515 results on '"Michael M. Ward"'
Search Results
2. Repeated Spinal Mobility Measures and Their Association With Radiographic Damage in Ankylosing Spondylitis
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Mark C. Hwang, MinJae Lee, Lianne S. Gensler, Michael M. Ward, Matthew A. Brown, Thomas J. Learch, Amirali Tahanan, Mohammad H. Rahbar, Mariko Ishimori, Michael H. Weisman, John D. Reveille, and the PSOAS Study Investigators
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Diseases of the musculoskeletal system ,RC925-935 - Abstract
Objective We sought to explore the relationship between changes in repeated mobility measures and spinal structural progression in patients with ankylosing spondylitis (AS) over time. Methods We studied patients with AS from the PSOAS (Prospective Study of Outcomes in AS) cohort and performed longitudinal multivariable regression modeling to assess the relationship of structural damage measured by their regional (cervical or lumbar) modified Stoke AS Spinal Score(mSASSS) and selected cervical (eg, cervical rotation, lateral bending, and occiput‐to‐wall distance) and lumbar spinal mobility measures (eg, Schöber’s test and lumbar lateral bending) that were collected at least every 2 years from 2003 to 2019. Results The median length of follow‐up for our 518 patients with cervical mSASSS measurements and 573 with lumbar mSASSS measurements was 4.08 (interquartile range [IQR] 2.25‐6.67) and 4.17 (IQR 2.25‐6.67) years, respectively. Among the mobility measures, based on multivariable regression models adjusting for clinical/demographic variables and C‐reactive protein, we did not observe meaningful associations between changes in spinal mobility with their respective regional mSASSS. Baseline mSASSS, male sex, increased C‐reactive protein (CRP), and longer disease duration were associated with increased longitudinal mSASSS in all analyses. Conclusion Our study shows that 2‐year changes in individual spinal mobility measures are not reliably associated with increased, longitudinal, AS‐related spinal structural progression. We also confirmed the relationship of baseline mSASSS, sex, CRP, and disease duration with AS‐related structural spinal progression over time.
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- 2021
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3. Circulating TNF-like protein 1A (TL1A) is elevated early in rheumatoid arthritis and depends on TNF
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Yun-Jeong Song, In Ah. Choi, Françoise Meylan, M. Kristen Demoruelle, Taylor Farley, Arianne C. Richard, Eric Hawley, John Botson, Yoo Jin Hong, Eun Young Lee, Sabina R. Mian, Bartlett C. Hamilton, Geoffrey M. Thiele, Ted R. Mikuls, Naveen Gara, Chris D. Ward, Sarah Lamberth, Kevin D. Deane, Theo Heller, Michael M. Ward, David M. Lee, Thi-Sau Migone, William Stohl, James R. O’Dell, Jill M. Norris, V. Michael Holers, Peter Gregersen, Yeong-Wook Song, and Richard M. Siegel
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Rheumatoid arthritis ,Cytokines ,Tumor necrosis factor-like cytokine 1A ,TNFSF15 ,Collagen-induced arthritis ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background The tumor necrosis factor (TNF) superfamily cytokine TNF-like protein 1A (TL1A) and its receptor DR3 are essential for diverse animal models of autoimmune disease and may be pathogenic in rheumatoid arthritis (RA). However, the relationship of TL1A to disease duration, activity, and response to anti-TNF and other therapies in RA is not clear. Methods We measured soluble TL1A in synovial fluid (SF), serum, or plasma from RA first-degree relatives (FDRs) and in early RA and established disease. We measured the effects of anti-TNF and methotrexate (MTX) therapy on circulating TL1A from multiple independent RA treatment trials. We also determined the ability of a blocking anti-TL1A antibody to inhibit clinical disease and articular bone destruction in the murine collagen-induced arthritis (CIA) model of human RA. Results Soluble TL1A was specifically elevated in the blood and SF of patients with RA compared to patients with other diseases and was elevated early in disease and in at-risk anti-cyclic citrullinated peptide (CCP) (+) first-degree relatives (FDRs). Therapeutic TNF inhibition reduced serum TL1A in both responders and non-responders, whereas TL1A declined following MTX treatment only in responders. In murine CIA, TL1A blockade was clinically efficacious and reduced bone erosions. Conclusions TL1A is specifically elevated in RA from early in the disease course and in at-risk FDRs. The decline in TL1A after TNF blockade suggests that TL1A levels may be a useful biomarker for TNF activity in RA. These results support the further investigation of the relationship between TL1A and TNF and TL1A blockade as a potential therapeutic strategy in RA.
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- 2020
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4. Feasibility and assessment of outcome measures for yoga as self-care for minorities with arthritis: a pilot study
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Kimberly R. Middleton, Michael M. Ward, Steffany Haaz Moonaz, Miriam Magaña López, Gladys Tataw-Ayuketah, Li Yang, Ana T. Acevedo, Zavera Brandon, and Gwenyth R. Wallen
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Yoga ,Minority ,Osteoarthritis ,Rheumatoid arthritis ,Feasibility study ,Medicine (General) ,R5-920 - Abstract
Abstract Background While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. Methods The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potential facilitators and barriers to self-care and self-efficacy. The third objective determined the feasibility of using computer-assisted self-interview (CASI) for data collection. Results Enrolled participants (n = 30) were mostly female (93%), Spanish speaking (69%), and diagnosed with RA (88.5%). Feasibility was evaluated using practicality, acceptability, adaptation, and expansion of an arthritis-adapted yoga intervention, modified for this population. Recruitment (51%) and participation (60%) rates were similar to previous research and clinical experience with the study population. Of those enrolled, 18 started the intervention. For adherence, 12 out of 18 (67%) participants completed the intervention. All (100%), who completed the intervention, continued to practice yoga 3 months after completing the study. Using nonparametric tests, selected outcome measures showed a measurable change post-intervention suggesting appropriate use in future studies. An in-person computerized questionnaire was determined to be a feasible method of data collection. Conclusions Findings from this pilot study confirm the feasibility of offering yoga to this racially/ethnically diverse population with arthritis. This article provides recruitment/retention rates, outcome measures with error rates, and data collection recommendations for a previously under-represented population. Suggestions include allocating resources for translation and using a multicultural design to facilitate recruitment and retention. Trial registration ClinicalTrials.gov, NCT01617421
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- 2018
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5. Testing the construct validity of a health transition question using vignette-guided patient ratings of health
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Michael M. Ward, Jinxiang Hu, Lori C. Guthrie, and Maria Alba
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Transition question ,Anchors ,Vignettes ,Self-rated health ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background A single-item transition question is often used to assess improvement or worsening in health, but its validity has not been tested extensively. The purpose of this study was to test the construct validity of a transition question by relating it to qualitative changes in patient’s self-rating of health guided by clinical vignettes. Methods We studied 169 patients with active rheumatoid arthritis (RA) before and after treatment escalation. At both assessments, patients scored their current health on a rating scale after first rating three vignettes describing mild, moderate, or severe RA. We classified patients into one of these three RA categories using a nearest-neighbor match. We then related the change in these self-rated categories between visits to responses to a transition question on visit 2. Results Sixty patients improved their RA vignette category after treatment, 86 remained in the same vignette category, and 23 worsened categories. On the transition question, 101 patients reported improvement, 48 reported no change, and 20 reported worsening, representing a modest association with changes in RA vignette categories (polychoric correlation r = 0.19). The association was stronger if patients who were in the mild RA category at both visits were also classified as improved if their self-rating changed from below to above their mild vignette rating (r = 0.23) and when incorporating the importance of changes on the transition question (r = 0.26). Conclusion Changes in health states, guided by clinical vignettes, support the construct validity of the transition question.
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- 2018
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6. Lifetime Risks of Valvular Heart Disease and Pacemaker Use in Patients With Ankylosing Spondylitis
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Michael M. Ward
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ankylosing spondylitis ,aortic valve replacement ,pacemaker ,valvular heart disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The likelihoods of valvular heart disease (VHD) and conduction abnormalities in patients with ankylosing spondylitis (ASp) are poorly defined. Knowing their lifetime risks of VHD and pacemaker use would help inform whether cardiac screening should be done. Methods and Results Patients with ASp and a comparison group without ASp were identified among US Medicare beneficiaries in 1999 to 2013. Frequencies of VHD and pacemaker use were compared in 4 age groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years or older, as were rates of valve surgeries, a measure of VHD severity, and new pacemaker insertions. Outcomes were compared between 42 327 patients with ASp and 19 211 703 patients without ASp. The prevalence of aortic valve disease in patients with ASp increased with age (2.6%, 6.7%, 10.9%, and 17.1%), as did the prevalence of mitral valve disease. Risks of VHD were slightly but significantly higher in patients with ASp (adjusted odds ratios 1.06–1.51). Rates of aortic valve replacement/repair were also higher in patients with ASp than in the comparison group (125 versus 93; 183 versus 149; 261 versus 208; 279 versus 191 per 100 000 patient‐years in the 4 age groups). Rates of mitral valve surgery did not differ between groups. Among patients with ASp, pacemaker use ranged from 1.0% to 7.6% across age groups, and was slightly higher than in controls (odds ratio range 1.11–1.32). Conclusions Lifetime risks of VHD and pacemaker use in ASp increase markedly with age, but are only slightly higher than in elderly people without ASp.
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- 2018
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7. 2021 DORIS definition of remission in SLE: final recommendations from an international task force
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Victoria P Werth, Ronald F van Vollenhoven, Laurent Arnaud, Ricard Cervera, Andrea Doria, Angela Tincani, Matthias Schneider, Marta Mosca, Nathalie Costedoat-Chalumeau, Cynthia Aranow, Michelle A Petri, Ian N Bruce, Dimitrios T Boumpas, Michael M Ward, Manuel Francisco Ugarte-Gil, Bernardo A Pons-Estel, Ann Elaine Clarke, Juanita Romero-Diaz, Caroline Gordon, Sang-Cheol Bae, Anisur Rahman, Murat Inanc, Søren Jacobsen, George Bertsias, Xavier Mariette, Thomas Dörner, Hendrika Bootsma, Josef Smolen, Mandana Nikpour, David Jayne, Martin Aringer, David Isenberg, László Czirják, Annegret Kuhn, Y K Onno Teng, Frédéric A Houssiau, Hermine Brunner, Eric Morand, Carlos Vasconcelos, Guillermo Pons-Estel, Graciela Alarcon, Eloisa Bonfa, Alexandre Voskuyl, Raquel Faria, Anne Voss, Maarten Limper, Anca D Askanase, Sandra Navarra, Cindy Coney, Ruth Fritsch-Stork, Bernadette van Leeuw, Michel Tsang-a-Sjoe, Rebecca Fischer, Marzena Helena Olesinska, Blanca Rubio, Yehuda Schoenfeld, and Elena Zakharhova
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Immunologic diseases. Allergy ,RC581-607 - Published
- 2021
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8. Risk of Hematologic Malignancies in Elderly Patients With Ankylosing Spondylitis: A Cohort Study and Systematic Review
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Sara Alehashemi and Michael M. Ward
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Cohort Studies ,Hematologic Neoplasms ,Lymphoma, Non-Hodgkin ,Humans ,Spondylitis, Ankylosing ,General Medicine ,Middle Aged ,Multiple Myeloma ,Medicare ,Inflammatory Bowel Diseases ,Leukemia, Lymphocytic, Chronic, B-Cell ,United States ,Aged - Abstract
To examine the risk of hematologic malignancies in older adults with ankylosing spondylitis (AS).We used US Medicare data from January 1, 1999, to December 31, 2010, to identify a population-based cohort of beneficiaries with AS. We also included beneficiaries with inflammatory bowel disease (IBD) as disease controls and beneficiaries without AS or IBD as unaffected controls. We excluded those treated with tumor necrosis factor inhibitors in this period. We followed up each group for new diagnosis claims for hematologic malignancies until September 30, 2015.We included 12,451 beneficiaries with AS, 234,905 with IBD, and 10,975,340 unaffected controls, with a mean follow-up of 9.9, 9.3, and 8.0 years, respectively. We identified 297 hematologic malignancies in the AS group, 4538 malignancies in the IBD group, and 128,239 malignancies in unaffected controls. The standardized incidence ratio in AS vs unaffected controls was 1.39 (95% CI, 1.05 to 1.61) for non-Hodgkin lymphoma, 1.50 (95% CI, 1.17 to 1.92) for chronic lymphocytic leukemia, and 1.52 (95% CI, 1.12 to 2.06) for multiple myeloma. Risks of acute myeloid leukemia and chronic myeloid leukemia were not elevated in AS, and there were too few cases of Hodgkin lymphoma to compute risks. Risks were comparable to those of beneficiaries with IBD. We also performed a systematic literature review of the risk of hematologic malignancy in AS, focusing on age associations, which have not been previously examined. We identified 21 studies in the systematic literature review, which included mainly young or middle-aged patients. Results suggested that AS was largely not associated with an increased risk of hematologic malignancies. Two cohort studies reported an increased risk of multiple myeloma in AS.The risks of non-Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma are increased among elderly patients with AS.
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- 2023
9. Syndesmophyte Growth in Ankylosing Spondylitis: from Laboratory to Bedside
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Michael M. Ward and Sovira Tan
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Rheumatology - Published
- 2023
10. Vertebral Bone Mineral Density, Vertebral Strength, and Syndesmophyte Growth in Ankylosing Spondylitis: The Importance of Bridging
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Sovira Tan, Hadi Bagheri, David Lee, Ahmad Shafiei, Tony M. Keaveny, Lawrence Yao, and Michael M. Ward
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Cross-Sectional Studies ,Lumbar Vertebrae ,Rheumatology ,Bone Density ,Immunology ,Humans ,Immunology and Allergy ,Spondylitis, Ankylosing ,Tomography, X-Ray Computed ,Spine - Abstract
To examine the relationship between vertebral trabecular bone mineral density (tBMD), vertebral strength, and syndesmophytes in patients with ankylosing spondylitis (AS) using quantitative computed tomography (QCT).We performed QCT of the spine to measure syndesmophytes and tBMD in 5 vertebrae (T11-L3) in 61 patients with AS. Finite element analysis was performed to measure vertebral strength in compressive overload, including in trabecular and cortical compartments. In cross-sectional analyses, we examined associations of syndesmophyte height with tBMD and vertebral strength in each vertebra. In 33 patients followed up for 2 years, we investigated whether baseline tBMD and vertebral strength predicted syndesmophyte growth in the same vertebra, and vice versa.In the cross-sectional analyses, 126 vertebrae had bridging, 77 vertebrae had nonbridging syndesmophytes, and 83 vertebrae had no syndesmophytes. There were strong inverse associations between syndesmophyte height and tBMD, total strength, and trabecular strength only among bridged vertebrae. In the longitudinal analysis, nonbridged vertebrae with low tBMD (adjusted β = -0.01 [95% confidence interval (95% CI) -0.019, -0.0012]) and low strength (adjusted β = -0.0003 [95% CI -0.0004, -0.0002]) had more syndesmophyte growth over time. Similar associations were absent among bridged vertebrae. Conversely, vertebrae with bridging at baseline had a significant loss in percent tBMD over time (adjusted β = -0.001 [95% CI -0.0017, -0.0004]).Associations between syndesmophytes and vertebral density and strength in AS differ between bridged and nonbridged vertebrae. Among nonbridged vertebrae, low tBMD and strength are associated with syndesmophyte growth. Bridging is associated with large subsequent losses in tBMD, possibly due to mechanical offloading.
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- 2022
11. Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults
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Angela Tincani, Michael M Ward, Marteen Limper, Maria G Tektonidou, and Laura Andreoli
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Medicine - Abstract
Objective To perform a systematic literature review (SLR) informing the European Lmmendations for the management of antiphospholipid syndrome (APS) in adults.Methods A SLR through January 2018 was performed. Research questions were constructed using the Patient, Intervention, Comparator, Outcome (PICO) format. We included data from articles that reported on each relevant intervention. Summary effect estimates were calculated for direct comparison studies that matched the PICO question exactly, and for studies with the relevant intervention and comparator. When meta-analyses were available, we used these estimates.Results From 7534 retrieved articles (+15 from hand searches), 188 articles were included in the review. In individuals with high-risk antiphospholipid antibody (aPL) profile without prior thrombotic or obstetric APS, two meta-analyses showed a protective effect of low-dose aspirin (LDA) against thrombosis. Two randomised controlled trials (RCTs) and three cohort studies showed no additional benefit of treatment with vitamin K antagonists at target international normalised ratio (INR) 3–4 versus INR 2–3 in patients with venous thrombosis. In patients with arterial thrombosis, two RCTs and two cohort studies showed no difference in risk of recurrent thrombosis between the two target INR groups. One open-label trial showed higher rates of thrombosis recurrences in triple aPL-positive patients treated with rivaroxaban than those treated with warfarin. RCTs and cohort studies showed that combination treatment with LDA and heparin was more effective than LDA alone in several types of obstetric APS. SLR results were limited by the indirect evidence and the heterogeneity of patient groups for some treatments, and only a few high-quality RCTs.Conclusion Well-designed studies of homogeneous APS patient populations are needed.
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- 2019
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12. Trends in Permanent Work Disability Associated With Rheumatoid Arthritis in the United States, 1999–2015
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Michael M. Ward
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Adult ,Population ,Medicare ,Great recession ,Arthritis, Rheumatoid ,Young Adult ,Rheumatology ,Humans ,Medicine ,Disabled Persons ,education ,Aged ,education.field_of_study ,business.industry ,Work disability ,Middle Aged ,medicine.disease ,United States ,Confidence interval ,Social security ,Unemployment ,Relative risk ,Rheumatoid arthritis ,business ,Disability insurance ,Demography - Abstract
BACKGROUND Advances in treatment over the past 20 years has resulted in improved control of rheumatoid arthritis (RA), but whether there has been a decrease in permanent work disability associated with RA in the U.S. has not been examined. METHODS Medicare data from 1999 to 2015 were used to identify beneficiaries age 20 to 59 with RA who became eligible for Medicare coverage under Social Security Disability Insurance. Diagnosis of RA was based on physician claims in the first year of enrollment. Annual rates of enrollment were sex- and age-standardized to the 2000 U.S. POPULATION RESULTS The study included 97,787 beneficiaries with RA and Social Security Disability Insurance across all years. Medicare enrollment was 26.0 per million in 1999 and 26.0 per million in 2015. Rates increased following the Great Recession of 2008-09 before returning to pre-recession levels. There was no linear trend over time after adjusting for the annual national unemployment rate (relative risk 0.99 per year; 95% confidence interval 0.99, 1.00; p = 0.69). Risks of work disability were much higher among workers over age 50. CONCLUSION Based on Medicare enrollment by recipients of Social Security Disability Insurance, there was no decrease in permanent work disability among young and middle-age workers with RA in the U.S. between 1999 and 2015.
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- 2022
13. The Association of Tumor Necrosis Factor Inhibitor Use With Incident Hypertension in Ankylosing Spondylitis: Data From the PSOAS Cohort
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Mariko L. Ishimori, Michael M. Ward, S. Reza Jafarzadeh, John D. Reveille, Susan R. Heckbert, Maureen Dubreuil, Matthew A. Brown, Lianne S. Gensler, Stephen J. Mooney, Jean W. Liew, and Michael H. Weisman
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Adult ,Male ,medicine.medical_specialty ,Immunology ,Population ,Diastole ,Marginal structural model ,Cohort Studies ,Rheumatology ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Spondylitis, Ankylosing ,Prospective Studies ,cardiovascular diseases ,Prospective cohort study ,education ,Ankylosing spondylitis ,education.field_of_study ,Tumor Necrosis Factor-alpha ,business.industry ,Confounding ,Middle Aged ,medicine.disease ,Treatment Outcome ,Blood pressure ,Antirheumatic Agents ,Hypertension ,Cohort ,Female ,Tumor Necrosis Factor Inhibitors ,business - Abstract
ObjectiveIndividuals with ankylosing spondylitis (AS) have a greater cardiovascular (CV) risk than those in the general population. The effect of tumor necrosis factor inhibitors (TNFis) on CV risk, including on the development of hypertension (HTN), remains unclear, with some data suggesting higher risk. We assessed the association of TNFi use with incident HTN in a longitudinal AS cohort.MethodsAdults with AS enrolled in a prospective cohort in 2002–2018 were examined every 4–6 months. TNFi use during the preceding 6 months was ascertained at each study visit. We defined HTN by patient-reported HTN, antihypertensive medication use, or, on 2 consecutive visits, systolic blood pressure (BP) ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. We evaluated the association between TNFi use and the development of HTN with marginal structural models, estimated by inverse probability-of-treatment weighting, to account for time-dependent confounders and informative censoring. Potential confounders included age, sex, race, site, nonsteroidal antiinflammatory drug use, and disease activity.ResultsWe included 630 patients without baseline HTN and with at least 1 year of follow-up. Of these, 72% were male, mean age was 39 ± 13 years, and 43% used TNFi at baseline. On follow-up (median 5 yrs), 129 developed incident HTN and 163 started on TNFi during follow-up. TNFi use was not associated with incident HTN (adjusted HR 1.10, 95% CI 0.83–1.37).ConclusionIn our prospective AS cohort, TNFi use was not significantly associated with incident HTN.
- Published
- 2021
14. Surgeon Volume and Differences in Rates of Primary Total Knee Arthroplasty Across 3 US States
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Michael M. Ward
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Rheumatology ,Immunology ,Immunology and Allergy - Abstract
Rates of total knee arthroplasty (TKA), one of the most common surgical procedures, vary markedly across regions, even after accounting for knee arthritis prevalence.
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- 2022
15. High precision semi-automated vertebral height measurement using computed tomography: A phantom study.
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Sovira Tan, Jianhua Yao 0001, Lawrence Yao, and Michael M. Ward
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- 2012
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16. Osteoarthritis Care and Risk of Total Knee Arthroplasty Among Medicare Beneficiaries: A Population‐Based Study of Regional Covariation
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Michael M. Ward
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Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Immunology ,MEDLINE ,Osteoarthritis ,Medicare ,Lower risk ,Arthroscopy ,Rheumatology ,Health care ,medicine ,Humans ,Immunology and Allergy ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Medicare beneficiary ,Retrospective cohort study ,Osteoarthritis, Knee ,musculoskeletal system ,medicine.disease ,Arthroplasty ,United States ,surgical procedures, operative ,Physical therapy ,Female ,business - Abstract
Objective To examine health care utilization among patients with knee osteoarthritis (OA) and assess whether utilization differs among residents of regions with high and low rates of total knee arthroplasty (TKA). Methods This was a retrospective cohort study of US Medicare beneficiaries with knee OA enrolled from 2005 to 2010. Health care utilization data for knee complaints, including rates of physician visits, physical therapy, knee injections, and arthroscopy, were abstracted from claims files until time of TKA or the end of the study in 2015. Utilization was compared among beneficiaries who lived in regions with high or low rates of TKA. Results Among 988,570 beneficiaries with knee OA, 327,499 (33.1%) underwent TKA during follow-up (median 5.6 years). Higher frequency of visits for knee complaints was associated with increased risk of TKA, whereas physical therapy, specialist care, and intraarticular treatments were associated with lower risk of TKA. Frequency of TKA varied from 26.4% in the lowest regional TKA rate quintile to 42.1% in the highest regional TKA rate quintile. Rates of physician visits, physical therapy, specialist care, and treatment with intraarticular injections varied inversely with regional TKA rate quintile. For example, 32.5% of beneficiaries in the lowest region quintile and 23.6% in the highest region quintile underwent physical therapy. Across all quintiles, physical therapy was associated with lower TKA rates. Conclusion Dedicated nonsurgical OA care was infrequently used to treat elderly Americans with knee OA. Nonsurgical care was more common in regions with low TKA rates, suggesting reciprocal emphasis on medical treatment compared to surgical treatment across regions.
- Published
- 2021
17. Why Do Some Patients Have Severe Sacroiliac Disease But No Syndesmophytes in Ankylosing Spondylitis? Data From a Nested Case-Control Study
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Lauren K. Ridley, Mark C. Hwang, John D. Reveille, Lianne S. Gensler, Mariko L. Ishimori, Matthew A. Brown, Mohammad H. Rahbar, Amirali Tahanan, Michael M. Ward, Michael H. Weisman, and Thomas J. Learch
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Rheumatology ,Immunology ,Immunology and Allergy - Abstract
ObjectiveSacroiliac (SI) joint and spinal inflammation are characteristic of ankylosing spondylitis (AS), but some patients with AS have been identified who have discordant radiographic disease. We studied an AS subgroup with long-standing disease and fused SI joints. We identified factors associated with discrepant degrees of radiographic damage between the SI joints and spine.MethodsFrom the Prospective Study of Outcomes in AS (PSOAS) cohort, patients with a disease duration ≥ 20 years and fused SI joints were included in a nested case-control design. Patients with and without syndesmophytes were used as cases and controls for analysis. We used classification and regression tree (CART) analysis to determine risk factors for syndesmophytes presence and reexamined the validity of the risk factors using univariable logistic regression models.ResultsThere were 354 patients in the subgroup, 23 of whom lacked syndesmophytes. CART analysis showed females were less likely to have syndesmophytes. The next important predictor was age of symptom onset in males, with age of onset ≤ 16 years being less likely to have syndesmophytes. Univariable analysis confirmed females were less likely to have syndesmophytes (odds ratio [OR] 0.17, 95% CI 0.07-0.41). Syndesmophyte presence was associated with HLA-B27 positivity (P= 0.03) and age of symptom onset > 16 years old (OR 2.72, 95% CI 1.15-6.45). All 23 patients who lacked syndesmophytes were HLA-B27 positive.ConclusionUsing CART analysis and univariable modeling, women were less likely to have syndesmophytes despite advanced disease duration and SI joint disease. Patients with younger age of symptom onset were less likely to have syndesmophytes. All patients without syndesmophytes were HLA-B27 positive, indicating HLA-B27 positivity may be more associated with SI disease than spinal disease.
- Published
- 2022
18. A Guide to Contemporary Clinical Practice Guidelines
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Michael M. Ward
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Evidence-Based Medicine ,Rheumatology ,Humans - Published
- 2022
19. 3D Multi-Scale Level Set Segmentation of Vertebrae.
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Sovira Tan, Jianhua Yao 0001, Michael M. Ward, Lawrence Yao, and Ronald M. Summers
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- 2007
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20. Computer aided evaluation of ankylosing spondylitis.
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Sovira Tan, Jianhua Yao 0001, Michael M. Ward, Lawrence Yao, and Ronald M. Summers
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- 2006
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21. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome
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George C Drosos, Daisy Vedder, Eline Houben, Laura Boekel, Fabiola Atzeni, Sara Badreh, Dimitrios T Boumpas, Nina Brodin, Ian N Bruce, Miguel Ángel González-Gay, Søren Jacobsen, György Kerekes, Francesca Marchiori, Chetan Mukhtyar, Manuel Ramos-Casals, Naveed Sattar, Karen Schreiber, Savino Sciascia, Elisabet Svenungsson, Zoltan Szekanecz, Anne-Kathrin Tausche, Alan Tyndall, Vokko van Halm, Alexandre Voskuyl, Gary J Macfarlane, Michael M Ward, Michael T Nurmohamed, Maria G Tektonidou, Rheumatology, ACS - Atherosclerosis & ischemic syndromes, Cardiology, and AII - Inflammatory diseases
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Vasculitis ,Gout ,Immunology ,General Biochemistry, Genetics and Molecular Biology ,Scleroderma ,Rheumatology ,Risk Factors ,Rheumatic Diseases ,Immunology and Allergy ,Humans ,Lupus Erythematosus, Systemic ,autoimmune diseases ,Musculoskeletal Diseases ,skin and connective tissue diseases ,Mixed Connective Tissue Disease ,Scleroderma, Systemic ,Lupus Erythematosus ,Myositis ,Systemic ,systemic ,Antiphospholipid Syndrome ,cardiovascular diseases ,Uric Acid ,Sjogren's Syndrome ,Cardiovascular Diseases ,Heart Disease Risk Factors ,antiphospholipid syndrome ,lupus erythematosus ,systemic vasculitis - Abstract
ObjectiveTo develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).MethodsFollowing European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion.ResultsFour overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target ConclusionThese recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.
- Published
- 2022
22. Sacroiliac Bone Marrow Edema: Innocent Until Proven Guilty?
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Michael M. Ward and Lawrence Yao
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Rheumatology ,Bone Marrow ,Immunology ,Immunology and Allergy ,Edema ,Humans ,Sacroiliac Joint ,Bone Marrow Diseases - Published
- 2022
23. Predicting Probability of Response to Tumor Necrosis Factor Inhibitors for Individual Patients With Ankylosing Spondylitis
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Runsheng Wang, Abhijit Dasgupta, and Michael M. Ward
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Adult ,Male ,Tumor Necrosis Factor-alpha ,Antirheumatic Agents ,Humans ,Spondylitis, Ankylosing ,Tumor Necrosis Factor Inhibitors ,General Medicine ,Probability - Abstract
Tumor necrosis factor inhibitors (TNFis) have revolutionized the management of ankylosing spondylitis (AS); however, the lack of notable clinical responses in approximately one-half of patients suggests important heterogeneity in treatment response. Identifying patients likely to respond or not respond to TNFis could provide opportunities to personalize treatment strategies.To develop models of the probability of short-term response to TNFi treatment in individual patients with active AS.This is a retrospective cohort study using data of the TNFi group (ie, treatment group) from 10 randomized clinical trials (RCTs) of TNFi treatment among patients with active AS, conducted from 2002 to 2016. Participants were adult patients with active AS who failed nonsteroidal anti-inflammatory drugs. Included RCTs were phase 3 and 4 studies that assessed the efficacy of an originator TNFi at week 12 and/or week 24, either compared with placebo or an antirheumatic drug. The cohort was divided into a training and a testing set. Data analysis was conducted from July 1, 2019, to November 30, 2020.All included patients received an originator TNFi for at least 12 weeks.Outcomes included major response and no response based on the change of AS Disease Activity Score at 12 weeks. Machine learning algorithms were applied to estimate the probability of having major response and no response for individual patients.The study included 1899 participants from 10 trials. The training set included 1207 individuals (mean [SD] age, 39 [12] years; 908 [75.2%] men), of whom 407 (33.7%) had major response and 414 (34.3%) had no response. In the reduced logistic regression models, accuracy was 0.74 for major response and 0.75 for no response. The probability of major response increased with higher C-reactive protein (CRP) level, patient global assessment (PGA), and Bath AS Disease Activity Index (BASDAI) question 2 score and decreased with higher body mass index (BMI) and Bath AS Functional Index (BASFI) score. The probability of no response increased with age and BASFI score, and decreased with higher CRP level, BASDAI question 2 score, and PGA. In the testing set (692 participants; mean [SD] age, 38 [11] years; 533 [77.0%] men), models demonstrated moderate to high accuracy.In this cohort study, the probability of initial response to TNFi was predicted from baseline variables, which may facilitate personalized treatment decision-making.
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- 2022
24. Nonsteroidal Antiinflammatory Drug Use and Association With Incident Hypertension in Ankylosing Spondylitis
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M. Rahbar, Jean W. Liew, Michael H. Weisman, MinJae Lee, Lianne S. Gensler, Matthew A. Brown, Michael M. Ward, Susan R. Heckbert, and John D. Reveille
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Ankylosing ,Adult ,Male ,medicine.medical_specialty ,Clinical Sciences ,Anti-Inflammatory Agents ,Article ,Drug Administration Schedule ,Rheumatology ,Internal medicine ,medicine ,Humans ,Psychology ,Spondylitis, Ankylosing ,Longitudinal Studies ,Prospective Studies ,Patient Reported Outcome Measures ,Prospective cohort study ,Ankylosing spondylitis ,Proportional hazards model ,business.industry ,Incidence ,Anti-Inflammatory Agents, Non-Steroidal ,Hazard ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Blood pressure ,Hypertension ,Cohort ,Public Health and Health Services ,Female ,Non-Steroidal ,business ,Body mass index ,Spondylitis - Abstract
Objective: Nonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort. Methods: Adults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4–6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models. Results: Of the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04–1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity. Conclusion: In our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use.
- Published
- 2020
25. Corticosteroid discontinuation, complete clinical response and remission in juvenile dermatomyositis
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Lisa G. Rider, Michael M. Ward, Ira N. Targoff, Nastaran Bayat, Takayuki Kishi, Adam M. Huber, William Warren-Hicks, Physiotherapy, Human Physiology and Anatomy, Mental Health and Wellbeing research group, Public Health Sciences, Neurogenetics, and Pediatrics
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Male ,Pediatrics ,medicine.medical_specialty ,Remission ,medicine.drug_class ,corticosteroid discontinuation ,outcomes ,Dermatomyositis ,Rheumatology ,Adrenal Cortex Hormones ,medicine ,complete clinical response ,Humans ,Initial treatment ,Pharmacology (medical) ,Child ,Juvenile dermatomyositis ,Myositis ,Muscle contracture ,juvenile dermatomyositis ,myositis autoantibodies ,business.industry ,ADRENAL CORTICOSTEROIDS ,Remission Induction ,Public Health, Environmental and Occupational Health ,Clinical Science ,medicine.disease ,Discontinuation ,Treatment Outcome ,Withholding Treatment ,Child, Preschool ,Disease remission ,Corticosteroid ,Female ,business - Abstract
Objective A North American registry of JDM patients was examined for frequency of and factors associated with corticosteroid discontinuation, complete clinical response and remission. Methods We evaluated probability of achieving final corticosteroid discontinuation, complete clinical response and remission in 307 JDM patients by Weibull time-to-event modelling; conditional probability of complete clinical response and remission using Bayesian network modelling; and significant predictors with multivariable Markov chain Monte-Carlo Weibull extension models. Results The probability of corticosteroid discontinuation was 56%, complete clinical response 38% and remission 30% by 60 months after initial treatment in 105 patients. The probability of remission was conditional on corticosteroid discontinuation and complete clinical response. Photosensitivity, contractures and a longer time to complete clinical response were predictive of the time to final corticosteroid discontinuation. Anti-MJ (NXP2) autoantibodies and a Northwest residential geoclimatic zone were predictive of shorter time to complete clinical response, while dysphonia, contractures, an increase in medications within 24 months and a longer time to corticosteroid discontinuation were associated with longer time to complete clinical response. Anti-p155/140 (TIF1) autoantibodies, an increase in medications within 12–24 months, or longer times to corticosteroid discontinuation and complete clinical response were associated with longer time to remission. Conclusion JDM patients achieve favourable outcomes, including corticosteroid discontinuation, complete clinical response and remission, although timelines for these may be several years based on time-dependent analyses. These outcomes are inter-related and strong predictors of each other. Selected clinical features and myositis autoantibodies are additionally associated with these outcomes.
- Published
- 2020
26. Pre-operative withholding of infliximab and the risk of infections after major surgery in patients with rheumatoid arthritis
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Michael M. Ward and Abhijit Dasgupta
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Infections ,Arthritis, Rheumatoid ,Sepsis ,03 medical and health sciences ,Coronary artery bypass surgery ,Postoperative Complications ,0302 clinical medicine ,Rheumatology ,Risk Factors ,Preoperative Care ,medicine ,Humans ,Surgical Wound Infection ,Pharmacology (medical) ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,Infection Control ,education.field_of_study ,Basic and Translational Science ,business.industry ,Retrospective cohort study ,Bowel resection ,Vascular surgery ,medicine.disease ,Infliximab ,Surgery ,Antirheumatic Agents ,Surgical Procedures, Operative ,Preoperative Period ,Cohort ,Female ,business ,medicine.drug - Abstract
Objectives Withholding TNF inhibitors (TNFI) before surgery has been recommended due to concern for post-operative infection. We examined the risks of post-operative infections and mortality in patients with RA in relation to the pre-operative timing of infliximab infusion. Methods In this population-based retrospective cohort study, we used US Medicare claims data from 2007 to 2015 to identify patients with RA who underwent coronary artery bypass grafting (CABG), aortic or vascular surgery, or bowel resection, and who were treated with infliximab in the 90 days prior to surgery. We examined associations between the timing of infusion and infections and mortality in the 30 days after surgery. We adjusted for the predicted probability of post-operative infection or death, demographic characteristics, use of MTX, post-operative blood transfusion and hospital volume. Results We studied 712 patients with CABG, 244 patients with vascular surgery and 862 patients with bowel resections. Post-operative pneumonia occurred in 7.4–11.9%, urinary tract infection in 9.0–15.2%, surgical site infection in 3.2–18.9%, sepsis in 4.2–9.6% and death in 3.5–7.0% among surgery cohorts. There was no association between the time from last infliximab dose to surgery and the risk of post-operative infection or mortality in any surgical cohort. No subgroups were identified that had an increased risk of infection with more proximate use of infliximab. Conclusion Among elderly patients with RA, risks of infection and mortality after major surgery were not related to the pre-operative timing of infliximab infusion.
- Published
- 2020
27. The changing profile of ankylosing spondylitis in the biologic era
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John D. Reveille, Mark C. Hwang, Mohammad H. Rahbar, Thomas J. Learch, MinJae Lee, Lianne S. Gensler, Michael M. Ward, Laura Diekman, Amirali Tahanan, Michael H. Weisman, and Mariko L. Ishimori
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Ankylosing spondylitis ,medicine.medical_specialty ,business.industry ,Disease progression ,General Medicine ,Disease ,medicine.disease ,Rheumatology ,Pharmacotherapy ,Internal medicine ,Medicine ,Disease characteristics ,Longitudinal cohort ,business - Abstract
To compare disease characteristics, comorbidities, and medication utilization of 1141 patients with ankylosing spondylitis (AS) with short ( 8 years. Patients with AS enrolling in this multicenter longitudinal cohort have different disease profiles and medication utilization over time, perhaps reflecting innovations in treatment and increasing disease awareness.
- Published
- 2020
28. Chronic oral anticoagluation and risk of prostate cancer: Evidence of detection bias
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Michael M. Ward
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Male ,Cancer Research ,medicine.medical_specialty ,Biopsy ,Population ,Rate ratio ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Bias ,Prostate ,Internal medicine ,Humans ,Medicine ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Coronary Thrombosis ,Incidence (epidemiology) ,Warfarin ,Anticoagulants ,Prostatic Neoplasms ,Cancer ,Venous Thromboembolism ,medicine.disease ,Confidence interval ,medicine.anatomical_structure ,Oncology ,Heart Valve Prosthesis ,030220 oncology & carcinogenesis ,business ,medicine.drug - Abstract
Warfarin treatment has been associated with lower risks of prostate cancer, without a specified biological mechanism. Our study tested the hypothesis that reluctance to perform prostate biopsies in men who are anticoagulated results in lower rates of diagnosed prostate cancer, leading to an apparent protective effect. Rates of prostate biopsies have decreased from 2000 to 2015, allowing calendar time to be used as the intervention. In a national population-based sample of elderly men, our study compared trends in prostate cancer incidence between 17,815 men treated with chronic oral anticoagulation for prosthetic heart valve thromboprophylaxis and a general population comparison group of 356,300 men. Cancer events were based on administrative claims. Among men enrolled in 2000-2001 and followed through 2015, prostate cancer incidence was substantially lower in the anticoagulation group (adjusted incidence rate ratio [IRR] 0.70; 95% confidence interval [CI] 0.62-0.80). Incidence decreased over time in the general population group to approach that of the anticoagulation group among men enrolled in 2008-2010 (IRR 0.86; 95% CI 0.71-1.04). Rates of prostate biopsies also decreased over time in the general population group to match the rate in the anticoagulation group. These results indicate that the apparent protective effect of warfarin treatment on the risk of prostate cancer is likely the result of detection bias from lower rates of biopsies among men who are anticoagulated.
- Published
- 2020
29. Longitudinal associations between depressive symptoms and clinical factors in ankylosing spondylitis patients: analysis from an observational cohort
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Amirali Tahanan, Thomas J. Learch, Mariko L. Ishimori, Lianne S. Gensler, MinJae Lee, Matthew A. Brown, John D. Reveille, Seth A. Eisen, Mohammad H. Rahbar, Michael M. Ward, Mark C. Hwang, and Michael H. Weisman
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Adult ,Male ,medicine.medical_specialty ,Immunology ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Interquartile range ,Internal medicine ,Activities of Daily Living ,Epidemiology ,medicine ,Humans ,Immunology and Allergy ,Spondylitis, Ankylosing ,Longitudinal Studies ,030212 general & internal medicine ,Prospective cohort study ,Generalized estimating equation ,Depression (differential diagnoses) ,030203 arthritis & rheumatology ,Ankylosing spondylitis ,Depression ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Middle Aged ,medicine.disease ,Antidepressive Agents ,Analgesics, Opioid ,Neuromuscular Agents ,Cohort ,Marital status ,Female ,Tumor Necrosis Factor Inhibitors ,business - Abstract
Although cross-sectional studies have shown that ankylosing spondylitis-specific factors correlate with depressive symptom severity, the association of these factors over time is unresolved. We examined the demographic and clinical factors associated with longitudinal depressive symptom severity in AS patients. We analyzed sociodemographic, clinical, behavioral and medication data from 991 patients from the Prospective Study of Outcomes in Ankylosing spondylitis cohort, and measured depression severity with the Center for Epidemiological Studies Depression (CES-D) Scale administered at approximately 6-month visit intervals. Multivariable longitudinal negative binomial regression models were conducted using generalized estimating equation modeling to assess the demographic, clinical, and medication-related factors associated with depression severity by CES-D scores over time. The median baseline CES-D score (possible range 0–60) was 10.0 (interquartile range = 5, 17). In longitudinal multivariable analyses, higher CES-D scores were associated with longitudinal smoking, greater functional impairment, greater disease activity, self-reported depression, and poor global health scores. Marital status (e.g., being married) was associated with lower CES-D. Adjusted mean CES-D scores in our model decreased over time, with a significant interaction between time and gender observed. This study identified longitudinal clinical factors such as greater disease activity, greater functional impairment, and poor global health to be associated with longitudinal depression severity. These factors are potentially modifiable and may help manage depressive symptoms in AS.
- Published
- 2020
30. Computer Aided Evaluation of Ankylosing Spondylitis Using High-Resolution CT.
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Sovira Tan, Jianhua Yao 0001, Michael M. Ward, Lawrence Yao, and Ronald M. Summers
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- 2008
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31. Racial/Ethnic Differences in Dialysis Discontinuation and Survival after Hospitalization for Serious Conditions among Patients on Maintenance Dialysis
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Abdulkareem Agunbiade, Michael M. Ward, and Abhijit Dasgupta
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Adult ,Male ,Adolescent ,medicine.medical_treatment ,030232 urology & nephrology ,Ethnic group ,Severity of Illness Index ,White People ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Up Front Matters ,medicine ,Humans ,030212 general & internal medicine ,Minority Groups ,Dialysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Asian ,business.industry ,Racial Groups ,Hazard ratio ,Retrospective cohort study ,Hispanic or Latino ,General Medicine ,Middle Aged ,Discontinuation ,Black or African American ,Hospitalization ,Survival Rate ,Withholding Treatment ,Nephrology ,Failure to thrive ,Cohort ,Kidney Failure, Chronic ,Female ,Racial/ethnic difference ,medicine.symptom ,business ,Demography - Abstract
Background Racial and ethnic minorities on dialysis survive longer than whites, and are less likely to discontinue dialysis. Both differences have been attributed by some clinicians to better health among minorities on dialysis. Methods To test if racial and ethnic differences in dialysis discontinuation reflected better health, we conducted a retrospective cohort study of survival and dialysis discontinuation among patients on maintenance dialysis in the US Renal Data System after hospitalization for either stroke (n=60,734), lung cancer (n=4100), dementia (n=40,084), or failure to thrive (n=42,950) between 2003 and 2014. We examined the frequency of discontinuation of dialysis and used simulations to estimate survival in minorities relative to whites if minorities had the same pattern of dialysis discontinuation as whites. Results Blacks, Hispanics, and Asians had substantially lower frequencies of dialysis discontinuation than whites in each hospitalization cohort. Observed risks of mortality were also lower for blacks, Hispanics, and Asians. In simulations that assigned discontinuation patterns similar to those found among whites across racial and ethnic groups, differences in survival were markedly attenuated and hazard ratios approached 1.0. Survival and dialysis discontinuation frequencies among American Indians and Alaska Natives were close to those of whites. Conclusions Racial and ethnic differences in dialysis discontinuation were present among patients hospitalized with similar health events. Among these patients, survival differences between racial and ethnic minorities and whites were largely attributable to differences in the frequency of discontinuation of dialysis.
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- 2019
32. 2021 DORIS definition of remission in SLE:Final recommendations from an international task force
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Yehuda Schoenfeld, Carlos Vasconcelos, Josef S Smolen, Blanca Rubio, Ricard Cervera, Nathalie Costedoat-Chalumeau, Y K Onno Teng, Søren Jacobsen, Hermine I. Brunner, Mandana Nikpour, Anne Voss, Cindy Coney, Rebecca Fischer, Sang Cheol Bae, M.W.P. Tsang-A-Sjoe, Angela Tincani, Frédéric Houssiau, Elena Zakharhova, Bernadette van Leeuw, Michelle Petri, Eric F Morand, Ian N. Bruce, Maarten Limper, Dimitrios T. Boumpas, Victoria P. Werth, Murat Inanc, Anka Askenase, Ann E. Clarke, Thomas Dörner, Cynthia Aranow, Bernardo A. Pons-Estel, Matthias Schneider, Marta Mosca, László Czirják, George Bertsias, Michael M. Ward, Hendrika Bootsma, Juanita Romero-Diaz, Marzena Olesińska, Guillermo J. Pons-Estel, Xavier Mariette, Andrea Doria, Ruth D E Fritsch-Stork, Graciela S. Alarcón, Eloisa Bonfa, David A. Isenberg, Manuel F. Ugarte-Gil, Annegret Kuhn, Martin Aringer, Laurent Arnaud, Sandra V. Navarra, David Jayne, Anisur Rahman, Raquel Faria, Caroline Gordon, Alexandre E. Voskuyl, Ronald F van Vollenhoven, van Vollenhoven, Ronald F [0000-0001-6438-8663], Doria, Andrea [0000-0003-0548-4983], Morand, Eric [0000-0002-9507-3338], Petri, Michelle A [0000-0003-1441-5373], Pons-Estel, Bernardo A [0000-0003-2518-0266], Ugarte-Gil, Manuel Francisco [0000-0003-1728-1999], Arnaud, Laurent [0000-0002-8077-8394], Bruce, Ian N [0000-0003-3047-500X], Houssiau, Frédéric A [0000-0003-1451-083X], Aringer, Martin [0000-0003-4471-8375], Bae, Sang-Cheol [0000-0003-4658-1093], Boumpas, Dimitrios T [0000-0002-9812-4671], Brunner, Hermine [0000-0001-9478-2987], Dörner, Thomas [0000-0002-6478-7725], Jacobsen, Søren [0000-0002-5654-4993], Teng, Y K Onno [0000-0001-9920-2195], Tsang-A-Sjoe, Michel [0000-0002-4982-3505], Werth, Victoria P [0000-0003-3030-5369], Aranow, Cynthia [0000-0001-9299-0053], Apollo - University of Cambridge Repository, Teng, YK Onno [0000-0001-9920-2195], Jayne, David [0000-0002-1712-0637], UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, and UCL - (SLuc) Service de rhumatologie
- Subjects
medicine.medical_specialty ,Prednisolone ,Immunology ,Therapeutics ,Disease ,Severity of Illness Index ,Health care ,medicine ,therapeutics ,Humans ,Lupus Erythematosus, Systemic ,Medical physics ,healthcare ,lupus erythematosus ,outcome assessment ,systemic ,Clinical care ,skin and connective tissue diseases ,Lupus erythematosus ,Epidemiology and outcomes ,Task force ,business.industry ,Healthcare ,Systemic ,Remission Induction ,General Medicine ,RC581-607 ,medicine.disease ,Clinical trial ,Outcome assessment ,Research questions ,Observational study ,Immunologic diseases. Allergy ,business ,Immunosuppressive Agents - Abstract
ObjectiveTo achieve consensus on a definition of remission in SLE (DORIS).BackgroundRemission is the stated goal for both patient and caregiver, but consensus on a definition of remission has been lacking. Previously, an international task force consisting of patient representatives and medical specialists published a framework for such a definition, without reaching a final recommendation.MethodsSeveral systematic literature reviews were performed and specific research questions examined in suitably chosen data sets. The findings were discussed, reformulated as recommendations and voted on.ResultsBased on data from the literature and several SLE-specific data sets, a set of recommendations was endorsed. Ultimately, the DORIS Task Force recommended a single definition of remission in SLE, based on clinical systemic lupus erythematosus disease activitiy index (SLEDAI)=0, Evaluator’s Global Assessment ConclusionThe 2021 DORIS definition of remission in SLE is recommended for use in clinical care, education, and research including clinical trials and observational studies.
- Published
- 2021
33. Panniculite consécutive à l’instauration d’un traitement par baricitinib dans la polyarthrite rhumatoïde
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Michael M. Ward, Rhett Kent, Alice Fike, and Ann Biehl
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Rheumatology ,business.industry ,Medicine ,business - Published
- 2021
34. Risk of 30-day Readmission After Knee or Hip Replacement in Rheumatoid Arthritis and Osteoarthritis by Non-Medicare and Medicare Payer Status
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Ali Yazdanyar, Anthony J. Donato, Mary Chester M. Wasko, and Michael M. Ward
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Immunology ,Knee replacement ,Osteoarthritis ,Logistic regression ,Medicare ,Patient Readmission ,Osteoarthritis, Hip ,Odds ,Arthritis, Rheumatoid ,Postoperative Complications ,Rheumatology ,Hip replacement ,Internal medicine ,Medicine ,Immunology and Allergy ,Humans ,Aged ,business.industry ,Odds ratio ,Venous Thromboembolism ,Osteoarthritis, Knee ,medicine.disease ,Confidence interval ,United States ,Rheumatoid arthritis ,business - Abstract
ObjectiveTo determine the indication and risk of 30-day rehospitalization after hip or knee replacement among patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by Medicare and non-Medicare status.MethodsUsing the Nationwide Readmission Database (2010–2014), we defined an index hospitalization as an elective hospitalization with a principal procedure of total hip (THR) or knee replacement (TKR) among adults aged ≥ 18 years. Primary payer was categorized as Medicare or non-Medicare. Survey logistic regression provided the odds of 30-day rehospitalization in RA relative to OA. We calculated the rates for principal diagnoses leading to rehospitalization.ResultsOverall, 3.53% of 2,190,745 index hospitalization had a 30-day rehospitalization. Patients with RA had a higher adjusted risk of rehospitalization after TKR (OR 1.11, 95% CI 1.02–1.21) and THR (OR 1.39, 95% CI 1.19–1.62). Persons with RA and OA did not differ with respect to rates of infections, cardiac events, or postoperative complications leading to the rehospitalization. After TKR, RA patients with Medicare had a lower venous thromboembolism (VTE) risk (OR 0.58, 95% CI 0.58–0.88), whereas those with RA had a greater VTE risk (OR 2.41, 95% CI 1.04–5.57) after THR.ConclusionPatients with RA had a higher 30-day rehospitalization risk than OA after TKR and THR regardless of payer type. While infections, postoperative complications, and cardiac events did not differ, there was a significant difference in VTE as the principal diagnosis of rehospitalization.
- Published
- 2021
35. Guideline Development and Implementation in Rheumatic Disease
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Michael M. Ward
- Subjects
Rheumatology - Published
- 2022
36. Interhospital variation in mortality among patients with systemic lupus erythematosus and sepsis in the USA
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Michael M. Ward, Abhijit Dasgupta, and Maria G Tektonidou
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Patient demographics ,Population ,Sepsis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,immune system diseases ,Internal medicine ,medicine ,Risk of mortality ,Humans ,Lupus Erythematosus, Systemic ,Pharmacology (medical) ,In patient ,Hospital Mortality ,030212 general & internal medicine ,skin and connective tissue diseases ,education ,030203 arthritis & rheumatology ,Inpatients ,education.field_of_study ,business.industry ,Organ dysfunction ,Middle Aged ,Clinical Science ,medicine.disease ,Hospitals ,United States ,Relative risk ,Female ,medicine.symptom ,business - Abstract
Objective To determine whether the risk of mortality in patients with SLE hospitalized with sepsis varies among hospitals in the USA. Methods We used the National Inpatient Sample (2002–2011) to obtain national population-based data on outcomes for adults with SLE admitted with sepsis, and compared it with that for patients without SLE admitted with sepsis at the same hospital. We computed expected mortality based on patient demographic characteristics, comorbidities and major organ dysfunction, and calculated observed/expected (O/E) mortality ratios separately for patients with SLE and without SLE for each hospital. We then computed the ratio of these O/E ratios within hospitals to assess relative SLE mortality. We considered hospitals with a risk ratio (RR) of ⩾2.0 as having high relative SLE mortality. Results Among 424 hospitals that treated a total of 4024 patients with SLE and sepsis, the risk of in-hospital mortality varied from 0% to 60% (median 11.1%). The RR ranged from 0 to 9.75, with a median of 0.84, indicating that O/E mortality was similar in patients with and without SLE at the average hospital. Sixty-one hospitals (14.4%) had a RR of ⩾2.0, indicating higher mortality among patients with SLE. Hospitals that on average treated ⩾3.9 patients with SLE and sepsis annually were less likely to have a RR of ⩾2.0 than hospitals that treated fewer patients (10% vs 17%; P = 0.004). Conclusion Mortality among patients with SLE and sepsis varied widely between hospitals, and was lower at hospitals that treated more of these patients.
- Published
- 2019
37. Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitis
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Matthew A. Brown, Laura Diekman, Maxime Breban, Nicholas G. Martin, Yuqin Wang, Erika De Guzman, Paul Leo, Zhixiu Li, Gary J. Macfarlane, Lisa Anderson, Simon Stebbings, Margaret J. Wright, Michael M. Ward, Gareth T. Jones, Mahdi Mahmoudi, Mohammad H. Rahbar, Zi-Bing Jin, Jing Song, Huji Xu, MinJae Lee, Mengmeng Li, Xiaobing Wang, Michael H. Weisman, Andrew A. Harrison, Nurullah Akkoc, Jian Zhan, B P Wordsworth, Lianne S. Gensler, So Young Bang, Li Lin, Xin Wu, Elham Farhadi, James Cheng-Chung Wei, John D. Reveille, Helena Marzo-Ortega, Lawrie Wheeler, Chung Tei Chou, Geng Wang, Jin San Zhang, Tae-Hwan Kim, Ahmadreza Jamshidi, Queensland University of Technology [Brisbane] (QUT), Manisa Celal Bayar University, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Infection et inflammation (2I), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Université Paris Diderot, Sorbonne Paris Cité, Paris, France, Université Paris Diderot - Paris 7 (UPD7), University of Aberdeen, Tehran University of Medical Sciences (TUMS), University of Leeds, National Yang Ming University (NYMU), University of Otago [Dunedin, Nouvelle-Zélande], Hanyang University, University of Queensland [Brisbane], QIMR Berghofer Medical Research Institute, Queensland Brain Institute, University of Texas Southwestern Medical Center [Dallas], Griffith University [Brisbane], Beijing Tongren Hospital, University of California [San Francisco] (UCSF), University of California, National Institutes of Health [Bethesda] (NIH), The University of Texas Health Science Center at Houston (UTHealth), University of Oxford [Oxford], ANR-10-MIDI-0002,GEMISA,GEnétique, Microbiote, Inflammation, et Spondylarthrite Ankylosante(2010), Second Military Medical University [Shanghai], Hôpital Ambroise Paré [AP-HP], Laboratoire d'Excellence INFLAMEX [Paris], Université Sorbonne Paris Cité (USPC), Leeds Teaching Hospitals NHS Trust, Taipei Veterans General Hospital [Taiwan], Chung Shan Medical University, China Medical University, Wenzhou Medical University [Wenzhou, China] (WMU), The First Affiliated Hospital of Wenzhou Medical University [Wenzhou, China], Wenzhou University [Wenzhou, China], Cedars-Sinai Medical Center, Tsinghua University [Beijing] (THU), King‘s College London, and TCRI AS Group: Jian Yin, Lei Jiang, Lin Zhou, Ting Li, Qingwen Wang, Tianwang Li, Guanmin Gao, Shengqian Xu, Weiguo Xiao, Hui Shen, Jingguo Zhou, Yuquan You, Dongbao Zhao, Qing Cai, Shengming Dai, Lan He, Ping Zhu, Zhenyu Jiang, Jian Xu, Huaxiang Wu, Lie Dai, Yang Li, Feng Ding, Xiaochun Zhu, Chongyang Liu, Dongyi He, Liyun Zhang, Zhijun Li, Futao Zhao, Hanshi Xu, Niansong Wang, Youlian Wang, Lindi Jiang, Yu Zhang, Jinwei Chen, Fang Cheng, Zhiyi Zhang, Yifang Mei, Liangjing Lv, Lingli Dong, Jing Yang, Yinong Li, Xiaodong Wang, Xiaofeng Li, Hongsheng Sun, Xianming Long, Xiao Zhang, Qinghong Yu, Xiaodan Kong, Yi Zheng, Miaojia Zhang, Yi Tao, Yisha Li, Xinwang Duan, Qianghua Wei, Xiaofei Wang, Jie Han, Rong Mu, Yiping Lin, Jian Zhu, Xiaoyuan Chen
- Subjects
0301 basic medicine ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Immunology ,General Biochemistry, Genetics and Molecular Biology ,polymorphism ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Back pain ,magnetic resonance imaging ,Immunology and Allergy ,Spondylitis ,low back pain ,030203 arthritis & rheumatology ,HLA-B27 ,Ankylosing spondylitis ,[SDV.GEN.GPO]Life Sciences [q-bio]/Genetics/Populations and Evolution [q-bio.PE] ,Receiver operating characteristic ,business.industry ,Area under the curve ,spondylitis ,medicine.disease ,Low back pain ,ankylosing ,030104 developmental biology ,[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system ,[SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics ,genetic ,medicine.symptom ,business - Abstract
ObjectiveWe sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain.MethodsPRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI.ResultsIn people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924. This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively.ConclusionsPRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied.
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- 2021
38. Response to: 'Correspondence on 'EULAR recommendations for the management of antiphospholipid syndrome in adults' by Gao and Qin
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Maria G Tektonidou, Angela Tincani, and Michael M Ward
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Rheumatology ,Immunology ,Immunology and Allergy ,General Biochemistry, Genetics and Molecular Biology - Published
- 2021
39. Contributors
- Author
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Joseph M. Ahearn, Marta E. Alarcón-Riquelme, Salem J. Almaani, Jennifer H. Anolik, Cynthia Aranow, Maria A. Bacalao, Maria-Louise Barilla-LaBarca, Jennifer L. Barnas, Guillermo Barturen, Bonnie L. Bermas, Sasha Bernatsky, I.N. Bruce, Richard Bucala, Jill P. Buyon, Elena Carnero-Montoro, Ann E. Clarke, Megan E.B. Clowse, Josef Symon S. Concha, Paul Dellaripa, Betty Diamond, Tracy J. Doyle, Michelle M.A. Fernando, John D. Fisk, Richard Furie, Caroline Gordon, Teri M. Greiling, Shuhong Han, John G. Hanly, Grace A. Hile, Diane Horowitz, David Isenberg, Peter Izmirly, Barbara Jacobs, Judith A. James, J. Michelle Kahlenberg, Kenneth C. Kalunian, Insoo Kang, Mariana J. Kaplan, Munther A. Khamashta, Mimi Kim, Jason S. Knight, Fotios Koumpouras, Martin A. Kriegel, Antonio La Cava, Alexandra Ladouceur, Robert G. Lahita, Iris Jung-Won Lee, Christopher J. Lessard, Laura B. Lewandowski, Yun Liang, Chau-Ching Liu, Meggan Mackay, Michael P. Madaio, Galina Marder, Eric L. Matteson, Sara McCoy, Maureen McMahon, Eric Meffre, Juan Mejia-Vilet, Joan Merrill, Eric F. Morand, Sara Moreira Pinto, Shuichiro Nakabo, Melissa Northcott, Antonina Omisade, Thomas L. Ortel, Andras Perl, Rosalind Ramsey-Goldman, Westley H. Reeves, Joyce Reyes-Thomas, J.A. Reynolds, Bruce Richardson, Juan Vicente Rodriguez, Brad H. Rovin, Alla Rudinskaya, Guillermo Ruiz-Irastorza, Amit Saxena, Laura E. Schanberg, Tarun S. Sharma, Brian Skaggs, Emily C. Somers, William Stohl, Mehret Birru Talabi, Kandice L. Tessneer, Betty P. Tsao, Amaia Ugarte, Bruce T. Volpe, Timothy J. Vyse, Benjamin J. Wainwright, Michael M. Ward, Mary Chester M. Wasko, Victoria P. Werth, Leanna Wise, Haoyang Zhuang, and Yu Zuo
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- 2021
40. Epidemiology of SLE and related diseases
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Michael M. Ward
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Population ,Epidemiology ,Ethnic group ,Medicine ,Risk of death ,education ,business ,Demography ,Incidence prevalence - Abstract
Recent estimates of the incidence of systemic lupus erythematosus (SLE) vary widely around the world, but mainly fall between 1.4 and 6.3 cases per 100,000 per year. Rates are higher in women than in men, and lowest among whites compared to other ethnic groups. There has been no clear trend in incidence rates over recent years. Prevalence among US whites and many studies from Europe range from 32 to 55 per 100,000, while prevalence among US blacks ranges from 118 to 241 per 100,000. Few large epidemiological studies have been performed in low- or middle-income countries. Standardized mortality ratios indicate a threefold higher risk of death among patients with SLE than the general population. Mortality has decreased over the past several decades.
- Published
- 2021
41. Risk Factors for COVID-19 and Rheumatic Disease Flare in a US Cohort of Latino Patients
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Sandra G. Williams, Alice Fike, Jun Chu, Pravitt Gourh, Michael M. Ward, James D. Katz, Sarfaraz Hasni, Yanira Ruiz-Perdomo, Julia Hartman, and Christopher Redmond
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Adult ,Male ,medicine.medical_specialty ,Immunology ,Disease ,Comorbidity ,Logistic regression ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Risk Factors ,Intensive care ,Internal medicine ,Rheumatic Diseases ,Medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Risk factor ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Incidence ,Brief Report ,COVID-19 ,Retrospective cohort study ,Odds ratio ,Hispanic or Latino ,Middle Aged ,United States ,Cohort ,Female ,Brief Reports ,business ,Body mass index - Abstract
OBJECTIVE Latino patients are overrepresented among cases of coronavirus disease 2019 (COVID-19) and are at an increased risk of severe disease. Prevalence of COVID-19 in Latinos with rheumatic diseases is poorly reported. This study was undertaken to characterize COVID-19 clinical features and outcomes in Latino patients with rheumatic diseases. METHODS We conducted a retrospective study of Latino patients with rheumatic diseases from an existing observational cohort in the Washington, DC area. Patients seen between April 1, 2020 and October 15, 2020 were analyzed in this study. We reviewed demographic characteristics, body mass index (BMI), comorbidities, and use of immunomodulatory therapies. An exploratory classification and regression tree (CART) analysis along with logistic regression analyses were performed to identify risk factors for COVID-19 and rheumatic disease flare. RESULTS Of 178 Latino patients with rheumatic diseases, 32 (18%) were identified as having COVID-19, and the incidence rate of infection was found to be 3-fold higher than in the general Latino population. No patients required intensive care unit-level care. A CART analysis and multivariable logistic regression analysis identified a BMI of >30.35 as a risk factor for COVID-19 (odds ratio [OR] 3.37 [95% confidence interval (95% CI) 1.5-7.7]; P = 0.004). COVID-19 positivity was a risk factor for rheumatic disease flare (OR 4.57 [95% CI 1.2-17.4]; P = 0.02). CONCLUSION Our findings indicate that Latino patients with rheumatic diseases have a higher rate of COVID-19 compared with the general Latino population. Obesity is a risk factor for COVID-19, and COVID-19 is a risk factor for rheumatic disease flare. Latino patients with risk factors should be closely followed up, especially post-COVID-19 in anticipation of disease flare.
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- 2020
42. Chronic back pain in first-degree relatives (FDRs) of patients with ankylosing spondylitis: predictive value of HLA-B27 and persistence of inflammatory back pain over time
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Michael M. Ward, David C. Kung, Mohammad H. Rahbar, Amirali Tahanan, MinJae Lee, Laura Diekman, John D. Reveille, Michael H. Weisman, Lianne S. Gensler, Karim Doughem, and Mariko L. Ishimori
- Subjects
Proband ,Adult ,Male ,Ankylosing ,medicine.medical_specialty ,Immunology ,lcsh:Medicine ,Rheumatology ,Genetic ,Internal medicine ,Spondylarthritis ,Spondyloarthritis ,Back pain ,Immunology and Allergy ,Medicine ,Humans ,Spondylitis, Ankylosing ,First-degree relatives ,Polymorphism ,Allele frequency ,Spondylitis ,HLA-B27 Antigen ,Ankylosing spondylitis ,HLA-B27 ,business.industry ,lcsh:R ,medicine.disease ,Nutrition Surveys ,Low back pain ,Back Pain ,medicine.symptom ,business ,Low Back Pain - Abstract
Background/PurposeFirst-degree relatives (FDRs) of patients with ankylosing spondylitis (AS) may be at high risk of spondyloarthritis. We examined the frequency, characteristics of chronic back pain (CBP), associated features, persistence of symptoms, and HLA-B27 allele frequency in FDRs of AS patients, also comparing those FDRs with participants in NHANES 2009–2010 with CBP.Methods399 FDRs of AS probands were divided into: (1) No CBP (subjects >40 years old at study visit without CBP) (n=162); (2) NICBP (non-inflammatory CBP) (n=82), and (3) CIBP (inflammatory CBP) (n=155). White FDRs with CBP were compared with 772 participants in NHANES 2009–2010 with CBP. FDRs were invited to return for reassessment.ResultsFDRs with CIBP had earlier onset of CBP than those with NICBP (pConclusionCIBP in FDRs of AS patients is HLA-B27-associated, has earlier onset and tends to persist compared to NICBP.
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- 2020
43. Regional Variation in Surgical Procedure Rates
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Michael M. Ward
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Regional variation ,business.industry ,MEDLINE ,Medicine ,Surgery ,business ,Cartography ,Geographic difference - Published
- 2022
44. Response to: 'Correspondence on 'EULAR recommendations for the management of antiphospholipid syndrome in adults' by Zhou
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Angela Tincani, Maria G Tektonidou, and Michael M. Ward
- Subjects
0301 basic medicine ,Adult ,medicine.medical_specialty ,Immunology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Antiphospholipid syndrome ,Epidemiology ,medicine ,Immunology and Allergy ,Humans ,Lupus Erythematosus, Systemic ,In patient ,Intensive care medicine ,030203 arthritis & rheumatology ,Lupus erythematosus ,business.industry ,Retrospective cohort study ,medicine.disease ,Antiphospholipid Syndrome ,Pregnancy Complications ,030104 developmental biology ,Systematic review ,Prednisolone ,Antibodies, Antiphospholipid ,Female ,business ,Rheumatism ,medicine.drug - Abstract
We thank Zhou et al 1 for their interest in the 2019 European League Against Rheumatism (EULAR) recommendations for the management of antiphospholipid syndrome (APS) in adults.2 Although glucocorticoids (GC) are widely used in systemic lupus erythematous-associated APS, there is some uncertainty about their use in primary APS, and more specifically, about their use and dosage in the second and third trimester of pregnancy. In the EULAR recommendations for APS management, the use of GC in patients with primary APS is recommended only in catastrophic APS (CAPS), and may be considered in refractory cases of obstetric APS at low-doses (≤10 mg prednisolone daily) and for only the first trimester.2 The latter statement is based on expert opinion due to the limited evidence. The only retrospective cohort study that addressed this question is described in the accompanying article with the results of the systematic literature review …
- Published
- 2020
45. Accuracy of diagnoses of inflammatory arthritis in administrative hospitalization databases
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Michael M. Ward
- Subjects
Epidemiology ,Inflammatory arthritis ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Arthritis ,computer.software_genre ,Medicare ,030226 pharmacology & pharmacy ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Myocardial infarction ,Arthroplasty, Replacement, Knee ,Aged ,Ankylosing spondylitis ,Database ,business.industry ,Pharmacoepidemiology ,medicine.disease ,Arthroplasty ,United States ,Hospitalization ,Rheumatoid arthritis ,business ,Medicaid ,computer - Abstract
PURPOSE Studies using administrative hospitalization data often classify patients as having inflammatory arthritis based on diagnoses recorded at the hospitalization. We examined the agreement of these diagnoses with patients' prior medical histories. METHODS We identified Medicare beneficiaries hospitalized in 2011 to 2015 for total hip arthroplasty (THA), total knee arthroplasty (TKA), acute myocardial infarction (AMI), or sepsis. We compared diagnoses of rheumatoid arthritis (RA) or ankylosing spondylitis (AS) at the index hospitalization to diagnoses over prior inpatient and outpatient claims. To assess the impact of potential misclassification, we compared hospital outcomes using the alternative methods of detecting beneficiaries with arthritis. Analyses were repeated using Medicaid data. RESULTS Among 506 781 Medicare beneficiaries with THA, 18282 had RA and 571 had AS at the arthroplasty hospitalization, while 13 212 had RA and 1519 had AS based on claims history. Diagnoses at the hospitalization were highly specific (0.98-0.99), but sensitivities (0.65 for RA; 0.31 for AS) and positive predictive values (PPV) (0.47 for RA; 0.83 for AS) were lower. For TKA, AMI, and sepsis, specificities were 0.97 to 0.99, sensitivities 0.60 to 0.66 for RA and 0.18 to 0.22 for AS, and PPVs 0.43 to 0.47 for RA and 0.73 to 0.77 for AS. In Medicaid, sensitivities were 0.21 to 0.67 for RA and 0.07 to 0.49 for AS. Frequencies of some hospital outcomes differed when arthritis was classified by the index hospitalization or claims history. CONCLUSION Diagnoses of RA and AS in hospitalization databases are highly specific but fail to identify large proportions of patients with these diagnoses.
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- 2020
46. Regional Variation in Rates of Total Knee Arthroplasty Among Medicare Beneficiaries
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Abhijit Dasgupta and Michael M. Ward
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Knee arthritis ,Male ,Referral ,medicine.medical_treatment ,Total knee arthroplasty ,Medicare ,medicine ,Humans ,Arthroplasty, Replacement, Knee ,Original Investigation ,Aged ,Retrospective Studies ,Aged, 80 and over ,Spatial Analysis ,business.industry ,Research ,Health Policy ,Medicare beneficiary ,Retrospective cohort study ,Fee-for-Service Plans ,General Medicine ,medicine.disease ,Arthroplasty ,United States ,Online Only ,Regional variation ,Observational study ,Female ,business ,Demography - Abstract
Key Points Question How variable are rates of total knee arthroplasty across the United States after accounting for the prevalence of knee arthritis and other patient risk factors? Findings In this cohort study of more than 24 million Medicare beneficiaries annually from 2011 to 2015, observed to expected ratios for total knee arthroplasty ranged from 0.61 in Newark, New Jersey, to 1.82 in Idaho Falls, Idaho, suggesting areas of relative underuse and overuse. Regions with higher than expected rates were also associated with high rates among patients having relative contraindications to knee arthroplasty. Meaning Decision-making thresholds for performing total knee arthroplasty appear to differ across the US in a pattern suggesting overuse in some regions., Importance Rates of total knee arthroplasty vary widely across the United States. Whether this variation is associated with differences in patient characteristics or physician practice is unknown. Objectives To determine regional variations in rates of total knee arthroplasty after accounting for the prevalence of knee arthritis and other potentially associated patient risk factors and to assess the correlation of these variations with measures of access to care and surgical indications. Design, Setting, and Participants This retrospective national cohort study used Medicare data on more than 24 million deidentified beneficiaries annually from 2011 to 2015. Individuals included had fee-for-service coverage, were 65 to 89 years of age, and resided in 1 of 306 health referral regions. Data were analyzed from September 13, 2018, to August 15, 2019. Main Outcomes and Measures Rate of primary total knee arthroplasty indexed to the national rate using observed to expected ratios. The expected numbers of arthroplasty procedures were derived from estimates based on beneficiaries’ demographic and clinical characteristics. Observed to expected ratios were confounded by race/ethnicity; thus race/ethnicity–stratified analyses were conducted. Results In 2011, there were 218 282 total knee arthroplasty procedures among 24 583 706 white Medicare beneficiaries (mean [SD] age 74.2 [6.9] years; 54.6% women). The rate of arthroplasty during the study period (5 years) was 9.3 per 1000 person-years. Adjustment for clinical characteristics reduced the spread in observed to expected ratios among regions by 29% compared with adjustment for age and sex alone. However, substantial variation remained, with observed to expected ratios that ranged from 0.61 in Newark, New Jersey, to 1.82 in Idaho Falls, Idaho. High ratios were primarily present in the upper Midwest, Great Plains, and Mountain West regions. Higher ratios were associated with regions where beneficiaries had fewer outpatient visits (Spearman correlation [r], −0.64; 95% CI, −0.70 to −0.56) and with regions having more surgeons per capita who performed knee arthroplasty (r = 0.27; 95% CI, 0.16-0.37). Higher ratios were associated with higher rates of arthroplasty procedures among beneficiaries with dementia (r = 0.36; 95% CI, 0.25-0.46), peripheral vascular disease (r = 0.52; 95% CI, 0.42-0.61), and skin ulcers (r = 0.43; 95% CI, 0.32-0.53), which are relative contraindications to arthroplasty. Conclusions and Relevance Substantial regional variation in rates of total knee arthroplasty remained after adjustment for patient characteristics. Coexistence of high observed to expected ratios and high rates among patients at greater surgical risk suggested overuse of knee arthroplasty in some regions., This nationwide cohort study assesses whether rates of total knee arthroplasty are associated with the prevalence of knee arthritis, other potential risk factors, or geographic region among Medicare beneficiaries 65 to 89 years of age.
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- 2020
47. Minimal Clinically Important Improvement of Routine Assessment of Patient Index Data 3 in Rheumatoid Arthritis
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Isabel Castrejón, Maria I. Alba, Lori C. Guthrie, Martin J. Bergman, Theodore Pincus, and Michael M. Ward
- Subjects
Adult ,Male ,medicine.medical_specialty ,Index (economics) ,Immunology ,Severity of Illness Index ,Article ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Acute care ,Outcome Assessment, Health Care ,Severity of illness ,medicine ,Humans ,Immunology and Allergy ,Prospective Studies ,030212 general & internal medicine ,Medical diagnosis ,skin and connective tissue diseases ,Aged ,030203 arthritis & rheumatology ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Connective tissue disease ,Confidence interval ,Treatment Outcome ,Patient Satisfaction ,Antirheumatic Agents ,Rheumatoid arthritis ,Emergency medicine ,Female ,business - Abstract
OBJECTIVE: To compare the severity of illness of patients with systemic lupus erythematosus (SLE) between those hospitalized at academic medical centers and those hospitalized at community hospitals. METHODS: In this population based cross-sectional survey, data on all hospitalizations of patients with SLE in California, New York, and Pennsylvania in 2000 were obtained from discharge abstracts submitted by acute care hospitals to state health planning agencies. Patients hospitalized at one of 36 academic medical centers in these states (N = 2072) were compared to patients hospitalized at community hospitals (N = 9373). The primary measures of severity of illness were the SLE Comorbidity Index, a weighted index of SLE manifestations and comorbid medical conditions based on discharge diagnoses, and long lengths of stay, defined as stays that exceeded the 90th percentile of hospital stays in the same diagnosis-related group in the United States. RESULTS: Compared to patients at community hospitals, patients at academic medical centers had substantially higher scores on the SLE Comorbidity Index (odds ratio for each 1-point increase 1.27, 95% confidence interval 1.15-1.40, p or = 300 beds) community hospitals in the same metropolitan areas. Results for the SLE Comorbidity Index were similar in the subset of patients with SLE as the primary discharge diagnosis. CONCLUSION: Patients with SLE hospitalized at academic medical centers are generally more severely ill than those hospitalized at community hospitals, including large community hospitals in the same area.
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- 2018
48. Clinical Evolution in Patients With New-Onset Inflammatory Back Pain
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Runsheng Wang, Kerry Wright, Michael M. Ward, and Cynthia S. Crowson
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Longitudinal study ,Adolescent ,Minnesota ,Immunology ,Population ,Article ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rochester Epidemiology Project ,Rheumatology ,Internal medicine ,Spondylarthritis ,Prevalence ,Back pain ,Humans ,Immunology and Allergy ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,Family history ,education ,Retrospective Studies ,Inflammation ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Retrospective cohort study ,Prognosis ,stomatognathic diseases ,Back Pain ,Cohort ,Disease Progression ,Female ,medicine.symptom ,business - Abstract
Objective Inflammatory back pain (IBP) is often an early manifestation of spondyloarthritis (SpA), but the prognosis of patients with incident IBP is unknown. This study was undertaken to investigate long-term outcomes in patients with IBP, and predictors of progression to SpA, in a population-based cohort. Methods We conducted a retrospective, longitudinal study using the Rochester Epidemiology Project, a longstanding population-based cohort of residents of Olmsted County, MN. Patients ages 16-35 years with clinical visits for back pain from 1999 to 2003 were identified, and we screened these patients for the presence of new-onset IBP and performed medical record reviews to collect data on clinical, laboratory, and imaging features of SpA. Outcomes in these patients were followed up until July 2016. We used survival analysis for competing risks to examine progression to either SpA, a non-SpA diagnosis, or resolution of back pain. Recursive partitioning was used to identify predictors of progression to SpA. Results Among 5,304 patients with back pain, we identified 124 patients with new-onset IBP. After a median follow-up of 13.2 years, IBP had progressed to SpA in 39 patients, 15 patients developed a non-SpA diagnosis, and 58 patients had resolution of IBP. At 10 years, the probability of having SpA was 30%, while the probability of resolution of IBP was 43%. The most important predictors for progression to SpA were uveitis, male sex, and family history of SpA. Conclusion In a minority of patients, new-onset IBP progresses to SpA, while IBP resolves in many. That IBP often resolves may explain the difference between the prevalence of IBP (3-6%) and the prevalence of SpA (0.4-1.3%).
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- 2018
49. Origins of Discordant Responses among 3 Rheumatoid Arthritis Improvement Criteria
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Michael M. Ward, Lori C. Guthrie, Maria I. Alba, and Abhijit Dasgupta
- Subjects
Male ,musculoskeletal diseases ,medicine.medical_specialty ,Longitudinal study ,Immunology ,Blood Sedimentation ,Sensitivity and Specificity ,Article ,050105 experimental psychology ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Immunology and Allergy ,0501 psychology and cognitive sciences ,Longitudinal Studies ,Prospective Studies ,skin and connective tissue diseases ,Response criteria ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,Remission Induction ,05 social sciences ,Simplified disease activity index ,Middle Aged ,medicine.disease ,C-Reactive Protein ,Treatment Outcome ,Antirheumatic Agents ,Rheumatoid arthritis ,Baseline characteristics ,Erythrocyte sedimentation rate ,Female ,business ,Rheumatism - Abstract
Objective.We examined agreement between the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR), and Simplified Disease Activity Index (SDAI) response criteria in rheumatoid arthritis (RA) and tested whether discordant responses were associated with patients’ baseline characteristics or changes in RA activity encapsulated by the different criteria.Methods.In a prospective longitudinal study, we examined responses of 243 patients with active RA to escalation of antirheumatic treatment. We computed agreement between pairs of response criteria using κ coefficients and identified patient characteristics associated with unique responses to individual criteria.Results.We found that 110 patients (45.3%) had an ACR 20% improvement (ACR20) response, 135 (55.5%) had a EULAR moderate/good response, and 83 (34.1%) had an SDAI50 response. Agreement was moderate to good (ACR20/EULAR κ 0.57; ACR20/SDAI50 κ 0.64; EULAR/SDAI50 κ 0.59). All who had SDAI50 response also had a EULAR response. Patient characteristics at baseline generally did not distinguish those who responded to both, 1, or neither criterion. Discordance was most often because of improvements in the erythrocyte sedimentation rate or C-reactive protein level among EULAR and SDAI50 responders, which were not as common among ACR20 responders. Based on receiver-operating characteristic curves, SDAI35 response had a better balance of sensitivity and specificity relative to ACR20 and EULAR moderate/good responses than SDAI50.Conclusion.Discordant responses to RA improvement criteria are most often because of differences in responses of acute-phase reactants. SDAI35 response had higher sensitivity for improvement, as reflected by other response criteria, than SDAI50 response.
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- 2018
50. Epidemiology of axial spondyloarthritis: an update
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Runsheng Wang and Michael M. Ward
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0301 basic medicine ,medicine.medical_specialty ,Population ,Comorbidity ,Article ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Environmental risk ,Risk Factors ,Internal medicine ,Spondylarthritis ,Epidemiology ,medicine ,Humans ,Spondylitis, Ankylosing ,In patient ,Axial spondyloarthritis ,education ,Spondylitis ,030203 arthritis & rheumatology ,education.field_of_study ,Ankylosing spondylitis ,business.industry ,Incidence (epidemiology) ,medicine.disease ,United States ,030104 developmental biology ,Cardiovascular Diseases ,Disease Progression ,business - Abstract
To provide an update of the prevalence and incidence of axial spondyloarthritis in the general population and in patients with spondyloarthritis-related conditions, environmental risk factors for ankylosing spondylitis, progression from nonradiographic axial spondyloarthritis to ankylosing spondylitis, mortality, and risks for cardiovascular events in patients with ankylosing spondylitis.Increasingly, administrative healthcare data have been used to study disease frequency and outcomes. The prevalence of ankylosing spondylitis ranged from 9 to 30 per 10 000 persons, which are lower than previous estimates. Data on whether childhood infections influence the risk of ankylosing spondylitis were equivocal, while having been breast-fed may be protective. Progression of patients with nonradiographic axial spondyloarthritis to ankylosing spondylitis is slow, with estimates of 5.1% in 5 years and 19% in 10 years. Risk of mortality is slightly increased in ankylosing spondylitis. Risks for cardiovascular events in ankylosing spondylitis were either not different from, or only slightly higher than in controls. No studies have examined these outcomes in the broader group of patients with axial spondyloarthritis.Expanded use of administrative and registry data has facilitated studies of the epidemiology of ankylosing spondylitis, but lack of specific diagnostic codes limits use of these resources for studying axial spondyloarthritis in general.
- Published
- 2018
Catalog
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