Rheumatology Commons^™

Macrophage Activation Syndrome As A Complication Of Systemic Lupus Erythematosus In An Adult Male, Rajesh Gopalarathinam, Vamsee Chirumamilla, Balachandran Vaidyanathan

Marshall Journal of Medicine

Macrophage activation syndrome (MAS) is a rare life-threatening complication that sometimes occurs in patients with systemic lupus erythematosus (SLE) and other connective tissue diseases. This syndrome is universally fatal without treatment, and therefore, prompt diagnosis and initiation of treatment is of vital importance.

Does Patient-Provider Race/Ethnicity Concordance Impact Outcomes For Adults With Lupus?, Pamela C. Delis Phd, Rn, Cne, Inge B. Corless Phd, Rn, Fnap, Faan, Indigo Young Ms, Ccc-Slp, Mary W. Hildebrand Otd,Otr/L, Jessica G. Bell Ms, Amanda Tarbet Mslis

Journal of Health Disparities Research and Practice

Background: Health disparities exist among the 1.5 million Americans with lupus, with women of color bearing higher disease rates and burden. Complex reasons include genetics, comorbidities, and socioeconomics. These factors may lead to differences in health-related outcomes in lupus.

Aim: To determine if patient-provider racial/ethnic concordance plays a role in outcomes for adults with lupus.

Method: For this scoping review, the authors searched PubMed Medline and CINAHL using keywords and subject headings for lupus, race or ethnicity, and patient-health professional concordance.

Results: Despite an intentionally broadened search of literature, the authors identified a lack of studies examining the topic.

Conclusions: …

How Rare Is Isolated Rheumatic Tricuspid Valve Disease?, Edme R. Mustafa, Octavian Istrătoaie, Roxana Mandia, Georgică C. Târtea, Cristina Florescu

Journal of Mind and Medical Sciences

The incidence of rheumatic fever (RF) has markedly decreased in Europe since the beginning of the 20th century due to improved living conditions, early antibiotic therapy in streptococcal pharyngitis, and changes in serotypes of circulating streptococci. Isolated outbreaks of RF are still found in various parts of the world and the disease has changed its presentation with milder joint symptoms and subclinical carditis that make the correct diagnosis more difficult. Patients can present many years later with severe valve disease and significant disability. This article presents a case of isolated rheumatic tricuspid valve disease that presented with signs and symptoms …

Inhibition Of Radiographic Progression Across Levels Of Composite Index-Defined Disease Activity In Patients With Active Psoriatic Arthritis Treated With Intravenous Golimumab: Results From A Phase-3, Double-Blind, Placebo-Controlled Trial., Philip Mease, M Elaine Husni, Shelly Kafka, Soumya D Chakravarty, Diane D Harrison, Kim Hung Lo, Stephen Xu, Elizabeth C Hsia, Arthur Kavanaugh

Articles, Abstracts, and Reports

BACKGROUND: In the GO-VIBRANT trial of intravenous golimumab in psoriatic arthritis (PsA), golimumab significantly inhibited radiographic progression. In post hoc analyses, we evaluated changes in total PsA-modified Sharp/van der Heijde scores (SHS) across levels of composite index-defined disease activity following treatment.

METHODS: In this phase-3, double-blind, placebo-controlled trial, 480 bio-naïve patients with active PsA randomly received intravenous golimumab 2 mg/kg (N = 241; week 0, week 4, every 8 weeks [q8w]) or placebo (N = 239; week 0, week 4, week 12, week 20) followed by golimumab (week 24, week 28, q8w) through week 52. Week 24 and week 52 …

Enthesitis In Psoriatic Arthritis (Part 3): Clinical Assessment And Management., Philip Mease

Articles, Abstracts, and Reports

Enthesitis is a common clinical feature of PsA, which is characterized by inflammation at the site of insertion of tendons, ligaments and joint capsule fibres into bone. Enthesitis is relatively unique to the spondyloarthritides, setting this group of diseases apart from other rheumatological conditions. The pathophysiological underpinnings of this clinical domain, and the imaging assessment of it, are described in accompanying articles in this supplement. The focus of this article is on the assessment of enthesitis by physical examination, the impact of enthesitis on function and quality of life, the impact of concomitant FM on clinical assessment, and the evidence …

Preface To The Psoriatic Arthritis Supplement., Philip Mease

Articles, Abstracts, and Reports

No abstract provided.

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.

Cell-Bound Complement Activation Products Associate With Lupus Severity In Sle., C. Arriens, R. V. Alexander, S. Narain, A. Saxena, C. E. Collins, D. J. Wallace, E. Massarotti, J. Conklin, R. A. Furie, T. Dervieux, +11 Additional Authors

Journal Articles

OBJECTIVES: To evaluate the association between lupus severity and cell-bound complement activation products (CB-CAPs) or low complement proteins C3 and C4.

METHODS: All subjects (n=495) fulfilled the American College of Rheumatology (ACR) classification criteria for SLE. Abnormal CB-CAPs (erythrocyte-bound C4d or B-lymphocyte-bound C4d levels >99th percentile of healthy) and complement proteins C3 and C4 were determined using flow cytometry and turbidimetry, respectively. Lupus severity was estimated using the Lupus Severity Index (LSI). Statistical analysis consisted of multivariable linear regression and groups comparisons.

RESULTS: Abnormal CB-CAPs were more prevalent than low complement values irrespective of LSI levels (62% vs 38%, respectively, …

Clinical Mortality In A Large Covid-19 Cohort: Observational Study., M. Jarrett, S. Schultz, J. Lyall, J. Wang, L. Stier, M. De Geronimo, K. Nelson

Journal Articles

BACKGROUND: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic.

OBJECTIVE: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non-intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls.

METHODS: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, …

Comparative Survival Analysis Of Immunomodulatory Therapy For Coronavirus Disease 2019 Cytokine Storm., S. Narain, D. G. Stefanov, A. S. Chau, A. G. Weber, G. Marder, B. Kaplan, P. Malhotra, O. Bloom, A. Liu, M. M. Lesser, N. Hajizadeh, Northwell Covid-19 Research Consortium

Journal Articles

BACKGROUND:Cytokine storm is a marker of coronavirus disease 2019 (COVID-19) illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes. RESEARCH QUESTION:Do immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm (CCS)? STUDY DESIGN AND METHODS:We conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020, and April 24, 2020, were included. CCS was defined by inflammatory markers: ferritin, > 700 ng/mL; C-reactive protein (CRP), > 30 mg/dL; or lactate dehydrogenase (LDH), > 300 U/L. Patients were subdivided into six groups: no immunomodulatory treatment (standard of care) and …

Acthar Gel (Repository Corticotropin Injection) For Persistently Active Sle: Study Design And Baseline Characteristics From A Multicentre, Randomised, Double-Blind, Placebo-Controlled Trial, A. D. Askanase, E. Zhao, J. Zhu, E. Connolly-Strong, R. A. Furie

Journal Articles

© 2020 Author(s). Objective SLE is a chronic inflammatory autoimmune disease characterised by the excessive production of autoantibodies, immune complexes and proinflammatory cytokines. Repository corticotropin injection (RCI) is a naturally sourced complex mixture of adrenocorticotropic hormone analogues and other pituitary peptides. RCI is approved by the US Food and Drug Administration for use during an exacerbation or as maintenance therapy in select cases of SLE. This paper discusses the design and baseline characteristics of a multicentre, double-blind, randomised, placebo-controlled, 24-week clinical trial evaluating the effect of RCI in reducing disease activity for patients with persistently active SLE despite moderate-dose corticosteroid …

A Head-To-Head Comparison Of The Efficacy And Safety Of Ixekizumab And Adalimumab In Biological-Naïve Patients With Active Psoriatic Arthritis: 24-Week Results Of A Randomised, Open-Label, Blinded-Assessor Trial., Philip Mease, Josef S Smolen, Frank Behrens, Peter Nash, Soyi Liu Leage, Lingnan Li, Hasan Tahir, Melinda Gooderham, Eswar Krishnan, Hong Liu-Seifert, Paul Emery, Sreekumar G Pillai, Philip S Helliwell

Articles, Abstracts, and Reports

OBJECTIVES: To compare efficacy and safety of ixekizumab (IXE) to adalimumab (ADA) in biological disease-modifying antirheumatic drug-naïve patients with both active psoriatic arthritis (PsA) and skin disease and inadequate response to conventional synthetic disease-modifying antirheumatic drug (csDMARDs).

METHODS: Patients with active PsA were randomised (1:1) to approved dosing of IXE or ADA in an open-label, head-to-head, blinded assessor clinical trial. The primary objective was to evaluate whether IXE was superior to ADA at week 24 for simultaneous achievement of a ≥50% improvement from baseline in the American College of Rheumatology criteria (ACR50) and a 100% improvement from baseline in the …

Secukinumab Provides Sustained Improvements In The Signs And Symptoms Of Psoriatic Arthritis: Final 5-Year Results From The Phase 3 Future 1 Study., Philip Mease, Arthur Kavanaugh, Andreas Reimold, Hasan Tahir, Juergen Rech, Stephen Hall, Piet Geusens, Pascale Pellet, Eumorphia Maria Delicha, Luminita Pricop, Shephard Mpofu

Articles, Abstracts, and Reports

OBJECTIVE: To report the 5-year efficacy and safety of secukinumab in the treatment of patients with psoriatic arthritis (PsA) in the FUTURE 1 study (NCT01392326).

METHODS: Following the 2-year core trial, eligible patients receiving subcutaneous secukinumab entered a 3-year extension phase. Results are presented for key efficacy endpoints for the secukinumab 150-mg group (n = 236), including patients who escalated from 150 to 300 mg (approved doses) starting at week 156. Safety is reported for all patients (n = 587) who received 1 dose or more of study treatment.

RESULTS: Overall, 81.8%% (193 of 236) of patients in the secukinumab …

Unmet Need In Rheumatology: Reports From The Targeted Therapies Meeting 2019., Kevin L Winthrop, Michael E Weinblatt, Joan Bathon, Gerd R Burmester, Philip Mease, Leslie Crofford, Vivian Bykerk, Maxime Dougados, James Todd Rosenbaum, Xavier Mariette, Joachim Sieper, Fritz Melchers, Bruce N Cronstein, Ferry C Breedveld, Joachim Kalden, Josef S Smolen, Daniel Furst

Articles, Abstracts, and Reports

OBJECTIVES: To detail the greatest areas of unmet scientific and clinical needs in rheumatology.

METHODS: The 21st annual international Advances in Targeted Therapies meeting brought together more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of 5 disease-specific groups with 20-30 experts assigned to each group based on expertise. Specific groups included: rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus and other systemic autoimmune rheumatic diseases. In each group, experts were asked to identify unmet clinical and translational research needs in general …

An Investigation Of Infectious Etiologies Of Sporadic Inclusion Body Myositis, Tyler Kennedy, Michele Meltzer, Md

Phase 1

Introduction: Sporadic inclusion body myositis (sIBM) is a rare, debilitating disease that can significantly lower one’s quality of life. Unfortunately, there are no current effective treatments, as the underlying causes are still unknown. We hypothesize that preceding infections do not cause sporadic inclusion body myositis.

Methods: The study investigated patients with a diagnosis of inclusion body myositis, with a concurrent or previously documented infection. Men represented a larger proportion of the population as they have an increased preponderance of those affected. The primary objective was to discern which infection, if any, could induce the inflammatory and degenerative changes in muscle …

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 …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Secukinumab Efficacy On Resolution Of Enthesitis In Psoriatic Arthritis: Pooled Analysis Of Two Phase 3 Studies., Laura C Coates, Johan K Wallman, Dennis Mcgonagle, Georg A Schett, Iain B Mcinnes, Philip Mease, Lawrence Rasouliyan, Erhard Quebe-Fehling, Darren L Asquith, Andreas E R Fasth, Luminita Pricop, Corine Gaillez

Articles, Abstracts, and Reports

BACKGROUND: Enthesitis is one of the psoriatic arthritis (PsA) domains. Patients with enthesitis are associated with worse outcomes than those without enthesitis. The effect of secukinumab on the resolution of enthesitis in patients with PsA was explored using pooled data from the FUTURE 2 and 3 studies.

METHOD: Assessments of enthesitis through week 104 used the Leeds Enthesitis Index. These post hoc analyses included resolution of enthesitis count (EC = 0), median time to first resolution of enthesitis (Kaplan-Meϊer estimate), and shift analysis (as observed) of baseline EC (1, 2, or 3-6) to full resolution (FR), stable (similar or reduction …

Assessing Physical Activity And Sleep In Axial Spondyloarthritis: Measuring The Gap., Atul Deodhar, Lianne S Gensler, Marina Magrey, Jessica A Walsh, Adam Winseck, Daniel Grant, Philip Mease

Articles, Abstracts, and Reports

Patients with axial spondyloarthritis (axSpA) frequently report pain, stiffness, fatigue, and sleep problems, which may lead to impaired physical activity. The majority of reported-on measures evaluating physical activity and sleep disturbance in axSpA are self-reported questionnaires, which can be impacted by patient recall (reporting bias). One objective measure, polysomnography, has been employed to evaluate sleep in patients with axSpA; however, it is an intrusive measure and cannot be used over the long term. More convenient objective measures are therefore needed to allow for the long-term assessment of both sleep and physical activity in patients' daily lives. Wearable technology that utilizes …