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Yokose C, Challener G, Jiang B, Zhou B, McCormick N, Tanikella S, Panchot KMQ, Kohler MJ, Yinh J, Zhang Y, Bates DW, Januzzi JL, Sise M, Wexler D, Choi HK. Serum urate change among gout patients treated with sodium-glucose cotransporter type 2 inhibitors vs. sulfonylurea: A comparative effectiveness analysis. Semin Arthritis Rheum 2024; 66:152441. [PMID: 38657403 DOI: 10.1016/j.semarthrit.2024.152441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To investigate the serum urate (SU) change among gout patients initiating SGLT2i, and to compare with sulfonylurea, the second-most widely used glucose-lowering medication after metformin. METHODS We conducted a cohort study of patients with gout and baseline SU >6 mg/dL who had SU measured within 90 days before and after SGLT2i or sulfonylurea initiation. Using multivariable linear regression, we compared SU change among SGLT2i initiators between those with and without diabetes and then compared SU change between SGLT2i and sulfonylurea. RESULTS We identified 28 patients with gout initiating SGLT2i (including 16 with diabetes) and 28 patients initiating sulfonylurea (all with diabetes). Among SGLT2i initiators, the mean within-group SU change was -1.8 (95 % CI, -2.4 to -1.1) mg/dL, including -1.2 (-1.8 to -0.6) mg/dL and -2.5 (-3.6 to -1.3) mg/dL among patients with and without diabetes, respectively, with an adjusted difference between those with and without diabetes of -1.4 (-2.4 to -0.5) mg/dL. The SU did not change after initiating sulfonylurea (+0.3 [-0.3 to 1.0] mg/dL). The adjusted SU change difference between SGLT2i vs. sulfonylurea initiation was -1.8 (-2.7 to -0.9) mg/dL in all patients. The SU reduction persisted regardless of urate-lowering therapy or diuretic use and the presence of diabetes, chronic kidney disease, or heart failure. CONCLUSION Among patients with gout, SGLT2i was associated with a notable reduction in SU compared with sulfonylurea, with a larger reduction among patients without diabetes. With their proven cardiovascular-kidney-metabolic benefits, adding SGLT2i to current gout management could provide streamlined benefits for gout and its comorbidities.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Greg Challener
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bohang Jiang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Baijun Zhou
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie McCormick
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sruthi Tanikella
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Kila Mei Qin Panchot
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Minna J Kohler
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David W Bates
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James L Januzzi
- Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, Massachusetts, United States
| | - Meghan Sise
- Harvard Medical School, Boston, MA, USA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah Wexler
- Harvard Medical School, Boston, MA, USA; Diabetes Center, Massachusetts General Hospital, Boston, MA, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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2
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Weber B, Weisenfeld D, Massarotti E, Seyok T, Cremone G, Lam E, Golnik C, Brownmiller S, Liu F, Huang S, Todd DJ, Coblyn JS, Weinblatt ME, Cai T, Dahal K, Kohler M, Yinh J, Barrett L, Solomon DH, Plutzky J, Schelbert HR, Campisi R, Bolster MB, Di Carli M, Liao KP. Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study. J Am Heart Assoc 2024; 13:e030387. [PMID: 38686879 DOI: 10.1161/jaha.123.030387] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction as measured by myocardial flow reserve (MFR) is associated with increased cardiovascular risk in rheumatoid arthritis (RA). The objective of this study was to determine the association between reducing inflammation with MFR and other measures of cardiovascular risk. METHODS AND RESULTS Patients with RA with active disease about to initiate a tumor necrosis factor inhibitor were enrolled (NCT02714881). All subjects underwent a cardiac perfusion positron emission tomography scan to quantify MFR at baseline before tumor necrosis factor inhibitor initiation, and after tumor necrosis factor inhibitor initiation at 24 weeks. MFR <2.5 in the absence of obstructive coronary artery disease was defined as coronary microvascular dysfunction. Blood samples at baseline and 24 weeks were measured for inflammatory markers (eg, high-sensitivity C-reactive protein [hsCRP], interleukin-1b, and high-sensitivity cardiac troponin T [hs-cTnT]). The primary outcome was mean MFR before and after tumor necrosis factor inhibitor initiation, with Δhs-cTnT as the secondary outcome. Secondary and exploratory analyses included the correlation between ΔhsCRP and other inflammatory markers with MFR and hs-cTnT. We studied 66 subjects, 82% of which were women, mean RA duration 7.4 years. The median atherosclerotic cardiovascular disease risk was 2.5%; 47% had coronary microvascular dysfunction and 23% had detectable hs-cTnT. We observed no change in mean MFR before (2.65) and after treatment (2.64, P=0.6) or hs-cTnT. A correlation was observed between a reduction in hsCRP and interleukin-1b with a reduction in hs-cTnT. CONCLUSIONS In this RA cohort with low prevalence of cardiovascular risk factors, nearly 50% of subjects had coronary microvascular dysfunction at baseline. A reduction in inflammation was not associated with improved MFR. However, a modest reduction in interleukin-1b and no other inflammatory pathways was correlated with a reduction in subclinical myocardial injury. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02714881.
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Affiliation(s)
- Brittany Weber
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Dana Weisenfeld
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Thany Seyok
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Gabrielle Cremone
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Ethan Lam
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Charlotte Golnik
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Seth Brownmiller
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Feng Liu
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Sicong Huang
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Derrick J Todd
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jonathan S Coblyn
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Kumar Dahal
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Minna Kohler
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Janeth Yinh
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Leanne Barrett
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | | | - Roxana Campisi
- Instituto Argentino de Diagnóstico y Tratamiento S.A. Buenos Aires Argentina
| | - Marcy B Bolster
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Katherine P Liao
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
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3
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Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T, Fuller A, Rosenthal A, Becce F, Bardin T, Ea HK, Filippou G, FitzGerald J, Iagnocco A, Lioté F, McCarthy GM, Ramonda R, Richette P, Sivera F, Andres M, Cipolletta E, Doherty M, Pascual E, Perez-Ruiz F, So A, Jansen TL, Kohler MJ, Stamp LK, Yinh J, Adinolfi A, Arad U, Aung T, Benillouche E, Bortoluzzi A, Dau J, Maningding E, Fang MA, Figus FA, Filippucci E, Haslett J, Janssen M, Kaldas M, Kimoto M, Leamy K, Navarro GM, Sarzi-Puttini P, Scirè C, Silvagni E, Sirotti S, Stack JR, Truong L, Xie C, Yokose C, Hendry AM, Terkeltaub R, Taylor WJ, Choi HK. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol 2023; 75:1703-1713. [PMID: 37494275 PMCID: PMC10543651 DOI: 10.1002/art.42619] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. METHODS Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. RESULTS Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). CONCLUSION The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
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Affiliation(s)
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lille, France
| | - Augustin Latourte
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Ann Rosenthal
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Bardin
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Hang Korng Ea
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Georgios Filippou
- Rheumatology Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - John FitzGerald
- David Geffen School of Medicine, University of California, and Veterans Administration for Greater Los Angeles, Los Angeles, California
| | - AnnaMaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy
| | - Frédéric Lioté
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, Service de Rhumatologie, AP-HP, Lariboisière Hospital, and Université Paris Cité, Faculté de Santé, Paris, France
| | - Geraldine M McCarthy
- School of Medicine and Medical Science, University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Pascal Richette
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain, and Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Mariano Andres
- Department of Medicine, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Eliseo Pascual
- Rheumatology Division, Cruces University Hospital, Bilbao, Spain
| | - Fernando Perez-Ruiz
- Arthritis Investigation Group, Biocruces-Bizkaia Health Research Institute, Spain, Department of Medicine, Medicine and Nursing School, University of the Basque Country, and Basque Country Rheumatology Society, Bilbao, Spain
| | - Alexander So
- Lausanne University Hospital, Lausanne, Switzerland
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands, and Medical Cell BioPhysics Group, University of Twente, Enschede, The Netherlands
| | - Minna J Kohler
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Janeth Yinh
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Uri Arad
- Department of Rheumatology, Te Whatu Ora-Health New Zealand Waikato, Hamilton, New Zealand
| | - Thanda Aung
- Division of Rheumatology, University of California, Los Angeles
| | - Eva Benillouche
- Department of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, and Azienda Ospedaliera-Universitaria di Ferrara, Cona (FE), Italy
| | - Jonathan Dau
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, Boston
| | | | - Meika A Fang
- David Geffen School of Medicine, University of California, and Veterans Administration for Greater Los Angeles, Los Angeles, California
| | - Fabiana A Figus
- Rheumatology Division, Local Health Unit (ASL), Turin-3, Collegno and Pinerolo, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Janine Haslett
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Marian Kaldas
- David Geffen School of Medicine, University of California, Los Angeles
| | - Maryann Kimoto
- David Geffen School of Medicine, University of California, Los Angeles
| | - Kelly Leamy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Carlo Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Ettore Silvagni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, and Azienda Ospedaliera-Universitaria di Ferrara, Cona (FE), Italy
| | - Silvia Sirotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - John R Stack
- School of Medicine and Medical Science, University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Linh Truong
- Division of Rheumatology, University of California, Los Angeles, California
| | - Chen Xie
- Division of Rheumatology, University of California, Los Angeles, California
| | - Chio Yokose
- Harvard Medical School, Boston, Massachusetts
| | - Alison M Hendry
- Department of Medicine, General Medicine and Rheumatology, Middlemore Hospital, Counties Manukau Health District, New Zealand
| | - Robert Terkeltaub
- San Diego Veterans Administration Healthcare Service, and University of California, San Diego
| | - William J Taylor
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Hyon K Choi
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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4
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Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T, Fuller A, Rosenthal A, Becce F, Bardin T, Ea HK, Filippou G, Fitzgerald J, Iagnocco A, Lioté F, McCarthy GM, Ramonda R, Richette P, Sivera F, Andrés M, Cipolletta E, Doherty M, Pascual E, Perez-Ruiz F, So A, Jansen TL, Kohler MJ, Stamp LK, Yinh J, Adinolfi A, Arad U, Aung T, Benillouche E, Bortoluzzi A, Dau J, Maningding E, Fang MA, Figus FA, Filippucci E, Haslett J, Janssen M, Kaldas M, Kimoto M, Leamy K, Navarro GM, Sarzi-Puttini P, Scirè C, Silvagni E, Sirotti S, Stack JR, Truong L, Xie C, Yokose C, Hendry AM, Terkeltaub R, Taylor WJ, Choi HK. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Ann Rheum Dis 2023; 82:1248-1257. [PMID: 37495237 PMCID: PMC10529191 DOI: 10.1136/ard-2023-224575] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. METHODS Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. RESULTS Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score>56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). CONCLUSION The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
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Affiliation(s)
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lille, France
| | - Augustin Latourte
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Ann Rosenthal
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Bardin
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Hang-Korng Ea
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Georgios Filippou
- Rheumatology Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - John Fitzgerald
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Veterans Administration for Greater Los Angeles, Los Angeles, California, USA
| | - AnnaMaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy
| | - Frédéric Lioté
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
- Université Paris Cité, Faculté de Santé, Paris, France
| | - Geraldine M McCarthy
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Pascal Richette
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
- Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Mariano Andrés
- Department of Medicine, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Eliseo Pascual
- Rheumatology Division, Cruces University Hospital, Bilbao, Spain
| | - Fernando Perez-Ruiz
- Arthritis Investigation Group, Biocruces-Bizkaia Health Research Institute, Spain, Department of Medicine, Medicine and Nursing School, University of the Basque Country, and Basque Country Rheumatology Society, Bilbao, Spain
| | - Alexander So
- Lausanne University Hospital, Lausanne, Switzerland
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands
- Medical Cell BioPhysics Group, University of Twente, Enschede, The Netherlands
| | - Minna J Kohler
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Janeth Yinh
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Uri Arad
- Department of Rheumatology, Te Whatu Ora-Health New Zealand Waikato, Hamilton, New Zealand
| | - Thanda Aung
- Division of Rheumatology, University of California, Los Angeles, California, USA
| | - Eva Benillouche
- Department of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Azienda Ospedaliera-Universitaria di Ferrara (Cona FE), Cona FE, Italy
| | - Jonathan Dau
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Meika A Fang
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Veterans Administration for Greater Los Angeles, Los Angeles, California, USA
| | - Fabiana A Figus
- Rheumatology Division, Local Health Unit (ASL), Turin-3, Collegno and Pinerolo, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Janine Haslett
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Marian Kaldas
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Maryann Kimoto
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelly Leamy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Geraldine M Navarro
- Division of Rheumatology, University of California, Los Angeles, California, USA
| | | | - Carlo Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Ettore Silvagni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Azienda Ospedaliera-Universitaria di Ferrara (Cona FE), Cona FE, Italy
| | - Silvia Sirotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - John R Stack
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Linh Truong
- Division of Rheumatology, University of California, Los Angeles, California, USA
| | - Chen Xie
- Division of Rheumatology, University of California, Los Angeles, California, USA
| | - Chio Yokose
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alison M Hendry
- Department of Medicine, General Medicine and Rheumatology, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand
| | - Robert Terkeltaub
- San Diego Veterans Administration Healthcare Service, and University of California, San Diego, California, USA
| | - William J Taylor
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Hyon K Choi
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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5
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Yokose C, McCormick N, Lu N, Joshi AD, Jackson L, Kohler MJ, Yinh J, Zhang Y, Hsu J, Dalbeth N, Saag KG, Choi HK. Nationwide racial/ethnic disparities in US emergency department visits and hospitalizations for gout. Rheumatology (Oxford) 2023; 62:2247-2251. [PMID: 36218483 PMCID: PMC10234199 DOI: 10.1093/rheumatology/keac590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Gout prevalence is reportedly ∼20% higher in US Black adults than Whites, but racial differences in emergency department (ED) visits and hospitalizations for gout are unknown. We evaluated the latest US national utilization datasets according to racial/ethnic groups. METHODS Using 2019 US National Emergency Department Sample and National Inpatient Sample databases, we compared racial/ethnic differences in annual population rates of ED visits and hospitalizations for gout (primary discharge diagnosis) per 100 000 US adults (using 2019 age- and sex-specific US census data). We also examined rates of ED visits and hospitalizations for gout among all US ED visits/hospitalizations and mean costs for each gout encounter. RESULTS Compared with White patients, the per capita age- and sex-adjusted rate ratio (RR) of gout primary ED visits for Black patients was 5.01 (95% CI 4.96, 5.06), for Asian patients 1.29 (1.26, 1.31) and for Hispanic patients 1.12 (1.10, 1.13). RRs for gout primary hospitalizations were 4.07 (95% CI 3.90, 4.24), 1.46 (1.34, 1.58) and 1.06 (0.99, 1.13), respectively. Corresponding RRs among total US hospitalizations were 3.17 (95% CI 2.86, 3.50), 3.23 (2.71, 3.85) and 1.43 (1.21, 1.68) and among total ED visits were 2.66 (95% CI, 2.50, 2.82), 3.28 (2.64, 4.08), and 1.14 (1.05, 1.24), respectively. RRs were largest among Black women. Costs for ED visits and hospitalizations experienced by race/ethnicity showed similar disparities. CONCLUSIONS These first nationwide data found a substantial excess in both gout primary ED visits and hospitalizations experienced by all underserved racial/ethnic groups, particularly by Black women, revealing an urgent need for improved care to eliminate inequities in gout outcomes.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie McCormick
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, BC, Canada
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Amit D Joshi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lesley Jackson
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Minna J Kohler
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John Hsu
- Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hyon K Choi
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Arthritis Research Canada, Vancouver, BC, Canada
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6
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Tedeschi SK, Becce F, Pascart T, Guermazi A, Budzik JF, Dalbeth N, Filippou G, Iagnocco A, Kohler MJ, Laredo JD, Smith SE, Simeone FJ, Yinh J, Choi H, Abhishek A. Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group. Arthritis Care Res (Hoboken) 2023; 75:825-834. [PMID: 35439343 PMCID: PMC9579212 DOI: 10.1002/acr.24898] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 04/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities. METHODS The American College of Rheumatology and European Alliance of Associations for Rheumatology CPPD classification criteria Imaging Advisory Group (IAG) and Steering Committee drafted definitions of imaging features that are characteristic of CPPD on conventional radiography (CR), conventional computed tomography (CT), dual-energy CT (DECT), and magnetic resonance imaging (MRI). An anonymous expert survey was undertaken by a 35-member Combined Expert Committee, including all IAG members. The IAG and 5 external musculoskeletal radiologists with expertise in CPPD convened virtually to further refine item definitions and voted on example images illustrating CR, CT, and DECT item definitions, with ≥90% agreement required to deem them acceptable. RESULTS The Combined Expert Committee survey indicated consensus on all CR definitions. The IAG and external radiologists reached consensus on CT and DECT item definitions, which specify that calcium pyrophosphate deposits appear less dense than cortical bone. The group developed an MRI definition and acknowledged limitations of this modality for CPPD. Ten example images for CPPD were voted acceptable (4 CR, 4 CT, and 2 DECT), and 3 images of basic calcium phosphate deposition were voted acceptable to serve as contrast against imaging features of CPPD. CONCLUSION An international group of rheumatologists and musculoskeletal radiologists defined imaging features characteristic of CPPD on CR, CT, and DECT and assembled a set of example images as a reference for future clinical research studies.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Lille, France
| | - Ali Guermazi
- Department of Radiology, Boston VA Healthcare System, Boston University School of Medicine, Boston, USA
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals, Lille, France
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Georgios Filippou
- Division of Rheumatology, Luigi Sacco University Hospital, Milan, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Minna J. Kohler
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Jean-Denis Laredo
- Department of Orthopedic Surgery, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, UMR CNRS 7052, Université de Paris, Paris, France
| | - Stacy E. Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States
| | - F. Joseph Simeone
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Janeth Yinh
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, United States
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
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7
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Tedeschi SK, Pascart T, Latourte A, Godsave C, Kundakci B, Naden RP, Taylor WJ, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andres M, Bardin T, Doherty M, Ea HK, Filippou G, FitzGerald J, Guitierrez M, Iagnocco A, Jansen TL, Kohler MJ, Lioté F, Matza M, McCarthy GM, Ramonda R, Reginato AM, Richette P, Singh JA, Sivera F, So A, Stamp LK, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. Identifying Potential Classification Criteria for Calcium Pyrophosphate Deposition Disease: Item Generation and Item Reduction. Arthritis Care Res (Hoboken) 2022; 74:1649-1658. [PMID: 33973414 PMCID: PMC8578594 DOI: 10.1002/acr.24619] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Classification criteria for calcium pyrophosphate deposition (CPPD) disease will facilitate clinical research on this common crystalline arthritis. Our objective was to report on the first 2 phases of a 4-phase process for developing CPPD classification criteria. METHODS CPPD classification criteria development is overseen by a 12-member steering committee. Item generation (phase I) included a scoping literature review of 5 literature databases and contributions from a 35-member combined expert committee and 2 patient research partners. Item reduction and refinement (phase II) involved a combined expert committee meeting, discussions among clinical, imaging, and laboratory advisory groups, and an item-rating exercise to assess the influence of individual items toward classification. The steering committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development. RESULTS Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The advisory groups eliminated items that they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item-rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases. As numerous imaging items were rated +3, the steering committee recommended focusing on imaging of the knee and wrist and 1 additional affected joint for calcification suggestive of CPP crystal deposition. CONCLUSION A data- and expert-driven process is underway to develop CPPD classification criteria. Candidate items comprise clinical, imaging, and laboratory features.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation and Immunity,
Brigham and Women’s Hospital and Harvard Medical School, Boston, United
States
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University,
Lille, France
| | - Augustin Latourte
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Cattleya Godsave
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Burak Kundakci
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Raymond P. Naden
- Department of Medicine, Auckland City Hospital, Auckland,
New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland,
New Zealand
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of
Medicine, Boston, MA, United States
| | - Fernando Perez-Ruiz
- Osakidetza, OSI EE-Cruces, Cruces University Hospital,
Biocruces-Bizkaia Health Research Institute and University of the Basque Country,
Basque Country, Spain
| | - Ann Rosenthal
- Department of Rheumatology, Medical College of
Wisconsin, Milwaukee, United States
| | - Fabio Becce
- Department of Radiology, Lausanne University Hospital,
Lausanne, Switzerland
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Mariano Andres
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Thomas Bardin
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Michael Doherty
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Hang-Korng Ea
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Georgios Filippou
- Division of Rheumatology, Luigi Sacco University
Hospital, Milan, Italy
| | - John FitzGerald
- Greater Los Angeles VA Healthcare Service and Division
of Rheumatology, David Geffen School of Medicine, University of California-Los
Angeles, Los Angeles, United States
| | - Marwin Guitierrez
- Division of Musculoskeletal and Rheumatic Disorders,
Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze
Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Tim L. Jansen
- Department of Rheumatology, VieCuri Medical Center,
Venlo, Noord-Limburg, and University of Twente, Faculty Science & Technology,
Enschede, Netherlands
| | - Minna J. Kohler
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Frédéric Lioté
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Mark Matza
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED,
University of Padova, Padova, Italy
| | | | - Pascal Richette
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Jasvinder A. Singh
- Division of Rheumatology, University of Alabama at
Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, United
States
| | - Francisca Sivera
- Department of Rheumatology, Hospital General
Universitario Elda, Elda, Spain, and Departamento de Medicina, Universidad Miguel
Hernandez, Elche, Spain
| | - Alexander So
- Department of Musculoskeletal Medicine, University
Hospital of Lausanne, Lausanne, Switzerland
| | - Lisa K. Stamp
- Division of Medicine, University of Otago, Christchurch,
New Zealand
| | - Janeth Yinh
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Chio Yokose
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Robert Terkeltaub
- San Diego VA Healthcare Service, Division of
Rheumatology, Allergy and Immunology, University of California-San Diego, San Diego,
United States
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
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Bethina NK, Torralba KD, Choi KS, Fairchild RM, Cannella AC, Salto L, Kissin EY, Yinh J, Aggarwal M, Thiele R, Nishio MJ. North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study. Clin Rheumatol 2022; 41:3825-3835. [PMID: 36008579 DOI: 10.1007/s10067-022-06337-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. METHOD Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. RESULTS Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. CONCLUSIONS This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.
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Affiliation(s)
- Narandra K Bethina
- Division of Rheumatology and Clinical Immunology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristal S Choi
- Division of Rheumatology, University of CA-Los Angeles, Los Angeles, CA, USA
| | - Robert M Fairchild
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Amy C Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Salto
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Harvard Medical School, Boston, MA, USA
| | - Manushi Aggarwal
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Ralf Thiele
- Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA
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Yokose C, Mccormick N, Lu N, Joshi A, Jackson L, Kohler M, Yinh J, Zhang Y, Saag K, Choi H. POS1171 TRIPLE THE RATE OF EMERGENCY ROOM VISITS AND HOSPITALIZATIONS FOR GOUT AMONG US BLACKS VS WHITES – 2019 NATIONWIDE ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGout is a highly prevalent inflammatory arthritis with increasing global disease burden in recent years.1,2 Gout prevalence has been reported to be higher among Blacks compared to Whites,3 and that they are less likely to receive allopurinol in outpatient care.4 The potential nationwide impact of these racial disparities on emergency department (ED) visits and hospitalizations is unknown.ObjectivesTo examine the contemporary racial disparities in ED visits and hospitalizations with a primary discharge diagnosis of gout in the US (2019).MethodsWe compared ED visits and hospitalizations between Blacks and Whites in the latest data (2019) from the US National Emergency Department Sample (NEDS) and National Inpatient Sample (NIS). We focused on encounters for which the primary diagnosis was gout based on ICD codes (M1A.xx, M10.xx). We calculated annual population rates of ED visits and hospitalizations for gout (per 100,000 US adults) using the 2019 US census adult population (>18 years) according to race.ResultsThere were a total of 160,759 ED visits and 9,560 hospitalizations among White and Blacks with a gout diagnosis in the US in 2019. The mean age (58.2 years vs. 56.5 years) and male proportion (78.0% vs. 74.8%) tended to be higher among Whites, while more Blacks tended to live in the South (40.7% vs. 66.5%) and reported a median household income of < $50,000 (30.7% vs. 57.1%). Compared to Whites, Blacks had 2.7- and 3.2-fold higher rates of gout ED visits and hospitalizations, respectively, after adjusting for age, sex, payer, region, and household income (Table 1 & Figure 1). Black women, in particular, had 3.4- and 4.0-fold higher rates of ED visits and hospitalizations compared to White women, while the corresponding rate ratios for men were 2.5 and 2.8, respectively. The mean costs per gout ED visit were similar for Blacks compared to Whites (adjusted difference, -$7.6 [95% CI, -25.4 to 1.0]), while hospitalizations were more costly (adjusted difference, $1,055.3 [95% CI, 553.1 to 1557.5]). The duration of ED visits and hospitalizations was also higher among Blacks than Whites (adjusted difference of 0.41 days [95% CI, 0.19 to 0.63] and 0.59 days [95% CI, 0.25 to 0.94], respectively).Table 1.Racial Disparities in Emergency Department Visits and Hospitalizations with Primary Diagnosis of Gout in 2019Emergency Department VisitsHospitalizationsRaceWhiteBlackWhiteBlackAll6801196524521330198510434519150Visits, N888107194962003360Rate per 100,000130.6293.431.274.4Rate Ratio (95% CI)*1.0 (ref)2.81 (2.63, 3.00)1.0 (ref)3.08 (2.79, 3.40)Rate Ratio (95% CI)**1.0 (ref)2.66 (2.50, 2.82)1.0 (ref)3.17 (2.86, 3.50)Women3785136914363031110390932647105Visits, N195671816317701145Rate per 100,00051.7126.516.043.3Rate Ratio (95% CI)*1.0 (ref)3.68 (3.39, 3.99)1.0 (ref)4.01 (3.40, 4.73)Rate Ratio (95% CI)**1.0 (ref)3.36 (3.11, 3.62)1.0 (ref)4.02 (3.39, 4.78)Men301561011015657388098151871620Visits, N692285378344302215Rate per 100,000229.6529.550.3118.3Rate Ratio (95% CI)*1.0 (ref)2.59 (2.42, 2.78)1.0 (ref)2.66 (2.36, 3.00)Rate Ratio (95% CI)**1.0 (ref)2.47 (2.32, 2.64)1.0 (ref)2.77 (2.45, 3.14)*Adjusted for age and sex for all, adjusted for age for sex-specific rate ratios**Adjusted for age, sex, payment, region, and household incomeConclusionThese latest national data indicate that ED visits and hospitalization due to gout are both 3 times higher among Blacks than Whites; this disparity was particularly prominent among women with gout. Higher risk of developing gout3 and suboptimal care4 both translate to these avoidable costly healthcare utilizations, calling for improved primary prevention and gout care.References[1]Safiri et al., PMID 32755051[2]Xia et al., PMID 31624843[3]Chen-Xu et al., PMID 30618180[4]Krishnan et al., PMID 18260174Disclosure of InterestsChio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Lesley Jackson: None declared, Minna Kohler Speakers bureau: Lilly, Consultant of: Mymee, Novartis, Grant/research support from: Setpoint Medical, Janeth Yinh: None declared, Yuqing Zhang: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon
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10
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Tedeschi S, Pascart T, Latourte A, Godsave C, Kundaki B, Naden R, Taylor W, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andrés M, Bardin T, Doherty M, Ea HK, Filippou G, Fitzgerald J, Gutierrez M, Iagnocco A, Jansen T, Kohler M, Lioté F, Matza M, Mccarthy G, Ramonda R, Reginato A, Richette P, Singh J, Sivera F, So A, Stamp L, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. POS1124 IDENTIFYING POTENTIAL CLASSIFICATION CRITERIA FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE (CPPD): RESULTS FROM THE INITIAL PHASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. ACR/EULAR are jointly sponsoring development of CPPD classification criteria using a multi-phase process.Objectives:To report preliminary results from the first two phases of a four-phase process for developing CPPD classification criteria.Methods:CPPD classification criteria development is overseen by a 12-member Steering Committee. Item generation (Phase I) included a scoping literature review of five literature databases and contributions from a 35-member Combined Expert Committee and two Patient Research Partners. Item reduction and refinement (Phase II) involved a Combined Expert Committee meeting, discussions among Clinical, Imaging, and Laboratory Advisory Groups, and an item rating exercise to assess the influence of individual items toward classification. The Steering Committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development.Results:Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The Advisory Groups eliminated items they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases (see Table 1). As numerous imaging items were rated +3, the Steering Committee recommended focusing on imaging of the knee, wrist, and one additional affected joint for calcification suggestive of CPP crystal deposition.Conclusion:The ACR/EULAR CPPD classification criteria working group has adopted both data- and expert-driven approaches, leading to 56 candidate items broadly categorized as clinical, imaging, and laboratory features. Remaining steps for criteria development include domain establishment, item weighting through a multi-criteria decision analysis exercise, threshold score determination, and criteria validation.Table 1.Categories of items retained for future phases of classification criteria developmentAge in decade at symptom onsetAcute inflammatory arthritis (e.g. knee, wrist, 1st MTP joint*)Recurrence and pattern of joint involvement (e.g. 1 self-limited episode, >1 self-limited episode)Physical findings (e.g. palpable subcutaneous tophus*, psoriasis*)Co-morbidities and family history (e.g. Gitelman disease, hemochromatosis, familial CPPD)Osteoarthritis location and features (e.g. 2nd or 3rd MCP joint, wrist)Synovial fluid findings (e.g. CPP crystals present, CPP crystals absent on 1 occasion* or 2 occasions*, monosodium urate crystals present*)Laboratory findings (e.g. hypomagnesemia, hyperparathyroidism, rheumatoid factor*, anti-CCP*)Plain radiograph: calcification in regions of fibro- or hyaline cartilage+Plain radiograph: calcification of the synovial membrane/capsule/tendon+Conventional CT: calcification in regions of fibro- or hyaline cartilage+Conventional CT: calcification of the synovial membrane/capsule/tendon+Ultrasound: CPP crystal deposition in fibro- or hyaline cartilage+Ultrasound: CPP crystal deposition in synovial membrane/capsule/tendons+Dual-energy CT: CPP crystal deposition in fibro- or hyaline cartilage+Dual-energy CT: CPP crystal deposition in synovial membrane/capsule/tendon+*Potential negative predictor +Assessed in the knee, wrist, and/or 1 additional affected jointDisclosure of Interests:Sara Tedeschi Consultant of: NGM Biopharmaceuticals, Tristan Pascart: None declared, Augustin Latourte Consultant of: Novartis, Cattleya Godsave: None declared, Burak Kundaki: None declared, Raymond Naden: None declared, William Taylor: None declared, Nicola Dalbeth Speakers bureau: Abbvie and Janssen, Consultant of: AstraZeneca, Dyve, Selecta, Horizon, Arthrosi, and Cello Health, Tuhina Neogi: None declared, Fernando Perez-Ruiz: None declared, Ann Rosenthal: None declared, Fabio Becce Consultant of: Horizon Therapeutics, Grant/research support from: Siemens Healthineers, Eliseo Pascual: None declared, Mariano Andrés: None declared, Thomas Bardin: None declared, Michael Doherty: None declared, Hang Korng Ea: None declared, Georgios Filippou: None declared, John FitzGerald: None declared, Marwin Gutierrez: None declared, Annamaria Iagnocco: None declared, Tim Jansen Speakers bureau: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Consultant of: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Minna Kohler Speakers bureau: Lilly, Consultant of: Novartis, Frederic Lioté: None declared, Mark Matza: None declared, Geraldine McCarthy Consultant of: PK Med, Roberta Ramonda: None declared, Anthony Reginato: None declared, Pascal Richette: None declared, Jasvinder Singh Speakers bureau: Simply Speaking, Consultant of: Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, Francisca Sivera: None declared, Alexander So: None declared, Lisa Stamp: None declared, Janeth Yinh: None declared, Chio Yokose: None declared, Robert Terkeltaub Consultant of: Sobi, Horizon Therapeutics, Astra-Zeneca, Selecta, Grant/research support from: Astra-Zeneca, Hyon Choi: None declared, Abhishek Abhishek Consultant of: NGM Biopharmaceuticals.
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Yinh J, Torralba KD, Choi KS, Fairchild RM, Cannella A, Salto L, Kissin EY, Thiele R, Oberle EJ, Marston B, Nishio MJ. North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study. Clin Rheumatol 2021; 40:4233-4242. [PMID: 33821367 DOI: 10.1007/s10067-021-05716-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs. METHODS Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test. RESULTS Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation. CONCLUSION Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points • The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. • The transverse sacroiliac joint view was suggested to be performed based on practice focus.
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Affiliation(s)
- Janeth Yinh
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Yawkey 2C, Boston, MA, 02144, USA.
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristal S Choi
- Division of Rheumatology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Robert M Fairchild
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Amy Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Salto
- Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University, Boston, MA, USA
| | - Ralf Thiele
- Division of Rheumatology, University of Rochester, Rochester, NY, USA
| | - Edward J Oberle
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bethany Marston
- Division of Pediatric Rheumatology and Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA
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Naredo E, Canoso JJ, Yinh J, Salomon-Escoto K, Kalish RA, Pascual-Ramos V, Martínez-Estupiñán L, Kissin E. Dynamic changes in the infrapatellar knee structures with quadriceps muscle contraction. An in vivo study. Ann Anat 2021; 235:151663. [PMID: 33387611 DOI: 10.1016/j.aanat.2020.151663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/14/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the effect of knee flexion and submaximal isometric quadriceps muscle (Q) contraction on the patellar tendon (PT), the infrapatellar fat pad (IPFP), and the deep infrapatellar bursa (IPB) from extension to full flexion. METHODS In Study 1, the dominant knee of seven healthy subjects was studied in full extension and at 60° flexion during relaxation and Q contraction. Each knee was inspected and palpated, the transverse infrapatellar diameter was measured by plicometry, and measurements of the anteroposterior (AP) thickness of the IPFP were made by ultrasound (US). In Study 2, the dominant knee of seven healthy subjects was studied by US in full flexion, and then, at 15° decrements, down to 60° flexion during relaxation and Q contraction. Both studies had IRB approval. Results were analyzed with the Wilcoxon test and descriptive statistics. RESULTS In Study 1, Q contraction caused straightening of the patellar tendon (PT), a statistically significant widening of the IPFP by plicometry, and an increased AP thickness of the IPFP by US, in both knee positions. In Study 2, in full knee flexion, the PT contacted the tibial cortex in all seven subjects. Upon increasing extension, the PT-tibial cortex contact was lost in all subjects nearing 90° flexion. The contraction of the Q made the concave PT straight, grew the width of the underlying IPFP, and the apron of the IPFP moved distally within the IPB in all knee positions. A small amount of bursal fluid was present in all seven subjects. CONCLUSION Q contraction makes the IPFP bulge anteriorly, on both sides of the PT, and distally into the IPB, with possible biomechanical implications. In full knee flexion, the PT contacted the tibia, confirming a fulcrum at this site.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan J Canoso
- ABC Medical Center, Mexico City, Mexico; Tufts Medical School, Boston, MA, USA.
| | - Janeth Yinh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Robert A Kalish
- Tufts Medical Center and Tufts Medical School, Boston, MA, USA
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Eugene Kissin
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
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Scott AM, Yinh J, McAlindon T, Kalish R. Two cases of sarcoidosis presenting as longitudinally extensive transverse myelitis. Clin Rheumatol 2018; 37:2899-2905. [PMID: 29770929 DOI: 10.1007/s10067-018-4144-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 01/31/2023]
Abstract
Neurosarcoidosis is uncommon with an incidence of approximately 5 to 15%. Central nervous system involvement can be divided into brain and spinal cord neurosarcoidosis. Spinal cord sarcoidosis is extremely rare, occurring in less than 1% of all sarcoidosis cases. Its manifestations may include cauda equina syndrome, radiculopathy, syringomyelia, cord atrophy, arachnoiditis, and myelopathy or transverse myelitis. We highlight two cases of spinal cord sarcoidosis, each presenting with longitudinally extensive transverse myelitis, that demonstrate the dilemmas that physicians face with regard to diagnosis and treatment. Given its rarity and the diversity of possible manifestations, establishing the diagnosis of spinal cord sarcoidosis is often very difficult. Extensive evaluation must be conducted to rule out primary neurologic, primary rheumatologic, infectious, and neoplastic diseases. MRI often demonstrates hyperintensity on T2-weighted images and enhancement following gadolinium administration. CSF analysis most consistently shows a lymphocytic pleocytosis and elevated proteins. While these less invasive investigations may be helpful, the gold standard for diagnosis is biopsy of neurologic or non-neurologic tissue confirming the presence of non-caseating granulomas. Evidence-based guidelines for the treatment of transverse myelitis secondary to sarcoidosis are lacking due to its rarity; therefore, therapy is based on expert and anecdotal experience and usually consists of high doses of steroids in combination with various immunosuppressive agents. The use of infliximab in particular appears promising, but there is a need for further investigation into the ideal treatment regimen.
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Affiliation(s)
- Amanda Mary Scott
- Rheumatology Division, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.
| | - Janeth Yinh
- Rheumatology Division, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Timothy McAlindon
- Rheumatology Division, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Robert Kalish
- Rheumatology Division, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
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Rahi MS, Yinh J, Rishikof D. Airway Involvement as an Initial Presentation of Relapsing Polychondritis. Chest 2017. [DOI: 10.1016/j.chest.2017.08.967] [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: 10/18/2022] Open
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Abstract
BACKGROUND Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia. METHODS We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response. RESULTS Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed. CONCLUSIONS Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)
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Affiliation(s)
- Chenchen Wang
- Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
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Affiliation(s)
- Janeth Yinh
- Tufts Medical Center, Boston, Massachusetts 02111, USA.
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