Rheumatology Commons^™

Detection Of Subclinical Rheumatic Heart Disease In Children Using A Deep Learning Algorithm On Digital Stethoscope: A Study Protocol, Fatima Ali, Babar Hasan, Huzaifa Ahmad, Zahra Hoodbhoy, Zainab Bhuriwala, Muhammad Hanif, Shahab U. Ansari, Devyani Chowdhury

Department of Paediatrics and Child Health

Introduction: Rheumatic heart diseases (RHDs) contribute significant morbidity and mortality globally. To reduce the burden of RHD, timely initiation of secondary prophylaxis is important. The objectives of this study are to determine the frequency of subclinical RHD and to train a deep learning (DL) algorithm using waveform data from the digital auscultatory stethoscope (DAS) in predicting subclinical RHD.
Methods and analysis: We aim to recruit 1700 children from a group of schools serving the underprivileged over a 12-month period in Karachi (Pakistan). All consenting students within the age of 5-15 years with no underlying congenital heart disease will be eligible …

Perceptions And Challenges Experienced By African Physicians When Prescribing Methotrexate For Rheumatic Disease: An Exploratory Study, Carol A Hitchon, Girsh M Mody, Candace H Feldman, Yan Lau, Steven Shi, Michele Meltzer, Rosie Scuccimarri, Michael E Weinblatt, Ines Colmegna

Department of Medicine Faculty Papers

OBJECTIVE: Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations.

METHODS: African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI.

RESULTS: Physicians (23 rheumatologists; …

Perceptions And Challenges Experienced By African Physicians When Prescribing Methotrexate For Rheumatic Disease: An Exploratory Study, Carol A Hitchon, Girsh M Mody, Candace H Feldman, Yan Lau, Steven Shi, Michele Meltzer, Rosie Scuccimarri, Michael E Weinblatt, Ines Colmegna

Department of Medicine Faculty Papers

Objective: Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations.

Methods: African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI.

Results: Physicians (23 rheumatologists; …

Nonbacterial Thrombotic Mitral Valve Endocarditis Presenting As Embolic Stroke In A Young Patient With Lupus And Anti-Phospholipid Syndrome, Andrew Mccuen, Muhammad Saad, Erin Jm Terpstra, Adam T. Stys

Aesculapius Journal (Health Sciences & Medicine)

A 37-year-old man on systemic immunosuppression for clinically and biochemically quiescent lupus nephritis, presented with left hemiparesis. Brain MRI was concerning for right sided embolic stroke. Workup was negative for atrial fibrillation, deep venous thrombosis, and heart failure. Transesophageal echocardiogram was remarkable for fixed mitral valve leaflet echodensities. In the absence of bacteremia and systemic signs of infection, and with a history of lupus, small vegetations on atrial and ventricular sides of mitral valve leaflets are suggestive of nonbacterial thrombotic endocarditis. Nonbacterial thrombotic vegetations are composed of fibrin deposits on otherwise-healthy valves. Mainstay of treatment is therapeutic anticoagulation with clinical …

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 …

Enhanced Arthrocentesis Of The Flexed Knee With Pneumatic Compression, Sumir Brahmbhatt, Maheswari Muruganandam, Ahsan Iqbal, David Cisneros, Adnan Kiani, Nicole Suzanne Emil, Sharon Nunez, William Hayward, Philip Band, Wilmer Sibbitt Jr.

Quality Improvement/Patient Safety Symposium

Background/Objective: To explore an alternative to standard extended knee arthrocentesis using pneumatic compression of the flexed knee.

Methods: Using a paired sample design, 41 consecutive effusive knees underwent arthrocentesis in the flexed knee position first without and then with pneumatic compression of suprapatellar bursa. Arthrocentesis success and fluid yield in milliliters (ml) were measured. For comparison 41 consecutive patients who had undergone extended knee arthrocentesis without and with compression were also studied.

Results: Successful diagnostic arthrocentesis (≥ 3 ml) of the effusive flexed knee was 85% (35/41) without compression and increased significantly to 100% (41/41) with pneumatic compression (p=0.027). Synovial …

Septic Arthritis With Concomitant Pseudogout, Ravin Patel, James Schuck, Nicole Zucconi, David Aderholdt

Rowan-Virtua Research Day

Monoarticular joint pain is a common complaint, however it demands a broad differential diagnosis. These differentials include fracture, dislocation, septic arthritis, gout, pseudogout and several others. The diagnosis of septic arthritis requires a high index of suspicion as early diagnosis is a vital part of initial treatment.

We present a case with multifactorial joint pathology contributing to a patient’s presentation, specifically septic joint and pseudogout. The incidence of these entities being present in the same patient, let alone the same joint, is not well documented in the literature.

The presentation of these diseases have a multitude of similarities and differences, …

Cardiovascular Complications Of Systemic Lupus Erythematosus: Impact Of Risk Factors And Therapeutic Efficacy--A Tertiary Centre Experience In An Appalachian State, Elise Danielle Mcveigh, Amna Batool, Arnold J. Stromberg, Ahmed K. Abdel-Latif, Nayef Mohammed Kazzaz

Statistics Faculty Publications

OBJECTIVES: Cardiovascular complications became a notable cause of morbidity and mortality in patients with lupus as therapeutic advancements became more efficient at managing other complications. The Appalachian community in Kentucky has a higher prevalence of traditional cardiovascular risk factors, predisposing them to cardiovascular events. Namely, the mean body mass index of the members of the Kentucky Appalachian community was reported at 33 kg/m² and 94.3% of male members of this community use tobacco. We sought to identify risk factors that predispose patients with lupus to cardiovascular morbidities and examine the effect of immunomodulatory drugs.

METHODS: We identified 20 UKHS …

Pediatric Rheumatology In Africa: Thriving Amidst Challenges, Angela Migowa, Djohra Hadef, Wafa Hamdi, Oscar Mwizerwa, Madeleine Ngandeu, Yassmin Taha, Faleye Ayodele, Kate Webb, Christiaan Scott

Paediatrics and Child Health, East Africa

Background: Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent.

Main body: This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR).

Conclusion: This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond.

Localization Of Hand And Wrist Anatomic Structures Among Physical Medicine And Rehabilitation Residents: Implication Of Ultrasonography In Palpation Skill Verification, Se Won Lee, Phuong Uyen Le, Craig Van Dien, Stefanie Lai, Eric Aguila

HCA Healthcare Journal of Medicine

Objective

The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification.

Methods

PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US.

Results

Overall palpation accuracy for 16 joint line and soft tissue structures was …

Igg4-Related Disease With Multiorgan Involvement: A Case-Based Review, Nikhil N. Tarte, Chandana Shilpa Ravipati, Jose A. Leon De La Rocha, Elizabeth Rinker, Nirupa J. Patel

School of Medicine Faculty Publications

IgG4-related disease (IgG4-RD) is an immune-mediated multi-organ inflammatory disorder caused by tissue infiltration of lymphocytes with IgG4-secreting plasma cells. Herein, we discuss a case of a patient with IgG4-RD who had involvement of multiple organs: the kidneys, lymph nodes, bone marrow (biopsy performed), lungs, liver, and small intestine (imaging abnormalities). Although several case reports and series of IgG4-RD involving different organ involvement are in the literature, our patient has extensive simultaneous multi-organ involvement. We utilized the four domains (serologic, pathologic, radiologic, and pathologic) as discussed in the new 2019 ACR/EULAR classification criteria to provide a useful framework in considering an …

Need For Clinical Guidelines For Management Of Osteoporosis And Way Forward For Pakistan, Aysha Habib Khan, Manju Chandran

Department of Pathology and Laboratory Medicine

No abstract provided.

Assessment Of Down Syndrome-Associated Arthritis: A Survey Of Down Syndrome Clinic Providers., Jordan T. Jones, Chelsey Smith, Nasreen Talib

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Challenges In Medicine: The Odyssey Of A Patient With Isolated Igg4-Related Eosinophilic Angiocentric Fibrosis Presenting As A Locally Destructive Sinonasal Mass, Snigdha Nutalapati, Richard O'Neal, William O'Connor, Brett T. Comer, Gerhard C. Hildebrandt

Otolaryngology--Head & Neck Surgery Faculty Publications

Eosinophilic angiocentric fibrosis (EAF) is an exceeding rare clinical entity and is considered a part of the spectrum of IgG4-related disease (IgG4RD). We hereby present such an unusual case of a 60-year-old female who presented to us with recurrent sinonasal mass, after a decade long haul of multiple clinical evaluations, biopsies, and debulking surgery without a definitive diagnosis. Over this period, the mass eroded through the ethmoid cells along with nasal septal destruction leading to saddle nose deformity, extended superiorly through the cribriform plates to right frontal lobe, and compressed the optic nerve leading to visual loss. Although initial biopsy …

Exploring Pediatric Tele-Rheumatology Practices During Covid-19: A Survey Of The Prcoin Network., Y Ingrid Goh, Danielle R. Bullock, Janalee Taylor, Rajdeep Pooni, Tzielan C. Lee, Sheetal S. Vora, Cagri Yildirim-Toruner, Esi M. Morgan, Nancy Pan, Julia G. Harris, Andrew Warmin, Kendra Wiegand, Jon M. Burnham, Fatima Barbar-Smiley

Manuscripts, Articles, Book Chapters and Other Papers

Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care …

Association Of Vitamin D Deficiency And Disease Activity In Systemic Lupus Erythematosus Patients: Two-Year Follow-Up Study, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Adil A. Manji, Akash Kumar Ahuja

Section of Internal Medicine

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.
Patients and methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and …

Engaging Patients And Parents To Improve Mental Health Intervention For Youth With Rheumatological Disease., Oluwatunmise A. Fawole, Michelle V. Reed, Julia G. Harris, Aimee Hersh, Martha Rodriguez, Karen Onel, Erica Lawson, Tamar Rubinstein, Kaveh Ardalan, Esi Morgan, Anne Paul, Judy Barlin, R Paola Daly, Mitali Dave, Shannon Malloy, Shari Hume, Suzanne Schrandt, Laura Marrow, Angela Chapson, Donna Napoli, Michael Napoli, Miranda Moyer, Vincent Delgaizo, Ashley Danguecan, Emily Von Scheven, Andrea Knight, Carra Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Mental health disorders are common in youth with rheumatological disease yet optimal intervention strategies are understudied in this population. We examined patient and parent perspectives on mental health intervention for youth with rheumatological disease.

METHODS: We conducted a mixed methods cross-sectional study, via anonymous online survey, developed by researchers together with patient/parent partners, to quantitatively and qualitatively examine youth experiences with mental health services and resources in North America. Patients ages 14-24 years with juvenile idiopathic arthritis, juvenile dermatomyositis, or systemic lupus erythematous, and parents of patients ages 8-24 with these diseases were eligible (not required to participate in …

Duration Of Rheumatoid Arthritis And The Risk Of Developing Interstitial Lung Disease, Michael P. Mohning, Isabelle Amigues, M. Kristen Demoruelle, Evans R. Fernández Pérez, Tristan J. Huie, Rebecca K. Keith, Amy L. Olson, Zulma X. Yunt, Jonathan H. Chung, Stephen B. Hobbs, Jeffrey J. Swigris, Joshua J. Solomon

Radiology Faculty Publications

Age of ILD onset is similar in patients with RA-UIP and RA-NSIP but duration of RA before ILD onset differs.

Patient-Reported Outcomes Data In Patients With Psoriatic Arthritis From A Randomised Trial Of Etanercept And Methotrexate As Monotherapy Or In Combination., Vibeke Strand, Philip Mease, Ervant J Maksabedian Hernandez, Bradley S Stolshek, Lyrica X H Liu, David H Collier, Gregory Kricorian, Joseph F Merola

Articles, Abstracts, and Reports

OBJECTIVES: We examined patient-reported outcomes (PROs) in The Study of Etanercept And Methotrexate in Patients with Psoriatic Arthritis (PsA); a 48-week, phase 3, randomised controlled trial that compared outcomes with methotrexate (MTX) monotherapy, etanercept monotherapy, and MTX+ etanercept in patients with PsA.

METHODS: Efficacy endpoints included: mean changes from baseline and proportion of patients who reported improvements≥minimal clinically important difference (MCID) at week 24 in treatment groups for Health Assessment Questionnaire-Disability Index, Patient Global Assessment (PtGA), Patient Global Assessment of Joint Pain (PtGAJP) and Medical Outcomes Study Short Form-36 Questionnaire (SF-36) Physical Component Summary (PCS), and Mental Component Summary, and …

The Quality Of Intervention Reporting In Trials Of Therapeutic Exercise For Hip Osteoarthritis: A Secondary Analysis Of A Systematic Review, Louise C. Burgess, Thomas C. Wainwright, Khara A. James, Johan Von Heideken, Maura D. Iversen

Physical Therapy Faculty Publications

Background: Therapeutic exercise is recommended as a core treatment for hip osteoarthritis (HOA). Whilst it is widely accepted that exercise can improve pain and disability, optimal type and dose of exercise are yet to be agreed upon. This may, in part, be attributed to the wide variation and inadequate reporting of interventions within the literature. This study evaluates the quality of intervention reporting among trials of therapeutic exercise in HOA.

Methods: Randomised controlled trials (RCTs) were sourced in a systematic review, completed in August 2020. Two raters independently used the Template for Intervention Description and Replication (TIDieR) and Consensus on …