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Yau MS, Filbay SR, Block JA, Lohmander LS. Reflections on 30 years of publishing osteoarthritis research: Where we've been and where we're going. Osteoarthritis Cartilage 2024; 32:349-351. [PMID: 38401669 DOI: 10.1016/j.joca.2024.02.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Michelle S Yau
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
| | - Stephanie R Filbay
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Skåne, Sweden
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Arora S, Block JA, Nika A, Sequeira W, Katz P, Jolly M. Does higher quality of care in systemic lupus erythematosus translate to better patient outcomes? Lupus 2023; 32:771-780. [PMID: 37121602 DOI: 10.1177/09612033231172664] [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] [Indexed: 05/02/2023]
Abstract
PURPOSE To assess if high quality of care (QOC) in SLE results in improved outcomes of quality of life (QOL) and non-routine health care utilization (HCU). METHODS One hundred and forty consecutive SLE patients were recruited from the Rheumatology clinic at an academic center. Data on QOC and QOL were collected along with demographics, socio-economic, and disease characteristics at baseline. LupusPRO assessing health-related (HR) QOL and non (N)HRQOL was utilized. Follow up QOL and HCU were collected prospectively at 6 months. High QOC was defined as those meeting ≥80% of the eligible quality indicators. Univariate and multivariate regression analyses were performed with QOC and high QOC as independent variables and HRQOL and NHRQOL as dependent variables at baseline and follow up. Multivariable models were adjusted for demographics and disease characteristics. Secondary outcomes included non-routine HCU and disease activity at follow up. RESULTS Baseline and follow up data on 140 and 94 patients, respectively, were analyzed. Mean (SD) performance rate (QOC) was 78.6 (13.4) with 52% patients in the high QOC group. QOC was associated with better NHRQOL at baseline and follow up but not with HRQOL. Of all the NHRQOL domains, QOC was positively associated with treatment satisfaction. QOC or high QOC were not associated with non-routine HCU and were instead associated with higher disease activity at follow up. CONCLUSION Higher QOC predicted better NHRQOL by directly impacting treatment satisfaction in SLE patients in this cohort. Higher QOC, however, was not associated with HRQOL, HCU, or improvement in disease activity at follow up.
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Affiliation(s)
- Shilpa Arora
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Ailda Nika
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Winston Sequeira
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Katz
- Department of Rheumatology, University of California, San Francisco, CA, USA
| | - Meenakshi Jolly
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Filbay SR, Yau MS, Block JA, Stefan Lohmander L. Thirty years of publishing osteoarthritis research in perspective - a special journal issue to mark the 30th anniversary of Osteoarthritis and Cartilage. Osteoarthritis Cartilage 2023; 31:721-722. [PMID: 36907543 DOI: 10.1016/j.joca.2023.03.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Affiliation(s)
- S R Filbay
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Science, The University of Melbourne, Melbourne, Australia.
| | - M S Yau
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.
| | - J A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Sweden
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Pincus T, Schmukler J, Block JA, Goodson N, Yazici Y. Should quantitative assessment of rheumatoid arthritis include measures of joint damage and patient distress, in addition to measures of apparent inflammatory activity? ACR Open Rheumatol 2022; 5:49-50. [PMID: 36540953 PMCID: PMC9837390 DOI: 10.1002/acr2.11514] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | - Nicola Goodson
- Liverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - Yusuf Yazici
- New York University School of MedicineNew YorkNY
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5
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Block JA, Pincus T. Duloxetine may have clinical value: comment on the article by van den Driest et al. Arthritis Rheumatol 2022; 74:1859-1860. [PMID: 35791999 DOI: 10.1002/art.42293] [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: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL
| | - Theodore Pincus
- Division of Rheumatology, Rush University Medical Center, Chicago, IL
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6
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Arora S, Katz P, Nika A, Sequeira W, Block JA, Yazdany J, Yelin E, Jolly M. Does Higher Quality of Care in Systemic Lupus Erythematosus Improve Quality of Life? Arthritis Care Res (Hoboken) 2022; 75:1198-1205. [PMID: 35792677 DOI: 10.1002/acr.24979] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the association between high quality of care (QOC) and quality of life (QOL) and nonroutine health care use (HCU) in systemic lupus erythematosus. METHODS Data were derived from 814 participants from the Lupus Outcomes Study sample. Data on sociodemographic information, disease status, medications, and health care variables were collected through annual interviews. QOC was measured at baseline on 13 quality indices amenable to self-report. Follow-up QOL was measured using the Short Form 36 health survey (SF-36) 2 years later. Univariate and multivariate regression analyses assessed the relationship between QOC and SF-36 scores at baseline, and logistic regression analyses evaluated QOC at baseline as a predictor of minimal clinically important difference (MCID) improvements in SF-36 scores, emergency room (ER) visits, and hospitalizations at follow-up. RESULTS Higher QOC was associated with worse scores on SF-36 domains on univariate analysis at baseline, which was mediated by comorbidities and high disease activity. QOC and the number of years in high QOC were not predictive of MCID improvements in SF-36 scores at follow-up, which were driven by baseline SF-36 scores, disease activity, and nonroutine HCU. A similar pattern was noted for ER visits and hospitalizations, for which disease activity, damage, and glucocorticoid dose were significant predictors and not QOC. CONCLUSION High QOC at baseline and the number of years with high QOC are not associated with MCID improvement in SF-36 scores and nonroutine HCU on follow-up. High QOC, as determined by currently defined criteria, serves as a surrogate of greater disease activity, morbidity, and nonroutine HCU.
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Affiliation(s)
- Shilpa Arora
- Rush University Medical Center, Chicago, Illinois
| | | | - Ailda Nika
- Rush University Medical Center, Chicago, Illinois
| | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
| | | | - Ed Yelin
- University of California, San Francisco
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Kwiatkowski A, Shakoor N, Manadan A, Block JA, Khandelwal S. Incorporating interactive workshops into bedside teaching: completion of a multi-modal rheumatology rotation significantly increases internal medicine residents' competency and comfort with comprehensive knee examinations. BMC Med Educ 2022; 22:355. [PMID: 35538536 PMCID: PMC9092684 DOI: 10.1186/s12909-022-03425-4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents' competency and comfort with knee examinations when compared to the rotation alone. METHODS Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. RESULTS Fifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025). CONCLUSION An elective in rheumatology augmented residents' MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.
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Affiliation(s)
- Alysia Kwiatkowski
- Division of Allergy, Immunology & Rheumatology, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Sonali Khandelwal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Block JA, Cherny D. Management of Knee Osteoarthritis: What Internists Need to Know. Rheum Dis Clin North Am 2022; 48:549-567. [PMID: 35400378 DOI: 10.1016/j.rdc.2022.02.011] [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] [Indexed: 10/18/2022]
Abstract
Knee osteoarthritis (OA) is a common and morbid condition. No disease-modifying therapies exist; hence the goals of current treatment are to palliate pain and to retain function. OA pain is significantly influenced by the placebo effect. Nonpharmacologic interventions are essential and have been shown to improve outcomes. Canes, unloading braces, and therapeutic heating/cooling may be valuable. Pharmacotherapy options include topical and oral nonsteroidal anti-inflammatory drugs, duloxetine, and periodic intra-articular glucocorticoids and hyaluronans. Opioids, intra-articular stem cells, and platelet-rich plasma are not recommended. Novel targets such as nerve growth factor are under investigation and may be approved soon for OA pain.
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Affiliation(s)
- Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA.
| | - Dmitriy Cherny
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA
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9
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Block JA, Beier F, Roos EM. The Fundamentals of OA. Osteoarthritis Cartilage 2022; 30:9. [PMID: 34903449 DOI: 10.1016/j.joca.2021.11.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
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10
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Abstract
OBJECTIVE Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome. There are many reports of PRES occurring in the setting of rheumatic diseases. However, it remains uncertain whether rheumatic diseases are truly a risk factor for PRES, as the literature consists of case reports and small clinical series. Here, we evaluated the relationship between PRES and the rheumatic diseases, using a large population-based data set as the reference. METHODS We conducted a medical records review of hospitalizations in the United States during 2016 with a diagnosis of PRES. Hospitalizations were selected from the National Inpatient Sample. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to identify rheumatic diseases. A multivariate logistic regression analysis was used to calculate odds ratios (ORs) for the association of PRES and rheumatic diseases. RESULTS There were 3125 hospitalizations that had a principal billing diagnosis of PRES. Multivariate logistic regression revealed the multiple independent associations with PRES. The demographic and nonrheumatic associations included acute renal failure (OR, 1.52), chronic renal failure (OR, 12.1), female (OR, 2.28), hypertension (OR, 8.73), kidney transplant (OR, 1.97), and preeclampsia/eclampsia (OR, 11.45). Rheumatic associations with PRES included antineutrophil cytoplasmic antibody-associated vasculitis (OR, 9.31), psoriatic arthritis (OR, 4.61), systemic sclerosis (OR, 6.62), systemic lupus erythematosus (SLE) nephritis (OR, 7.53), and SLE without nephritis (OR, 2.38). CONCLUSIONS This analysis represents the largest sample to date to assess PRES hospitalizations. It confirms that several rheumatic diseases are associated with PRES, including antineutrophil cytoplasmic antibody-associated vasculitis, systemic sclerosis, SLE, and psoriatic arthritis. Acute and unexplained central nervous system symptoms in these patient populations should prompt consideration of PRES.
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Affiliation(s)
| | | | | | - Chimuanya Okoli
- From the Division of Rheumatology, Rush University Medical Center
| | - Joel A Block
- From the Division of Rheumatology, Rush University Medical Center
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11
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Abstract
PURPOSE Pneumococcal vaccination (PV) is indicated for the elderly (age ≥65 years) and those with chronic disease or who are immunosuppressed. We aimed to study the rate and predictors of recommendation/receipt of 23 valent pneumococcal polysaccharide vaccine (PPSV23) in immunosuppressed systemic lupus erythematosus (SLE) patients. METHODS Data were obtained through self-report questionnaires and medical chart review of 150 SLE patients. Information on rheumatologist recommendation or receipt of PPSV23 in the preceding 5 years was collected if self-reported in a questionnaire or documented in the medical chart. Chart review was also done to collect data on patient demographics, physician characteristics (if patients had a primary care physician and rheumatologist's SLE patient volume), and the disease characteristics of SLE. Comparisons using χ2 or t tests and logistic regression analyses were conducted for predictors of recommendation/receipt of PV. RESULTS The mean (SD) age was 47.4 (15.9) years; 90% were women. Sixty-five of 94 eligible patients for PV (based on immunosuppressive medications use or age) had been either recommended or administered PPSV23. On univariate logistic regression analysis, age, duration of disease, current use of hydroxychloroquine or mycophenolate, and rheumatologist's SLE patient volume were significant correlates of recommendation/receipt of PPSV23. However, on multivariate analysis, the only significant predictor was rheumatologist's SLE patient volume after adjusting for the above correlates such that with every 50 patients increase in SLE patient clinic volume, the odds of recommendation/receipt of PPSV23 increased by 2.37 times. CONCLUSIONS The volume of lupus patients that rheumatologists see is strongly associated with the likelihood that their SLE patients will have PPSV23 recommended and delivered, suggesting a volume outcome relationship.
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Affiliation(s)
- Shilpa Arora
- From the Department of Medicine, Rush University Medical Center, Chicago, IL
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12
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Block JA. Are Intraarticular Glucocorticoids Safe in Osteoarthritis? Arthritis Rheumatol 2021; 74:181-183. [PMID: 34841739 DOI: 10.1002/art.42032] [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: 11/05/2021] [Revised: 09/10/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Joel A Block
- Rush University Medical Center, Chicago, Illinois
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13
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Block JA. The plain language summary (Lay Language Summary) in Osteoarthritis and Cartilage. Osteoarthritis Cartilage 2021; 29:1093. [PMID: 33991688 DOI: 10.1016/j.joca.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Block JA. The reproducibility crisis and statistical review of clinical and translational studies. Osteoarthritis Cartilage 2021; 29:937-938. [PMID: 33940138 DOI: 10.1016/j.joca.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Affiliation(s)
- J A Block
- Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL, 60612, USA.
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15
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Abstract
Knee osteoarthritis (OA) is a common and morbid condition. No disease-modifying therapies exist; hence the goals of current treatment are to palliate pain and to retain function. OA is significantly influenced by the placebo effect. Nonpharmacologic interventions are essential and have been shown to improve outcomes. Canes, unloading braces, and therapeutic heating/cooling may be valuable. Pharmacotherapy options include topical and oral nonsteroidal anti-inflammatory drugs, duloxetine, and periodic intra-articular glucocorticoids and hyaluronans. Opioids, intra-articular stem cells, and platelet-rich plasma are not recommended. Novel targets such as nerve growth factor are under investigation and may be approved soon for OA pain.
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Affiliation(s)
- Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA.
| | - Dmitriy Cherny
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA
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16
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Pincus T, Gibson KA, Yazici Y, Bergman M, Schmukler J, Block JA. Comment on: 'It can't be zero!' Difficulties in completing patient global assessment in rheumatoid arthritis: a mixed methods study. Rheumatology (Oxford) 2021; 60:e28-e29. [PMID: 33020808 DOI: 10.1093/rheumatology/keaa489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/09/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Theodore Pincus
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital and University of New South Wales, Sydney, NSW, Australia
| | - Yusuf Yazici
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Martin Bergman
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Juan Schmukler
- Department of Medicine, Mount Sinai Hospital, Chicago, IL, USA
| | - Joel A Block
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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17
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Manadan AM, Kambhatla S, Gauto‐Mariotti E, Okoli C, Block JA. Reasons for Hospitalization and In-Hospital Mortality in Adult Systemic Lupus Erythematosus. ACR Open Rheumatol 2020; 2:683-689. [PMID: 33164350 PMCID: PMC7672299 DOI: 10.1002/acr2.11195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/07/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease with an increased risk of hospitalization. Multiple studies have reported SLE flare, infection, and cardiovascular (CV) events as the most common reasons for hospitalization. The aim of this study was to use a large US population-based database to comprehensively analyze all indications for adult SLE hospitalization and reasons for in-hospital mortality. METHODS We conducted a retrospective study of SLE hospitalizations in 2017 from the National Inpatient Sample database. The "reason for hospitalization" and "reason for in-hospital mortality" in patients with SLE were divided into 19 categories based on their principal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis. RESULTS A total of 180 975 hospitalizations carried either a principal or secondary ICD-10 code for SLE. The leading reasons for hospitalization were CV (16%), rheumatologic (13%), infectious (11%), respiratory (10%), and gastrointestinal (10%). SLE itself was the principal diagnosis in only 6% of the hospitalizations. In-hospital death occurred in 1 of every 50 SLE hospitalizations. Infectious (37%) and CV diagnoses (21%) were the most common reasons for in-hospital death, with sepsis being the most frequent reason for death. CONCLUSION This analysis represents the only report to date that comprehensively categorizes the reasons for hospitalization and reasons for in-hospital mortality of patients with SLE on a US national level. SLE itself was the principal diagnosis for only a small percentage of hospitalizations. CV diagnoses were the most common reason for hospitalization. In-hospital death occurred in 1 of every 50 SLE hospitalizations. Infectious and CV diagnoses were the most common reason for in-hospital death.
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Affiliation(s)
- Augustine M. Manadan
- Rush University Medical Center, ChicagoIllinois and John Stroger Junior Hospital of Cook CountyChicagoIllinois
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18
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Schmukler J, Block JA, Pincus T, Yazici Y, Gibson KA. Functional Status Measures and Indices in Rheumatoid Arthritis: Comment on the Articles by Barber et al and England et al. Arthritis Care Res (Hoboken) 2020; 72:1185-1186. [DOI: 10.1002/acr.24229] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Yusuf Yazici
- New York University School of Medicine New York New York
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19
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Katz JN, Neogi T, Callahan LF, Block JA, Conaghan PG, Simon LS, Kraus VB, Hochberg MC. Disease modification in osteoarthritis; pathways to drug approval. Osteoarthr Cartil Open 2020; 2:100059. [PMID: 36474586 PMCID: PMC9718177 DOI: 10.1016/j.ocarto.2020.100059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To summarize proceedings of a workshop convened to discuss advances in disease modifying osteoarthritis (OA) drugs and regulatory challenges in bringing these drugs to market. Design Summary of a one day workshop held in Washington, DC in May 2019. Results Attendees presented data documenting the prevalence, cost and disability burden of OA; recent documentation of disease modification without concomitant clinical benefit in trials of disease modifying drugs; regulatory considerations pertinent to disease modifying therapy; and methodologic approaches to addressing these regulatory considerations. Conclusions The research, pharmaceutical and regulatory communities must continue to collaborate on defining pathways for approval of disease modifying osteoarthritis drugs that document effects on clinical endpoints (such as pain, function or joint replacement) as well as on bone, cartilage and other structures.
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Affiliation(s)
- Jeffrey N. Katz
- Brigham and Women's Hospital, Orthopaedics and Rheumatology, 75 Francis Street, Hale 5016, Boston, MA 2115, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Rheumatology, 650 Albany St., Clin Epi Unit, Suite X-200, Boston, Massachusetts 02118, USA
| | - Leigh F. Callahan
- University of North Carolina School of Medicine, Department of Orthopaedics, 3102 Bioinformatics Building, CB #7055, Chapel Hill, NC 27516, USA
| | - Joel A. Block
- Rush University Medical Center, Rush Medical College, Section of Rheumatology, 1611 W. Harrison St., Suite 510, Chicago, IL 60612-3854, USA
| | - Philip G. Conaghan
- University of Leeds, Leeds Institute of Rheumatic & MSK Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, W Yorks LS74SA, UK
| | | | - Virginia Byers Kraus
- Duke Molecular Physiology Institute and Medicine, 300 N Duke St., Durham, NC 27701, USA
| | - Marc C. Hochberg
- University of Maryland School of Medicine, 620 W. Lexington St., Baltimore, MD 21201, USA
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20
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Abstract
Chronic pain represents a substantial unmet medical need globally. In recent years, the quest for a new generation of novel, safe, mechanism-based analgesic treatments has focused on neurotrophic factors, a large group of secreted proteins that control the growth and survival of different populations of neurons, but that postnatally are involved in the genesis and maintenance of pain, with biological activity in both the periphery and the central nervous system. In this narrative review, we discuss the two families of neurotrophic proteins that have been extensively studied for their role in pain: first, the neurotrophins, nerve growth factor (NGF) and brain-derived growth factor (BDNF), and secondly, the GDNF family of ligands (GFLs). We provide an overview of the pain pathway, and the pain-producing effects of these different proteins. We summarize accumulating preclinical and clinical findings with a focus on musculoskeletal pain, and on osteoarthritis in particular, because the musculoskeletal system is the most prevalent source of chronic pain and of disability, and clinical testing of these novel agents - often biologics- is most advanced in this area.
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Affiliation(s)
- Anne-Marie Malfait
- Division of Rheumatology, Rush University Medical Center, 1611 W Harrison Street, Suite 510, Chicago, IL 60612, United States of America
| | - Rachel E Miller
- Division of Rheumatology, Rush University Medical Center, 1611 W Harrison Street, Suite 510, Chicago, IL 60612, United States of America
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1611 W Harrison Street, Suite 510, Chicago, IL 60612, United States of America.
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21
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Abstract
Mycobacterium haemophilum is a rare pathogen, predominately present in the immunocompromised population. It is especially studied in HIV and haematological malignancy patients. Given its unique living conditions, it is often difficult to establish its diagnosis, but it is often suspected by its classic association with ulcerating skin findings. Our case is unique in that our patient is immunocompromised by his rheumatoid arthritis treatment, and presented without any skin lesions, but was found to have this rare pathogen causing a constellation of unusual symptoms.
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Affiliation(s)
- Navina Kapur
- Internal Medicine, Rush University, Chicago, Illinois, USA
| | - Ritu Ghai
- Internal Medicine, Rush University, Chicago, Illinois, USA
| | - Joel A Block
- Internal Medicine, Rush University, Chicago, Illinois, USA
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Jolly M, Sethi B, O'Brien C, Sequeira W, Block JA, Toloza S, Bertoli A, Blazevic I, Vilá LM, Moldovan I, Torralba KD, Cicognani E, Mazzoni D, Hasni S, Goker B, Haznedaroglu S, Bourre-Tessier J, Navarra SV, Mok CC, Clarke A, Weisman M, Wallace D. Drivers of Satisfaction With Care for Patients With Lupus. ACR Open Rheumatol 2019; 1:649-656. [PMID: 31872187 PMCID: PMC6917325 DOI: 10.1002/acr2.11085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/22/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE. Methods A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA‐SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors. Results The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC. Conclusion Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient's external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Ana Bertoli
- Instituto Reumatológico Strusberg, Cordoba, Argentina
| | | | - Luis M Vilá
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | | | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | - Ann Clarke
- University of Calgary, Calgary, Alberta, Canada
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Pincus T, Castrejon I, Yazici Y, Gibson KA, Bergman MJ, Block JA. Osteoarthritis is as severe as rheumatoid arthritis: evidence over 40 years according to the same measure in each disease. Clin Exp Rheumatol 2019; 37 Suppl 120:7-17. [PMID: 31621569] [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: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
Osteoarthritis (OA) may be associated with substantial work disability, morbidity, costs, and increased mortality rates, often similar to rheumatoid arthritis (RA), documented in many published reports over the last 4 decades. However, OA generally has been viewed as less severe than RA. This discrepancy may be explained in part by:a) RA may have been considerably more severe in the past, prior to effective therapies.b) most older individuals have radiographic joint damage, which often is not associated with clinical symptoms.c) RA is associated with abnormal laboratory tests, which are regarded as conveying greater significance than symptoms of pain and disability according to a "biomedical model," the dominant paradigm of modern medicine.d) Most reports of OA and RA have emphasised differences between the 2 diseases even beyond laboratory abnormalities in pathogenesis, physical findings, and imaging.e) Even pain and functional disability seen in both diseases are assessed using different patient self-report questionnaires, a WOMAC (Western Ontario McMaster Universities osteoarthritis index) in OA, and HAQ (health assessment questionnaire) in RA.An identical measure is required for optimal direct comparisons, which has been used in 8 studies performed between 1979 and 2019 at 8 sites in North America, Europe, and Australia. These studies were primarily based on retrospective analyses at sites which collected a patient questionnaire in routine clinical care by all patients at all visits to inform clinical decisions. A pain visual analogue scale (VAS) was higher in OA compared to RA in 11/12 patient groups, while physical function on a HAQ (health assessment questionnaire) or derivative MDHAQ (multidimensional HAQ) and RAPID3 (routine assessment of patient index data) were slightly higher in RA before 2013 and higher in OA in later reports. Furthermore, a study of population-based data from the 1978 US Health Interview Survey indicated similar levels of disability and earnings losses according to surrogate variables for OA and RA. Therefore, at least over the last 40 years, pain and functional disability in OA have appeared to be severe and similar to RA. These observations also-illustrate the potential value of using an identical patient questionnaire in all patients at all visits in routine care settings, analogous to using the same laboratory tests such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) in all rheumatic diseases, and maintaining a database of the results for later analyses.
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Affiliation(s)
- Theodore Pincus
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
| | - Isabelle Castrejon
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, New York, NY, USA
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, NSW, and Ingham Research Institute, Liverpool, Sydney, NSW, Australia
| | - Martin J Bergman
- Arthritis and Rheumatology, Taylor Hospital, Ridley Park, PA, USA
| | - Joel A Block
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Schmukler J, Jamal S, Castrejon I, Block JA, Pincus T. Fibromyalgia Assessment Screening Tools (FAST) Based on Only Multidimensional Health Assessment Questionnaire (MDHAQ) Scores as Clues to Fibromyalgia. ACR Open Rheumatol 2019; 1:516-525. [PMID: 31777833 PMCID: PMC6857971 DOI: 10.1002/acr2.11053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Received: 01/22/2019] [Accepted: 06/13/2019] [Indexed: 01/06/2023] Open
Abstract
Objective The study was designed to develop fibromyalgia assessment screening tool (FAST) indices based only on multidimensional health assessment questionnaire (MDHAQ) scores as clues to fibromyalgia (FM), analyzed for possible agreement with the 2011 FM criteria. Methods All patients with all diagnoses complete an MDHAQ at each visit in routine care. The MDHAQ includes scores for physical function, pain, global assessment, fatigue, self-report painful joint count, and a 60-symptom checklist. MDHAQ items similar or identical to the 2011 FM criteria symptom severity scale (SSS) and widespread pain index (WPI) components of a polysymptomatic distress scale (PSD) were compiled into continuous MDHAQ-FM-SSS, MDHAQ-FM-WPI, and MDHAQ-FM-PSD indices. Ten candidate MDHAQ scores were analyzed against the 2011 FM criteria using descriptive statistics, Spearman correlations, kappa statistics, and receiver operating characteristic curves for the area under the curve (AUC). MDHAQ candidate variables with the highest AUC were compiled into cumulative MDHAQ-FAST indices of three (FAST3) or four (FAST4) scores. Results The highest AUCs among MDHAQ scores were seen for symptom checklist, painful joint count, fatigue, and pain, which are included in FAST4; FAST3-F excludes pain, and FAST3-P excludes fatigue. AUCs for FAST3-P, FAST3-F, and FAST4, as well as continuous MDHAQ-FM scores, all were greater than 0.92, indicating excellent criterion validity. Kappa statistics versus the 2011 criteria were 0.63-0.68, higher than 0.41-0.47 versus physician ICD-10 diagnoses. Conclusion Pragmatic FAST3, FAST4, and MDHAQ-FM indices are similar to FM criteria to screen for FM in routine care. It is more feasible to collect the same MDHAQ, which is informative in all rheumatic diseases studied, from each patient than to ask different patients with different diagnoses to complete different questionnaires.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Shakeel Jamal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Theodore Pincus
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
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Chua JR, Jamal S, Riad M, Castrejon I, Malfait AM, Block JA, Pincus T. Disease Burden in Osteoarthritis Is Similar to That of Rheumatoid Arthritis at Initial Rheumatology Visit and Significantly Greater Six Months Later. Arthritis Rheumatol 2019; 71:1276-1284. [PMID: 30891933 DOI: 10.1002/art.40869] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyze disease burden in osteoarthritis (OA) according to Multidimensional Health Assessment Questionnaire (MDHAQ)/Routine Assessment of Patient Index Data 3 (RAPID3) scores at the initial visit and the 6-month follow-up visit, compared with rheumatoid arthritis (RA) as a benchmark for high disease burden. METHODS All patients with all diagnoses at the Rush University Medical Center Division of Rheumatology complete a paper MDHAQ at all visits, saved as a PDF in the electronic health record. MDHAQ 0-10 scores for physical function, pain, and patient global assessment (compiled into RAPID3 0-30 scores) and additional scales at the initial and 6-month follow-up visits, for new OA and RA patients seen from 2011 to 2017, were compared. OA and RA patients were classified as self-referred or physician-referred, and RA patients were classified as disease-modifying antirheumatic drug (DMARD)-naive or having prior-DMARD treatment. Patient groups were compared using t-tests and analysis of variance, adjusted for age, disease duration, body mass index (BMI), education, and ethnicity. RESULTS Compared with RA patients, OA patients had higher age, BMI, and disease duration. At initial visit, the mean RAPID3 did not differ significantly in OA versus DMARD-naive RA patients, whether self- or physician-referred (range 14.8-16.4 [P = 0.38]), or in all OA patients versus DMARD-naive RA patients versus prior-DMARD RA patients (15.0, 15.7, and 15.8, respectively [P = 0.49]). After 6 months, RAPID3 was improved to 13.3, 10.3, and 10.8, respectively, which represented substantially greater improvement in RA patients than OA patients (P < 0.001). Similar results were seen for most self-reported measures and in adjusted analyses. CONCLUSION MDHAQ/RAPID3 scores are similar in OA and RA patients at the initial visit, but higher in OA patients than in RA patients 6 months later, reflecting superior RA treatments. The same MDHAQ/RAPID3 allows comparisons of disease burdens in different diseases.
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Affiliation(s)
| | | | - Mariam Riad
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
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Tóth DM, Ocskó T, Balog A, Markovics A, Mikecz K, Kovács L, Jolly M, Bukiej AA, Ruthberg AD, Vida A, Block JA, Glant TT, Rauch TA. Amelioration of Autoimmune Arthritis in Mice Treated With the DNA Methyltransferase Inhibitor 5'-Azacytidine. Arthritis Rheumatol 2019; 71:1265-1275. [PMID: 30835944 DOI: 10.1002/art.40877] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Disease-associated, differentially hypermethylated regions have been reported in rheumatoid arthritis (RA), but no DNA methyltransferase inhibitors have been evaluated in either RA or any animal models of RA. The present study was conducted to evaluate the therapeutic potential of 5'-azacytidine (5'-azaC), a DNA methyltransferase inhibitor, and explore the cellular and gene regulatory networks involved in the context of autoimmune arthritis. METHODS A disease-associated genome-wide DNA methylation profile was explored by methylated CpG island recovery assay-chromatin immunoprecipitation (ChIP) in arthritic B cells. Mice with proteoglycan-induced arthritis (PGIA) were treated with 5'-azaC. The effect of 5'-azaC on the pathogenesis of PGIA was explored by measuring serum IgM and IgG1 antibody levels using enzyme-linked immunosorbent assay, investigating the efficiency of class-switch recombination (CSR) and Aicda gene expression using real-time quantitative polymerase chain reaction, monitoring germinal center (GC) formation by immunohistochemistry, and determining alterations in B cell subpopulations by flow cytometry. The 5'-azaC-induced regulation of the Aicda gene was explored using RNA interference, ChIP, and luciferase assays. RESULTS We explored arthritis-associated hypermethylated regions in mouse B cells and demonstrated that DNA demethylation had a beneficial effect on autoimmune arthritis. The 5'-azaC-mediated demethylation of the epigenetically inactivated Ahr gene resulted in suppressed expression of the Aicda gene, reduced CSR, and compromised GC formation. Ultimately, this process led to diminished IgG1 antibody production and amelioration of autoimmune arthritis in mice. CONCLUSION DNA hypermethylation plays a leading role in the pathogenesis of autoimmune arthritis and its targeted inhibition has therapeutic potential in arthritis management.
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Affiliation(s)
| | - Timea Ocskó
- Rush University Medical Center, Chicago, Illinois
| | - Attila Balog
- Albert Szent-Györgyi Clinical Center, Szeged, Hungary
| | | | | | - László Kovács
- Albert Szent-Györgyi Clinical Center, Szeged, Hungary
| | | | | | | | - András Vida
- Rush University Medical Center, Chicago, Illinois
| | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
| | | | - Tibor A Rauch
- Rush University Medical Center, Chicago, Illinois, and University of Pécs, Pécs, Hungary
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Lillis TA, Tirone V, Gandhi N, Weinberg S, Nika A, Sequeira W, Hobfoll SE, Block JA, Jolly M. Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus. Arthritis Care Res (Hoboken) 2019; 71:406-412. [PMID: 29726637 DOI: 10.1002/acr.23593] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). METHODS A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress. RESULTS Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (β = 0.30) and depression symptoms (β = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (β = 0.20) and stress (β = 0.22) remained significantly linked to CD (overall model R2 = 0.53; all P < 0.05). CONCLUSION After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.
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Affiliation(s)
| | | | | | | | - Ailda Nika
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
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Jolly M, Sequeira W, Block JA, Toloza S, Bertoli A, Blazevic I, Vila LM, Moldovan I, Torralba KD, Mazzoni D, Cicognani E, Hasni S, Goker B, Haznedaroglu S, Bourre-Tessier J, Navarra SV, Mok CC, Weisman M, Clarke AE, Wallace D, Alarcón G. Sex Differences in Quality of Life in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 71:1647-1652. [PMID: 29693320 DOI: 10.1002/acr.23588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) predominantly affects women. Clinical phenotype and outcomes in SLE may vary by sex and are further complicated by unique concerns that are dependent upon sex-defined roles. We aimed to describe sex differences in disease-specific quality of life (QoL) assessment scores using the Lupus Patient-Reported Outcome (LupusPRO) tool in a large international study. METHODS Cross-sectional data from 1,803 patients with SLE on demographics, self-identified sex status, LupusPRO, and disease activity were analyzed. The LupusPRO tool has 2 constructs: health-related QoL (HRQoL) and non-HRQoL. Disease activity and damage were evaluated using the Safety of Estrogens in Lupus Erythematosus National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, respectively. Nonparametric tests were used to compare QoL and disease activity by sex. RESULTS A total of 122 men and 1,681 women with SLE participated. The mean age was similar by sex, but the damage scores were greater among men. Men fared worse on the non-HRQoL social support domain than women (P = 0.02). When comparing disease and QoL among men and women ages ≤45 years, men were found to have greater damage and worse social support than women. However, women fared significantly worse on lupus symptoms, cognition, and procreation domains with trends for worse functioning on physical health and pain-vitality domains. CONCLUSION In the largest study of a diverse group of SLE patients, utilizing a disease-specific QoL tool, sex differences in QoL were observed on both HRQoL and non-HRQoL constructs. Although men performed worse in the social support domain, women (especially those in the reproductive age group) fared worse in other domains. These observations may assist physicians in appropriately addressing QoL issues in a sex-focused manner.
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Affiliation(s)
| | | | | | | | - Ana Bertoli
- Instituto Reumatologico Strusberg, Cordoba, Argentina
| | | | - Luis M Vila
- University of Puerto Rico, San Juan, Puerto Rico
| | | | | | | | | | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | - Ann E Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Castrejon I, Shakoor N, Chua JR, Block JA. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 2018; 38:2137-2145. [PMID: 30293155 DOI: 10.1007/s00296-018-4166-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Abstract
The study compares patient-physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ - 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient-physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12-1.78) and RA (OR 1.47 95% CI 1.04-2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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Dua AB, Neogi T, Mikolaitis RA, Block JA, Shakoor N. Somatosensation in OA: exploring the relationships of pain sensitization, vibratory perception and spontaneous pain. BMC Musculoskelet Disord 2018; 19:307. [PMID: 30144797 PMCID: PMC6109299 DOI: 10.1186/s12891-018-2206-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/20/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pain in osteoarthritis (OA) remains poorly understood. Different types of somatosensory alterations exist in OA including hyperesthesia and increased sensitivity to painful stimuli as well as those of decreased sensitivity to cutaneous stimuli including vibratory perception threshold. The relationship between these different somatosensory measures has not been previously evaluated in OA. In this observational study, we evaluated relationships between vibratory perception (VPT), pressure pain detection thresholds (PPT), allodynia and subjective pain in knee OA. Methods Forty-two persons with moderate to severe knee OA and 12 controls without OA were evaluated. VPT was measured using a biothesiometer. Allodynia was measured by application of a 60 g Von Frey monofilament repeatedly to predetermined sites. PPTs were measured using a pressure algometer. Results Increased vibratory acuity was associated with lower PPTs and presence of allodynia. Allodynia was more common in OA than controls (54.8% vs 16.6%, p = 0.024 in the ipsilateral knee, and 42.9% vs 0%, p = 0.005 in the contralateral knee). OA participants with allodynia had lower PPTs than those without allodynia. In those with OA, spontaneous knee pain was associated with lower PPTs and with allodynia. Conclusion This study confirms the presence of somatosensory alterations in OA. Sensory alterations (vibratory perception) were shown to be related to nociceptive alterations (sensitization) in OA, showing a general increased sensitivity to cutaneous mechanical stimulation. Understanding these relationships is an important step in delineating the complicated pathophysiology of pain processing in OA.
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Affiliation(s)
- Anisha B Dua
- Section of Rheumatology, University of Chicago, 5841 S Maryland Ave, MC0930, Chicago, IL, 60637, USA.
| | - Tuhina Neogi
- Section of Rheumatology, University of Chicago, 5841 S Maryland Ave, MC0930, Chicago, IL, 60637, USA.,Section of Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | | | - Joel A Block
- Division of Rheumatology, Rush Medical College, Chicago, IL, USA
| | - Najia Shakoor
- Division of Rheumatology, Rush Medical College, Chicago, IL, USA
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Abstract
There is a big need for the development of novel therapies for the safe management of chronic pain associated with OA. Here we reviewed PubMed (2015 onward) and ClinicalTrials.gov for ongoing and recently completed trials where pain in OA is the primary outcome measure. Three broad categories were identified: biological therapies, small molecules and cryoneurolysis. The most promising new strategy is blockade of nerve growth factor with antibodies. Two anti-nerve growth factor antibodies, tanuzemab and fasinumab, are in active development after the 2010 hold on trials was lifted in 2015. In addition, several active clinical trials are testing distinct mechanism-based interventions, including cytokine inhibition, selective μ, δ or κ opioid receptor agonists, zoledronate and intra-articular capsaicin. In addition to pharmacological approaches, cryoneurolytic strategies that directly target peripheral nerves may play a role in OA pain management, but efficacy profiles and long-term effects of such treatments need more study. Clearly, the therapeutic landscape for OA pain is rapidly expanding. Since symptomatic OA is a heterogeneous disease, the challenge will be to identify patients that will benefit the most from specific approaches.
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Affiliation(s)
- Rachel E Miller
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Ding Q, Ren Y, Che H, Ma C, Li H, Yu S, Zhang Y, An H, O’Keefe RJ, Chen D, Block JA, Yin G, Li T. Cyclooxygenase-2 deficiency causes delayed ossification of lumbar vertebral endplates. Am J Transl Res 2018; 10:718-730. [PMID: 29636862 PMCID: PMC5883113] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/24/2017] [Indexed: 06/08/2023]
Abstract
Based on previous findings that cyclooxygenase-2 (COX-2) is a critical molecule in chondrocyte differentiation and skeletal repair, we hypothesized that COX-2 deficiency or inhibition affects the ossification of vertebral endplates (VEP) and degeneration of intervertebral discs (IVD) and thus is involved in the pathogenesis of low back pain (LBP). We aimed to delineate the COX-2 working mechanism and its interacting molecules, and to explore the effect of NSAIDs and selective COX-2 inhibitor on degenerative spinal diseases. Here, lumbar spinal samples harvested from Cox-2 mutant (Cox-2-/-) and wild type (WT) mice were used for histological examinations. Nucleus pulposus (NP) cells isolated from rat were treated with PGE-2. Mouse endplate chondrocytes (mEC) isolated from mice were treated with a recombinant sonic hedgehog (Shh) protein. A mouse IVD organ culture system was established and treated COX-2 inhibitor Celecoxib. Human lumbar endplate chondrocytes were cultured and treated with Celecoxib. Immunohistochemical (IHC) studies were done in the human and mouse VEP samples. Radiographic and histological examinations revealed delayed VEP ossification in Cox-2-/- mice compared to WT ones. Decreased PGE-2 expression was found to promote Shh expression in rat NP cells, while Shh increased noggin expression in mEC. IHC showed that noggin expression was increased while pSmad1 expression decreased in the VEP of Cox-2-/- mice. Human VEP samples from patients with severe IVD degeneration showed decreased expression of Shh and noggin and increased expression of COX-2 and pSmad1 compared with milder cases. In cultured mouse IVDs and human endplate chondrocytes, Celecoxib enhanced expression of Shh and noggin and decreased Smad1 phosphorylation. In conclusion, COX-2/PGE-2 axis plays an important role in VEP ossification and IVD degeneration through crosstalk with Shh and BMP signaling pathways. These findings may facilitate clinical use of COX-2 inhibitor to prevent LBP progression.
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Affiliation(s)
- Qingfeng Ding
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, China
| | - Yongxin Ren
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, China
| | - Hui Che
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, China
| | - Cheng Ma
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, China
| | - Huiwu Li
- Department of Orthopaedics, The Ninth Hospital of Shanghai Jiaotong UniversityShanghai, China
| | - Suojing Yu
- Institute of Orthopaedic Research, Zhejiang University of Traditional Chinese MedicineZhejiang, China
| | - Yejia Zhang
- Department of Physical Medicine & Rehabilitation and Orthopedic Surgery, Perelman School of Medicine, University of PennsylvaniaUSA
| | - Howard An
- Department of Orthopaedics, Rush University Medical CenterChicago, USA
| | - Regis J O’Keefe
- Department of Orthopaedics, Washington University at St. LouisUSA
| | - Di Chen
- Department of Biochemistry, Rush University Medical CenterChicago, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical CenterChicago, USA
| | - Guoyong Yin
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, China
| | - Tianfang Li
- Department of Biochemistry, Rush University Medical CenterChicago, USA
- Department of Rheumatology, The First Affiliated Hospital, Zhengzhou UniversityZhengzhou, China
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Annapureddy N, Giangreco D, Devilliers H, Block JA, Jolly M. Psychometric properties of MDHAQ/RAPID3 in patients with systemic lupus erythematosus. Lupus 2018; 27:982-990. [DOI: 10.1177/0961203318758503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USA
| | - D Giangreco
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - H Devilliers
- Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France
| | - J A Block
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - M Jolly
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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Kugasia A, Sehgal N, Dollear M, Sequeira W, Block JA, Jolly M. Practice patterns in longitudinal lupus care provision: patient and physician perspectives. Lupus 2017; 26:1556-1561. [DOI: 10.1177/0961203317716788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background/purpose To plan a quality improvement project, we need to understand the practice patterns of physicians. We undertook an online survey of systemic lupus erythematosus (SLE) patients and physicians providing care to SLE patients to determine the patterns of medical care provided to SLE patients. Materials and methods Two self-report surveys were developed. A 12-item survey for the patients and a 13-item survey for physicians enquired about longitudinal care for SLE. Surveys were administered online to physicians providing care to SLE patients, and to patients who self-identified as having SLE, through the Lupus Society of Illinois. Patient and physician data were analyzed for physician practice patterns for SLE care, using chi square tests and t tests. A P value of 0.05 or less was considered significant on two-tailed tests. Results A total of 283 patients completed the survey. Mean (SD) age and disease duration of patients were 45.9 (13.2) and 12.7 (9.7) years. Half of the participants were being seen at 3–4-month intervals. More than 70% of patients reported being tested for antinuclear antibody (ANA), and 20–30% anti-ENA antibody and Sjögren’s (SSA/SSB) antibodies, respectively, at each follow-up visit. Eighty-six rheumatologists completed the surveys. Mean (SD) age was 55 (12) years and 56% were men. More than half (54%) provided care only in a private practice setting. More than 80% of physicians reported seeing their SLE patients at 3–4-month interval. Only 2% reported performing ANA tests at each visit, while 4–5% performed anti-ENA and anti-SSA/SSB antibody tests at each visit for their SLE patients. More than 75% of physicians in private practice also ordered sedimentation rate at each visit for their SLE patients. Conclusions Unnecessary laboratory investigations may be being ordered routinely for patients at every visit. These results indicate a need for physician education on indications and utility of some of the laboratory tests such as ANA.
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Affiliation(s)
- A Kugasia
- Rush University Medical Center, Chicago, USA
| | - N Sehgal
- Indiana University, Bloomington, USA
| | | | - W Sequeira
- Rush University Medical Center, Chicago, USA
| | - J A Block
- Rush University Medical Center, Chicago, USA
| | - M Jolly
- Rush University Medical Center, Chicago, USA
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Azizoddin DR, Weinberg S, Gandhi N, Arora S, Block JA, Sequeira W, Jolly M. Validation of the LupusPRO version 1.8: an update to a disease-specific patient-reported outcome tool for systemic lupus erythematosus. Lupus 2017; 27:728-737. [PMID: 29087259 DOI: 10.1177/0961203317739128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/16/2022]
Abstract
Objectives LupusPRO has shown good measurement properties as a disease-specific patient-reported outcome tool in systemic lupus erythematosus (SLE). For the purpose of clinical trials, the version 1.7 (v1.7) domain of Pain-Vitality was separated into distinct Pain, Vitality and Sleep domains in v1.8, and the psychometric properties examined. Methods A total of 131 consecutive SLE patients were self-administered surveys assessing fatigue (FACIT, SF-36), pain (Pain Inventory, SF-36), insomnia (Insomnia Severity Index), emotional health (PHQ-9, SF-36) and quality of life (SF-36, LupusPRO) at routine care visits. Internal consistency reliability (ICR) for each domain was obtained using Cronbach's alpha. The convergent construct validity of LupusPRO domains with corresponding SF-36 domains or tools were tested using Spearman correlation. Varimax rotations were conducted to assess factor structures of the LupusPRO v1.8. Results Mean (SD) age was 40.04 (14.10) years. Scores from the LupusPRO-Sleep domain strongly correlated with insomnia scores, while LupusPRO-Vitality correlated strongly with fatigue (FACIT) and SF-36 vitality. The LupusPRO-Pain domain correlated strongly with pain (SF36 Bodily-Pain, Pain Inventory) scores. Similarly, the LupusPRO domains of Physical and Emotional Health had significant correlations with corresponding SF-36 domains. The ICR for HRQoL and non-HRQoL were 0.96 and 0.81. LupusPRO (domains HRQoL and QoL) scores correlated with disease activity. Principal component analysis included seven factor loadings presenting for the HRQOL subscales (combined Sleep, Vitality, and Pain), and three factors for the NHRQoL (Combined Coping and Social Support). Conclusions LupusPRO v1.8 (including its Sleep, Vitality, and Pain domains) has acceptable reliability and validity. Use of LupusPRO as an outcome measure in clinical trials would facilitate responsiveness assessment.
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Affiliation(s)
- D R Azizoddin
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Weinberg
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - N Gandhi
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - S Arora
- 2 Division of Rheumatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - J A Block
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - W Sequeira
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
| | - M Jolly
- 1 Department of Medicine and Behavioral Sciences, Rush University, Chicago, IL, USA
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Miller RE, Malfait AM, Block JA. Current status of nerve growth factor antibodies for the treatment of osteoarthritis pain. Clin Exp Rheumatol 2017; 35 Suppl 107:85-87. [PMID: 28967370 PMCID: PMC6007861] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/16/2017] [Indexed: 06/07/2023]
Abstract
Blockade of nerve growth factor (NGF) with antibodies is a promising strategy for treatment of chronic pain associated with osteoarthritis (OA). This narrative review describes the current status of NGF-blockade for the treatment of OA pain. We summarise briefly current evidence for the efficacy and risks of anti-NGF blockade. Two anti-NGF antibodies, tanuzemab and fasinumab, are in active development, with tanuzemabclose to completing Phase 3 trials in preparation for an application for approval for clinical use.
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Affiliation(s)
- Rachel E Miller
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago IL, USA
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago IL, USA
| | - Joel A Block
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago IL, USA.
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Pincus T, Block JA, Yazici Y, Bergman MJ, Sokka T. Limited Value of the Multi‐Biomarker Disease Activity Assay Compared to the Routine Assessment of Patient Index Data 3 (RAPID3) Score in the Prognosis of Important Clinical Outcomes in Rheumatoid Arthritis: Comment on the Article by Fleischmann et al and Accompanying Editorial by Davis. Arthritis Rheumatol 2017; 69:866-867. [DOI: 10.1002/art.40022] [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: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Yusuf Yazici
- Hospital for Joint Diseases, New York UniversityNew York NY
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Tezcan ME, Goker B, Lidtke R, Block JA. Long-term effects of lateral wedge orthotics on hip and ankle joint space widths. Gait Posture 2017; 51:36-40. [PMID: 27693959 PMCID: PMC5140676 DOI: 10.1016/j.gaitpost.2016.09.017] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/10/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use. METHODS We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up. FINDINGS 45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month. INTERPRETATION We found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).
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Affiliation(s)
- Mehmet E. Tezcan
- Gazi University, School of Medicine, Department of Internal Medicine, Section of Rheumatology, Ankara, Turkey
| | - Berna Goker
- Gazi University, School of Medicine, Department of Internal Medicine, Section of Rheumatology, Ankara, Turkey
| | - Roy Lidtke
- Rush Medical College, Department of Internal Medicine, Section of Rheumatology, Department of Biochemistry, Chicago, IL, USA
| | - Joel A. Block
- Rush Medical College, Department of Internal Medicine, Section of Rheumatology, Department of Biochemistry, Chicago, IL, USA
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Castrejon I, Nikiphorou E, Jain R, Huang A, Block JA, Pincus T. Assessment of fatigue in routine care on a Multidimensional Health Assessment Questionnaire (MDHAQ): a cross-sectional study of associations with RAPID3 and other variables in different rheumatic diseases. Clin Exp Rheumatol 2016; 34:901-909. [PMID: 27382923] [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: 12/30/2015] [Accepted: 03/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To characterise associations of fatigue with other variables within a multidimensional health assessment questionnaire (MDHAQ) in routine care of patients with different rheumatic diagnoses. METHODS All patients complete MDHAQ, which includes fatigue on a 0-10 visual analogue scale (VAS), and routine assessment of patient index data (RAPID3), a composite of function, pain, and patient global. Physicians complete a RheuMetric checklist which includes 4 VAS for overall global status (DOCGL), inflammation, damage, and distress. Median score for fatigue and other MDHAQ and RheuMetric scores were compared in 4 diagnosis groups: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM), using a Kruskall-Wallis test. Associations of fatigue with other variables were analysed using Spearman correlations and multivariate regressions. RESULTS 612 patients were included: 173 RA, 199 with OA, 146 with SLE, and 94 with FM. Median fatigue was significantly higher in FM (7) than in RA (4), OA (5), and SLE (5). Fatigue was correlated significantly with all other MDHAQ scores, at higher levels in RA and SLE versus OA and FM. Fatigue was correlated significantly with DOCGL in RA, OA, SLE, but not FM. In multivariate analyses, fatigue scores were explained independently by higher pain and symptom number in RA; lower age and higher symptom number in OA; only higher pain in SLE; and none of the variables in FM. CONCLUSIONS Fatigue is common in rheumatic diseases and strongly associated with higher pain and number of symptoms. The MDHAQ provides a useful tool to assess fatigue in clinical settings.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | | | - Ruchi Jain
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Annie Huang
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Theodore Pincus
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
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Block JA. Changing of the guard: OAC in transition. Osteoarthritis Cartilage 2016; 24:1125. [PMID: 27208421 DOI: 10.1016/j.joca.2016.05.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/02/2023]
Affiliation(s)
- J A Block
- Division of Rheumatology, Rush Medical College, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA.
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Manadan AM, Mathur T, Thiagarajan S, Hota B, Block JA. The Authors Respond. J Clin Rheumatol 2015; 21:389. [DOI: 10.1097/rhu.0000000000000314] [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: 11/25/2022]
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Abstract
Aims Systemic lupus erythematosus (SLE) mostly affects young women, adversely affecting their quality of life (QOL). Caregivers may experience caregiver burden (CGB), and it may lower the quality of their relationship. Herein we studied caregiving and CGB and their effects on QOL and relationships in SLE. Methods We recruited 10 dyads from the Lupus Clinic. Data collected included demographics, CGB (CGB Scale, screen for CGB), QOL (SF-36) and the quality of the dyadic relationship (Dyadic Adjustment Scale (DAS)). We calculated correlation coefficients for associations between (i) CGB and (ii) dyadic QOL or DAS. Results The mean (± SD) age of SLE patients was 35.2 (± 9) years and of caregivers was 37.3 (± 9.64) years. The mean (± SD, min–max) total CGB score was 9.1 (± 5.8, 0–19). The caregiver's QOL correlated strongly with some of the domains of the patient's QOL. The SLE-related CGB was associated with the caregiver's own QOL and their SLE partner's QOL. The dyadic DAS was linked to the patient's QOL. Conclusions Because (i) CGB in SLE is associated with the caregiver's own QOL and with their SLE partner's QOL, and because (ii) the dyadic DAS score is linked primarily to the patient's QOL, then to optimize patient health outcomes and to decrease CGB, focus should be not only on the patient but should include the dyadic unit. Significant findings: To optimize patient outcomes of SLE patients, focus should be on the dyadic unit. CGB in SLE is associated with the caregiver's own QOL and with the SLE partner's QOL, making it crucial to study this relationship in more detail.
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Affiliation(s)
- M Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - A Thakkar
- Rush University Medical Center, Chicago, IL, USA
| | | | - J A Block
- Rush University Medical Center, Chicago, IL, USA
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Pincus T, Gibson KA, Block JA. Premature Mortality: A Neglected Outcome in Rheumatic Diseases? Arthritis Care Res (Hoboken) 2015; 67:1043-6. [DOI: 10.1002/acr.22554] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 11/05/2022]
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Giangreco D, Devilliers H, Annapureddy N, Block JA, Jolly M. Lupus Impact Tracker is responsive to physician and patient assessed changes in systemic lupus erythematosus. Lupus 2015; 24:1486-91. [PMID: 26162686 DOI: 10.1177/0961203315593168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 02/02/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of Lupus Impact Tracker (LIT) to changes in physician and patient disease activity assessments over time. METHODS Available longitudinal data from routine patient care visits on LIT, physician assessed disease activity (physician global assessment (PGA), SELENA-SLEDAI score, SELENA Flare Index (SFI)), and patient-reported changes in systemic lupus erythematosus (SLE) health status were analyzed. Significant, clinically important change (worsening or improvement) in physician disease activity assessment or patient-reported SLE health status were judged using the following criteria: change of 0.3 on PGA, 4 on SELENA-SLEDAI, change in SFI status over time, and change of 2 in either direction in patient-reported SLE health status. Mixed model regression analysis was used to compare changes in LIT using the above criteria. RESULTS There were 1184 observations with significant changes in physician disease activity or patient-reported measure for 182 patients' data across 1364 visits. Patients' mean (SD) age and SELENA-SLEDAI were 43.5 (13.2) years and 6.4 (7.3) respectively. LIT mean scores decreased by more than 3 with improvement in PGA (standardized response mean -0.26, p < 0.05), while it increased by more than 5 with worsening in SELENA-SLEDAI (standardized response mean 0.42, p = 0.01). Mean change in LIT of greater than ±3 was noted with change in SFI status (p < 0.05). Mean LIT score decreased by greater than 4 and increased by greater than 2 with patient-reported improvement and worsening in SLE health status respectively (p < 0.05). CONCLUSIONS LIT is responsive to physician-assessed and patient-assessed changes in disease status. A mean LIT change of 2-4 may represent a significant clinical change in LIT. It is an effective tool that may be used by patients and physicians in tracking disease impact in SLE patients.
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Affiliation(s)
- D Giangreco
- Division of Rheumatology, Rush University Medical Center, Chicago, USA
| | - H Devilliers
- Department of Internal Medicine and Systemic Diseases, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - N Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, USA
| | - J A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, USA
| | - M Jolly
- Division of Rheumatology, Rush University Medical Center, Chicago, USA
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Castrejon I, Gibson KA, Block JA, Everakes SL, Jain R, Pincus T. RheuMetric A Physician Checklist to Record Patient Levels of Inflammation, Damage and Distress as Quantitative Data Rather than as Narrative Impressions. Bull Hosp Jt Dis (2013) 2015; 73:178-184. [PMID: 26535596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND A physician global estimate of patient status (DOCGL) was designed to quantitate inflammatory activity but may be influenced by the presence of damage and distress. Therefore, three additional 0 to 10 visual analog scales (VAS) have been developed on a RheuMetric checklist to record physician estimates of inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) (such as fibromyalgia and somatization). We analyzed patient scores on a multidimensional health assessment questionnaire (MDHAQ) and four RheuMetric physician estimates inpatients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), and fibromyalgia (FM). METHODS All patients with all diagnoses seen by Rush University Medical Center rheumatologists complete an MDHAQ and have four RheuMetric 0 to 10 VAS estimates for DOCGL, DOCINF, DOCDAM, and DOCSTR assigned by the rheumatologist at each visit. A random visit of 205 patients with RA (N = 50), OA (N = 67), SLE (N = 66), and FM (N = 32) was analyzed for mean MDHAQ scores, RheuMetric estimates, and Spearman correlations. RESULTS Mean MDHAQ scores and DOCGL were highest for FM, followed by OA, RA, and SLE. Highest estimates and highest correlations with DOCGL were seen for DOCINF in RA, for DOCDAM in OA, and for DOCSTR in FM. DOCDAM estimates were higher than DOCINF in RA and SLE, suggesting that damage may be as severe a clinical problem as inflammation. DOCGL was correlated significantly with patient global estimate (PATGL) in RA, SLE, and OA, but not in FM. CONCLUSIONS Physician estimates for inflammation, damage,and distress differ in different rheumatic diagnoses. Many patients have inflammation and damage or distress, or all three problems, reflecting challenges of rheumatology care.
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Shakoor N, Foucher KC, Wimmer MA, Mikolaitis-Preuss RA, Fogg LF, Block JA. Asymmetries and relationships between dynamic loading, muscle strength, and proprioceptive acuity at the knees in symptomatic unilateral hip osteoarthritis. Arthritis Res Ther 2014; 16:455. [PMID: 25496937 PMCID: PMC4298074 DOI: 10.1186/s13075-014-0455-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 09/10/2014] [Indexed: 01/06/2023] Open
Abstract
Introduction High joint loading, knee muscle weakness, and poor proprioceptive acuity are important factors that have been linked to knee osteoarthritis (OA). We previously reported that those with unilateral hip OA and bilateral asymptomatic knees are more predisposed to develop progressive OA in the contralateral knee relative to the ipsilateral knee. In the present study, we evaluate asymmetries in muscle strength and proprioception between the limbs and also evaluate relationships between these factors and joint loading that may be associated with the asymmetric evolution of OA in this group. Methods Sixty-two participants with symptomatic unilateral hip OA and asymptomatic knees were evaluated for muscle strength, joint position sense and dynamic joint loads at the knees. Muscle strength and proprioception were compared between limbs and correlations between these factors and dynamic joint loading were evaluated. Subgroup analyses were also performed in only those participants that fulfilled criteria for severe hip OA. Results Quadriceps muscle strength was 15% greater, and in the severe subgroup, proprioceptive acuity was 25% worse at the contralateral compared to ipsilateral knee of participants with unilateral hip OA (P <0.05). In addition, at the affected limb, there was an association between decreased proprioceptive acuity and higher knee loading (Spearman’s rho = 0.377, P = 0.007) and between decreased proprioceptive acuity and decreased muscle strength (Spearman’s rho = −0.328, P = 0.016). Conclusions This study demonstrated asymmetries in muscle strength and proprioception between the limbs in a unilateral hip OA population. Early alterations in these factors suggest their possible role in the future development of OA at the contralateral ‘OA-predisposed knee’ in this group. Furthermore, the significant association observed between proprioception, loading, and muscle strength at the affected hip limb suggests that these factors may be interrelated.
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Affiliation(s)
- Meenakshi Jolly
- Department of Medicine/Rheumatology, Rush University Medical Center, 1611 W Harrison Street, suite 510, Chicago, IL, 60612, USA.
| | - Winston Sequeira
- Department of Medicine/Rheumatology, Rush University Medical Center, 1611 W Harrison Street, suite 510, Chicago, IL, 60612, USA.
| | - Joel A Block
- Department of Medicine/Rheumatology, Rush University Medical Center, 1611 W Harrison Street, suite 510, Chicago, IL, 60612, USA.
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Goker B, Block JA, Lidtke RH. Analysis of intrinsic biomechanical factors are needed to identify parameters that may predict benefit from lateral wedge orthotics in medial knee osteoarthritis. Comment on the article by Parkes MJ, et al. Clin Exp Rheumatol 2014; 32:S-3. [PMID: 24641818] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Affiliation(s)
- B Goker
- Department of Internal Medicine, Rheumatology, Gazi University, Ankara, Turkey.
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Bourré-Tessier J, Clarke AE, Kosinski M, Mikolaitis-Preuss RA, Bernatsky S, Block JA, Jolly M. The French-Canadian validation of a disease-specific, patient-reported outcome measure for lupus. Lupus 2014; 23:1452-9. [PMID: 25081500 DOI: 10.1177/0961203314543921] [Citation(s) in RCA: 18] [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: 11/17/2022]
Abstract
OBJECTIVES The objective of this paper is to perform the cross-cultural validation of the French version of the LupusPRO, a disease-targeted patient-reported outcome measure, among systemic lupus erythematosus (SLE) patients in Canada. METHODS The French version of the LupusPRO and the MOS SF-36 were administered; demographic, clinical and serological characteristics were obtained. Disease activity (SELENA-SLEDAI and the Lupus Foundation of America definition of flare) and damage (SLICC/ACR SDI) were assessed. Physician disease activity and damage assessments were ascertained using visual analog scales. Internal consistency reliability (ICR), test-retest reliability (TRT), convergent and discriminant validity (against corresponding domains of the SF-36), criterion validity (against disease activity, damage or health status) and known group validity were tested. RESULTS A total of 99 French-Canadian SLE patients participated (97% women, mean (SD) age 45.2 (14.5) years). The median (IQR) SELENA-SLEDAI and SDI were 3.5 (6.0) and 1.0 (2.0), respectively. The ICR of the LupusPRO domains ranged from 0.81 to 0.93 (except for lupus symptoms, procreation and coping), while TRT ranged from 0.72 to 0.95. Convergent and discriminant validity, criterion validity and known group validity against disease activity, damage and health status measures were observed. Confirmatory factor analysis showed a good fit. CONCLUSION The LupusPRO has fair psychometric properties among French-Canadian patients with SLE.
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Affiliation(s)
- J Bourré-Tessier
- Department of Medicine, Division of Rheumatology, University of Montreal Health Center, Canada
| | - A E Clarke
- Department of Medicine, Division of Rheumatology, University of Calgary, Canada
| | - M Kosinski
- QualityMetric Inc, Outcomes Insight Consulting Division, USA
| | - R A Mikolaitis-Preuss
- Department of Medicine, Division of Rheumatology, Rush University Medical Center, USA
| | - S Bernatsky
- Department of Medicine, Division of Rheumatology, McGill University Health Centre, Canada Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, McGill University, Canada
| | - J A Block
- Department of Medicine, Division of Rheumatology, Rush University Medical Center, USA
| | - M Jolly
- Department of Medicine, Division of Rheumatology, Rush University Medical Center, USA
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