine J. Barr, Kevin Soe, Robert P. Magner, Katherine C. Saunders, Eric M. Ruderman, Tmirah Haselkorn, Jeffrey D. Greenberg, Allan Gibofsky, J. Timothy Harrington, Joel M. Kremer

Open Access Articles

OBJECTIVE: To assess the feasibility and efficacy of implementing a treat-to-target approach versus usual care in a US-based cohort of rheumatoid arthritis patients.

METHODS: In this behavioral intervention trial, rheumatology practices were cluster-randomized to provide treat-to-target care or usual care. Eligible patients with moderate/high disease activity (Clinical Disease Activity Index [CDAI] score > 10) were followed for 12 months. Both treat-to-target and usual care patients were seen every 3 months. Treat-to-target providers were to have monthly visits with treatment acceleration at a minimum of every 3 months in patients with CDAI score > 10; additional visits and treatment acceleration were at ...


Acute Vitreoretinal Trauma And Inflammation After Traumatic Brain Injury In Mice, Lucy P. Evans, Elizabeth A. Newell, MaryAnn Mahajan, Stephen H. Tsang, Polly J. Ferguson, Jolonda Mahoney, Christopher D. Hue, Edward W. Vogel, Barclay Morrison, Ottavio Arancio, Russell Nichols, Alexander G. Bassuk, Vinit B. Mahajan 2018 University of Iowa

Acute Vitreoretinal Trauma And Inflammation After Traumatic Brain Injury In Mice, Lucy P. Evans, Elizabeth A. Newell, Maryann Mahajan, Stephen H. Tsang, Polly J. Ferguson, Jolonda Mahoney, Christopher D. Hue, Edward W. Vogel, Barclay Morrison, Ottavio Arancio, Russell Nichols, Alexander G. Bassuk, Vinit B. Mahajan

Stead Family Department of Pediatrics Publications

Objective: Limited attention has been given to ocular injuries associated with traumatic brain injury (TBI). The retina is an extension of the central nervous system and evaluation of ocular damage may offer a less-invasive approach to gauge TBI severity and response to treatment. We aim to characterize acute changes in the mouse eye after exposure to two different models of TBI to assess the utility of eye damage as a surrogate to brain injury.

Methods: A model of blast TBI (bTBI) using a shock tube was compared to a lateral fluid percussion injury model (LFPI) using fluid pressure applied directly ...


The Conundrum Of Indeterminate Quantiferon-Tb Gold Results Before Anti-Tumor Necrosis Factor Initiation, Shahrad Hakimian, Yevgeniy Popov, Abbas Rupawala, Karen I. Salomon-Escoto, Steven Hatch, Randall Pellish 2018 University of Massachusetts Medical School

The Conundrum Of Indeterminate Quantiferon-Tb Gold Results Before Anti-Tumor Necrosis Factor Initiation, Shahrad Hakimian, Yevgeniy Popov, Abbas Rupawala, Karen I. Salomon-Escoto, Steven Hatch, Randall Pellish

Open Access Articles

Background: Tumor necrosis factor alpha (TNFalpha) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFalpha medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI.

Methods: We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications ...


Impact Of Rituximab On Patient-Reported Outcomes In Patients With Rheumatoid Arthritis From The Us Corrona Registry, Leslie R. Harrold, Ani John, Jennie Best, Steve Zlotnick, Chitra Karki, YouFu Li, Jeffrey D. Greenberg, Joel M. Kremer 2018 University of Massachusetts Medical School

Impact Of Rituximab On Patient-Reported Outcomes In Patients With Rheumatoid Arthritis From The Us Corrona Registry, Leslie R. Harrold, Ani John, Jennie Best, Steve Zlotnick, Chitra Karki, Youfu Li, Jeffrey D. Greenberg, Joel M. Kremer

Leslie R. Harrold

To evaluate the impact of rituximab on patient-reported outcomes (PROs) in a US-based observational cohort of patients with rheumatoid arthritis (RA). Patients with active RA, prior exposure to > /=1 tumor necrosis factor inhibitor (TNFi) and who newly initiated rituximab were identified. Changes in PROs were assessed 1 year after rituximab initiation. PRO measures included Clinical Disease Activity Index (CDAI); patient global disease activity, pain and fatigue (visual analog score; 0-100); morning stiffness (hours); modified Health Assessment Questionnaire (mHAQ; 0-3); and EuroQoL EQ-5D. Of the 667 patients who newly initiated rituximab, baseline PRO and clinical measures indicated that patients were substantially ...


Safety And Efficacy Of Subcutaneous Tanezumab In Patients With Knee Or Hip Osteoarthritis, Charles Birbara, Eugene J. Dabezies Jr, Aimee M. Burr, Robert J. Fountaine, Michael D. Smith, Mark T. Brown, Christine R. West, Rosalin H. Arends, Kenneth M. Verburg 2018 University of Massachusetts Medical School

Safety And Efficacy Of Subcutaneous Tanezumab In Patients With Knee Or Hip Osteoarthritis, Charles Birbara, Eugene J. Dabezies Jr, Aimee M. Burr, Robert J. Fountaine, Michael D. Smith, Mark T. Brown, Christine R. West, Rosalin H. Arends, Kenneth M. Verburg

Open Access Articles

Background/objective: The objective of this study was to investigate the safety and efficacy of subcutaneous (SC) and intravenous (IV) tanezumab administration in osteoarthritis (OA) patients.

Materials and methods: Study 1027 (NCT01089725), a placebo-controlled trial, evaluated the efficacy of SC tanezumab (ie, 2.5, 5, and 10 mg) and the therapeutic equivalence of 10 mg tanezumab given subcutaneously versus intravenously every 8 weeks in the symptomatic treatment of OA. Coprimary endpoints were: change from baseline in Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) Pain and Physical Function indices, and Patient's Global Assessment (PGA) of OA. Study 1043 (NCT00994890 ...


One-Year Risk Of Serious Infection In Patients Treated With Certolizumab Pegol As Compared With Other Tnf Inhibitors In A Real-World Setting: Data From A National U.S. Rheumatoid Arthritis Registry, Leslie R. Harrold, Heather J. Litman, Katherine C. Saunders, Kimberly J. Dandreo, Bernice Gershenson, Jeffrey D. Greenberg, Robert Low, Jeffrey Stark, Robert Suruki, Srihari Jaganathan, Joel M. Kremer, Mohamed Yassine 2018 University of Massachusetts Medical School

One-Year Risk Of Serious Infection In Patients Treated With Certolizumab Pegol As Compared With Other Tnf Inhibitors In A Real-World Setting: Data From A National U.S. Rheumatoid Arthritis Registry, Leslie R. Harrold, Heather J. Litman, Katherine C. Saunders, Kimberly J. Dandreo, Bernice Gershenson, Jeffrey D. Greenberg, Robert Low, Jeffrey Stark, Robert Suruki, Srihari Jaganathan, Joel M. Kremer, Mohamed Yassine

Open Access Articles

BACKGROUND: Registry studies provide a valuable source of comparative safety data for tumor necrosis factor inhibitors (TNFi) used in rheumatoid arthritis (RA), but they are subject to channeling bias. Comparing safety outcomes without accounting for channeling bias can lead to inaccurate comparisons between TNFi prescribed at different stages of the disease. In the present study, we examined the incidence of serious infection and other adverse events during certolizumab pegol (CZP) use vs other TNFi in a U.S. RA cohort before and after using a methodological approach to minimize channeling bias.

METHODS: Patients with RA enrolled in the Corrona registry ...


Evaluation Of Performance, Acceptance, And Compliance Of An Auto-Injector In Healthy And Rheumatoid Arthritic Subjects Measured By A Motion Capture System., Xiao Xiao, Wei Li, Corbin Clawson, David Karvani, Perceval Sondag, James K Hahn 2018 George Washington University

Evaluation Of Performance, Acceptance, And Compliance Of An Auto-Injector In Healthy And Rheumatoid Arthritic Subjects Measured By A Motion Capture System., Xiao Xiao, Wei Li, Corbin Clawson, David Karvani, Perceval Sondag, James K Hahn

Pediatrics Faculty Publications

Purpose: The study aimed to develop a motion capture system that can track, visualize, and analyze the entire performance of self-injection with the auto-injector.

Methods: Each of nine healthy subjects and 29 rheumatoid arthritic (RA) patients with different degrees of hand disability performed two simulated injections into an injection pad while six degrees of freedom (DOF) motions of the auto-injector and the injection pad were captured. We quantitatively measured the performance of the injection by calculating needle displacement from the motion trajectories. The max, mean, and SD of needle displacement were analyzed. Assessments of device acceptance and usability were evaluated ...


Impact Of Tocilizumab Monotherapy On Clinical And Patient-Reported Quality-Of-Life Outcomes In Patients With Rheumatoid Arthritis, Leslie R. Harrold, Ani John, George W. Reed, Tmirah Haselkorn, Chitra Karki, YouFu Li, Jennie Best, Steve Zlotnick, Joel M. Kremer, Jeffrey D. Greenberg 2017 University of Massachusetts Medical School

Impact Of Tocilizumab Monotherapy On Clinical And Patient-Reported Quality-Of-Life Outcomes In Patients With Rheumatoid Arthritis, Leslie R. Harrold, Ani John, George W. Reed, Tmirah Haselkorn, Chitra Karki, Youfu Li, Jennie Best, Steve Zlotnick, Joel M. Kremer, Jeffrey D. Greenberg

Open Access Articles

INTRODUCTION: Tocilizumab (TCZ) monotherapy has been proven as an effective treatment for rheumatoid arthritis (RA) in clinical trials. However, there are limited data available regarding the effectiveness of TCZ monotherapy in real-world clinical settings in the United States. The objective of this study was to evaluate the impact of TCZ monotherapy on disease activity and patient-reported outcomes (PROs) in a US-based observational cohort of patients with RA seen in routine clinical practice.

METHODS: Eligible patients had active RA, no prior use of TCZ, and initiated TCZ as monotherapy. Changes in disease activity and PROs were assessed 1 year after TCZ ...


Long-Term Effectiveness Of Adalimumab In Patients With Rheumatoid Arthritis: An Observational Analysis From The Corrona Rheumatoid Arthritis Registry, Dimitrios A. Pappas, Joel M. Kremer, Jenny Griffith, George W. Reed, Bob Salim, Chitra Karki, Vishvas Garg 2017 Columbia University

Long-Term Effectiveness Of Adalimumab In Patients With Rheumatoid Arthritis: An Observational Analysis From The Corrona Rheumatoid Arthritis Registry, Dimitrios A. Pappas, Joel M. Kremer, Jenny Griffith, George W. Reed, Bob Salim, Chitra Karki, Vishvas Garg

Open Access Articles

INTRODUCTION: Current recommendations for the management of rheumatoid arthritis (RA) focus on a treat-to-target approach with the objective of maximizing long-term health-related quality-of-life in patients with RA. Published studies from randomized clinical trials have reported limited data regarding the long-term efficacy and safety of adalimumab in patients with RA. This study aims to evaluate the long-term (10+ years) persistency and effectiveness of adalimumab in patients with RA in a real-world setting.

METHODS: Included in this study were biologic-naive adults with RA initiating adalimumab during follow-up enrolled in the Corrona RA registry. More than 10 years of data on persistency of ...


Ixekizumab Efficacy And Safety With And Without Concomitant Conventional Disease-Modifying Antirheumatic Drugs (Cdmards) In Biologic Dmard (Bdmard)-Naive Patients With Active Psoriatic Arthritis (Psa): Results From Spirit-P1, L Coates, M Kishimoto, Alice Gottlieb, C Shuler, C Lin, C Lee, P Mease 2017 New York Medical College

Ixekizumab Efficacy And Safety With And Without Concomitant Conventional Disease-Modifying Antirheumatic Drugs (Cdmards) In Biologic Dmard (Bdmard)-Naive Patients With Active Psoriatic Arthritis (Psa): Results From Spirit-P1, L Coates, M Kishimoto, Alice Gottlieb, C Shuler, C Lin, C Lee, P Mease

Faculty Publications

Objective: To evaluate the efficacy and safety of ixekizumab alone or with concomitant conventional disease-modifying antirheumatic drugs (cDMARDs) versus placebo in patients with active psoriatic arthritis (PsA) as part of a SPIRIT-P1 subgroup analysis (NCT01695239). Methods: Patients were stratified by cDMARD use (concomitant cDMARDs use (including methotrexate) or none (past or naive use)) and randomly assigned to treatment groups (ixekizumab 80 mg every 4 weeks (IXEQ4W) or every 2 weeks (IXEQ2W) or placebo). Efficacy was evaluated versus placebo at week 24 by the American College of Rheumatology criteria (ACR20/50/70), modified total Sharp score and Health Assessment Questionnaire-Disability Index ...


A Case Of Refractory Primary Angiitis Of The Central Nervous System., Anam Malik MD, Samer Bolis DO, Susan Kim MD 2017 Lehigh Valley Health Network

A Case Of Refractory Primary Angiitis Of The Central Nervous System., Anam Malik Md, Samer Bolis Do, Susan Kim Md

Department of Medicine

No abstract provided.


Tocilizumab Combination Therapy Or Monotherapy Or Methotrexate Monotherapy In Methotrexate-Naive Patients With Early Rheumatoid Arthritis: 2-Year Clinical And Radiographic Results From The Randomised, Placebo-Controlled Function Trial, Gerd R. Burmester, William F. Rigby, Ronald F. van Vollenhoven, Jonathan Kay, Andrea Rubbert-Roth, Ricardo Blanco, Alysha Kadva, Sophie Dimonaco 2017 Charite-Universitatsmedizin Berlin

Tocilizumab Combination Therapy Or Monotherapy Or Methotrexate Monotherapy In Methotrexate-Naive Patients With Early Rheumatoid Arthritis: 2-Year Clinical And Radiographic Results From The Randomised, Placebo-Controlled Function Trial, Gerd R. Burmester, William F. Rigby, Ronald F. Van Vollenhoven, Jonathan Kay, Andrea Rubbert-Roth, Ricardo Blanco, Alysha Kadva, Sophie Dimonaco

Jonathan Kay

OBJECTIVE: Investigate whether the efficacy and safety of intravenous tocilizumab (TCZ) demonstrated at week 52 in patients with early rheumatoid arthritis (RA) are maintained to week 104. METHODS: Methotrexate (MTX)-naive patients with early progressive RA were randomly assigned to double-blind 4 mg/kg TCZ+MTX, 8 mg/kg TCZ+MTX, 8 mg/kg TCZ+placebo or placebo+MTX for 104 weeks. Patients not receiving 8 mg/kg TCZ and not achieving Disease Activity Score-28 joints (DAS28-erythrocyte sedimentation rate (ESR)) < /=3.2 at week 52 switched to escape therapy (8 mg/kg TCZ+MTX). Analyses were exploratory. RESULTS: Intent-to-treat and ...


False Reassurance: Complications Of Mi2+ Dermatomyositis., Grace Berlin DO, Susan Kim MD, Carolyn Casey 2017 Lehigh Valley Health Network

False Reassurance: Complications Of Mi2+ Dermatomyositis., Grace Berlin Do, Susan Kim Md, Carolyn Casey

Department of Medicine

No abstract provided.


Sarcoidosis, The Great Imitator: An Unusual Finding On Bone Marrow Pathology., Grace Berlin DO, Carolyn Casey, Susan Kim MD, Marie O'Brien 2017 Lehigh Valley Health Network

Sarcoidosis, The Great Imitator: An Unusual Finding On Bone Marrow Pathology., Grace Berlin Do, Carolyn Casey, Susan Kim Md, Marie O'Brien

Department of Medicine

No abstract provided.


Patient-Reported Outcome Assessment Of Inflammatory Arthritis Patient Experience With Intravenously Administered Biologic Therapy, Norman B. Gaylis, Joanne Sagliani, Shawn Black, Kezhen L. Tang, Raphael J. DeHoratius, Wesley A. Kafka, Dennis Parenti 2017 Arthritis & Rheumatic Disease Specialties

Patient-Reported Outcome Assessment Of Inflammatory Arthritis Patient Experience With Intravenously Administered Biologic Therapy, Norman B. Gaylis, Joanne Sagliani, Shawn Black, Kezhen L. Tang, Raphael J. Dehoratius, Wesley A. Kafka, Dennis Parenti

Department of Medicine Faculty Papers

Objective: To evaluate patient perspectives regarding utilization of intravenous (IV) therapy for inflammatory arthritis (IA). Methods: This was a single-center, non-interventional, patient questionnaire-based study of adult IA patients currently receiving IV biologics. At a single visit, patients completed the questionnaire comprising 30 questions centered on their experience receiving an intravenously administered therapy to treat their IA. The questionnaire included questions on patient demographics, disease characteristics, and previous biologic treatment for IA (subcutaneous [SC] and IV). Patients rated their level of agreement with statements regarding satisfaction with current IV biologic therapy and potential advantages and disadvantages of IV biologic therapy using ...


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