1
|
Mahajan A, Mousa A, Aslam F. Ultrasound in diagnosis of cutaneous sarcoidosis. Joint Bone Spine 2024; 91:105667. [PMID: 38043679 DOI: 10.1016/j.jbspin.2023.105667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Affiliation(s)
| | | | - Fawad Aslam
- Mayo Clinic in Arizona, Scottsdale, AZ, USA.
| |
Collapse
|
2
|
Balbach ML, Corty R, Hill B, Frech T, Aslam F, Chew EY. Development of a Musculoskeletal Ultrasound Protocol to Evaluate Hand Pain in Systemic Sclerosis Patients. Diagnostics (Basel) 2024; 14:669. [PMID: 38611582 PMCID: PMC11011600 DOI: 10.3390/diagnostics14070669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Hand impairment is a frequently reported complaint in systemic sclerosis (SSc) patients and a leading cause of disability and diminished quality of life. Managing hand pain can be particularly challenging due to the coexistence of non-inflammatory arthralgias, inflammatory arthritis, acro-osteolysis, tenosynovitis, joint contractures, tendon friction rubs, nerve entrapment, Raynaud's phenomenon (RP), digital ulcers (DU), sclerodactyly, calcinosis, and chronic pain. While physical examination and radiographs are the first line methods for evaluating hand pain, they are limited in scope and miss many underlying etiologies of hand impairment. We propose a joint ultrasound (US) hand protocol to differentiate between various articular, periarticular, ischemic, skin, and nerve pathologies and to assist in targeted treatment strategies.
Collapse
Affiliation(s)
- Meridith L. Balbach
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (M.L.B.); (R.C.); (T.F.)
| | - Robert Corty
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (M.L.B.); (R.C.); (T.F.)
| | - Bradford Hill
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Tracy Frech
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (M.L.B.); (R.C.); (T.F.)
| | - Fawad Aslam
- Mayo Clinic in Arizona, Department of Rheumatology, Scottsdale, AZ 85259, USA
| | - Erin Y. Chew
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (M.L.B.); (R.C.); (T.F.)
| |
Collapse
|
3
|
Kaur IP, Mughal MS, Aslam F, Schram J, Bansal P. Non-surgical treatment of aseptic olecranon bursitis: A systematic review. Reumatol Clin (Engl Ed) 2023; 19:482-487. [PMID: 37945181 DOI: 10.1016/j.reumae.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB. METHODS This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy. CONCLUSION Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.
Collapse
Affiliation(s)
- Ikwinder Preet Kaur
- Department of Rheumatology, University of Florida College of Medicine, 653-1 8th St W, Jacksonville, FL 32209, United States
| | - Mohsin Sheraz Mughal
- Department of Cardiology, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic - Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States
| | - Jennifer Schram
- Librarian and Supervisor, Mayo Clinic Libraries - Wisconsin, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States.
| |
Collapse
|
4
|
Subhas N, Wu F, Fox MG, Nacey N, Aslam F, Blankenbaker DG, Caracciolo JT, DeJoseph DA, Frick MA, Jawetz ST, Said N, Sandstrom CK, Sharma A, Stensby JD, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023; 20:S20-S32. [PMID: 37236743 DOI: 10.1016/j.jacr.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | - Fangbai Wu
- Research Author, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael G Fox
- Program Director and Panel Chair, Mayo Clinic Arizona, Phoenix, Arizona
| | - Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia
| | - Fawad Aslam
- Mayo Clinic, Scottsdale, Arizona, Rheumatologist
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Section Head, Musculoskeletal Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; and Chair, MSK-RADS (Bone) Committee
| | | | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Claire K Sandstrom
- University of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
| |
Collapse
|
5
|
Habib E, Macphee L, Marshall C, Lemond LM, McBride N, Aslam F, Sekiguchi H, Soh I, Grill M, Patel B, Sen A. “WILL I GO BACK TO MY NORMAL LIFE?”: AN UNUSUAL PRESENTATION OF TAKAYASU ARTERITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
6
|
Sanghavi D, Bansal P, Kaur IP, Mughal MS, Keshavamurthy C, Cusick A, Schram J, Yarrarapu SNS, Giri AR, Kaur N, Moreno Franco P, Abril A, Aslam F. Impact of colchicine on mortality and morbidity in COVID-19: a systematic review. Ann Med 2022; 54:775-789. [PMID: 35258357 PMCID: PMC8920395 DOI: 10.1080/07853890.2021.1993327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Colchicine, because of its anti-inflammatory and possible anti-viral properties, has been proposed as potential therapeutic option for COVID-19. The role of colchicine to mitigate "cytokine storm" and to decrease the severity and mortality associated with COVID-19 has been evaluated in many studies. OBJECTIVE To evaluate the role of colchicine on morbidity and mortality in COVID-19 patients. METHODS This systematic review was conducted in accordance with the PRISMA recommendations. The literature search was conducted in 6 medical databases from inception to February 17, 2021 to identify studies evaluating colchicine as a therapeutic agent in COVID-19. All included studies were evaluated for risk of bias (ROB) using the Revised Cochrane ROB tool for randomised controlled trials (RCTs) and Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS Four RCTs and four observational studies were included in the final analysis. One study evaluated colchicine in outpatients, while all others evaluated inpatient use of colchicine. There was significant variability in treatment protocols for colchicine and standard of care in all studies. A statistically significant decrease in all-cause mortality was observed in three observational studies. The risk of mechanical ventilation was significantly reduced only in one observational study. Length of hospitalisation was significantly reduced in two RCTs. Risk for hospitalisation was not significantly decreased in the study evaluating colchicine in outpatients. Very few studies had low risk of bias. CONCLUSION Based on the available data, colchicine shall not be recommended to treat COVID-19. Further high-quality and multi-center RCTs are required to assess the meaningful impact of this drug in COVID-19.KEY MESSAGESColchicine, an anti-inflammatory agent has demonstrated anti-viral properties in in-vitro studies by degrading the microtubules, as well as by inhibiting the production of pro-inflammatory cytokines.Colchicine has been studied as a potential therapeutic option for COVID-19, with variable results.Until further research can establish the efficacy of colchicine in COVID-19, the use of colchicine in COVID-19 shall be restricted to clinical trials.
Collapse
Affiliation(s)
- Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic - Florida, Jacksonville, FL, USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Ikwinder Preet Kaur
- Department of Internal Medicine, Rutgers/Monmouth Medical Center, Long Branch, NJ, USA
| | - Mohsin Sheraz Mughal
- Department of Internal Medicine, Rutgers/Monmouth Medical Center, Long Branch, NJ, USA
| | | | - Austin Cusick
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | - Jennifer Schram
- Mayo Clinic Libraries - Wisconsin, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Siva Naga S Yarrarapu
- Department of Internal Medicine, RWJ Barnabas Health, Monmouth Medical Center, Long Branch, NJ, USA
| | - Abhishek R Giri
- Department of Critical Care Medicine, Mayo Clinic - Florida, Jacksonville, FL, USA
| | - Nirmaljot Kaur
- Department of Internal Medicine, Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic - Florida, Jacksonville, FL, USA
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic - Florida, Jacksonville, FL, USA
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic - Arizona, Scottsdale, AZ, USA
| |
Collapse
|
7
|
Tao M, Al-Sadawi M, Aslam F, Mann N, Goldschmidt M, Tam E. Association of late gadolinium enhancement in cardiac magnetic resonance with heart failure outcomes in patients with non-ischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Late-gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) has been found to be associated with increased mortality in patients with non-ischemic cardiomyopathy (NICM). The correlation between LGE and heart failure (HF) hospitalization, referral for heart transplant, and ejection fraction (EF) improvement have not been well established.
Purpose
This meta-analysis assessed the relationship between LGE in CMR with HF hospitalization, referral for heart transplant and EF improvement in patients with NICM.
Methods
We searched the databases for studies reporting the association between LGE in CMR for NICM and HF outcomes including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar for all studies. The search was not restricted to time or publication status. The minimal follow up duration is one year.
Results
A total of 216 studies resulted from the literature search. A total of 25 studies and 3,039 patients (1,265 with LGE vs 1,774 without LGE) were included; mean follow up is around 33 months (ranging between 13 to 71 months). Our analysis demonstrated that LGE in NICM was associated with increased risk of HF hospitalization (odds ratio 3.38, 95% confidence interval 2.27–5.04; P<0.01), referral for transplant (odds ratio 5.08, 95% confidence interval 2.49–10.35; P<0.01), and lower chance for EF improvement (odds ratio 0.16, 95% confidence interval 0.03–0.85; P 0.03). Heterogeneity is moderate: χ2=49.5, df=21 (P=0.001), I2=57%. (Figures 1 and 2)
Conclusions
Our results suggest that LGE is associated with increased risk of HF hospitalization and referral for heart transplant and lower chance for EF improvement in long-term follow up.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Tao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - N Mann
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Goldschmidt
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Tam
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
8
|
Aslam F, Al-Sadawi MA, Aleem S, Ijaz H, Jacob R, Cao K, Santore L, Almasry I, Singh A, Fan R, Rashba E. Outcomes of additional substrate modification in de novo atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Data regarding additional substrate modification has been conflicting, both in paroxysmal and persistent atrial fibrillation.
Purpose
To assess the effect of additional linear substrate modification during de novo AF ablation on AF recurrence.
Methods
We reviewed 1575 AF ablations in 1254 patients from January 2013 to June 2021 at a single academic medical center. There were 1096 de novo ablations. We defined substrate modification as linear ablations including cavotricuspid isthmus (CTI), superior vena cava isolation, intercaval line, mitral isthmus, and left atrial roof and floor lines. We evaluated clinical and procedural characteristics to identify risk factors for AF recurrence and complications. Patients were followed for a minimum of 6 months.
Results
The 1096 de novo ablations included 65.5% males with mean age 61.1 years, mean BMI 31.3, 81.8% paroxysmal AF and 18.2% persistent AF. There were four AF ablation subgroups: PVI alone (41.6%), PVI and CTI ablation (37.1%), PVI with CTI and additional substrate modification (15.6%), and PVI with substrate modification without CTI ablation (5.7%). Overall, AF recurred in 36.9% cases. AF recurrence with PVI only ablation was 41% compared to 32.7% in patients with PVI and CTI ablation (p=0.02). When looking at patients with paroxysmal and persistent AF, results were similar, with decreased AF recurrence with the addition of CTI ablation in both paroxysmal (37.3% v. 29.2%, p=0.03) and persistent AF (58.1% v. 40.0%, p=0.02). Additional substrate modification did not result in significant difference in outcome in either paroxysmal or persistent AF (Figure 1).
Conclusions
In de novo AF ablations, addition of CTI ablation to de novo PVI ablation is associated with lower AF recurrence in both paroxysmal and persistent AF. Additional linear substrate modification did not impact outcomes.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M A Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Jacob
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Cao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - L Santore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
9
|
Ijaz H, Al-Sadawi M, Aslam F, Aleem S, Jacob R, Cao K, Santore L, Almasry I, Singh A, Fan R, Rashba E. Safety of same day discharge after atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) ablation is an outpatient procedure with traditionally an overnight hospital observation (OHO). Recently, there has been a trend towards same day discharge (SDD).
Purpose
Compare AF ablation procedure safety outcomes with SDD vs. OHO.
Methods
We reviewed consecutive AF procedures performed from January 2013 to June 2021 at a single academic center. Patients underwent OHO until June 2020, after which patients had SDD whenever feasible. Adverse events were assessed at three months, which included pericardial effusion, pericarditis, post-procedure hypotension, embolic events, and vascular complications. We also assessed emergency department (ED) visits and procedure-related hospital admissions.
Results
There were 1254 patients who underwent 1575 AF ablations. 1440 patients underwent OHO and 135 had SDD. Mean age was 62.2 years, BMI 33 kg/m2, 65% were male, and 27.6% had persistent AF, without significant differences in baseline characteristics between OHO and SDD. We found that SDD was not associated with increased complications (OHO 0.20% v. SDD 0.49%; p>0.05), ED visits, or hospital admissions (2% v. 5%; p>0.05) (Figure 1, 2). There were no gender or age-related disparities in all outcomes (p>0.05).
Conclusion
SDD protocol after AF ablation is feasible and not associated with higher incidence of complications, ED visits, and procedure-related hospitalizations.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Jacob
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Cao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - L Santore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
10
|
Aslam F, Al-Sadawi M, Gore A, Ijaz H, Dhar K, Dhaliwal A, Singh A. Race disparities in atrial fibrillation detection using implantable loop recorder for cryptogenic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryptogenic stroke represents about 25–30% of all ischemic strokes. Continuous electrocardiographic monitoring using implantable loop recorder (ILR) can detect asymptomatic and undiagnosed atrial fibrillation (AF).
Purpose
To assess patient-specific factors in ILR implantation and AF detection in patients with cryptogenic strokes.
Methods
We retrospectively reviewed 379 patients with cryptogenic stroke indicated for ILR implantation, from January 2017 to June 2021 at our university hospital. We evaluated patient demographic and clinical characteristics to assess the risk factors associated with higher incidence of AF detection, using logistic regression models.
Results
Of the 379 ILRs implanted, 60.4% were males with 71.2% Caucasian, mean age 67.6 years, and mean BMI 28.5. The mean CHADSVASC score of 3.9 at the time of ischemic stroke. These patients had prior diagnosis of diabetes mellitus (27.4%), hypertension (65.7%), chronic kidney disease (19.5%), coronary artery disease (20%) and congestive heart failure (2%). Of the entire cohort, AF was diagnosed in 16% of patients with 14 months mean follow up. There were more females diagnosed with AF on ILR (20% v. 18.7%, p>0.05). Caucasians were more likely to have AF detected compared to non-Caucasians (OR 2.3, 95% CI, p<0.02). There were 52 patients with mobile cardiac outpatient telemetry (MCOT) before having ILR implantation. AF was not detected on MCOT, but 15% were diagnosed with AF with ILR monitoring. In univariate analysis, increasing age is strongly associated with the detection of AF (p=0.03).
Conclusions
There continues to exist race disparities in ILR implantation and eventual AF detection, leading to further socioeconomic health disparities. ILR should be considered especially in elderly with cryptogenic stroke given the higher incidence of AF detection.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Gore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Dhar
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Dhaliwal
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
11
|
Aslam F, Al-Sadawi M, Aleem S, Alsaiqali M, Almasry I, Singh A, Rashba E, Fan R. Effect of defibrillator on long term all-cause mortality in patients with chronic kidney disease: an updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The beneficial role of implantable defibrillator (ICD) in patients with chronic kidney disease (CKD) is less understood as this population is often not well represented in clinical trials.
Purpose
Evaluate the effect of ICD use in patients with CKD on long term outcomes.
Methods
Literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD, which is defined as glomerular filtration rate (GFR) <60 mL/min. The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The minimum duration of follow-up required for inclusion was one year.
Results
The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow up was 39 months (12–81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log HR −0.247, SE 0.101, p=0.015); Heterogeneity: df=13 (P<0.01), I2=97.057; Test for overall effect: Z=−2.431 (Figure 1). When further stratified based on dialysis, CKD patients without the need for dialysis had favorable outcome (log HR −0.211, SE 0.095, p=0.026); Heterogeneity: df=6 (P<0.01), I2=70.146; Test for overall effect: Z=−2.225, whereas ICD implantation in CKD patients requiring dialysis was not associated with mortality benefit (log HR −0.262, SE 0.134, p=0.051) (Figure 2A, B).
Conclusion
ICD implantation is associated with mortality benefit in patients with CKD, but this association is not present for patients requiring dialysis.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Alsaiqali
- Suny Downstate Medical Center , Brooklyn , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
12
|
Aslam F, Al-Sadawi M, Tao M, Aleem S, Almasry I, Singh A, Rashba E, Fan R. Association of late-gadolinium enhancement in cardiac magnetic resonance with ventricular arrhythmias and mortality in patients with non-ischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Late-gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) is a predictor of adverse events such as cardiovascular mortality, cardiovascular related hospitalization and defibrillation shocks in patients with non-ischemic cardiomyopathy (NICM). The correlation between LGE and ventricular arrhythmia and mortality has not been completely established.
Purpose
This meta-analysis assessed the relationship between LGE in CMR with ventricular arrhythmias: sustained, non-sustained and ICD therapy; and mortality in patients with NICM.
Methods
Databases were queried for studies reporting the association between LGE in CMR in NICM and ventricular arrhythmias and mortality, including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimal follow up duration was one year.
Results
A total of 46 studies and 10,548 patients (4,610 with LGE vs 5,938 without LGE) were included; mean follow up was 3 years (ranging between 13 to 71 months) and mean left ventricular ejection fraction 33%. LGE in NICM was associated with increased risk of ventricular arrhythmias and sudden cardiac death (odds ratio 4.595, 95% confidence interval 3.54–5.97; P<0.01) and mortality (odds ratio 2.949, 95% confidence interval 2.285–3.806; P<0.01). Heterogeneity is low to moderate: χ2=82.2, df =45 (P=0.001), I2=45% (Figures 1, 2).
Conclusions
Our results suggest that LGE is associated with increased risk of ventricular arrhythmias, sudden cardiac death and mortality in long-term follow up. These results further substantiate the need for larger prospective randomized trials using LGE to decide ICD indication regardless of EF. There are two ongoing trials testing this indication: CMR-ICD and CMR-GUIDE.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Tao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
13
|
Aleem S, Al-Sadawi M, Aslam F, Ijaz H, Cao K, Jacob R, Santore L, Almasry I, Fan R, Rashba E, Singh A. Does body mass index affect atrial fibrillation ablation outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There are conflicting reports in the literature regarding whether body-mass index (BMI) influences the success and procedural complication rates of atrial fibrillation (AF) ablation.
Purpose
To determine if differences in BMI affect AF ablation outcomes
Methods
At a single academic center, AF ablation procedures were reviewed from 2013 to 2021. Primary outcomes were AF recurrence (after a 90 day blanking period), procedure-related complications, emergency department visits or hospital admission (ED/HOSP). Patients had a minimum of 6 months follow-up
Results
We analyzed 1569 AF ablation consecutive procedures (1093 de novo, 476 repeat ablation) using either radiofrequency or cryoablation. The study population was 65% male with a mean age 62 years, with 28% persistent AF. BMI was separated into three cohorts: <25 kg/m2 (N=218), 25–30 kg/m2 (N=547), and >30 kg/m2 (N=804). There were no significant differences in the type of AF, left atrial diameter, or left ventricular ejection fraction in the BMI subgroups. There was a direct relationship between the prevalence of co-morbid conditions and increasing BMI: hypertension (49.1%, 59.9%, 60.2%; p 0.04), diabetes (6.4%, 13.5%, 21.3%; p 0.01), and obstructive sleep apnea (5.5%, 10.8%, 26.7%; p<0.01). There were no significant differences in AF recurrence, procedural complications or ED/HOSP among the BMI cohorts (p>0.05) (Figure 1). No gender related disparities were noted in outcomes (p>0.05).
Conclusion
Higher BMI was not associated with AF recurrence, complications, or ED/HOSP after AF ablation despite a higher prevalence of comorbid medical conditions
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Aleem
- Stony Brook University Hospital , Stony Brook , United States of America
| | - M Al-Sadawi
- Stony Brook University Hospital , Stony Brook , United States of America
| | - F Aslam
- Stony Brook University Hospital , Stony Brook , United States of America
| | - H Ijaz
- Stony Brook University Hospital , Stony Brook , United States of America
| | - K Cao
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Jacob
- Stony Brook University Hospital , Stony Brook , United States of America
| | - L Santore
- Stony Brook University Hospital , Stony Brook , United States of America
| | - I Almasry
- Stony Brook University Hospital , Stony Brook , United States of America
| | - R Fan
- Stony Brook University Hospital , Stony Brook , United States of America
| | - E Rashba
- Stony Brook University Hospital , Stony Brook , United States of America
| | - A Singh
- Stony Brook University Hospital , Stony Brook , United States of America
| |
Collapse
|
14
|
Aslam F, Ali I, Babar Z, Yang Y. Building evidence for improving vaccine adoption and uptake of childhood vaccinations in low- and middle-income countries: a systematic review. Drugs Ther Perspect 2022; 38:133-145. [PMID: 35340931 PMCID: PMC8933664 DOI: 10.1007/s40267-021-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/27/2022]
Abstract
Vaccine coverage for children is an important indicator of the performance of national health and immunization systems. Most of the existing literature has targeted mothers’ low educational level, living in underserved districts and/or remote rural areas and economic poverty that are correlated with low immunization coverage but the supply- and demand-side constraints to immunization in low- and middle- income countries (LMICs) are not well understood. The reliability of claimed administrative immunization coverage in these contexts is questionable. To address these barriers within the present Expanded Programme on Immunization (EPI), the difficulties related to inadequate vaccination uptake must be addressed in more depth. Building on already produced literature, this study aims to determine the extent of immunization coverage among children in LMICs, as well as to fill in the gaps in awareness about system-level obstacles that currently hinder the effective delivery and uptake of immunization services through EPI. By two reviewers, a literature search using PubMed and Google Scholar along with targeted grey literature was conducted on the 2nd of June 2021 by following PRISMA guidelines. The search techniques for electronic databases used both Medical Subject Headings (Mesh) and free-text words were tailored to each database's specific needs using a controlled vocabulary that was limited to the English language from 2000 and 2020. Of the 689 records, eleven articles were included in this review meeting the inclusion criteria. In total, five articles related to vaccination coverage, four studies on components of the routine immunization system, one article on the implementation of new and under-utilized vaccines and one were on vaccines financing. We evaluated the quality of the included studies and extracted into tables created by one investigator and double-checked by another. Review findings suggest that specific strategies to reduce inequality may be required. Vaccine procurement and pricing strategies, as well as vaccine customization to meet the needs of LMICs, are all critical components in strengthening immunization systems. Our findings could be used to establish practical strategies for countries and development partners to address coverage gaps and improve vaccination system effectiveness.
Collapse
Affiliation(s)
- F. Aslam
- International Food and Drug Policy and Law Research Center, School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - I. Ali
- Department of Social and Cultural Anthropology, University of Vienna, Vienna, Austria
- Department of Anthropology, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Z. Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
| | - Y. Yang
- International Food and Drug Policy and Law Research Center, School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
- Biomedicine, Institute of Regulatory Science, Tsinghua University, Hall, Rm C104, Beijing, 100084 China
| |
Collapse
|
15
|
McPherson M, Aslam F. Green Pixels on DECT: Is it Gout? Am J Med Sci 2022; 364:e27-e28. [DOI: 10.1016/j.amjms.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 11/01/2022]
|
16
|
Bansal P, Sonani B, Aslam F. Progression from palindromic rheumatism to rheumatoid arthritis after COVID-19 vaccination. ARP Rheumatol 2022; 1:100-101. [PMID: 35633584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Infections including COVID-19 infection are associated with immune overactivation and hyperinflammation, and cases of incident inflammatory arthritis after COVID-19 and other respiratory viral infections have been reported. Theoretical concerns of autoimmunity due to molecular mimicry exist with vaccines including vaccines for COVID-19, and rare cases of flares of underlying chronic inflammatory disorders such as systemic lupus erythematosus have been reported after COVID-19 vaccination. Here we present the case of a patient with a 7-year history of well-controlled palindromic rheumatism who developed rheumatoid arthritis 2 weeks after vaccination for COVID-19. This is the first such case to our knowledge, and further studies can elaborate on the risk of autoimmunity due to COVID-19 vaccines if one exists. Given the overall safety and efficacy of COVID-19 vaccines, the proven benefits of vaccinating vulnerable patients with autoimmune disorders outweigh this potential theoretical risk of autoimmune disease flare, and vaccinations in this at-risk population shall be strongly encouraged.
Collapse
Affiliation(s)
| | - Bhavin Sonani
- Department of Internal Medicine. HSHS St John's Hospital
| | | |
Collapse
|
17
|
Bansal P, Goyal A, Cusick A, Lahan S, Dhaliwal HS, Bhyan P, Bhattad PB, Aslam F, Ranka S, Dalia T, Chhabra L, Sanghavi D, Sonani B, Davis JM. Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019. Ann Med 2021; 53:117-134. [PMID: 33095083 PMCID: PMC7880079 DOI: 10.1080/07853890.2020.1839959] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022] Open
Abstract
Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19. KEY MESSAGES HCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions. HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported. HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.
Collapse
Affiliation(s)
| | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Austin Cusick
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | | | - Poonam Bhyan
- Cape Fear Valley Hospital, Fayetteville, NC, USA
| | | | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Lovely Chhabra
- Heartland Regional Medical Center, Southern IL University, Carbondale, IL, USA
| | | | | | | |
Collapse
|
18
|
Sullivan MM, Pham MM, Marks LA, Aslam F. Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord 2021; 22:792. [PMID: 34525992 PMCID: PMC8444402 DOI: 10.1186/s12891-021-04651-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Persistent monoarthritis in otherwise well-controlled rheumatoid arthritis presents a therapeutic challenge. Intra-articular (IA) steroids are a mainstay of treatment, though some have queried whether IA disease modifying anti-rheumatic drugs (DMARD) and biologics can be used in those who fail steroid injections. Methods A systematic literature review was conducted using four medical databases to identify randomized, controlled trials assessing IA therapies in RA patients. Included studies underwent Cochrane Risk of Bias 2 assessment for quality. Results Twelve studies were included, 6 of which examined intra-articular (IA) TNF inhibitors (TNFi), and 6 studies evaluating IA methotrexate. Of those evaluating IA TNFi, one study reported statistical improvement in TNFi therapy when compared with placebo. The remaining 5 studies compared IA TNFi therapy with steroid injections. IA TNFi had statistically improved symptom scores and clinical assessments comparable with IA steroid treatments. In the 6 studies evaluating IA methotrexate, the addition of methotrexate to steroid intra-articular therapy was not found to be beneficial, and singular methotrexate injection was not superior to the control arms (saline or triamcinolone). Risk-of-bias (ROB) assessment with the Revised Cochrane ROB tool indicated that 2 of 6 TNFi studies were at some risk or high risk for bias, compared with 5 out of 6 methotrexate studies. Conclusion For persistent monoarthritis in rheumatoid arthritis, IA methotrexate was not found to have clinical utility. Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04651-5.
Collapse
Affiliation(s)
- Megan M Sullivan
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Michael M Pham
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, Scottsdale, AZ, USA
| | - Lisa A Marks
- Mayo Clinic Libraries Arizona, Mayo Clinic, Scottsdale, AZ, USA
| | - Fawad Aslam
- Division of Rheumatology, Department of Internal Medicine Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
19
|
Khan NA, Torralba KD, Aslam F. Missing data in randomised controlled trials of rheumatoid arthritis drug therapy are substantial and handled inappropriately. RMD Open 2021; 7:rmdopen-2021-001708. [PMID: 34330848 PMCID: PMC8327847 DOI: 10.1136/rmdopen-2021-001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022] Open
Abstract
Objectives To analyse the amount, reporting and handling of missing data, approach to intention-to-treat (ITT) principle application and sensitivity analysis utilisation in randomised clinical trials (RCTs) of rheumatoid arthritis (RA). To assess the trend in such reporting 10 years apart (2006 and 2016). Methods Parallel group drug therapy RA RCTs with a clinical primary endpoint. Results 176 studies enrolling a median of 160 (IQR 62–339) patients were eligible. In terms of actual analysis: 81 (46%) RCTs conducted ITT, 42 (23.9%) conducted modified ITT while 53 (30.1%) conducted non-ITT analysis. Only 58 of 97 (59.8%) RCTs reporting an ITT analysis actually performed it. The median (IQR) numbers of participants completing the trial and included in analysis for primary outcome were 86% (74%–91%) and 100% (97.1%–100%), respectively. 53 (32.7%) and 65 (40.1%) RCTs had >20% and 10%–20% missing primary outcome data, respectively. Missing data handling was unreported by 58 of 171 (33.9%) RCTs. When reported, vast majority used simple imputation methods. No significant trend towards improved reporting was seen between 2006 and 2016. Sensitivity analysis numerically improved from 2006 to 2016 (14.7% vs 21.4%). Conclusions There is significant discrepancy in the reported and the actual performed analysis in RA drug therapy RCTs. Nearly one-third of RCTs had >20% missing data. The reporting and methods of missing data handling remain inadequate with high usage of non-preferred simple imputation methods. Sensitivity analysis utilisation was low. No trend towards better missing data reporting and handling was seen.
Collapse
Affiliation(s)
- Nasim A Khan
- Rheumatology Section, CHI St Vincent Little Rock Diagnostic Clinic, Little Rock, Arkansas, USA
| | - Karina D Torralba
- Division of Rheumatology, Loma Linda University, Loma Linda, California, USA
| | - Fawad Aslam
- Divison of Rheumatology, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|
20
|
Aslam F, Meyer M, Pham M. POS0602 ROLE OF INTRAARTICULAR BIOLOGICS AND METHOTREXATE IN THE MANAGEMENT OF ACTIVE INFLAMMATORY MONOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Expansion of immunosuppressive medications has greatly improved disease activity control in rheumatoid arthritis (RA) patients. However, persistent symptomatic monoarthritis can be a problem in some patients who otherwise have satisfactory disease control. Intra-articular (IA) corticosteroid (CS) injections have remained a treatment cornerstone for these patients, but the need for other therapies is clear. Patients can fail such therapy, may develop adverse effects or have comorbidities that are exacerbated by IA CS. 50% of patients relapse after IA CS therapy. Several studies have looked at other agents such as methotrexate (MTX) or tumor necrosis factor inhibitors (TNF-i) as IA treatment options.Objectives:To systematically review the evidence regarding utility of IA methotrexate and biologics in managing inflammatory monoarthritis in patients with RA.Methods:A systematic literature review, in accordance with PRISMA guidelines, was conducted looking at trials investigating the use of IA MTX and/or TNF-i, against IA CS, in managing inflammatory monoarthritis in patients with RA. A trained librarian conducted search of Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science databases. Included studies were assessed for risk of bias as per the Cochrane tool.Results:A total of 1013 citations were retrieved from the medical database searches. 12 studies were included in the final review. 6 studies investigated IA MTX while 5 studied IA etanercept. One study investigated different biologic agents: infliximab, etanercept, or adalimumab. Multitude of dosing regimens and administration protocols were used in various studies. 5 of the 6 MTX studies only included knees. IA MTX was compared against saline, CS and as combined MTX/CS vs CS alone. There was no evidence to support the use of IA MTX as a superior or equivalent agent to the comparator groups. Unlike MTX, etanercept was investigated in multiple joint types e.g. elbows, knees and wrists. IA etanercept was found to have utility as a successful IA alternative to CS. The only study investigating infliximab and adalimumab found them to be superior to IA CS across multiple joint types. All therapies were generally well tolerated. Etanercept studies had low risk of bias while the MTX studies mostly suffered from higher risk of bias.Conclusion:Etanercept may be used as an IA agent in select patients with inflammatory arthritis when systemic treatment is not an option and IA corticosteroids cannot be used. Limited data also supports the utility of IA adalimumab and infliximab as better IA agents compared to CS. IA MTX, however, did not have such supporting data.References:[1]Fisher BA, Keat A. (2006) Should we be using intraarticular tumor necrosis factor blockade in inflammatory monoarthritis? J Rheumatol. 33(10), 1934-5.[2]Weitoft T, Uddenfeldt P. (2000) Importance of synovial fluid aspiration when injecting intra-articular corticosteroids. Ann Rheum Dis. 59(3), 233-5.Disclosure of Interests:None declared
Collapse
|
21
|
Affiliation(s)
- Bhavin Sonani
- Department of Internal Medicine, HSHS St John's Hospital, 800 E Carpenter St, Springfield, IL, 62769, USA
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Amandeep Goyal
- Department of Cardiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Janki Patel
- Department of Infectious Diseases, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI, 54701, USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI, 54701, USA.
| |
Collapse
|
22
|
Sonani B, Aslam F, Goyal A, Patel J, Bansal P. COVID-19 vaccination in immunocompromised patients. Clin Rheumatol 2021; 40:797-798. [PMID: 33426632 PMCID: PMC7797352 DOI: 10.1007/s10067-020-05547-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Bhavin Sonani
- Department of Internal Medicine, HSHS St John’s Hospital, 800 E Carpenter St, Springfield, IL 62769 USA
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA
| | - Amandeep Goyal
- Department of Cardiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Janki Patel
- Department of Infectious Diseases, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701 USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701 USA
| |
Collapse
|
23
|
Qayyum MA, Sabri AA, Aslam F. Medical Aspects Taken for Granted. Mcgill J Med 2020. [DOI: 10.26443/mjm.v10i1.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
24
|
Abstract
A questionnaire-based cross-sectional study was carried out to assess the awareness of diabetes mellitus among rural and urban diabetics. After analyzing the awareness level of both populations, the urban diabetics were found to be more educated about diabetes. A 25-question survey was used to judge the awareness level of diabetes mellitus. A total of 240 diabetics were surveyed, 120 each from rural and urban areas. The mean awareness among the rural population was 13 (SD± 2) correct answers out of a possible 25. Similarly, in the case of the urban diabetics the mean awareness was 18 (SD± 2) correct answers. The survey was conducted on randomly chosen diabetics belonging to Lahore and Faisalabad, (urban areas), as well as Habibabad, Haveli Koranga and Baba Kanwal (rural areas). The results emphasize the interrelation between demography and awareness of diabetes mellitus. The rural diabetics are far less knowledgeable about diabetes mellitus, its management and its complications. Thus, there is an urgent need to improve the awareness level of diabetes mellitus in rural areas. Doing so will give rise to a healthier workforce and a lessened economic burden on Pakistan.
Collapse
|
25
|
Meyer MM, Marks LA, Aslam F. Clinical implications of synovial fluid specimen handling for crystal associated arthritides: A systematic review. Int J Rheum Dis 2020; 24:10-20. [PMID: 33150706 DOI: 10.1111/1756-185x.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
AIM To identify the appropriate methods of synovial fluid (SF) specimen storage, manipulation and handling for crystal associated arthritides (CAA) diagnosis. METHOD A systematic literature review was conducted using 5 medical databases to identify diagnostic studies assessing SF specimen handling for calcium pyrophosphate (CPP) and monosodium urate (MSU) crystals identification. All included studies were rated for quality using the Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS Fifteen studies, including 2 non-English language manuscripts, were included. Eight studies examined both types of crystals, while 3 studies examined CPP and 4 studies examined MSU crystals only. Overall, MSU crystals were more stable over time compared to CPP crystals. MSU stability was generally independent of time, preservative and temperature. CPP crystals deteriorated with time and were more stable if refrigerated. Ethylenediaminetetraacetic acid (EDTA) was a suitable preservative. Re-examining an initially negative SF sample at 24 hours facilitated detection of additional cases. Very few studies had an overall low risk of bias and applicability. CONCLUSION Monosodium urate crystals remain stable over time independent of storage time, temperature and preservative. CPP crystals are mostly stable for 24-48 hours but can deteriorate with time. Overall, SF crystal examination should ideally be done within 24-48 hours. They may be stored at room temperature without any preservative. Otherwise, refrigeration (4°C/39°F) and EDTA preservation is reasonable. Stored SF re-examination, at 24 hours, helps identify a small number of additional MSU and CPP cases. Centrifugation techniques allow better and easier crystal identification, particularly CPP. Most studies were of unclear or low quality.
Collapse
Affiliation(s)
- Megan M Meyer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Lisa A Marks
- Department of Medical Education and Medical Libraries, Mayo Clinic, Scottsdale, AZ, USA
| | - Fawad Aslam
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
26
|
Bansal P, Goyal A, Cusick A, Aslam F. Use of Apremilast in Patients With Psoriatic Arthritis During the COVID-19 Pandemic: Comment on the Article by Mikuls et al. Arthritis Rheumatol 2020; 73:547-548. [PMID: 33142038 DOI: 10.1002/art.41575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Austin Cusick
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | | |
Collapse
|
27
|
Aslam F, England BR, Cannella A, Sharp V, Kao L, Arnason J, Albayda J, Bakewell C, Sanghvi S, Fairchild R, Torralba KD, Evangelisto A, DeMarco PJ, Bethina N, Kissin EY. Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis. Ann Rheum Dis 2020; 79:908-913. [PMID: 32213497 DOI: 10.1136/annrheumdis-2020-216927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility. METHODS Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC. RESULTS We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L. CONCLUSIONS A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.
Collapse
Affiliation(s)
- Fawad Aslam
- Rheumatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bryant R England
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Rheumatology, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Amy Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Veronika Sharp
- Division of Rheumatology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Lily Kao
- Division of Rheumatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jon Arnason
- Division of Rheumatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine Bakewell
- Division of Rheumatology, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Shruti Sanghvi
- Division of Rheumatology, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Robert Fairchild
- Division of Rheumatology, Stanford University, Stanford, California, USA
| | - Karina D Torralba
- Division of Rheumatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Amy Evangelisto
- Division of Rheumatology, Arthritis, Rheumatic & Back Disease Associates, Voorhees, New Jersey, USA
| | - Paul J DeMarco
- Center for Rheumatology and Bone Research, Arthritis and Rheumatism Associates, Wheaton, Maryland, USA.,Rheumatology, Georgetown University School of Medicine, Washington, DC, USA
| | - Narandra Bethina
- Division of Rheumatology, University of Vermont, Burlington, Vermont, USA
| | - Eugene Y Kissin
- Rheumatology, Boston University Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Aslam F, Wiedmeier JE, DiCaudo DJ. A Man With Recurrent Fever, Episodic Rash, and Pain. Arthritis Care Res (Hoboken) 2020; 73:1106-1113. [PMID: 31961498 DOI: 10.1002/acr.24142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
|
29
|
Aslam F, Chivers FS, Doshi KB, Chang‐Miller A. Positive HLA‐B27 and sacroiliitis is not always spondyloarthritis. Int J Rheum Dis 2019; 22:2213-2217. [DOI: 10.1111/1756-185x.13738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/26/2019] [Accepted: 10/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
| | | | - Krupa B. Doshi
- Division of Endocrinology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
| | - April Chang‐Miller
- Division of Rheumatology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
| |
Collapse
|
30
|
Rayfield C, Mertz L, Kelemen K, Aslam F. Vasculitis on brain angiography is not always vasculitis: intravascular large B-cell lymphoma mimicking central nervous system vasculitis. BMJ Case Rep 2019; 12:12/8/e230753. [PMID: 31451471 DOI: 10.1136/bcr-2019-230753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 68-year-old man, with a history of non-Hodgkin's lymphoma in remission, was admitted for homonymous hemianopsia, headaches and subacute progressive cognitive decline. Imaging revealed brain infarcts and angiography suggested vasculitis. A brain biopsy, however, revealed an intravascular large B-cell lymphoma (IVLBL). Central nervous system (CNS) vasculitis and IVLBL of the brain are extremely rare diseases that can have an almost identical clinical presentation. Angiographic findings are very similar but usually are reported as compatible with vasculitis. Brain biopsy or a random skin biopsy are crucial in diagnosing IVLBL as the accuracy of angiographic findings for CNS vasculitis is low.
Collapse
|
31
|
Parsons AM, Aslam F, Grill MF, Aksamit AJ, Goodman BP. Rheumatoid Meningitis: Clinical Characteristics, Diagnostic Evaluation, and Treatment. Neurohospitalist 2019; 10:88-94. [PMID: 32373270 DOI: 10.1177/1941874419859769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Due to the potential for high mortality and neurologic complications of rheumatoid meningitis (RM), awaiting biopsy confirmation may delay vital treatment intervention. Our aim was to describe the clinical presentations of RM in our population and determine whether meningeal biopsy impacted diagnosis, treatment, and outcomes. Methods A retrospective chart review was completed for patients at Mayo Clinic with a diagnosis of RM within the last 28 years. Those with identified alternative inflammatory, infectious, or neoplastic causes of pachymeningitis or leptomeningitis were excluded. Results Fourteen patients meeting inclusion/exclusion criteria were identified. All patients were positive for rheumatoid factor or cyclic citrullinated peptide. All patients had magnetic resonance imaging abnormalities characterized by pachymeningeal and/or leptomeningeal enhancement. Of the 10 patients who underwent biopsy, nonspecific findings were seen in 74%. All patients except one were treated with corticosteroids with subsequent symptomatic improvement. Radiographic improvement or resolution was seen in 10 (83%) of 12. Patients improved with corticosteroid treatment, including those who were diagnosed with RM on clinical basis without undergoing a biopsy as well. Conclusions This retrospective review displays the myriad of clinical presentations of RM. It also suggests that with appropriate exclusion of infectious, neoplastic, and other autoimmune etiologies, biopsy may not be necessary to initiate treatment.
Collapse
Affiliation(s)
| | - Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Marie F Grill
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | |
Collapse
|
32
|
Cheema R, Chang-Miller A, Aslam F. Myalgia with Elevated Inflammatory Markers in an Obese Young Female: Fibromyalgia or Polymyalgia Rheumatica? Am J Case Rep 2019; 20:659-663. [PMID: 31064976 PMCID: PMC6524750 DOI: 10.12659/ajcr.915564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patient: Female, 38 Final Diagnosis: Fibromyalgia Symptoms: Myalgia • pain Medication: — Clinical Procedure: — Specialty: Rheumatology
Collapse
Affiliation(s)
- Rabia Cheema
- Department of Medicine, St. Mary's Hospital, Waterbury, CT, USA.,Department of Medicine, Frank H. Netter MD School of Medicine, North Haven, CT, USA
| | | | - Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
33
|
Abstract
Felty syndrome(FS) is an uncommon, but severe, extra-articular manifestation of rheumatoid arthritis (RA). It occurs in patients with longstanding RA. It is extremely rare for RA to present as FS or develop after initially presenting as neutropaenia and splenomegaly. We describe a case of 47-year-old woman who was diagnosed simultaneously with FS and possible RA after testing positive for anticyclic citrullinated peptide antibody, but a negative rheumatoid factor. She had an excellent response to methotrexate. We review the existing literature of such cases and emphasise the importance of serological testing for RA in patients presenting with neutropaenia and splenomegaly, even in the absence of joint symptoms or prior diagnosis of RA.
Collapse
Affiliation(s)
- Fawad Aslam
- Department of Rheumatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Rabia S Cheema
- Internal Medicine, St. Mary's Hospital, Waterbury, Connecticut, USA
| | - Michael Feinstein
- Department of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - April Chang-Miller
- Department of Rheumatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| |
Collapse
|
34
|
Abstract
Introduction Comorbidities influence the prognosis, clinical outcomes, disease activity, and treatment response in rheumatoid arthritis (RA). RA patients have a high-comorbidity burden necessitating their study. Comorbidity indices are used to measure comorbidities and to study their impacts on different outcomes. A large number of such indices are used in clinical research. Some indices have been specifically developed in RA patients. Aim This review aims to provide an overview of generic and specific comorbidity indices commonly used in RA research. Methods We performed a critical literature review of comorbidity indices in RA using the PubMed database. Results/discussion This non-systematic literature review provides an overview of generic and specific comorbidity indices commonly used in RA studies. Some of the older but commonly used comorbidity indices like the Charlson comorbidity index and the Elixhauser comorbidity measure were primarily developed to estimate mortality risk from comorbid diseases. They were not specifically developed for RA patients but have been widely used in rheumatology comorbidity measurement. Of the many comorbidity indices available, only the rheumatic disease comorbidity index (RDCI) and the multimorbidity index have been specifically developed in RA patients. The functional comorbidity index was developed to look at functional disability and has been used in RA patients considering that morbidity is more important than mortality in such patients. While there is limited data comparing these indices, available evidence seems to favor the use of RDCI as it predicts mortality, hospitalization, disability, and healthcare utilization. The choice of the index, however, depends on several factors such as the population under study, outcome of interest, and sources of data. More research is needed to study the RA-specific comorbidity measures to make evidence-based recommendations for the choice of a comorbidity measure.
Collapse
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, United States
| | - Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences & Central Arkansas Veterans Health Care System, Little Rock, AR, United States
| |
Collapse
|
35
|
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|
36
|
Aslam F, Fox M, Chang-Miller A. Ultrasound for the rheumatologist - focal myositis. Acta Reumatol Port 2017; 42:336-338. [PMID: 29231909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
37
|
Abstract
Gout is the most common form of inflammatory arthritis in the United States. Nevertheless, gout remains misunderstood, misdiagnosed, underdiagnosed, and undertreated. Several new recommendation and guideline documents regarding the management of gout have been published in the past few years. New diagnostic modalities, such as ultrasound and dual-energy computed tomography, are now available. Newer treatment options exist, and older agents and their interactions are now better understood. This review addresses these recent diagnostic and therapeutic developments and describes our management protocol with the aim of providing the clinician with a pragmatic approach to gout management.
Collapse
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ
| | | |
Collapse
|
38
|
Malik UT, Aslam F. Ultrasound for the rheumatologist - Subcutaneous Sarcoidosis. Acta Reumatol Port 2016; 41:376-377. [PMID: 27683184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
39
|
Aslam F, Matteson EL. Polyarthritis as a Rare Presentation of Hydroxyapatite Deposition Disease. Arthritis Rheumatol 2016; 68:2056. [DOI: 10.1002/art.39717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/07/2016] [Indexed: 11/08/2022]
|
40
|
Grøn KL, Ornbjerg LM, Hetland ML, Aslam F, Khan NA, Jacobs JWG, Henrohn D, Rasker JJ, Kauppi MJ, Lang HC, Mota LMH, Aggarwal A, Yamanaka H, Badsha H, Gossec L, Cutolo M, Ferraccioli G, Gremese E, Bong Lee E, Inanc N, Direskeneli H, Taylor P, Huisman M, Alten R, Pohl C, Oyoo O, Stropuviene S, Drosos AA, Kerzberg E, Ancuta C, Mofti A, Bergman M, Detert J, Selim ZI, Abda EA, Rexhepi B, Sokka T. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program. Clin Exp Rheumatol 2014; 32:869-877. [PMID: 25327997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA). METHODS Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP. RESULTS Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant. CONCLUSIONS Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.
Collapse
Affiliation(s)
- Kathrine Lederballe Grøn
- Copenhagen University Hospital at Glostrup, Department of Rheumatology RM, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Ng B, Aslam F, Yu HJ. Reply. Arthritis Care Res (Hoboken) 2013; 65:836-8. [DOI: 10.1002/acr.21906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
Aslam F, Pandey T, Lipsmeyer E. Arthritis, clubbing and periosteal reaction in liver failure. Acta Reumatol Port 2013; 38:131-132. [PMID: 24141351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
44
|
Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care Res (Hoboken) 2013; 65:534-43. [DOI: 10.1002/acr.21861] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/10/2012] [Indexed: 12/11/2022]
|
45
|
Ng B, Aslam F, Petersen NJ, Yu HJ, Suarez-Almazor ME. Identification of rheumatoid arthritis patients using an administrative database: a Veterans Affairs study. Arthritis Care Res (Hoboken) 2013; 64:1490-6. [PMID: 22623324 DOI: 10.1002/acr.21736] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The accuracy of the diagnosis is vital when administrative databases are used for pharmacoepidemiologic and outcome studies. Data pertaining to the utility of databases for rheumatoid arthritis (RA) are sparse and variable. We assessed the utility of various diagnostic algorithms to identify RA patients within the Veterans Health Administration (VHA) databases. METHODS Using the International Classification of Diseases, Ninth Revision code for RA at 2 visits at least 6 months apart, we identified 1,779 patients between October 1, 1998 and September 30, 2009 in our local Veterans Affairs Medical Center (VAMC) administrative database. Disease-modifying antirheumatic drug (DMARD) use was ascertained from the pharmacy database. Cases were analyzed based on DMARD therapy and RA codes at clinic visits. A total of 543 patients' medical records, selected by stratification and random selection on the basis of their visits, were reviewed to ascertain the clinicians' diagnoses and clinical criteria documentation. Positive predictive values (PPVs) were calculated for various database case identification algorithms using diagnosis of RA by medical record review as the gold standard. RESULTS The PPV for identification of RA with 2 RA codes 6 months apart was 30.9%. Addition of DMARD therapy increased the PPV to 60.4%. The PPV further increased to 91.4% when having an RA code at the last VAMC rheumatology clinic visit criterion was added. An algorithm using only 2 administrative RA codes 6 months apart had a low PPV for correctly identifying patients with RA in the VHA database. CONCLUSION Including DMARD therapy and requiring an RA code at the last visit with a rheumatologist increased the performance of the data extraction algorithm.
Collapse
Affiliation(s)
- Bernard Ng
- Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, and Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, University of Arkansas for Medical Sciences, AR, USA.
| | | | | |
Collapse
|
47
|
Aslam F. Spiritual currency. CMAJ 2012; 184:2028. [DOI: 10.1503/cmaj.121463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
48
|
Aslam F, Brown HH, Pandey T, Russell EB. Giant cell arteritis presenting with a lateral medullary stroke in a patient with multiple atherosclerotic risk factors. Scand J Rheumatol 2012; 42:82-3. [PMID: 22992025 DOI: 10.3109/03009742.2012.709273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
49
|
|
50
|
|