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Coronavirus disease 2019 (COVID-19) vaccine uptake among individuals with rheumatic conditions remains low despite heightened risk for related adverse outcomes. This is especially pronounced among historically marginalized populations who suffered disproportionately from the COVID-19 pandemic. Among the myriad of reasons for low vaccine uptake, mistrust in the healthcare system, misinformation related to the vaccine development process, fear of rheumatic disease flares, and inconsistent physician recommendations, are highlighted. Two randomized controlled trials are underway leveraging multimodal strategies and community partnerships to disseminate COVID-19 vaccine information, reduce hesitancy and hopefully improve vaccine uptake, particularly in marginalized communities., Competing Interests: Disclosure Dr N. Ezeh and Ms T. Boadi have no disclosures. Dr M.I. Danila: Research grants: NIH (P30 AR072583, P50 AR060772, R01 AI153365, R01 AR065493, R01 AR080784) Pfizer, Radius–sums paid to the Institution. Associate Editor for Arthritis Care and Research. Speaker fees <10k. Hospital for special surgery, UT Southwestern, Cedars Sinai, RheumNow. Dr R. Ramsey-Goldman: Research Grants: NIH (R01AR071091, R01 AR080089, R01 AI170938, P30AR072579, R21AI171491); DOD, United States (W81XWWH2010692); MUSC18-053-8D365; LuCIN subcontract; MP-CPI-21 to 005 OMH (subcontracts with ACR, LFA, University of Alabama); NU58DP0069080100 (subcontract with ACR); PCORI no number (subcontract with University of Alabama, Birmingham), Consulting, Honoraria, Speaking fees (all <10K): State University of New York, Syracuse; Merck; Biogen; Cabaletta; Exagen Diagnostics; Duke University, Ampel Solutions, Clarivate, Upstart Research Consulting, AstraZeneca, Georgetown University. Chair, Collaborative Initiatives Special Committee (COIN) American College of Rheumatology. Dr C.H. Feldman: Research Grants: NIH, United States (1OT2HL161841, 1P30AG064199-03, R01AR080089, 30AR072577, R03AR083661, R01MD019235, R01AR074290), the Bristol Myers Squibb Foundation, United States, the Arthritis Foundation, United States, Brigham and Women’s Hospital Health Equity Innovation Pilot. Consulting: Harvard Pilgrim, OM1, Inc., Bain Capital, LP, the American College of Rheumatology, the Lupus Foundation of America, and the University of Alabama. Speaker honorarium (<10K) from University of Texas Southwestern, University of Alabama at Birmingham, Hospital for Special Surgery, University of Washington. Conference travel reimbursement from RLITE Foundation, the Rheumatology Research Foundation, and EULAR. Associate Editor for Lupus Science and Medicine, Editorial Board for Arthritis Care and Research and Medical-Scientific Advisory Board Member for the Lupus Foundation of America. Member of the American College of Rheumatology Diversity, Equity and Inclusion Committee and the Climate Change Task Force., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Rheumatoid arthritis (RA) is an inflammatory arthritis in which the immune system targets synovial joints. Methotrexate serves as the mainstay of treatment for RA due to its efficacy. However, patients treated with methotrexate are uniquely at risk for vitamin B12 deficiency and hyperhomocysteinemia due to coincident disease risk factors and the fact that methotrexate use is associated with malabsorption. The objective of this study was to assess for vitamin B12 deficiency among patients with RA treated with methotrexate and folic acid., Methods: This cross-sectional study included 50 patients with RA treated with methotrexate and folic acid and 49 patients with RA treated with other therapies. Patients were matched by age, sex, race, renal function, and disease activity. We compared plasma vitamin B12, methylmalonic acid, and homocysteine levels between these two groups utilizing quantitative and categorical analyses., Results: Thirty-seven (74%) RA patients on methotrexate and folic acid had elevated plasma homocysteine levels compared with only 27 (55%) RA patients receiving other therapies (P < 0.05). The proportion of patients with low vitamin B12 and high methylmalonic acid levels did not differ between the two groups., Conclusions: Our data show high plasma homocysteine levels among RA patients treated with methotrexate and folic acid. While plasma vitamin B12 levels were similar between the two groups, high plasma homocysteine is also a sensitive marker of vitamin B12 deficiency. Additional studies should evaluate for the presence of clinical features of vitamin B12 deficiency and hyperhomocysteinemia among RA patients treated with methotrexate and folic acid., Competing Interests: Declaration of competing interest Dr. Maria Danila: Pfizer: Research grants UCB: Consultant, ad hoc advisory board, (Published by Elsevier Inc.)

Background: Little is known about satisfaction with different modes of telemedicine delivery. The objective of this study was to determine whether patient satisfaction with phone-only was noninferior to video visits., Methods: We conducted a parallel group, randomized (1:1), single-blind, noninferiority trial in multispecialty clinics at a tertiary academic medical center. Adults age ≥ 60 years or with Medicare/Medicaid insurance were eligible. Primary outcome was visit satisfaction rate (9 or 10 on a 0-10 satisfaction scale). Noninferiority was determined if satisfaction with phone-only (intervention) versus video visits (comparator) was no worse by a -15% prespecified noninferiority margin. We performed modified intent-to-treat (mITT) and per protocol analyses, after adjusting for age and insurance., Results: 200 participants, 43% Black, 68% women completed surveys. Visit satisfaction rates were high. In the mITT analysis, phone-only visits were noninferior by an adjusted difference of 3.2% (95% CI, -7.6% to 14%). In the per protocol analysis, phone-only were noninferior by an adjusted difference of -4.1% (95% CI, -14.8% to 6.6%). The proportion of participants who indicated they preferred the same type of telemedicine visit as their next clinic visit were similar (30.2% vs 27.9% video vs phone-only, p = 0.78) and a majority said their medical concerns were addressed and would recommend a telemedicine visit., Conclusions: Among a group of diverse, established older or underserved patients, the satisfaction rate for phone-only was noninferior to video visits. These findings could impact practice and policies governing telemedicine., Competing Interests: Declaration of Competing Interests The authors do not have any conflict of interest to disclose related to this work., (Published by Elsevier Inc.)

Purpose: There is a critical need for genomic medicine research that reflects and benefits socioeconomically and ancestrally diverse populations. However, disparities in research populations persist, highlighting that traditional study designs and materials may be insufficient or inaccessible to all groups. New approaches can be gained through collaborations with patient/community stakeholders. Although some benefits of stakeholder engagement are recognized, routine incorporation into the design and implementation of genomics research has yet to be realized., Methods: The National Institutes of Health-funded Clinical Sequencing Evidence-Generating Research (CSER) consortium required stakeholder engagement as a dedicated project component. Each CSER project planned and carried out stakeholder engagement activities with differing goals and expected outcomes. Examples were curated from each project to highlight engagement strategies and outcomes throughout the research lifecycle from development through dissemination., Results: Projects tailored strategies to individual study needs, logistical constraints, and other challenges. Lessons learned include starting early with engagement efforts across project stakeholder groups and planned flexibility to enable adaptations throughout the project lifecycle., Conclusion: Each CSER project used more than 1 approach to engage with relevant stakeholders, resulting in numerous adaptations and tremendous value added throughout the full research lifecycle. Incorporation of community stakeholder insight improves the outcomes and relevance of genomic medicine research., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Osteoporosis medication use is suboptimal. Simple interventions personalized to a patients' stage of readiness are needed to encourage osteoporosis medication use., Objectives: To estimate interrelationships of sociodemographic factors, perceived fracture risk, health literacy, receipt of medication information, medication trust and readiness to use osteoporosis medication; and apply observed relationships to inform design specifications for a clinical decision support application that can be used for personalized patient counseling., Methods: Data from a national sample of older women (n = 1759) with self-reported history of fractures and no current use of osteoporosis medication treatment were used to estimate an acceptable path model that describes associations among key sociodemographic characteristics, health literacy, perceived fracture risk, receipt of osteoporosis medication information within the past year, trust in osteoporosis medications, and readiness to use osteoporosis medication. Path model results were used to inform an application for personalized patient counseling that can be easily integrated into clinical decision support systems., Results: Increased age (β = 0.13), trust for medications (β = 0.12), higher perceived fracture risk (β = 0.21), and having received medication information within the past year (β = 0.21) were all positively associated with readiness to use osteoporosis medication (p < 0.0001). Whereas, health literacy (β = -0.09) was inversely associated with readiness to use osteoporosis medication (p < 0.0001). Using these results, a brief 6-item question set was constructed for simple integration into clinical decision support applications. Patient responses were used to inform a provider dashboard that integrates a patient's stage of readiness for osteoporosis medication use, predictors of readiness, and personalized counseling points appropriate to their stage of readiness., Conclusion: Content of counseling strategies must be aligned with a patient's stage of readiness to use treatment. Path modeling can be effectively used to identify factors for inclusion in an evidenced-based clinical decision support application designed to assist providers with personalized patient counseling and osteoporosis medication use decisions., (Copyright © 2020 Elsevier Inc. All rights reserved.)