1
|
Lieber SB, Nahid M, Legge A, Rajan M, Lipschultz RA, Lin M, Reid MC, Mandl LA. Comparison of two frailty definitions in women with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1384-1390. [PMID: 37555816 PMCID: PMC11065438 DOI: 10.1093/rheumatology/kead393] [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: 01/17/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Frailty is a risk factor for adverse health in SLE. The Fried phenotype (FP) and the SLICC Frailty Index (SLICC-FI) are common frailty metrics reflecting distinct approaches to frailty assessment. We aimed to (1) compare frailty prevalence according to both metrics in women with SLE and describe differences between frail and non-frail participants using each method and (2) evaluate for cross-sectional associations between each metric and self-reported disability. METHODS Women aged 18-70 years with SLE were enrolled. FP and SLICC-FI were measured, and agreement calculated using a kappa statistic. Physician-reported disease activity and damage, Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests, and Valued Life Activities (VLA) self-reported disability were assessed. Differences between frail and non-frail participants were evaluated cross-sectionally, and the association of frailty with disability was determined for both metrics. RESULTS Of 67 participants, 17.9% (FP) and 26.9% (SLICC-FI) were frail according to each metric (kappa = 0.41, P < 0.01). Compared with non-frail women, frail women had greater disease damage, worse PROMIS scores, and greater disability (all P < 0.01 for FP and SLICC-FI). After age adjustment, frailty remained associated with a greater odds of disability [FP: odds ratio (OR) 4.7, 95% CI 1.2, 18.8; SLICC-FI: OR 4.6, 95% CI 1.3, 15.8]. CONCLUSION Frailty is present in 17.9-26.9% of women with SLE. These metrics identified a similar, but non-identical group of women as frail. Further studies are needed to explore which metric is most informative in this population.
Collapse
Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Legge
- Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Myriam Lin
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
2
|
Braverman G, Barbhaiya M, Nong M, Bykerk VP, Hupert N, Lewis V C, Mandl LA. Association of COVID-19 Vaccinations With Flares of Systemic Rheumatic Disease: A Case-Crossover Study. Arthritis Care Res (Hoboken) 2024; 76:733-742. [PMID: 38163750 PMCID: PMC11039379 DOI: 10.1002/acr.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We aimed to determine the association of COVID-19 vaccination with flares of systemic rheumatic disease (SRD). METHODS Adults with systemic rheumatic disease (SRD) in a single-center COVID-19 Rheumatology Registry were invited to enroll in a study of flares. COVID-19 vaccine information from March 5, 2021, to September 6, 2022, was obtained from chart review and self-report. Participants self-reported periods of SRD flare and periods without SRD flare. "Hazard periods" were defined as the time before a self-report of flare and "control periods" as the time before a self-report of no flare. The association between flare and COVID-19 vaccination was evaluated during hazard and control periods through univariate conditional logistic regression stratified by participant, using lookback windows of 2, 7, and 14 days. RESULTS A total of 434 participants (mean ± SD age 59 ± 13 years, 84.1% female, 81.8% White, 64.5% with inflammatory arthritis, and 27.0% with connective tissue diseases) contributed to both the hazard and control periods and were included in analysis. A total of 1,316 COVID-19 vaccinations were identified (58.5% Pfizer-BioNTech, 39.5% Moderna, and 1.4% Johnson & Johnson); 96.1% of participants received at least one dose and 93.1% at least two doses. There was no association between COVID-19 vaccination and flares in the subsequent 2, 7, or 14 days (odds ratio [OR] 1.46, 95% confidence interval [CI] 0.86-2.46; OR 1.09, 95% CI 0.76-1.55; and OR 0.85, 95% CI 0.64-1.13, respectively). Analyses stratified on sex, age, SRD subtype, and vaccine manufacturer similarly showed no association between vaccination and flare. CONCLUSION COVID-19 vaccination was not associated with flares in this cohort of participants with SRD. These data are reassuring and can inform shared decision-making on COVID-19 immunization.
Collapse
Affiliation(s)
- Genna Braverman
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Medha Barbhaiya
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | - Vivian P. Bykerk
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Colby Lewis V
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A. Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
3
|
Jalali K, Mandl LA. Rheumatology: What You May Have Missed in 2023. Ann Intern Med 2024; 177:S82-S90. [PMID: 38621248 DOI: 10.7326/m24-0678] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Many patients with rheumatologic conditions receive care from physicians other than rheumatologists. Here we note key findings from 6 studies in rheumatology published in 2023 that offer valuable insights for internal medicine specialists and subspecialists outside of rheumatology. The first study investigated the effect of low-dose glucocorticoids on patients with rheumatoid arthritis (RA) over 2 years and challenged existing perceptions about the risks of glucocorticoids in this setting. The second study focused on the updated guideline for preventing and treating glucocorticoid-induced osteoporosis. With the chronic and widespread use of glucocorticoids, the American College of Rheumatology emphasized the importance of assessing fracture risk and initiating pharmacologic therapy when appropriate. The third study explored the potential use of methotrexate in treating inflammatory hand osteoarthritis, suggesting a novel approach to managing this challenging and common condition. The results of the fourth article we highlight suggest that sarilumab has promise as an adjunct treatment of polymyalgia rheumatica relapse during glucocorticoid dosage tapering. The fifth study evaluated sublingual cyclobenzaprine for fibromyalgia treatment, noting both potential benefits and risks. Finally, the sixth article is a systematic review and meta-analysis that assessed the therapeutic equivalence of biosimilars and reference biologics in the treatment of patients with RA. Knowledge of this recent literature will be useful to clinicians regardless of specialty who care for patients with these commonly encountered conditions.
Collapse
Affiliation(s)
- Kafaf Jalali
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada (K.J.)
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (L.A.M.)
| |
Collapse
|
4
|
LaValva SM, Grubel J, Ong J, Chiu YF, Lyman S, Mandl LA, Cushner FD, Gonzalez Della Valle A, Parks ML. Substantial Weight Loss May Not Improve Early Outcomes of Total Knee Arthroplasty in the Morbidly Obese. J Arthroplasty 2024:S0883-5403(24)00327-9. [PMID: 38670174 DOI: 10.1016/j.arth.2024.04.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Body mass index (BMI) cutoffs for morbidly obese patients otherwise indicated for total knee arthroplasty (TKA) have been widely proposed and implemented, though they remain controversial. Previous studies suggested that a 5% reduction in BMI may be associated with fewer postoperative complications. Thus, the purpose of this study was to determine whether a substantial reduction in preoperative BMI in morbidly obese patients improved 90-day outcomes after TKA. METHODS There were 1,270 patients who underwent primary TKA at a single institution and had a BMI > 40 recorded during the year prior to surgery. Patients were stratified into three cohorts based on whether their BMI within 3 months to 1 year preoperatively had decreased by ≥ 5% (228 patients [18%]); increased by ≥ 5% (310 [24%]); or remained unchanged (within 5%) (732 [58%]) on the day of surgery. There were several baseline differences between the cohorts with respect to medical comorbidities. The rate of 90-day complications and six-week patient-reported outcome measures were compared via univariate and multivariable analyses. RESULTS On univariate analysis, individual and total complication rates were similar between the cohorts (P > .05). On multivariable logistic regression, the risk of complications was similar in patients who had decreased versus unchanged BMI (OR [odds ratio] 1.0; P = .898). However, there was a higher risk of complications in the increased BMI cohort compared to those patients who had an unchanged BMI (OR 1.5; P = .039). The six-week patient-reported outcome measures were similar between the cohorts. CONCLUSIONS Patients who have a BMI > 40 who achieved a meaningful reduction in BMI prior to TKA did not have a lower rate of 90-day complications than those whose BMI remained unchanged. Furthermore, considering that nearly one in four patients experienced a significant increase in BMI while awaiting surgery, postponing TKA may actually be detrimental.
Collapse
Affiliation(s)
- Scott M LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jacqueline Grubel
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Justin Ong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Stephen Lyman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Fred D Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Michael L Parks
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| |
Collapse
|
5
|
Mandl LA, Rajan M, Lipschultz RA, Lian S, Sheira D, Frey MB, Shea YM, Lane JM. The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low-Energy Hip Fracture. J Orthop Trauma 2024; 38:e149-e156. [PMID: 38212973 PMCID: PMC10950514 DOI: 10.1097/bot.0000000000002772] [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] [Accepted: 01/09/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate whether social isolation or loneliness is associated with outcomes 1 year after low-energy hip fracture. METHODS DESIGN Prospective inception cohort study. SETTING Academic level I trauma center. PATIENT SELECTION CRITERIA Participants were 65 years or older and enrolled 2-4 days after surgery for a first low-energy hip fracture. Exclusion criteria were bilateral or periprosthetic hip fracture, previous hip fracture, non-English speaking, international address, active cancer, stage 4 cancer in the past 5 years, radiation to the hip region, and cognitive impairment. Participants were followed longitudinally for 1 year. OUTCOME MEASURES AND COMPARISONS The patient-reported outcomes measurement information system (PROMIS)-29 was elicited 2-4 days postoperatively and 1 year later. Patient-reported risk factors included the Lubben Social Networks Scale and the University of California, Los Angeles Loneliness Scale, which were compared with the lower extremity activity scale and PROMIS-29 domains. RESULTS Three hundred and twenty-five patients were enrolled. Participants had a median age of 81.7 years, were 70.9% female, and were 85.9% White. In total, 31.6% of patients were socially isolated at the time of fracture. At 1 year, 222 of the 291 subjects who were confirmed alive at 1 year provided data. Multivariable linear models were performed separately for each outcome, including lower extremity activity scale and PROMIS-29 domains. Controlling for age, sex, education, and body mass index, those who were socially isolated at the time of fracture had worse PROMIS-29 function (β = -3.83; P = 0.02) and ability to participate in social roles (β = -4.17; P = 0.01) at 1 year. Secondary analyses found that prefracture loneliness was associated with clinically meaningfully worse function, anxiety, depression, fatigue, sleep, pain, and ability to participate in social roles at 1 year (all P < 0.01). CONCLUSIONS Prefracture social isolation was associated with worse outcomes 1 year after surgical repair of low-energy hip fracture. These data suggest loneliness may be more strongly associated with important patient-centric metrics than prefracture social isolation. Given the dearth of modifiable risk factors in this population, future studies are needed to evaluate whether improving social connections could affect outcomes in this rapidly growing demographic. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Lisa A. Mandl
- Division of Rheumatology and Department of Medicine, Hospital for Special Surgery & Weill Cornell Medicine, New York, NY
| | - Mangala Rajan
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | - Joseph M. Lane
- Orthopedic Trauma Service, Hospital for Special Surgery & Weill Cornell Medicine, New York, NY
| |
Collapse
|
6
|
Lieber SB, Lipschultz RA, Syed S, Rajan M, Venkatraman S, Lin M, Reid MC, Lue NF, Mandl LA. Association of phenotypic frailty and hand grip strength with telomere length in SLE. Lupus Sci Med 2024; 11:e001008. [PMID: 38519061 PMCID: PMC10961526 DOI: 10.1136/lupus-2023-001008] [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: 08/01/2023] [Accepted: 12/09/2023] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Frailty and objective hand grip strength (one of the components of the frailty phenotype) are both risk factors for worse health outcomes in SLE. Whether telomere length, an established cellular senescence marker, is a biologic correlate of the frailty phenotype and hand grip strength in patients with SLE is not clear. First, we aimed to evaluate differences in telomere length between frail and non-frail women with SLE and then assessed whether frailty or hand grip strength is differentially associated with telomere length after adjusting for relevant confounders. METHODS Women ≥18 years of age with validated SLE enrolled at a single medical centre. Fried frailty status (which includes hand grip strength), clinical characteristics and telomere length were assessed cross-sectionally. Differences between frail and non-frail participants were evaluated using Fisher's exact or Wilcoxon rank-sum tests. The associations between frailty and hand grip strength and telomere length were determined using linear regression. RESULTS Of the 150 enrolled participants, 131 had sufficient data for determination of frailty classification; 26% were frail with a median age of 45 years. There was a non-significant trend towards shorter telomere length in frail versus non-frail participants (p=0.07). Hand grip strength was significantly associated with telomere length (beta coefficient 0.02, 95% CI 0.004, 0.04), including after adjustment for age, SLE disease activity and organ damage, and comorbidity (beta coefficient 0.02, 95% CI 0.002, 0.04). CONCLUSIONS Decreased hand grip strength, but not frailty, was independently associated with shortened telomere length in a cohort of non-elderly women with SLE. Frailty in this middle-aged cohort may be multifactorial rather than strictly a manifestation of accelerated ageing.
Collapse
Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Hospital for Special Surgery, New York city, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
| | - Robyn A Lipschultz
- New York University Grossman School of Medicine, New York city, New York, USA
| | - Shahrez Syed
- Department of Biochemistry and Structural Biology and Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York city, New York, USA
| | - Sara Venkatraman
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York city, New York, USA
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, USA
| | - Myriam Lin
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York city, New York, USA
| | - Neal F Lue
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York city, New York, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York city, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York city, New York, USA
| |
Collapse
|
7
|
Lima SF, Pires S, Rupert A, Oguntunmibi S, Jin WB, Marderstein A, Funez-dePagnier G, Maldarelli G, Viladomiu M, Putzel G, Yang W, Tran N, Xiang G, Grier A, Guo CJ, Lukin D, Mandl LA, Scherl EJ, Longman RS. The gut microbiome regulates the clinical efficacy of sulfasalazine therapy for IBD-associated spondyloarthritis. Cell Rep Med 2024; 5:101431. [PMID: 38378002 PMCID: PMC10982976 DOI: 10.1016/j.xcrm.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/28/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Abstract
Sulfasalazine is a prodrug known to be effective for the treatment of inflammatory bowel disease (IBD)-associated peripheral spondyloarthritis (pSpA), but the mechanistic role for the gut microbiome in regulating its clinical efficacy is not well understood. Here, treatment of 22 IBD-pSpA subjects with sulfasalazine identifies clinical responders with a gut microbiome enriched in Faecalibacterium prausnitzii and the capacity for butyrate production. Sulfapyridine promotes butyrate production and transcription of the butyrate synthesis gene but in F. prausnitzii in vitro, which is suppressed by excess folate. Sulfasalazine therapy enhances fecal butyrate production and limits colitis in wild-type and gnotobiotic mice colonized with responder, but not non-responder, microbiomes. F. prausnitzii is sufficient to restore sulfasalazine protection from colitis in gnotobiotic mice colonized with non-responder microbiomes. These findings reveal a mechanistic link between the efficacy of sulfasalazine therapy and the gut microbiome with the potential to guide diagnostic and therapeutic approaches for IBD-pSpA.
Collapse
Affiliation(s)
- Svetlana F Lima
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Silvia Pires
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Amanda Rupert
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Seun Oguntunmibi
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Wen-Bing Jin
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Andrew Marderstein
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gabriela Funez-dePagnier
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Grace Maldarelli
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Monica Viladomiu
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Gregory Putzel
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wei Yang
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Nancy Tran
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Grace Xiang
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Alex Grier
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Chun-Jun Guo
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA
| | - Dana Lukin
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery and Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Ellen J Scherl
- Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
| | - Randy S Longman
- Jill Roberts Institute for Research in IBD, Weill Cornell Medicine, New York, NY 10065, USA; Division of Gastroenterology and Hepatology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; Jill Roberts Center for IBD, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
| |
Collapse
|
8
|
Mandl LA, Lin MA, Gottesman SP, Mich‐Gennari E, Wall N, Nathif A, Ma X, Aizer J. An Online Program for Primary Care Practitioners to Enhance Confidence in Ability to Care for Patients With or at Risk of Painful Knee Osteoarthritis. ACR Open Rheumatol 2024; 6:145-154. [PMID: 38158771 PMCID: PMC10933678 DOI: 10.1002/acr2.11643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Primary care practitioners (PCPs) care for the majority of patients with knee osteoarthritis (KOA). Despite the existing evidence-based guidelines, PCPs often feel unequipped to evaluate and effectively treat patients with KOA. To address this need, we designed and implemented a free internet-based program focusing on the diagnosis and treatment of KOA. We assessed whether the program led to improvements in participants' confidence in their knowledge and skills related to effectively recognizing and caring for patients with or at risk of KOA. METHODS We used Caffarella's integrative model to develop a program aligned with the American College of Rheumatology 2019 Guideline for the treatment of KOA. The program incorporated 18 case-based questions to provide retrieval practice and mastery experiences. We assessed changes in participants' confidence in their KOA knowledge and skills after program completion. RESULTS Of the first 353 learners completing the program, 53.8% were women, 41.9% had a clinical focus in primary care, and 69.1% were nonphysicians. Overall confidence in KOA knowledge and skills improved after program completion (P < 0.001; effect size = 1.28, 95% confidence interval 1.12-1.45), with largest improvements among participants with lower pre-program confidence. A total of 95.8% of participants indicated they would recommend the program to others. CONCLUSION A free online program focusing on the effective care for patients with KOA attracted a wide range of learners, even though it targeted PCPs. Participants overwhelmingly endorsed it as highly relevant and would recommend it to others. Whether improvements in confidence translate into better patient outcomes is an important area for future research.
Collapse
Affiliation(s)
- Lisa A. Mandl
- Hospital for Special Surgery and Weill Cornell MedicineNew YorkNew York
| | | | | | | | - Nicole Wall
- Hospital for Special SurgeryNew YorkNew York
| | - Anan Nathif
- Hospital for Special SurgeryNew YorkNew York
| | | | - Juliet Aizer
- Hospital for Special Surgery and Weill Cornell MedicineNew YorkNew York
| |
Collapse
|
9
|
Cheema H, Brophy R, Collins J, Cox CL, Guermazi A, Kumara M, Levy BA, MacFarlane L, Mandl LA, Marx R, Selzer F, Spindler K, Katz JN, Murray EJ. Causal relationships between pain, medical treatments, and knee osteoarthritis: A graphical causal model to guide analyses. Osteoarthritis Cartilage 2024; 32:319-328. [PMID: 37939895 DOI: 10.1016/j.joca.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/15/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects. We describe a process for synthesizing expert knowledge and apply this to long-term follow-up of an RCT of treatments for meniscal tears in patients with knee osteoarthritis (OA). METHODS We identified 2 post-randomization events likely to impact accurate assessment of pain outcomes beyond 5 years in trial participants: loss to follow-up and total knee replacement (TKR). We conducted literature searches for covariates related to pain and TKR in individuals with knee OA and combined these with expert input. We synthesized the evidence into graphical models. RESULTS We identified 94 potential covariates potentially related to pain and/or TKR among individuals with knee OA. Of these, 46 were identified in the literature review and 48 by expert panelists. We determined that adjustment for 50 covariates may be required to estimate the long-term effects of knee OA treatments on pain. CONCLUSION We present a process for combining literature reviews with expert input to synthesize existing knowledge and improve covariate selection. We apply this process to the long-term follow-up of a randomized trial and show that expert input provides additional information not obtainable from literature reviews alone.
Collapse
Affiliation(s)
- Haadiya Cheema
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Health Sciences, Sargent College, Boston University, Boston, MA, USA
| | - Robert Brophy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jamie Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Charles L Cox
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ali Guermazi
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Mahima Kumara
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA
| | | | - Lindsey MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lisa A Mandl
- Division of Rheumatology and Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Robert Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| |
Collapse
|
10
|
Driscoll DA, Grubel J, Ong J, Chiu YF, Mandl LA, Cushner F, Parks ML, Gonzalez Della Valle A. Obesity Severity Does Not Associate With Rate, Timing, or Invasiveness of Early Reinterventions After Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00182-7. [PMID: 38428689 DOI: 10.1016/j.arth.2024.02.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The use of body mass index (BMI) cutoff values has been suggested for proceeding with total knee arthroplasty (TKA) in obese patients. However, the relationship between obesity severity and early reoperations after TKA is poorly defined. This study evaluated whether increased World Health Organization (WHO) obesity class was associated with risk, severity, and timing of reintervention within one year after TKA. METHODS There were 8,674 patients from our institution who had a BMI ≥ 30 and underwent unilateral TKA for primary osteoarthritis between 2016 and 2021. Patients were grouped by WHO obesity class: 4,456 class I (51.5%), 2,527 class II (29.2%), and 1,677 class III (19.4%). A chart review was performed to determine patient characteristics and identify patients who underwent any closed or open reintervention requiring anesthesia within the first postoperative year. Regression analyses were performed to identify variables associated with increased odds ratios (ORs) for requiring a reintervention, its timing, and invasiveness. RESULTS There were 158 patients (1.8%) who required at least one reintervention, and 15 patients (0.2%) required at least 2 reinterventions. Reintervention rates for obesity classes I, II, and III were 1.8% (n = 81), 2.0% (n = 51), and 1.4% (n = 23), respectively. There were 65 closed procedures (41.1%), 47 minor procedures (29.7%), 34 open with or without liner exchange (21.5%), and 12 revisions with component exchange (7.6%). Obesity class was not associated with reintervention rate (P = .3), timing (P = .36), or invasiveness (P = .93). Diabetes (odds ratio [OR] = 2.47; P = .008) was associated with a need for reintervention. Non-Caucasian race (OR = 1.7; P = .01) and Charlson comorbidity index (OR = 2.1; P = .008) were associated with earlier reintervention. No factors were associated with the invasiveness of reintervention. CONCLUSIONS The WHO obesity class did not associate with rate, timing, or invasiveness of reintervention after TKA in obese patients. These findings suggest that policies that restrict the indication for elective TKA based only on a BMI limit have limited efficacy in reducing early reintervention after TKA in obese patients. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Daniel A Driscoll
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jacqueline Grubel
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Justin Ong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Fred Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael L Parks
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | |
Collapse
|
11
|
Zhou W, Bultman E, Mandl LA, Giori NJ, Kishore SA. Combined genicular artery embolization and genicular nerve block to treat chronic pain following total knee arthroplasty. CVIR Endovasc 2024; 7:4. [PMID: 38170403 PMCID: PMC10764703 DOI: 10.1186/s42155-023-00409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic knee pain after total knee arthroplasty (TKA) is a common complication that is difficult to treat. This report aims to highlight the benefit of combining embolotherapy and neurolysis intervention for symptomatic relief of post-TKA pain in a patient with long-standing pain refractory to conservative management. CASE PRESENTATION A 77-year-old man who had previously undergone left knee arthroplasty has been grappling with worsening knee effusion and debilitating pain, resulting in limited mobility and progressive musculature deconditioning over a 20-year period. Diagnostic arteriography showed marked diffuse periarticular hyperemia around the medial and lateral joint spaces of the left knee, along with capsular distention. The patient initially underwent microsphere embolization to selectively target multiple branches of the genicular arteries, achieving a 50% reduction in pain at the one-month follow-up. Subsequently, the patient underwent image-guided genicular nerve neurolysis, targeting multiple branches of the genicular nerves, which led to further pain reduction (80% compared to the initial presentation or 60% compared to post-embolization) at the one-month follow-up. This improvement facilitated weight-bearing and enabled participation in physical therapy, with sustained pain relief over the 10-month follow-up period. CONCLUSION The combination of genicular artery embolization and genicular nerve block may be a technically safe and effective option for alleviating chronic pain after total knee arthroplasty.
Collapse
Affiliation(s)
- Wenhui Zhou
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
| | - Eric Bultman
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Nicholas J Giori
- Department of Orthopedic Surgery, Stanford University Medical Center, Stanford, CA, USA
- Orthopedic Surgery Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sirish A Kishore
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
- Interventional Radiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| |
Collapse
|
12
|
Barbhaiya M, Schneider B, Levine JM, Bruce O, Do H, Siegel CH, Bykerk VP, Feldman CH, Jannat-Khah D, Mandl LA. Factors Associated With COVID-19 Vaccine Hesitancy in Rheumatology Outpatients in New York City. J Clin Rheumatol 2024; 30:e1-e8. [PMID: 37946323 DOI: 10.1097/rhu.0000000000002041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to measure COVID-19 vaccine hesitancy among rheumatology outpatients from an early COVID-19 "hotspot" during the initial period of vaccine availability. METHODS In March 2021, a Web-based survey was sent to 7505 adults seen at a Rheumatology Division in New York City. We evaluated characteristics associated with 3 categories of COVID-19 vaccination status: declined, undecided, and willing/already received. We used multinomial logistic regression models to calculate relative risk ratios assessing predictors of vaccination status. RESULTS Among 2384 (32%) respondents (80% female, 87% White, 59% with systemic rheumatic disease), 2240 (94.0%) were willing/already received COVID-19 vaccination, 88 (3.7%) were undecided, and 56 (2.3%) declined. Compared with those willing/already vaccinated, those declining or undecided were younger, more likely identified as Black or Hispanic/Latinx, and had lower household income and educational attainment. Immunosuppressive medication use did not differ among groups. After multivariable adjustment, every 1-year increase in age was associated with a 0.96 lower relative risk of declining or being undecided versus willing/already vaccinated. Respondents identifying as Black versus White had a higher relative risk ratio of being undecided (4.29 [95% confidence interval, 1.96-9.36]), as did those identifying as Hispanic/Latinx versus non-Hispanic/non-Latinx (2.81 [95% confidence interval, 1.29-6.09]). Those declining vaccination were least likely to believe in general vaccine importance or the safety and efficacy of the COVID-19 vaccine. CONCLUSIONS Among rheumatology patients in New York City with and without systemic rheumatic disease, COVID-19 vaccine uptake was high after its initial availability. Sociodemographic but not medication-related factors were associated with vaccine hesitancy; these findings can inform future rheumatology vaccination programs.
Collapse
Affiliation(s)
| | | | | | - Omar Bruce
- Hospital for Special Surgery, New York, NY
| | - Huong Do
- Hospital for Special Surgery, New York, NY
| | | | | | - Candace H Feldman
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | |
Collapse
|
13
|
Katz JN, Collins JE, Brophy RH, Cole BJ, Cox CL, Guermazi A, Jones MH, Levy BA, MacFarlane LA, Mandl LA, Marx RG, Selzer F, Spindler KP, Wright RW, Losina E, Chang Y. Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25197. [PMID: 37474452 PMCID: PMC10799184 DOI: 10.1002/acr.25197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Meniscal tear in persons aged ≥45 years is typically managed with physical therapy (PT), and arthroscopic partial meniscectomy (APM) is offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes. METHODS We assessed changes between baseline and 60 months in the Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 years enrolled into a seven-center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed a 60-month change in the OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group. RESULTS We analyzed data from 142 subjects (100 APM, 42 PT). The mean ± SD weighted baseline OARSI radiographic score was 3.8 ± 3.5 in the APM group and 4.0 ± 4.9 in the PT group. OARSI scores increased by a mean of 4.1 (95% confidence interval [95% CI] 3.5-4.7) in the APM group and 2.4 (95% CI 1.7-3.2) in the PT group (P < 0.001) due to changes in the osteophyte component. We did not observe statistically significant differences in the KL grade. Sensitivity analyses yielded similar findings to the primary analysis. CONCLUSION Subjects treated with APM had greater progression in the OARSI score because of osteophyte progression but not in the KL grade. The clinical implications of these findings require investigation.
Collapse
Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert H Brophy
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Ali Guermazi
- Boston Veteran's Medical Center and Boston University Medical Center, Boston, Massachusetts
| | - Morgan H Jones
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
14
|
Kasturi S, Ahearn EL, Batterman A, Horton R, Kleinman J, Rose-Smith J, LeClair AM, Mandl LA. Measuring What Matters: A Qualitative Study of the Relevance and Clinical Utility of PROMIS Surveys in Systemic Lupus Erythematosus. J Rheumatol 2023; 51:jrheum.2023-0184. [PMID: 37399463 PMCID: PMC10757986 DOI: 10.3899/jrheum.2023-0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the relevance and clinical utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys in patients with systemic lupus erythematosus (SLE). METHODS Adults with SLE receiving routine outpatient care at a tertiary care academic medical center participated in a qualitative study. Patients completed PROMIS computerized adaptive tests (CATs) in 12 selected domains and rated the relevance of each domain to their experience with SLE. Focus groups and interviews were conducted to elucidate the relevance of the PROMIS surveys, identify additional domains of importance, and explore the utility of the surveys in clinical care. Focus group and interview transcripts were coded, and a thematic analysis was performed using an iterative inductive process. RESULTS Twenty-eight women and 4 men participated in 4 focus groups and 4 interviews, respectively. Participants endorsed the relevance and comprehensiveness of the selected PROMIS domains in capturing the effect of SLE on their lives. They ranked fatigue, pain interference, sleep disturbance, physical function, and applied cognition abilities as the most salient health-related quality of life (HRQOL) domains. They suggested that the disease-agnostic PROMIS questions holistically captured their lived experience of SLE and its common comorbidities. Participants were enthusiastic about using PROMIS surveys in clinical care and described potential benefits in enabling disease monitoring and management, facilitating communication, and empowering patients. CONCLUSION PROMIS includes the HRQOL domains that are of most importance to individuals with SLE. Patients suggest that these universal tools can holistically capture the impact of SLE and enhance routine clinical care.
Collapse
Affiliation(s)
- Shanthini Kasturi
- S. Kasturi, MD, MS, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Emily L Ahearn
- E.L. Ahearn, BS, Tufts University School of Medicine, Boston, Massachusetts
| | - Adena Batterman
- A. Batterman, MSW, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Roberta Horton
- R. Horton, LCSW, ACSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Juliette Kleinman
- J. Kleinman, LCSW, ACSW, Department of Social Work, Montefiore Health System, Bronx, New York
| | - Jillian Rose-Smith
- J. Rose-Smith, PhD, MPH, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Amy M LeClair
- A.M. LeClair, PhD, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Lisa A Mandl
- L.A. Mandl, MD, MPH, Division of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
15
|
Lieber SB, Nahid M, Navarro-Millán I, Rajan M, Sattui SE, Mandl LA. Frailty and emergency department utilisation in adults with systemic lupus erythematosus ≤65 years of age: an administrative claims data analysis of Medicaid beneficiaries. Lupus Sci Med 2023; 10:e000905. [PMID: 37524516 PMCID: PMC10391790 DOI: 10.1136/lupus-2023-000905] [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: 01/23/2023] [Accepted: 06/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Frailty is a risk factor for adverse health in adults with SLE, including those <65 years. Emergency department (ED) utilisation is high in adults with SLE, but to our knowledge, whether frailty is associated with ED use is unknown. In a large administrative claims dataset, we assessed risk of ED utilisation among frail adults with SLE ≤65 years of age relative to non-frail adults ≤65 years of age with SLE. METHODS Using the MarketScan Medicaid subset from 2011 to 2015, we identified beneficiaries 18-65 years with SLE (≥3 SLE International Classification of Diseases, Ninth Revision codes ≥30 days apart). Comparators without a systemic rheumatic disease (SRD) were matched 4:1 on age and gender. Frailty status in 2011 was determined using two claims-based frailty indices (CFIs). We compared risk of recurrent ED utilisation among frail and non-frail beneficiaries with SLE using an extension of the Cox proportional hazard model for recurrent events data. RESULTS Of 2262 beneficiaries with SLE and 9048 non-SRD comparators, 28.8% and 11.6% were frail, respectively, according to both CFIs. Compared with non-frail beneficiaries with SLE, frail beneficiaries with SLE had significantly higher hazard of recurrent ED use (HR 1.75, 95% CI 1.48 to 2.08). CONCLUSION Frailty increased hazard of recurrent ED visits in frail adults ≤65 years of age with SLE relative to comparable non-frail adults with SLE. Frailty is a potential target for efforts to improve quality of care in SLE.
Collapse
Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Musarrat Nahid
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Iris Navarro-Millán
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Mangala Rajan
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Sebastian E Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
| |
Collapse
|
16
|
Ghomrawi HMK, Riddle DL, Hasan MM, Song J, Kang RH, Mandl LA, Parks ML, Moussa M, Beal M, Russell LA, Mathias JS, Semanik P, Dunlop DD, Franklin PD, Chang RW. Incorporating Expected Outcomes Into Clinical Decision-Making for Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2023; 75:1132-1139. [PMID: 35638705 PMCID: PMC9708948 DOI: 10.1002/acr.24961] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Expected outcomes (e.g., expected survivorship after a cancer treatment) have improved decision-making around treatment options in many clinical fields. Our objective was to evaluate the effect of expected values of 3 widely available total knee arthroplasty (TKA) outcomes (risk of serious complications, time to revision, and improvement in pain and function at 2 years after surgery) on clinical recommendation of TKA. METHODS The RAND/University of California Los Angeles appropriateness criteria method was used to evaluate the role of the 3 expected outcomes in clinical recommendation of TKA. The expected outcomes were added to 5 established preoperative factors from the modified Escobar appropriateness criteria. The 8 indication factors were used to develop 279 clinical scenarios, and a panel of 9 clinicians rated the appropriateness of TKA for each scenario as inappropriate, inconclusive, and appropriate. Classification tree analysis was applied to these ratings to identify the most influential of the 8 factors in discriminating TKA appropriateness classifications. RESULTS Ratings for the 279 appropriateness scenarios deemed 34.4% of the scenarios as appropriate, 40.1% as inconclusive, and 25.5% as inappropriate. Classification tree analyses showed that expected improvement in pain and function and expected time to revision were the most influential factors that discriminated among the TKA appropriateness classification categories. CONCLUSION Our results showed that clinicians would use expected postoperative outcome factors in determining appropriateness for TKA. These results call for further work in this area to incorporate estimates of expected pain/function and revision outcomes into clinical practice to improve decision-making for TKA.
Collapse
Affiliation(s)
| | | | - Mohamed M Hasan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jing Song
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raymond H Kang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lisa A Mandl
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Matthew Beal
- Hughston Clinic Orthopedics, Nashville, Tennessee
| | | | - Jason S Mathias
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Dorothy D Dunlop
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Rowland W Chang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
17
|
Katz JN, Collins JE, Jones M, Spindler KP, Marx RG, Mandl LA, Levy BA, Wright R, Jarraya M, Guermazi A, MacFarlane LA, Losina E, Chang Y. Association Between Structural Change Over Eighteen Months and Subsequent Symptom Change in Middle-Aged Patients Treated for Meniscal Tear. Arthritis Care Res (Hoboken) 2023; 75:340-347. [PMID: 34606692 PMCID: PMC8977396 DOI: 10.1002/acr.24796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/24/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Middle-aged subjects with meniscal tear treated with arthroscopic partial meniscectomy (APM) experience greater progression of damage to joint structures on imaging than subjects treated nonoperatively. It is unclear whether these changes are clinically relevant. The goal of this study was to assess whether worsening in magnetic resonance imaging (MRI)-assessed tissue damage over 18 months leads to subsequent worsening in knee pain over the subsequent 3.5 years. METHODS We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of APM versus physical therapy for subjects ages ≥45 years with knee pain, cartilage damage, and meniscal tear. We assessed whether change in cartilage surface area damage score (and other structural measures) from baseline to 18 months, assessed on MRI with the MRI Osteoarthritis Knee Score (MOAKS) system, was associated with change in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (range 0-100; 100 = worst) from 18 to 60 months. RESULTS The primary analysis included 168 subjects with complete MRI data at baseline and 18 months and KOOS data at 18 and 60 months. We did not observe clinically important associations between change in cartilage surface area score between baseline and 18 months and change in pain scores from 18 to 60 months. Pain scores in the worst tertile for cartilage surface area damage score progression worsened by 0.45 points more than in the best tertile (95% confidence interval -4.45, 5.35). Similarly, we did not observe clinically important associations between changes in bone marrow lesions, osteophytes, or synovitis and subsequent pain. CONCLUSION We did not observe clinically important associations between early changes in cartilage damage and other structural measures and worsening in pain over the subsequent 3.5 years. Further follow-up is required to assess this association over a longer follow-up period.
Collapse
Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York
| | | | - Rick Wright
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
18
|
Lieber SB, Nahid M, Rajan M, Barbhaiya M, Sammaritano L, Lipschultz RA, Lin M, Reid MC, Mandl LA. Association of Baseline Frailty with Patient-Reported Outcomes in Systemic Lupus Erythematosus at 1 Year. J Frailty Aging 2023; 12:247-251. [PMID: 37493387 PMCID: PMC11012234 DOI: 10.14283/jfa.2023.24] [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] [Indexed: 07/27/2023]
Abstract
The relationship of baseline frailty with subsequent patient-reported outcomes in systemic lupus erythematosus (SLE) remains unclear. We assessed these associations in a pilot prospective cohort study. Frailty based on the FRAIL scale and the Fried phenotype and patient-reported outcomes, namely Patient Reported Outcomes Measurement Information System computerized adaptive tests and Valued Life Activities disability, were measured at baseline and 1 year among women aged 18-70 years with SLE enrolled at a single center. Differences in Patient Reported Outcomes Measurement Information System computerized adaptive tests between frail and non-frail participants were evaluated using Wilcoxon rank sum tests, and the association of baseline frailty with self-report disability at 1 year was estimated using linear regression. Of 51 participants, 24% (FRAIL scale) and 16% (Fried phenotype) met criteria for frailty at baseline despite median age of 55.0 and 56.0 years, respectively. Women with (versus without) baseline frailty using either measure had worse 1-year Patient Reported Outcomes Measurement Information System computerized adaptive test scores across multiple domains and greater self-report disability. Baseline frailty was significantly associated with self-report disability at 1 year (FRAIL scale: parameter estimate 0.55, 95% confidence interval (CI) 0.21-0.89, p<0.01; Fried phenotype: parameter estimate 0.61, 95% CI 0.22-1.00, p<0.01), including only slight attenuation after adjustment for SLE cumulative organ damage (FRAIL scale: parameter estimate 0.45, 95% CI 0.09-0.81, p=0.02; Fried phenotype: parameter estimate 0.49, 95% CI 0.09-0.90, p=0.02). These preliminary findings support frailty as an independent risk factor for clinically relevant patient-reported outcomes, including disability onset, among women with SLE.
Collapse
Affiliation(s)
- S B Lieber
- Sarah B. Lieber, MD, MS, Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, Phone (212)606-1935, Fax (212) 606-1519, , ORCID ID: 0000-0002-6176-9740
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Siegel CH, Choi JM, D'Angelo D, Christos P, Lally L, Navarro-Millan I, Cooke J, Goyal P, Mandl LA, Barbhaiya M. Outcomes of COVID-19 and Factors Associated With Its Severity Among Hospitalized Patients With and Without Systemic Rheumatic Disease During the First Wave of the Pandemic in New York City. J Clin Rheumatol 2023; 29:7-15. [PMID: 35905465 PMCID: PMC9803346 DOI: 10.1097/rhu.0000000000001891] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Conflicting data exist regarding whether patients with systemic rheumatic disease (SRD) experience more severe outcomes related to COVID-19. Using data from adult patients hospitalized with COVID-19 in New York City during the first wave of the pandemic, we evaluated whether patients with SRD were at an increased risk for severe outcomes. METHODS We conducted a medical records review study including patients aged ≥18 years with confirmed SARS-CoV-2 infection hospitalized at 3 NewYork-Presbyterian sites, March 3-May 15, 2020. Inverse probability of treatment weighting was applied to a multivariable logistic regression model to assess the association between SRD status and the composite of mechanical ventilation, intensive care unit admission, or death. RESULTS Of 3710 patients hospitalized with COVID-19 (mean [SD] age, 63.7 [17.0] years; 41% female, 29% White, and 34% Hispanic/Latinx), 92 (2.5%) had SRD. Patients with SRD had similar age and body mass index but were more likely to be female, ever smokers, and White or Black, compared with those without SRD. A higher proportion of patients with versus without SRD had hypertension and pulmonary disease, and used hydroxychloroquine, corticosteroids, and immunomodulatory/immunosuppressive medications before admission. In the weighted multivariable analysis, patients with SRD had an odds ratio of 1.24 (95% confidence interval, 1.10-1.41; p < 0.01) for the composite of mechanical ventilation, intensive care unit admission, or death, compared with patients without SRD. CONCLUSIONS During the initial peak of the pandemic in New York City, patients with versus without SRD hospitalized with COVID-19 had a 24% increased likelihood of having severe COVID-19 after multivariable adjustment.
Collapse
Affiliation(s)
- Caroline H. Siegel
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Jacky M. Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Lindsay Lally
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Iris Navarro-Millan
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medicine
- Department of Medicine, NewYork-Presbyterian/Queens, Queens, NY
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine
| | - Lisa A. Mandl
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Medha Barbhaiya
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| |
Collapse
|
20
|
Aizer J, Abramson EL, Berman JR, Paget SA, Frey MB, Cooley V, Li Y, Hoffman KL, Schell JA, Tiongson MD, Lin MA, Mandl LA. An Instrument for Measuring Critical Appraisal Self-Efficacy in Rheumatology Trainees. ACR Open Rheumatol 2023; 5:4-9. [PMID: 36317552 PMCID: PMC9837389 DOI: 10.1002/acr2.11505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Self-efficacy, the internal belief that one can perform a specific task successfully, influences behavior. To promote critical appraisal of medical literature, rheumatology training programs should foster both competence and self-efficacy for critical appraisal. This study aimed to investigate whether select items from the Clinical Research Appraisal Inventory (CRAI), an instrument measuring clinical research self-efficacy, could be used to measure critical appraisal self-efficacy (CASE). METHODS One hundred twenty-five trainees from 33 rheumatology programs were sent a questionnaire that included two sections of the CRAI. Six CRAI items relevant to CASE were identified a priori; responses generated a CASE score (total score range 0-10; higher = greater confidence in one's ability to perform a specific task successfully). CASE scores' internal structure and relation to domain-concordant variables were analyzed. RESULTS Questionnaires were completed by 112 of 125 (89.6%) trainees. CASE scores ranged from 0.5 to 8.2. The six CRAI items contributing to the CASE score demonstrated high internal consistency (Cronbach's α = 0.95) and unidimensionality. Criterion validity was supported by the findings that participants with higher CASE scores rated their epidemiology and biostatistics understanding higher than that of peers (P < 0.0001) and were more likely to report referring to studies to answer clinical questions (odds ratio 2.47, 95% confidence interval 1.41-4.33; P = 0.002). The correlation of CASE scores with percentage of questions answered correctly was only moderate, supporting discriminant validity. CONCLUSION The six-item CASE instrument demonstrated content validity, internal consistency, discriminative capability, and criterion validity, including correlation with self-reported behavior, supporting its potential as a useful measure of critical appraisal self-efficacy.
Collapse
Affiliation(s)
- Juliet Aizer
- Weill Cornell Medicine and Hospital for Special SurgeryNew YorkNew York
| | | | - Jessica R. Berman
- Weill Cornell Medicine and Hospital for Special SurgeryNew YorkNew York
| | - Stephen A. Paget
- Weill Cornell Medicine and Hospital for Special SurgeryNew YorkNew York
| | - Marianna B. Frey
- University of Rochester School of Medicine and DentistryRochesterNew York
| | | | - Ying Li
- Weill Cornell MedicineNew YorkNew York
| | | | - Julie A. Schell
- The University of Texas at Austin, and Harvard UniversityCambridgeMassachusetts
| | | | | | - Lisa A. Mandl
- Weill Cornell Medicine and Hospital for Special SurgeryNew YorkNew York
| |
Collapse
|
21
|
Kasturi S, Price LL, LeClair A, Patel N, Shetty S, Sheira D, Weber S, Curtis D, Nowell WB, Salmon J, Terrin N, McAlindon TE, Mandl LA. Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study. Rheumatology (Oxford) 2022; 61:4763-4774. [PMID: 35357445 PMCID: PMC9707322 DOI: 10.1093/rheumatology/keac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
Collapse
Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University
- Institute for Clinical Research and Health Policy Studies
| | - Amy LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Neena Patel
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Shreya Shetty
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Dina Sheira
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
| | - Serena Weber
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | | | | | - Jane Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University
| | | | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
22
|
Sattui SE, Jannat-Khah D, Lally L, Lieber SB, Mandl LA, Spiera RF. Prevalence of frailty in patients with polymyalgia rheumatica and association with health-related quality of life, cognition and sarcopenia. Rheumatology (Oxford) 2022; 61:4455-4464. [PMID: 35136992 PMCID: PMC9629413 DOI: 10.1093/rheumatology/keac050] [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: 09/07/2021] [Revised: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the prevalence of frailty in a single-centre cohort of patients with PMR and describe its association with health-related quality of life (HRQoL), cognition and sarcopenia. METHODS This was a cross-sectional study of patients with PMR, according to 2012 EULAR/ACR Classification Criteria, presenting within 12 months of diagnosis and on treatment with glucocorticoids. Frailty was defined according to the Fried frailty criteria. HRQoL was assessed using Patient-Reported Outcomes Measurement Information System Computerized Adaptive Test (PROMIS-CAT) and cognition was assessed using the Mini-Mental State Examination. Sarcopenia was measured by DXA. RESULTS Forty-one patients were enrolled. Prevalence of frailty and pre-frailty was 17% and 59%, respectively. Frail patients had higher inflammatory markers at diagnosis compared with pre-frail and robust patients. Of 27 patients with DXA results, 26% were sarcopenic. Frail patients had worse physical function, and more pain behaviour and interference compared with pre-frail and robust patients. In univariable analyses, frail patients were more likely to have worse physical function, and more pain behaviour and pain interference, which remained significant after adjusting for age. There were no significant associations between cognition or sarcopenia and frailty. CONCLUSIONS In this cohort of PMR patients, there was a higher prevalence of frailty and pre-frailty compared with that reported in community-dwelling elderly. Frailty was associated with worse physical function, and increased pain behaviour and pain interference, differences that were also clinically meaningful. Larger prospective studies are needed to confirm these findings and analyse the association of frailty with other PMR disease outcomes.
Collapse
Affiliation(s)
- Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deanna Jannat-Khah
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lindsay Lally
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Robert F Spiera
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
23
|
Debbi EM, Krell EC, Sapountzis N, Joseph AD, Gonzalez Della Valle A, Chiu YF, Lyman S, Mandl LA. Predicting Postdischarge Opioid Consumption After Total Hip and Knee Arthroplasty in the Opioid Naïve Patient. J Arthroplasty 2022; 37:e14. [PMID: 36229158 DOI: 10.1016/j.arth.2022.07.025] [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: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Eytan M Debbi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ethan C Krell
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Nicolas Sapountzis
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Amethia D Joseph
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Stephen Lyman
- Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| |
Collapse
|
24
|
Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. J Arthroplasty 2022; 37:1676-1683. [PMID: 35732511 DOI: 10.1016/j.arth.2022.05.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To develop updated American College of Rheumatology/American Association of Hip and Knee Surgeons guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
Collapse
Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
| |
Collapse
|
25
|
Barbhaiya M, Frey MB, Levine J, Vitone G, Lally L, Lockshin MD, Bykerk V, Feldman CH, Mandl LA. Modification of immunomodulatory medications by rheumatology patients during the peak of the COVID-19 pandemic in New York City. Clin Rheumatol 2022; 41:2597-2599. [PMID: 35596096 PMCID: PMC9122542 DOI: 10.1007/s10067-022-06203-1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Medha Barbhaiya
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY USA
| | | | | | | | - Lindsay Lally
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Michael D. Lockshin
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Lisa A. Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY USA
| |
Collapse
|
26
|
Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Rheumatol 2022; 74:1464-1473. [PMID: 35722708 DOI: 10.1002/art.42140] [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: 02/09/2022] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
Collapse
Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
| |
Collapse
|
27
|
Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2022; 74:1399-1408. [PMID: 35718887 DOI: 10.1002/acr.24893] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
Collapse
Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
| |
Collapse
|
28
|
Collins JE, Shrestha S, Losina E, Marx RG, Guermazi A, Jarraya M, Jones MH, Levy BA, Mandl LA, Williams EE, Wright RW, Spindler KP, Katz JN. Five-Year Structural Changes in Patients with Meniscal Tear and Osteoarthritis: Data from an RCT of Arthroscopic Partial Meniscectomy vs. Physical Therapy. Arthritis Rheumatol 2022; 74:1333-1342. [PMID: 35245416 PMCID: PMC9339455 DOI: 10.1002/art.42105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/12/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Data from long-term follow-up of several randomized controlled trials (RCTs) of arthroscopic partial meniscectomy (APM) vs. non-operative therapy or sham have suggested that APM may be associated with increased risk of worsening in radiographic features of osteoarthritis (OA). Our objective was to estimate the risk of MRI-based OA structural changes using baseline, 18-month, and 60-month MRI data from an RCT of APM vs. physical therapy in participants with meniscal tear and OA. METHODS We used data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical change in joint structure. Analyses assessed change from baseline to 18 months and 18-to-60 months. We performed both intention-to-treat and as-treated analyses. RESULTS The analytic sample included 302 participants. For both treatment groups, more change was seen over the earlier (baseline - 18 months) interval than the later interval. APM was associated with increased risk of any worsening in cartilage surface area damage score (relative risk 1.35, 95% CI 1.14-1.61), osteophytes, and effusion-synovitis over the earlier time period. Only change in osteophytes was significantly different between treatment groups in the later time period. CONCLUSION These findings suggest the association between APM and MRI-based changes is most apparent in the 18 months after surgery. The reason for the attenuation of this association over longer follow-up merits further investigation.
Collapse
Affiliation(s)
- Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Swastina Shrestha
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Boston University School of Public Health, Boston, MA
| | - Robert G Marx
- Department of Orthopaedic Surgery, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA
| | - Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Morgan H Jones
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Lisa A Mandl
- Department of Medicine, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Emma E Williams
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | |
Collapse
|
29
|
Schwartzman M, Abutalib Z, Mandl LA. Current Medication Practices and Preferences Among Patients With Psoriatic Arthritis. J Clin Rheumatol 2022; 28:55-61. [PMID: 35192589 PMCID: PMC8887780 DOI: 10.1097/rhu.0000000000001799] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate real-world psoriatic arthritis (PsA) medication use and patient medication preferences. METHODS This is a cross-sectional survey of Classification for Psoriatic Arthritis criteria defined PsA patients recruited from a single-center PsA registry from June to September 2020. Preferences were ranked on a 5-point Likert scale ranging from "not at all important" to "extremely important." RESULTS One hundred thirty-seven patients (29%) responded. The median duration (years) of PsA skin and joint symptoms was 19 (interquartile range, 10-34) and 12 (interquartile range, 8-21), respectively. The most common initial immunomodulatory medications were anti-tumor necrosis factor α (35%), methotrexate (19%), and anti-phosphodiesterase 4 (anti-PDE4) (12.4%). At survey administration, the most common immunomodulatory therapies were anti-tumor necrosis factor α (30%), anti-interleukin 17 (IL-17) (20.4%), and methotrexate (10.2%). After 2018, when updated guidelines from the American College of Rheumatology/National Psoriasis Foundation were published, a significantly higher percentage of patients' first medication was an anti-IL-17 compared with 2018 or earlier (30% vs 3.5%, p < 0.001), a pattern also seen with anti-PDE4 (40% vs 11.5%, p < 0.012). Medication preferences most ranked as "extremely" important were prevention of joint damage (80%), ability to perform daily activities (71%), prevention of pain (70.1%), rheumatologist recommendation (63%), and medication adverse effects (62%). CONCLUSIONS The significant increase of anti-IL-17 and anti-PDE4 medications as initial treatment after 2018 may reflect their inclusion as potential initial therapy in updated guidelines, along with the importance placed by patients on medication adverse effects. Given the expanding armamentarium of PsA medications, it is increasingly important to align patient preferences and therapeutic options to ensure durable use of effective therapy.
Collapse
|
30
|
Berkowitz JL, Mandl LA, Burge AJ, Roberts JA, Lin B, Schwartzman S, Carrino JA. MRI Assessment of Sacroiliitis With High-Resolution Protocol. HSS J 2022; 18:91-97. [PMID: 35087338 PMCID: PMC8753538 DOI: 10.1177/15563316211006710] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 02/03/2023]
Abstract
Background: Sacroiliac (SI) joint subchondral resorption on high-resolution magnetic resonance imaging (MRI) may be an early sign of the development of sacroiliitis. At our institution, high-resolution intermediate-weighted (proton density) MRI sequences are used in the workup of suspected spondyloarthritis (SpA). Questions/Purpose: We sought to test the hypothesis that SI joint subchondral resorption might be a useful MRI feature in the diagnosis of sacroiliitis. Methods: We retrospectively reviewed the records of patients with suspected SpA from a single rheumatologist's practice from January 1, 2010, to December 31, 2017. Patients had an MRI of the SI joints, using our institution's specialized protocol, and underwent standard physical examination and laboratory evaluation. The sensitivity and specificity of SI joint subchondral resorption in the identification of sacroiliitis were estimated using the clinical diagnosis as the reference standard and from a Bayesian latent class model with conditional dependence. Results: SI joint subchondral resorption on SI joint MRI was highly correlated with a positive diagnosis in patients worked up for axial SpA. It demonstrated superior sensitivity when compared with other MRI features used in the MRI diagnosis of sacroiliitis, such as bone marrow edema pattern, erosion, and ankylosis. Interobserver reliability was high for subchondral resorption. Conclusion: This retrospective study found that subchondral resorption on MRI evaluation of the SI joints appeared to be a sensitive indicator of SpA, potentially of early disease. This imaging feature warrants evaluation in other cohorts of patients suspected of having axial SpA to validate diagnostic performance in diverse populations.
Collapse
Affiliation(s)
- Jennifer L. Berkowitz
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Lisa A. Mandl
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA,Lisa A. Mandl, MD, MPH, Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY 10021, USA.
| | - Alissa J. Burge
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - John A. Roberts
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Bin Lin
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Sergio Schwartzman
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - John A. Carrino
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
31
|
Barbhaiya M, Levine JM, Bykerk VP, Mandl LA. Immunomodulatory and immunosuppressive medication modification among patients with rheumatic diseases at the time of COVID-19 vaccination. Lancet Rheumatol 2022; 4:e85-e87. [PMID: 34901886 PMCID: PMC8651251 DOI: 10.1016/s2665-9913(21)00372-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Medha Barbhaiya
- Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jonah M Levine
- Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
| | - Vivian P Bykerk
- Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
32
|
Lieber SB, Navarro-Millán I, Rajan M, Curtis JR, Sattui SE, Lui G, Schwartzman S, Mandl LA. Prevalence of Frailty in Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis: Data from a National Claims Dataset. ACR Open Rheumatol 2022; 4:300-305. [PMID: 34989169 PMCID: PMC8992466 DOI: 10.1002/acr2.11388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Frailty is associated with disability and mortality independent of age. Although studies have evaluated frailty in rheumatoid arthritis (RA), information on the prevalence of frailty in ankylosing spondylitis (AS) and psoriatic arthritis (PsA) is limited. We aimed to determine the prevalence of frailty in AS and PsA and to evaluate whether characteristics known to be associated with frailty, including anxiety, differ among these three types of inflammatory arthritis. METHODS We performed a cross sectional study of Centers for Medicare & Medicaid Services (CMS) beneficiaries aged 65 years or older with AS, PsA, or RA enrolled in 2014. We operationalized frailty using a validated claims-based frailty index. We also explored the prevalence of frailty among CMS beneficiaries younger than age 65 years with work disability, a younger population that also may be at risk of frailty. RESULTS The prevalence of frailty in beneficiaries aged 65 years or older with AS and PsA was 45.2% and 46.7%, respectively, significantly lower than in RA (65.9%, P < 0.05). The prevalence of frailty in beneficiaries less than 65 years old was much lower overall, though still highest in RA; 11.7%, 4.4%, and 7.0% in RA, AS, and PsA, respectively (P < 0.05). Anxiety was significantly associated with frailty in subjects of all ages, particularly among those less than 65 years old (P < 0.05). CONCLUSION Almost half of beneficiaries with AS or PsA aged 65 years old or older were frail, higher than in younger disabled beneficiaries. Further studies are needed to understand the risks of developing frailty in these diseases. Frailty was associated with anxiety, particularly in the younger age groups.
Collapse
Affiliation(s)
- Sarah B Lieber
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medicine, New York, New York
| | - Iris Navarro-Millán
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medicine, New York, New York
| | | | | | | | - Geyanne Lui
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Sergio Schwartzman
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medicine, New York, New York
| | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medicine, New York, New York
| |
Collapse
|
33
|
Kahlenberg CA, Gibbons JAB, Jannat-Khah DP, Goodman SM, Mandl LA, Sculco PK, Goodman SB, Figgie MP, Mehta BY. Use of Total Hip Arthroplasty in Patients Under 21 Years Old: A US Population Analysis. J Arthroplasty 2021; 36:3928-3933.e1. [PMID: 34456091 DOI: 10.1016/j.arth.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/03/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate trends in the use of total hip arthroplasty (THA) in the United States in patients under 21 years of age. Specifically, we examined the frequency of THA in this patient population over the past 2 decades, the epidemiologic characteristics of patients under 21 who underwent THA, and the characteristics of the hospitals where these procedures were performed. METHODS We retrospectively reviewed the Kids' Inpatient Database, an inpatient US national weighted sample of hospital admissions in patients under 21 from approximately 4200 hospitals in 46 states. We queried the database using Current Procedural Terminology codes for elective and non-elective primary THA for the years 2000-2016. We utilized the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes to determine primary diagnoses. RESULTS The weighted total number of THAs performed in patients under 21 in the Kids' Inpatient Database increased from 347 in 2000 to 551 in 2016. The most common diagnoses were osteonecrosis, osteoarthritis, and inflammatory arthritis. The frequency of THA for osteonecrosis increased from 24% in 2000 to 38% in 2016, while the frequency of THA for inflammatory arthritis decreased from 27% in 2000 to 4% in 2016. CONCLUSION The number of THAs in patients under 21 in the United States has increased over the past 2 decades and these procedures are increasingly performed in urban teaching hospitals. The decrease in THA for inflammatory arthritis in this population likely reflects improvements in medical management during the study period.
Collapse
Affiliation(s)
| | - J Alex B Gibbons
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY
| | - Deanna P Jannat-Khah
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Susan M Goodman
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Peter K Sculco
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Mark P Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Bella Y Mehta
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
34
|
Kishore S, Sheira D, Malin ML, Trost DW, Mandl LA. Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic Review of Indications, Safety, and Efficacy. ACR Open Rheumatol 2021; 4:209-217. [PMID: 34842365 PMCID: PMC8916547 DOI: 10.1002/acr2.11383] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/19/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Objective The study objective was to evaluate the safety and efficacy of transcatheter arterial “embolization” (TAE) in the treatment of chronic “musculoskeletal pain” refractory to standard therapy. Methods PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for original research articles evaluating TAE in patients with musculoskeletal conditions from database inception to January 21, 2020. Search terms employed were as follows: “embolization”, “pain”, “knee osteoarthritis”, joint replacement, epicondylitis, tenderness, inflammation, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), microspheres, Embozene, geniculate artery, neovascularity, transcatheter, embolic, imipenem/cilastatin sodium, angiogenesis, and “musculoskeletal”. Studies involving particle “embolization” for painful musculoskeletal conditions were included. Studies of TAE for hemarthrosis or malignancy‐related “musculoskeletal pain” were excluded. Results The primary search yielded 1,099 sources; 7 articles and 4 abstracts were included for data extraction. All were cohorts or case series, with low risk of bias and moderate to poor level of evidence. Heterogeneity between studies was high, precluding meta‐analysis. The reviewed studies reported the safety and efficacy of TAE for the treatment of “knee osteoarthritis”; adhesive capsulitis of the shoulder; tendinopathy/enthesopathy of the knee, shoulder, elbow, and ankle; and cervical myalgia. All TAEs were reported as technically successful without major complications or subsequent serious adverse events, including no reported osteonecrosis, cutaneous ulceration, limb ischemia, cartilage degeneration, or myotendinous injury. TAE significantly reduced pain and improved function for all of the treated conditions, with durable response up to 24 months post procedure. Conclusion TAE appears to be a safe and effective treatment for some types of chronic refractory “musculoskeletal pain”. Randomized placebo‐controlled studies are necessary to confirm these findings.
Collapse
Affiliation(s)
- SirishA Kishore
- Palo Alto Veterans Affairs Healthcare System, Palo Alto, California.,Department of Radiology, Stanford University, Palo Alto, California.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dina Sheira
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | | | - David W Trost
- Department of Radiology, Weill Cornell Medicine, New York, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
35
|
Lieber SB, Nahid M, Paget S, Berman JR, Barbhaiya M, Sammaritano LR, Kirou K, Carrino JA, Rajan M, Sheira D, Mandl LA. Evaluation of a Patient-reported Frailty Tool in Women With Systemic Lupus Erythematosus. J Rheumatol 2021; 49:60-67. [PMID: 34470795 DOI: 10.3899/jrheum.201466] [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] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Frailty is associated with mortality in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We aimed to compare 2 frailty metrics, the self-reported Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale (FS) and the Fried phenotype (FP), in SLE to evaluate differences between frail and nonfrail women and whether frailty is associated with self-reported disability. METHODS Adult women aged < 70 years with validated SLE and mild/moderate disease enrolled in this cross-sectional study between August 2018 and October 2019. Correlation and agreement between the FS and the FP were determined. Differences in sociodemographic and disease characteristics, patient-reported outcome measures (PROMs), and biomarkers between frail and nonfrail participants were evaluated, as well as the association of frailty with Valued Life Activities disability. RESULTS Of 67 participants, 27% and 18% were frail according to the FS and the FP, respectively. Correlation (r = 0.51; P < 0.0001) and agreement (κ = 0.46; P = 0.0004) between the FS and the FP were significant. Frail women had greater disease damage, high-sensitivity C-reactive protein, and interleukin 6, and worse PROMs according to both frailty definitions. Both frailty measures were associated with self-reported disability after adjustment for age, comorbidity, and disease activity and damage; this relationship was attenuated for the FP. CONCLUSION Frailty prevalence was high in this cohort of women with SLE using both frailty definitions, suggesting that frailty may be accelerated in women with SLE, particularly when based exclusively on self-report. Frailty remained associated with self-reported disability in adjusted analyses. The FS may be an informative point-of-care tool to identify frail women with SLE.
Collapse
Affiliation(s)
- Sarah B Lieber
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Musarrat Nahid
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Stephen Paget
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Jessica R Berman
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Medha Barbhaiya
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa R Sammaritano
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Kyriakos Kirou
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - John A Carrino
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Mangala Rajan
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Dina Sheira
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| | - Lisa A Mandl
- This work was supported by a Scientist Development Award from the Rheumatology Research Foundation and a Michael D. Lockshin Fellowship from the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number UL1TR002384. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. S.B. Lieber, MD, MS, Assistant Professor, S. Paget, MD, Professor, J.R. Berman, MD, Associate Professor, M. Barbhaiya, MD, MPH, Assistant Professor, L.R. Sammaritano, MD, Professor, K. Kirou, MD, Associate Professor, J.A. Carrino, MD, MPH, Professor, L.A. Mandl, MD, MPH, Assistant Research Professor, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York; M. Nahid, MSc, M. Rajan, MBA, Research Associate, Weill Cornell Medicine, New York, New York; 3D. Sheira, BA, Stanford School of Medicine, Palo Alto, California, USA. JAC declares the following conflicts of interest: Covera Health, Image Analysis Group, Image Biopsy Lab, Pfizer, Simplify Medical, and the Arthritis & Rheumatology and Osteoarthritis Imaging journals. LAM declares the following conflicts of interest: Regeneron Pharmaceuticals. All other authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.B. Lieber, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. . Accepted for publication August 17, 2021
| |
Collapse
|
36
|
Mehta B, Brantner C, Williams N, Szymonifka J, Navarro-Millan I, Mandl LA, Bass AR, Russell LA, Parks ML, Figgie MP, Nguyen JT, Ibrahim S, Goodman SM. Primary Care Provider Density and Elective Total Joint Replacement Outcomes. Arthroplast Today 2021; 10:73-78. [PMID: 34527799 PMCID: PMC8430425 DOI: 10.1016/j.artd.2021.05.010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/29/2021] [Accepted: 05/15/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes. METHODS We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years. Using geocoding, we identified the number of PCPs in the patient's census tract (communities). We used Augmented Inverse Probability Weighting and Cross-validated Targeted Minimum Loss-Based Estimation to compare provider density and outcomes adjusting for potential confounders. RESULTS Our sample included 3606 TKA and 4295 THA cases. The median number of PCPs in each community was similar for both procedures: TKA 2 (interquartile range 1, 6) and for THA 2 (interquartile range 1, 7). Baseline and 2-year follow-up WOMAC pain, function, and stiffness scores were not statistically significantly different comparing communities with more than median number of PCPs to those with less than median number of PCPs. In sensitivity analyses, adding 1 PCP to a community with zero PCPs would not have statistically significantly improved baseline or 2-year follow-up WOMAC pain, function, and stiffness scores. CONCLUSIONS In this sample of patients who underwent elective TKA or THA for osteoarthritis, we found no statistically significant association between PCP density and pain, function, or stiffness outcomes at baseline or 2 years. Further studies should examine what other provider factors affect access and outcomes in THA and TKA.
Collapse
Affiliation(s)
- Bella Mehta
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Collin Brantner
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Nicholas Williams
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Jackie Szymonifka
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Iris Navarro-Millan
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A. Mandl
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Anne R. Bass
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Linda A. Russell
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael L. Parks
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Mark P. Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Joseph T. Nguyen
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Susan M. Goodman
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
37
|
Kasturi S, Price LL, Paushkin V, Salmon JE, McAlindon TE, Mandl LA. Impact of the first wave of the COVID-19 pandemic on systemic lupus erythematosus patients: Results from a multi-center prospective cohort. Lupus 2021; 30:1747-1755. [PMID: 34284676 DOI: 10.1177/09612033211033981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the initial impact of the COVID-19 pandemic on individuals with systemic lupus erythematosus (SLE). METHODS Patients with SLE participating in a multi-center longitudinal cohort study in New York and Boston were invited to complete a supplemental web-based questionnaire in the summer of 2020. Participants completed standardized patient-reported outcome (PRO) measures and a combination of Likert scale and open-ended questions exploring the impact of the COVID-19 pandemic on their health and access to health care. Changes in PROs were evaluated with paired t-tests and frequencies of worsened symptoms were calculated. A thematic qualitative analysis was conducted on free text responses. RESULTS Of 97 patients invited, 63 (65%) completed a supplemental questionnaire. Nearly 50% of respondents exhibited increases in anxiety (47.5%) and depression (48.3%) and over 40% scored worse in measures of pain interference, fatigue, and cognitive abilities. Respondents with pre-existing diagnoses of anxiety did not differ from other participants in PRO scores, but were more than three times as likely to report worsened health status. Patients denied difficulties accessing medications (85%) or medical care (84%) and over 50% participated in telehealth visits. Anxiety and increased health risks due to immunosuppression were recurring themes in free text responses. CONCLUSIONS SLE patients experienced a significant physical and emotional toll in the initial months of the COVID-19 pandemic. Comprehensive patient-centered care, including monitoring and addressing anxiety and health-related quality of life, is critical to improving health outcomes in this population during the ongoing health crisis.
Collapse
Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Lori Lyn Price
- Institute of Clinical Research and Health Policy Studies, 1867Tufts Medical Center, Tufts Medical Center, Boston, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA
| | - Vasilissa Paushkin
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Jane E Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, USA
| |
Collapse
|
38
|
Barbhaiya M, Stamm B, Vitone G, Frey MB, Jannat-Khah D, Levine J, Vega J, Feldman CH, Salmon JE, Crow MK, Bykerk V, Lockshin MD, Sammaritano L, Mandl LA. Pregnancy and Rheumatic Disease: Experience at a Single Center in New York City During the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2021; 73:1004-1012. [PMID: 33342085 DOI: 10.1002/acr.24547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The present study was undertaken to evaluate the pregnancy experiences of women receiving care in the division of rheumatology at a major academic center in New York City during the COVID-19 pandemic. METHODS A web-based COVID-19 survey was emailed to 26,045 patients who were followed in the division of rheumatology at a single center in New York City. Women ages 18-50 years were asked about their pregnancy. We compared the COVID-19 experience between pregnant and nonpregnant women and also explored the impact of the pandemic on prenatal care and perinatal outcomes. RESULTS Among 7,094 of the 26,045 respondents, 1,547 were women ages 18-50 years, with 61 (4%) reporting being pregnant during the pandemic. The prevalence of self-reported COVID-19 was similar in pregnant and nonpregnant women (8% versus 9%, respectively; P = 0.76). Among women with COVID-19, pregnant women had a shorter duration of symptoms (P < 0.01) and were more likely to experience loss of smell or taste (P = 0.02) than nonpregnant women. Approximately three-fourths of women had a systemic rheumatic disease, with no differences when stratified by pregnancy or COVID-19 status. In all, 67% of pregnant women noted changes to prenatal care during the pandemic, and 23% of postpartum women stated that the pandemic affected delivery. CONCLUSION Among women followed in the division of rheumatology at a major center in New York City, pregnancy was not associated with increased self-reported COVID-19. Pregnancy was associated with a shorter duration of COVID-19 symptoms and a higher prevalence of loss of smell or taste. The COVID-19 pandemic impacted prenatal care for the majority of pregnant patients.
Collapse
Affiliation(s)
- Medha Barbhaiya
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Bessie Stamm
- Hospital for Special Surgery, New York, New York
| | | | | | - Deanna Jannat-Khah
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Jonah Levine
- Hospital for Special Surgery, New York, New York
| | - JoAnn Vega
- Hospital for Special Surgery, New York, New York
| | - Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Mary K Crow
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Vivian Bykerk
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa Sammaritano
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa A Mandl
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
39
|
Bass AR, Do HT, Mehta B, Lyman S, Mirza SZ, Parks M, Figgie M, Mandl LA, Goodman SM. Assessment of Racial Disparities in the Risks of Septic and Aseptic Revision Total Knee Replacements. JAMA Netw Open 2021; 4:e2117581. [PMID: 34287631 PMCID: PMC8295735 DOI: 10.1001/jamanetworkopen.2021.17581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Black patients are at higher risk of revision total knee replacement (TKR) than White patients, but whether racial disparities exist for both septic and aseptic revision TKR and the reason for any disparities are unknown. OBJECTIVE To assess the risk of septic and aseptic revision TKR in Black and White patients and to examine interactions among race and socioeconomic and hospital-related variables that are associated with revision TKR risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study included residents of New York, California, and Florida who underwent TKR. Patient-level data were obtained from the New York Statewide Planning and Research Cooperative System, California's Office of Statewide Health Planning and Development Patient Discharge Database, and Florida's Healthcare Utilization Project State Inpatient Database from January 1, 2004, to December 31, 2014. Community characteristics were calculated from the US Census and linked to discharges by patient zip code. American Hospital Association Annual Survey data were linked to discharges using hospital identifiers. The analyses were performed from March 1 to October 30, 2020, with subsequent analyses in April 2021. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression modeling was used to measure the association of race with septic and aseptic revision TKR. RESULTS A total of 722 492 patients underwent primary TKR, of whom 445 616 (61.68%) were female and 61 092 (8.46%) were Black. Black patients were at higher risk of septic (hazard ratio [HR], 1.11; 95% CI, 1.03-1.20) and aseptic (HR, 1.39; 95% CI, 1.33-1.46) revision TKR compared with White patients. Other risk factors for septic revision TKR were diabetes (HR, 1.24; 95% CI, 1.17-1.30), obesity (HR, 1.13; 95% CI, 1.17-1.30), kidney disease (HR, 1.42; 95% CI, 1.29-1.57), chronic obstructive pulmonary disease (HR, 1.22; 95% CI, 1.15-1.30), inflammatory arthritis (HR, 1.53; 95% CI, 1.39-1.69), surgical site complications during the index TKR (HR, 2.19; 95% CI, 1.87-2.56), Medicaid insurance (HR, 1.17; 95% CI, 1.04-1.31), and low annual TKR volume at the hospital where the index TKR was performed (HR, 1.54; 95% CI, 1.41-1.68). Risk factors for aseptic revision TKR were male sex (HR, 1.03; 95% CI, 1.00-1.06), workers' compensation insurance (HR, 1.61; 95% CI, 1.51-1.72), and low hospital TKR volume (HR, 1.14; 95% CI, 1.07-1.22). Patients with obesity had a lower risk of aseptic TKR revision (HR, 0.81; 95% CI, 0.77-0.84). In an analysis within each category of hospital TKR volume, the HR for aseptic revision among Black vs White patients was 1.20 (95% CI, 1.04-1.37) at very-low-volume hospitals (≤89 TKRs annually) compared with 1.68 (95% CI, 1.48-1.90) at very-high-volume hospitals (≥645 TKRs annually). CONCLUSIONS AND RELEVANCE In this cohort study, Black patients were at significantly higher risk of aseptic revision TKR and, to a lesser extent, septic revision TKR compared with White patients. Racial disparities in aseptic revision risk were greatest at hospitals with very high TKR volumes.
Collapse
Affiliation(s)
- Anne R. Bass
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Division of Rheumatology, Weill Cornell Medicine, New York, New York
| | - Huong T. Do
- Research Administration, Hospital for Special Surgery, New York, New York
| | - Bella Mehta
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Division of Rheumatology, Weill Cornell Medicine, New York, New York
| | - Stephen Lyman
- Research Division, Hospital for Special Surgery, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Medical Education Department, Kyushu University School of Medicine, Fukuoka, Japan
| | - Serene Z. Mirza
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Touro College of Osteopathic Medicine, New York, New York
| | - Michael Parks
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, New York
| | - Lisa A. Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Division of Rheumatology, Weill Cornell Medicine, New York, New York
| | - Susan M. Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Division of Rheumatology, Weill Cornell Medicine, New York, New York
| |
Collapse
|
40
|
Barbhaiya M, Levine JM, Bykerk VP, Jannat-Khah D, Mandl LA. Systemic rheumatic disease flares after SARS-CoV-2 vaccination among rheumatology outpatients in New York City. Ann Rheum Dis 2021; 80:1352-1354. [PMID: 34158370 DOI: 10.1136/annrheumdis-2021-220732] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Medha Barbhaiya
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA .,Department of Medicine and Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Vivian P Bykerk
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Deanna Jannat-Khah
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine and Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
41
|
Trachtman R, Wang CM, Murray E, Szymonifka J, Pan N, Adams AB, Taber SF, Onel KB, Mandl LA. PROMIS Computer Adaptive Tests and Their Correlation With Disease Activity in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:131-135. [PMID: 31743268 PMCID: PMC10364139 DOI: 10.1097/rhu.0000000000001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND/OBJECTIVE The importance of patient-reported outcomes, like the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, is increasingly recognized both in clinical care and in research. While "short forms" have been studied in juvenile idiopathic arthritis (JIA), study of PROMIS computer adaptive tests (CATs) in JIA is limited. This cross-sectional study evaluates whether PROMIS CATs correlate with disease activity in patients with JIA. METHODS A convenience sample of patients with JIA (N = 44) was recruited from a single center. Patients and parents completed pediatric and parent proxy PROMIS CATs. Disease activity was evaluated using the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) and the Childhood Health Assessment Questionnaire (CHAQ). Correlation of the CAT T scores with disease activity was assessed using Spearman correlation coefficients. RESULTS Forty-four of 80 eligible subjects (29 patients and 15 parents) completed all or some PROMIS CATs. Pain interference and mobility CATs correlated moderately with JADAS-71. Nearly all correlations with the JADAS-71 were weakened when the patient global was removed. Pain interference, mobility, and fatigue were strongly correlated with the CHAQ. Among parent proxy CATs, only mobility and depressive symptoms correlated strongly with the CHAQ. CONCLUSIONS Only pain interference and mobility PROMIS CATs showed strong correlation with standard disease activity measures in JIA, and nearly all correlations were weakened when the patient global was removed. Correlations of the CATs with the CHAQ were stronger than correlations with the JADAS-71, indicating that although the CHAQ is no longer routinely used it may be a better measure of health-related quality of life in routine clinical care.
Collapse
Affiliation(s)
| | | | | | | | - Nancy Pan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Alexa B. Adams
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sarah F. Taber
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Karen B. Onel
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Lisa A. Mandl
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| |
Collapse
|
42
|
Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, Potter HG, Trost DW. Genicular Artery Embolization for Refractory Hemarthrosis following Total Knee Arthroplasty: Technique, Safety, Efficacy, and Patient-Reported Outcomes. J Vasc Interv Radiol 2021; 32:1128-1135. [PMID: 33961990 DOI: 10.1016/j.jvir.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/22/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of genicular artery embolization for treatment of refractory hemarthrosis following total knee arthroplasty. MATERIAL AND METHODS Patients who underwent genicular artery embolization with spherical embolics between January 2010 and March 2020 at a single institution were included if they had undergone total knee arthroplasty and subsequently experienced recurrent hemarthrosis. Technical success was defined as the significant reduction or elimination of the hyperemic blush. Clinical success was defined as the absence of clinical evidence of further hemarthrosis. Clinical follow-up was performed 7-14 days after the procedure and at 3-month intervals thereafter via a telephone interview. A total of 117 embolizations, comprising 82 initial, 28 first repeat, and 7 second repeat, were performed. RESULTS An average of 2.5 arteries was treated per procedure. The superior lateral genicular artery was the most frequently embolized. The most utilized embolic size was 100-300 μm. Follow-up was available for all patients, with a median duration of 21.5 months. 65.9%, 25.6%, and 8.5% of patients underwent 1, 2, and 3 treatments, respectively. Complications occurred following 12.8% of treatments, of which the most common was transient cutaneous ischemia. Technical success was achieved in all cases. Clinical success was achieved in 56%, 79%, and 85% of patients following the first, second, and third treatment, respectively. 83% of patients reported being either satisfied or very satisfied with the overall result. CONCLUSIONS Targeted genicular artery embolization with spherical embolics is an effective treatment for recurrent hemarthrosis with infrequent serious complications. Repeat embolization should be considered in cases of recurrence following initial therapy.
Collapse
Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York.
| | - Sirish A Kishore
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bradford S Waddell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jacqueline Kesler
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Lisa A Mandl
- Department of Medicine, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - David W Trost
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
43
|
Duculan R, Jannat-Khah D, Mehta B, Mandl LA, Barbhaiya M, Bass AR, Mancuso CA. Variables Associated With Perceived Risk of Contracting SARS-CoV-2 Infection During the COVID-19 Pandemic Among Patients With Systemic Rheumatic Diseases. J Clin Rheumatol 2021; 27:120-126. [PMID: 33264246 DOI: 10.1097/rhu.0000000000001686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess patients' perceived risk of contracting SARS-CoV-2 at the peak of the pandemic in NYC in terms of their systemic rheumatic disease and medications. METHODS With the approval of their rheumatologists, patients were interviewed by telephone and were asked about their perceived risk of contracting SARS-CoV-2 considering their rheumatic condition and whether medications increased this risk. Patients also completed surveys assessing beliefs about medication and multidimensions of physical/mental well-being. Information about current medications and rheumatologist-initiated changes in medications during the pandemic were reported by patients and verified from medical records. RESULTS One hundred twelve patients (86% women; mean age, 50 years; 81% White, 15% Latino) with diverse diagnoses were enrolled. Fifty-four percent thought they were at "very much greater risk" of COVID-19 because of their rheumatic condition, and 57% thought medications "definitely" put them at greater risk. In multivariable analysis, the perception of "very much greater risk" was associated with greater belief that rheumatic disease medications were necessary, worse physical function, chronic pulmonary comorbidity, and more anxiety. In a separate model, the perception that medications "definitely" caused greater risk was associated with White race, not taking hydroxychloroquine, rheumatologists initiating change in medications, more anxiety, and taking biologics and corticosteroids. CONCLUSIONS Patients' perceived increased risk of contracting SARS-CoV-2 was associated with beliefs about their rheumatic disease, medications, comorbidity, and anxiety. Clinicians should be aware of patients' perceptions and foster self-management practices that will alleviate anxiety, minimize exposure to the virus, and optimize systemic rheumatic disease outcomes.
Collapse
|
44
|
Trachtman R, Murray E, Wang CM, Szymonifka J, Toussi SS, Walters H, Nellis ME, Onel KB, Mandl LA. Procalcitonin Differs in Children With Infection and Children With Disease Flares in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:87-91. [PMID: 31693652 PMCID: PMC10364140 DOI: 10.1097/rhu.0000000000001170] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with juvenile idiopathic arthritis (JIA) often present with signs and symptoms suggestive of serious bacterial infection (SBI). Procalcitonin (PCT) is a biomarker that is elevated in SBI. We conducted a comparative cohort study to test the hypothesis that PCT levels will differ between active JIA, quiescent JIA, and bacteremic patients and healthy controls. METHODS From October 2016 to May2018, consecutive children 6 months to 18 years of age with (a) active untreated JIA, (b) quiescent JIA, and (c) healthy elective presurgical candidates were recruited from clinics at a musculoskeletal specialty hospital. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Clinical data and serum samples meeting the same criteria were included from a prior study. Consecutive bacteremic patients were identified over the same period. Procalcitonin and other common measures of inflammation were measured. Descriptive statistics and univariate logistic analyses were performed. RESULTS Ninety-two study subjects were recruited. Erythrocyte sedimentation rate, C-reactive protein (CRP), and PCT levels were all elevated in bacteremic patients in comparison to the other groups. Erythrocyte sedimentation rate and CRP both had wide ranges that overlapped between groups; however, the PCT concentration was 0.15 μg/mL or greater in 1 of 59 patients with JIA, whereas it was 0.15 μg/mL or less in only 1 bacteremic patient. CONCLUSIONS Our study indicates that serum erythrocyte sedimentation rate, CRP, and PCT levels are all biomarkers that can be used to distinguish SBI versus active JIA at presentation. However, PCT is the most accurate, with the least overlap between patients with infection and noninfectious inflammatory arthritis. This finding can help clinicians direct therapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Karen B. Onel
- Hospital for Special Surgery
- Weill Cornell Medicine, New York
| | - Lisa A. Mandl
- Hospital for Special Surgery
- Northwell Health, Lake Success, NY
| |
Collapse
|
45
|
MacFarlane LA, Yang H, Collins JE, Brophy RH, Cole BJ, Spindler KP, Guermazi A, Jones MH, Mandl LA, Martin S, Marx RG, Levy BA, Stuart M, Safran-Norton C, Wright J, Wright RW, Losina E, Katz JN. Association Between Baseline "Meniscal symptoms" and Outcomes of Operative and Non-Operative Treatment of Meniscal Tear in Patients with Osteoarthritis. Arthritis Care Res (Hoboken) 2021; 74:1384-1390. [PMID: 33650303 PMCID: PMC8408275 DOI: 10.1002/acr.24588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/06/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Patients with meniscal tears reporting "meniscal symptoms" such as catching or locking, have traditionally undergone arthroscopy. We investigated whether patients with meniscal tears who report "meniscal symptoms" have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT). METHODS We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each "meniscal symptom" (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6-months. We used linear regression models to determine whether the difference in improvement in KOOS Pain at 6-months between those treated with APM versus PT was modified by the presence of each "meniscal symptom". We also determined the percent of participants with resolution of "meniscal symptoms" by treatment group. RESULTS We included 287 participants. The presence (vs. absence) of any of the "meniscal symptoms" did not modify the improvement in KOOS Pain between APM vs. PT by more than 0.5 SD (all p-interaction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% vs 46%, clicking 41% vs 25%). No difference in resolution of the other "meniscal symptoms" was observed. CONCLUSION "Meniscal symptoms" were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of "meniscal symptoms" in isolation should not inform clinical decisions surrounding APM vs. PT in patients with meniscal tear and knee OA.
Collapse
Affiliation(s)
- Lindsey A MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Heidi Yang
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Robert H Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University, Chicago, Illinois, United States
| | - Kurt P Spindler
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Ali Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Morgan H Jones
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Scott Martin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Robert G Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Michael Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Clare Safran-Norton
- Department of Physical Therapy, Brigham and Women's Hospital, Boston, MA, United States
| | - John Wright
- Johnson& Johnson, Raynham, Massachusetts, United States
| | - Rick W Wright
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| |
Collapse
|
46
|
Malik F, Scherl E, Weber U, Carrino JA, Epsten M, Wichuk S, Pedersen SJ, Paschke J, Schwartzman S, Kroeber G, Maksymowych WP, Longman R, Mandl LA. Utility of magnetic resonance imaging in Crohn's associated sacroiliitis: A cross-sectional study. Int J Rheum Dis 2021; 24:582-590. [PMID: 33528900 DOI: 10.1111/1756-185x.14081] [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: 06/29/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Prevalence of sacroiliitis in Crohn's disease (CD) is variable depending on defining criteria. This study utilized standardized sacroiliac joint (SIJ) magnetic resonance imaging (MRI) to identify sacroiliitis in CD patients and its association with clinical and serological markers. METHODS Consecutive adult subjects with CD prospectively enrolled from an inflammatory bowel disease clinic underwent SIJ MRI. Data collected included CD duration, history of joint/back pain, human leukocyte antigen-B27 status, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index, Harvey Bradshaw Index (HBI) for activity of CD, Ankylosing Spondylitis Disease Activity Score, and various serologic markers of inflammation. Three blinded readers reviewed MRIs for active and structural lesions according to the Spondyloarthritis Research Consortium of Canada modules. RESULTS Thirty-three CD patients were enrolled: 76% female, 80% White, median age 36.4 years (interquartile range 27.2-49.0), moderate CD activity (mean HBI 8.8 ± SD 4.5). Nineteen subjects (58%) reported any back pain, 13 of whom had inflammatory back pain. Four subjects (12%) showed sacroiliitis using global approach and 6 (18%) met Assessment of SpondyloArthritis international Society MRI criteria of sacroiliitis. Older age (mean 51.2 ± SD 12.5 vs. 37.2 ± 14; P = .04), history of dactylitis (50.0% vs. 3.4%, P = .03) and worse BASMI (4.1 ± 0.7 vs. 2.4 ± 0.8, P ≤ .001) were associated with MRI sacroiliitis; no serologic measure was associated. CONCLUSION There were 12%-18% of CD patients who had MRI evidence of sacroiliitis, which was not associated with back pain, CD activity or serologic measures. This data suggests that MRI is a useful modality to identify subclinical sacroiliitis in CD patients.
Collapse
Affiliation(s)
- Fardina Malik
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Ellen Scherl
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | | | | | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Georg Kroeber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Walter P Maksymowych
- University of Alberta, Edmonton, AB, Canada.,CARE Arthritis, Edmonton, AB, Canada
| | - Randy Longman
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
47
|
Aizer J, Schell JA, Frey MB, Tiongson MD, Mandl LA. Learning to Critically Appraise Rheumatic Disease Literature: Educational Opportunities During Training and into Practice. Rheum Dis Clin North Am 2021; 46:85-102. [PMID: 31757289 DOI: 10.1016/j.rdc.2019.09.006] [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] [Indexed: 11/25/2022]
Abstract
To provide optimal patient care, rheumatologists must be equipped and motivated to critically appraise the literature. The conceptual frameworks Retrieval Enhanced Learning, Self-Determination Theory, and Communities of Practice can inform the design of educational approaches to promote critical appraisal in practice. HSS CLASS-Rheum® is a learning tool that can be used to help rheumatologists learn skills for critical appraisal through retrieval practice. Combining retrieval practice with opportunities for connection through Peer Instruction, journal clubs, and other forums can help support engagement and internalization of motivation, promoting persistence with critical appraisal in practice.
Collapse
Affiliation(s)
- Juliet Aizer
- Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Julie A Schell
- School of Design and Creative Technologies, College of Education, Dual Appointment, The University of Texas at Austin, Office of Strategy and Policy, 405 West 25th Street, Stop F0900, Austin, TX 78705, USA; Associate with Mazur Group, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Marianna B Frey
- Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | | - Lisa A Mandl
- Rheumatology, Weill Cornell Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| |
Collapse
|
48
|
Sattui SE, Rajan M, Lieber SB, Lui G, Sterling M, Curtis JR, Mandl LA, Navarro-Millán I. Association of cardiovascular disease and traditional cardiovascular risk factors with the incidence of dementia among patients with rheumatoid arthritis. Semin Arthritis Rheum 2021; 51:292-298. [PMID: 33433365 DOI: 10.1016/j.semarthrit.2020.09.022] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the incidence of dementia in patients with rheumatoid arthritis (RA) 65 years and older, and compare the incidence of dementia in patients with RA with prevalent cardiovascular (CV) disease (CVD), CV risk factors but no prevalent CVD and neither (referent group). METHODS We analyzed claims data from the Center for Medicare & Medicaid Services (CMS) from 2006-2014. Eligibility criteria included continuous medical and pharmacy coverage for ≥ 12 months (baseline period 2006), > 2 RA diagnoses by a rheumatologist and at least 1 medication for RA. CVD and CV risk factors were identified using codes from the Chronic Condition Data Warehouse. Incident dementia was defined by 1 inpatient or 2 outpatient claims, or one dementia specific medication. Age-adjusted incident rates were calculated within each age strata. Univariate and multivariate Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals. RESULTS Among 56,567 patients with RA, 11,789 (20.1%) incident cases of dementia were included in the main analysis. Age adjusted incident rates were high among all groups and increased with age. After adjustment for age, sex, comorbidities and baseline CV and RA medications, patients with CVD and CV risk factors between 65 and 74 years had an increased risk for incident dementia compared to those without CVD and without CV risk factors (HR 1.18 (95% CI 1.04-1.33) and HR 1.03 (95% CI 1.00-1.11), respectively). We observed a trend towards increased risk in patients between 75 and 84 years with CVD at baseline. CONCLUSION Patients with RA with both CVD and CV risk factors alone are at an increased risk for dementia compared to those with neither CVD nor CV risk factors; however, this risk is attenuated with increasing age. The impact of RA treatment and CV primary prevention strategies in the prevention of dementia in patients with RA warrants further studies.
Collapse
Affiliation(s)
- Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States; Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Geyanne Lui
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Madeline Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States; Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Iris Navarro-Millán
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States.
| |
Collapse
|
49
|
Kasturi S, Wong JB, Mandl LA, McAlindon TE, LeClair A. "Unspoken Questions": A Qualitative Study of Rheumatologists' Perspectives on the Clinical Implementation of Patient-reported Outcome Measures. J Rheumatol 2020; 47:1822-1830. [PMID: 32611667 DOI: 10.3899/jrheum.200232] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify rheumatologists' views on perceived barriers and facilitators to the clinical implementation of patient-reported outcome measures (PROM). METHODS Semistructured interviews were conducted with academically affiliated clinical rheumatologists. Interviews were audio-recorded and transcribed. Deidentified transcripts were independently coded and analyzed for themes. RESULTS Fifteen attending rheumatologists, 8 women (53%) and 7 men (47%) with a mean of 17.3 years in practice (range 5-43) at 2 urban academic medical centers, participated in interviews. Rheumatologists identified several barriers to integrating PROM in clinical care, highlighting physician buy-in and culture change as significant challenges beyond logistical considerations. They further underscored the lack of effective interventions and resources for addressing the domains of most interest to patients. Physicians also recognized significant benefits of PROM in clinical care, including contributing to the clinical impression by providing the patient perspective, and promoting agenda setting by uncovering "unspoken questions." They additionally noted that PROM could support treatment planning, build patient-physician relationships, and facilitate patient engagement. Participants suggested that technology, physician education, and team-based care could facilitate the effective implementation of PROM. CONCLUSION Rheumatologists identified multiple mechanisms through which PROM could augment clinical care, but also noted several obstacles to implementation, questioning the added value of PROM and the limited availability of interventions to improve patient-centered outcomes. Programs seeking to successfully integrate PROM to enhance patient-centered care and meet quality benchmarks should prioritize physician buy-in and training, and provide resources to address the outcomes that are measured.
Collapse
Affiliation(s)
- Shanthini Kasturi
- S. Kasturi, MD, MS, T.E. McAlindon, MD, MPH, Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, Massachusetts;
| | - John B Wong
- J.B. Wong, MD, Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
| | - Lisa A Mandl
- L.A. Mandl, MD, MPH, Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Timothy E McAlindon
- S. Kasturi, MD, MS, T.E. McAlindon, MD, MPH, Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Amy LeClair
- A.LeClair, PhD, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
50
|
Mandl LA, Sasaki M, Yang J, Choi S, Cummings K, Goodman SM. Incidence and Risk of Severe Ileus After Orthopedic Surgery: A Case-Control Study. HSS J 2020; 16:272-279. [PMID: 33376458 PMCID: PMC7749875 DOI: 10.1007/s11420-019-09712-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-operative ileus (POI) is common and can be associated with significant morbidity. QUESTIONS/PURPOSES We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. METHODS We conducted a retrospective case-control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. RESULTS Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. CONCLUSIONS In this retrospective case-control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.
Collapse
Affiliation(s)
- Lisa A. Mandl
- Department of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10021 USA
| | - Mayu Sasaki
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Jingyan Yang
- Department of Biostatistics and Epidemiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Sara Choi
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Kelianne Cummings
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Susan M. Goodman
- Department of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10021 USA
| |
Collapse
|