Rheumatology Office Research Articles

Screening for juvenile idiopathic arthritis associated uveitis with laser flare photometry in the pediatric rheumatology office: a prospective observational study

BackgroundJuvenile Idiopathic Arthritis (JIA) Associated Uveitis (JIA-U) remains one of the most serious complications of JIA in children. Historically, pediatric JIA is diagnosed by an Optometrist or Ophthalmologist; however, barriers to scheduling increase wait times that may delay diagnosis and treatment. The purpose of this study was to evaluate laser flare photometry (LFP) use to diagnose JIA-U in the Pediatric Rheumatology clinic for patients with JIA.MethodsThis prospective, observational study assessed pediatric patients diagnosed with JIA without a previous history of uveitis between January 2020 and September 2022. All patients underwent at least one evaluation of both eyes using a Kowa FM-600 laser flare photometer during a routine Rheumatology appointment, as well as a standard slit lamp examination (SLE) by optometry or ophthalmology during routine clinical care. Data collected at patient visits included demographics, JIA characteristics, treatment, LFP readings, and anterior chamber (AC) cell grade score utilizing the SUN grading system. Data were summarized using descriptive analyses and the uveitis false positive rate was calculated.ResultsThe study cohort included 58 pediatric patients diagnosed with JIA. The mean age was 8.4 years (1.2–16.3 years) at diagnosis and 11.9 (4.8–16.5 years) at enrollment. The mean duration of disease at time of enrollment was 42 months (range; 0-157 months). Participants were predominantly female (n = 43, 74.1%) and white/Caucasian race (n = 37, 63.8%). The most common JIA subtypes included persistent oligoarticular JIA (n = 19, 32.8%), and RF negative polyarticular JIA (n = 12, 20.7%). There were 12 ANA positive patients (20.7%). At enrollment, 16 patients (27.6%) were not on medications, with 20 (34.5%) on methotrexate, 20 (34.5%) on adalimumab, 6 (10.3%) on tocilizumab, and 5 (8.6%) on etanercept. During the study period, no eye exams detected active uveitis based on SLE with a SUN grade over 0. However, of the 135 LFP readings, 131 (97.0%) were normal, yielding a false positive rate of 3% (95% CI: 0.8%, 7.4%).ConclusionsLFP is a non-invasive tool that can be utilized in the pediatric rheumatology clinic to evaluate for JIA-U. There is a low false positive rate of LFP when compared with standard slit lamp exam.

Using Electronic Health Records and Linked Claims Data to Assess New Medication Use and Primary Nonadherence in Rheumatology Patients.

The objective of this study was to determine the proportion of new medication prescriptions observed in electronic health records (EHR) that represent true incident medication use, accounting for undocumented previous prescriptions (prevalent medication use) and failure to initiate treatment (primary nonadherence) with linked administrative claims data as the reference standard. Using single-specialty rheumatology EHR data from more than 700 community practices in the United States linked to administrative claims data, we identified first (index) EHR prescriptions and assessed the positive predictive value (PPV) of different EHR-derived new user definitions to identify true incident use (no prior claims). We then assessed how often index EHR prescriptions that met a definition of new use resulted in primary nonadherence (no subsequent claims). Overall, 12,405 index EHR prescriptions were identified with PPVs of 0.59 to 0.67 for true incident use. PPVs increased to 0.76 to 0.85 by excluding medications listed during the EHR medication reconciliation process and further increased to 0.87 to 0.93 by requiring ≥12 elapsed months since the first rheumatology office visit. Primary nonadherence at three months was observed in 33% to 38% overall and varied substantially by medication class, ranging from 15% to 23% for conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to 54% to 64% for targeted synthetic DMARDs. New DMARD use was accurately distinguished from prevalent use with EHR prescriptions and simple new user definitions that include current medications collected during medication reconciliation. Primary nonadherence was frequent and varied by DMARD class. This has important implications for epidemiologic studies using EHR data and for optimal delivery of clinical care.

Development and validation of algorithms to build an electronic health record based cohort of patients with systemic sclerosis.

To evaluate methods of identifying patients with systemic sclerosis (SSc) using International Classification of Diseases, Tenth Revision (ICD-10) codes (M34*), electronic health record (EHR) databases and organ involvement keywords, that result in a validated cohort comprised of true cases with high disease burden. We retrospectively studied patients in a healthcare system likely to have SSc. Using structured EHR data from January 2016 to June 2021, we identified 955 adult patients with M34* documented 2 or more times during the study period. A random subset of 100 patients was selected to validate the ICD-10 code for its positive predictive value (PPV). The dataset was then divided into a training and validation sets for unstructured text processing (UTP) search algorithms, two of which were created using keywords for Raynaud's syndrome, and esophageal involvement/symptoms. Among 955 patients, the average age was 60. Most patients (84%) were female; 75% of patients were White, and 5.2% were Black. There were approximately 175 patients per year with the code newly documented, overall 24% had an ICD-10 code for esophageal disease, and 13.4% for pulmonary hypertension. The baseline PPV was 78%, which improved to 84% with UTP, identifying 788 patients likely to have SSc. After the ICD-10 code was placed, 63% of patients had a rheumatology office visit. Patients identified by the UTP search algorithm were more likely to have increased healthcare utilization (ICD-10 codes 4 or more times 84.1% vs 61.7%, p < .001), organ involvement (pulmonary hypertension 12.7% vs 6% p = .011) and medication use (mycophenolate use 28.7% vs 11.4%, p < .001) than those identified by the ICD codes alone. EHRs can be used to identify patients with SSc. Using unstructured text processing keyword searches for SSc clinical manifestations improved the PPV of ICD-10 codes alone and identified a group of patients most likely to have SSc and increased healthcare needs.

Musculoskeletal ultrasound as a screening-tool for rheumatoid arthritis: results of the \u201cRheuma-Truck\u201d screening and awareness initiative

ObjectiveTo evaluate musculoskeletal ultrasound (MSUS) as a screening tool for rheumatoid arthritis (RA) and osteoarthritis (OA) patients in a rheumatology-screening program.Patients and methodsTo raise awareness for rheumatic diseases, a mobile rheumatology office was deployed in different cities of Germany (“Rheuma-Truck”). Standardized questionnaire assessment, testing for rheumatoid factor and citrullinated peptide antibodies and medical student driven MSUS of the clinically dominant hand/foot including wrist, MCP-II, -III, -V, PIP-II, -III, MTP-II and -V were offered free of charge to the population. In case of suspicious results, a rheumatologist was consulted.ResultsIn MSUS, 192 of 560 selected volunteers (aged 18–89, mean 52.7 years; 72.9% female) had suspicious findings including synovitis or erosions primarily affecting the MTP-II (11.8%), dorsal wrist (8.9%), and MCP-II (7%). 354 of the 560 volunteers further visited a rheumatologist of whom 76 were diagnosed with RA. According to the ‘US7 Score’, a sum scores ≥ 5 was significantly predictive for RA (odds ratio (OR) 5.06; confidence interval (CI) 0.83–35.32). 313 volunteers displayed signs of OA including osteophytes, while MCP-II (36.2%), MCP-III (14.8%), and the wrist (10.5%) were mostly affected. Diagnosis of RA was favoured over OA if the wrist (OR 4.2; CI 1.28–13.95), MTP-II (OR 1.62; CI 1.0–2.6), and MCP-V (OR 2.0; CI 1.0–3.8) were involved.ConclusionMedical student driven MSUS by the ‘US7 Score’ can facilitate diagnosis of RA in rheumatology-screening programs due to the level of the score and the affected joints. A high rate of unknown OA signs was detected by MSUS. A mobile rheumatology office displays an opportunity to screen patients for RA and OA.

Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis

Background Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice. Setting Rheumatology offices in Germany. Method Analysis of socio economic and health economic parameters of the non-interventional, multicentre, prospective study GO-NICE. Analyses were performed in an exploratory manner using descriptive statistical methods. Further, p-values on socio economic variables were calculated based on one-sample t-test on the differences between baseline and follow-up visits. Results A total of 1458 patients were evaluable, of whom a total of 664 patients completed the 24-month observation period. The proportions of hospitalizations decreased statistically significantly (p ≤ .05) from 10.4/7.6/14.0% at baseline (BL) to 1.7/2.2/0.8%, and the in-patient rehabilitations decreased from 3.3/3.7/7.5% at BL to 0.6/1.8/2.1% at month 24 in patients with RA, PsA, and AS. When considering a 30-day period, the mean number of sick leave days decreased statistically significantly (p ≤ .005) from 4.0 at BL to 0.9 at month 24 (greatest improvement in RA), and the mean number of days with impaired capability decreased statistically significantly (p ≤ .001) from 14.9 at BL to 4.5 at month 24 (greatest improvement in patients with AS). There was also a reduction in the number of consultations and remedies. Conclusion This evaluation shows improvements in socio economic and health economic parameters on GLM treatment.

Use of FDA-Approved Medications: Biologics for Psoriatic Arthritis in Patients at an Urban Outpatient Rheumatology Clinic.

ObjectivePsoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that manifests as peripheral arthritis, dactylitis, enthesitis, and spondylitis. Biologics, particularly tumor necrosis factor inhibitors (TNFis) and some interleukin 17 (IL‐17) and interleukin 23 (IL‐23) inhibitors, are the only US Food and Drug Administration (FDA)–approved treatments shown to limit joint damage in clinical trials for PsA. Conventional synthetic disease‐modifying antirheumatic drugs have also been adapted to PsA treatment. Current 2018 American College of Rheumatology (ACR) guidelines regard TNFis as first‐line therapy in treatment‐naïve patients. The aim of this project is to review the prescribing practices for patients with PsA at an urban rheumatology office, with a focus on biologic prescribing.MethodsA retrospective chart review was performed to search for patients seen from June 1, 2017, to June 1, 2018, using International Classification of Diseases, 10th Revision codes for PsA. A log of prescribing practices listed the use of biologics versus oral small molecules (OSMs) (methotrexate, sulfasalazine, leflunomide, and apremilast) across different ages, sex, and disease severity.ResultsThis study included a total of 97 patients (40 women and 57 men), and 66% were on biologics (60% of women and 70% of men). There was no sex bias in biologic prescribing (P = 0.59). Use of biologics was highest in the 38 to 57 years age group and lowest in the 78 to 97 years age group, although, statistically, there was no age bias in biologic prescribing (P = 0.22). Biologics provided superior disease control (84.37%) compared with nonbiologics (66.6%) (P = 0.0016). OSMs provided slightly better control (69.5%) over apremilast monotherapy (61.5%) (P = 0.016).ConclusionThere is no age or sex bias in prescribing practices for PsA. In accordance with the ACR, patients with controlled symptoms on OSMs are being appropriately maintained. Although apremilast is allocated as an add‐on therapy, 13.4% of patients were on apremilast monotherapy. This quality improvement project reveals that in most instances, biologics are being appropriately initiated as the primary mode of therapy for patients with PsA at our outpatient practice; however, treatment modifications can be made regarding patients who are managed with apremilast alone.

Methodological approaches to the use of the Register of children with juvenile arthritis at the level of specialized medical care

Juvenile arthritis (JA) is a disease of unknown etiology that begins before the age of 16 years and lasts for at least 6 weeks. The main objective of most existing international registers of children with JA is assessment various aspects of the efficacy and safety of biologics in comparison with methotrexate. The results of the analysis of the effectiveness of registers as a tool for long-term monitoring of the disease and medical care for children with JA are not presented in the available literature. The aim of the study is to develop methodological approaches to maintaining the Register of children with JA and algorithms of actions of medical personnel on the basis of the experience of the Republican Children's Clinical Hospital (Ufa). This work is a retro- and prospective observational study. The Register included children under the age of 18 years with an established diagnosis of JA, who were admitted to the cardio-rheumatologic department of Republican Children's Clinical Hospital (Ufa). In this paper, we used the All-Russian register of children with JA, developed by «Aston Consulting» and «Norbit» (official partner of Microsoft) on the basis of the technological platform Microsoft Dynamics CRM 5.0. In total, the Register included information about 426 children with JA. The average age of children during the analysis of the register data was 10.9±4.3 years, and in the onset of the disease – 4.7±3.7 years. According to the results of the analysis, the tasks, areas of responsibility and scope of action for each subject of medical care (rheumatologist of rheumatology hospital and office, head of department, chief freelance specialist of the Ministry of Health) and the corresponding tools of the Register were determined. A clear algorithm of actions of specialists depending on the task will optimize the work with the register of patients, reduce the time required to enter and receive information and, at the same time, provide the possibility of the most complete and effective use of the Register in optimizing medical care for children with JA.

Clinical and pathogenetic interrelation between molecular regulation of apoptosis and cell differentiation in osteoarthritis

Цель. Установить клинико-патогенетические закономерности между уровнями апоптоза и регуляторами роста и дифференцировки (ингибитором роста 1, индуцированным оксидативным стрессом; фактором роста и дифференцировки 5) при остеоартрите.&#x0D; Методы. В условиях ревматологического кабинета Владивостокской поликлиники №3 были обследованы 65 пациентов с остеоартритом коленных суставов I-IV стадий по Kellgren в возрасте 66,5±8,0 лет. В качестве группы сравнения в исследование были включены 25 добровольцев, сопоставимых с основной группой по полу и возрасту, не имевших клинических и рентгенологических проявлений остеоартрита. Для определения концентраций искомых молекул в крови пациентов, включённых исследование, использовали иммуноферментный анализ.&#x0D; Результаты. У больных остеоартритом по сравнению с группой контроля отмечены статистически значимые повышения уровней Fas, фактора роста и дифференцировки 5 и соотношения «фактор роста и дифференцировки 5/ингибитор роста 1, индуцированный оксидативным стрессом». Показатели Fas были достоверно ниже на «поздних» III-IV стадиях остеоартрита по сравнению с I и II стадиями. Уровень фактора роста и дифференцировки 5 имел более низкие значения у больных с III-IV стадиями остеоартрита по сравнению с I и II. По мере прогрессирования рентгенологических симптомов остеоартрита зарегистрировано снижение соотношения «фактор роста и дифференцировки 5/ингибитор роста 1, индуцированный оксидативным стрессом», которое было достоверно ниже на II и III стадиях по сравнению с I стадией.&#x0D; Вывод. Внешний путь апоптоза имеет большое значение при формировании болевого синдрома при остеоартрите, а его поддержание реализуется по другим механизмам, к которым можно отнести влияние оксидативного стресса через опосредованное ингибитором роста 1, индуцированным оксидативным стрессом, угнетение клеточного цикла, снижение участия фактора роста и дифференцировки 5 в процессах дифференцировки и регуляции синтеза белков внеклеточного матрикса хрящевой ткани.

The Work-It Study for people with arthritis: Study protocol and baseline sample characteristics.

People with arthritis are at risk of work disability. Job accommodation and educational programs delivered before imminent work loss can minimize work disability, yet are not currently being widely implemented. The Work-It Study is a randomized controlled trial testing the efficacy of a problem solving program delivered by physical and occupational therapy practitioners to prevent work loss over a two-year period among people with arthritis and rheumatological conditions. The purpose of this paper is to describe the protocol of the randomized controlled trial, and describe the baseline characteristics of the subjects and their work outcomes. 287 participants were recruited from the Boston area in Massachusetts, USA. Eligible participants were aged between 21-65, self-reported a physicians' diagnosis of arthritis, rheumatic condition, or chronic back pain, reported a concern about working now or in the near future due to your health, worked at least 15 hours a week, had plans to continue working, and worked or lived in Massachusetts. Subjects were recruited through community sources and rheumatology offices. Participants in the experimental group received a structured interview and an education and resource packet, while participants in the control received the resource packet only. The baseline characteristics and work related outcomes of the participants were analyzed. To our knowledge, the Work-It Study is the largest and most diverse randomized controlled trial to date aiming to identify and problem solve work-related barriers, promote advocacy, and foster work disability knowledge among people with chronic disabling musculoskeletal conditions. Despite advances in medical management of arthritis and other rheumatological and musculoskeletal conditions, many people still have concerns about their ability to remain employed and are seeking strategies to help them sustain employment.

Medication risk communication during rheumatology office visits.

We used a multidimensional framework to describe the types of information about medication risks that rheumatologists provide to rheumatoid arthritis (RA) patients during routine office visits. We analyzed 1,094 audiotaped rheumatology office visits involving 450 RA patients. Each patient had up to 3 visits audiotaped. In conjunction with each office visit, patients also completed a self-administered questionnaire and interview and the rheumatologists provided ratings of patient health status. The number of medication risks discussed per visit ranged from 0-18, with a mean ± SD of 3.23 ± 2.93. The rheumatologist initiated ∼80% of the medication risk discussions. Approximately one-fourth of the discussions (25.6%) were limited to an assessment of whether or not the patient was experiencing a medication side effect. More risks were discussed during visits when changes to the patient's regimen were discussed than when no changes were discussed (X= 3.93, SD = 3.10 and X = 2.20, SD = 2.34, respectively; P < 0.0001). When medications were being proposed for addition to the patient's regimen, the most frequently discussed risk dimensions were the importance of monitoring (30%), probability (29.8%), things the patient should do to minimize risk (25.5%), and risk severity (21.8%). Most discussions of medication risks that we observed were quite limited and often restricted to an assessment of whether the patient was experiencing side effects from their current medications. The amount of information that is optimal and how to tailor information to the preferences and abilities of individual patients remain important areas for future research.

AB0719 2-Year Incidence of New Immune-Mediated Inflamatory Diseases in Patients with Spondyloarthritis. the Aquiles Study

BackgroundPatients with spondyloarthritis (SpA) frequently show other immune-mediated inflammatory diseases (IMID)ObjectivesTo describe the 2-year incidence of new diagnoses of IMID in patients with SpA recruited for the AQUILES studyMethodsAQUILES was...

AB1003 Is the Ultrasound Score Based on 7 Joints (US-7 SCORE) A Valid Screening Tool for Inflammatory Joint-Diseases in A Population of Volunteers? Results from the “Rheuma-Truck” Cohort

ObjectivesTo investigate the value of ultrasound (US) and the US-7 score as a screening tool in a population of volunteers visiting the “Rheuma-Truck”Methods“Rheuma-Truck” was a mobile rheumatology office located in...

AB1004 Inter-Rater Reliability of the US-7 Score in A Population of Volunteers: is A Post-Hoc Analysis of Still Images Comparable to the Dynamic Analysis? Results from the “Rheuma-Truck” Cohort

ObjectivesTo investigate the value of a follow-up analysis of ultrasonographic still images versus dynamic investigation using the US-7 ultrasound score.Methods“Rheuma-Truck” was a mobile rheumatology office located in different city center...

P604 Prevalence and characteristics of dermatologic manifestations in a Greek population of inflammatory bowel disease patients followed-up in tertiary centers

psoriasis aimed to study the incidence of these diseases over 2 years). Methods: Patients aged 18 years-old with known or newly diagnosed SpA, IBD or psoriasis were recruited from rheumatology, IBD and dermatology offices from 15 hospitals. Clinical data were collected through direct interview and patient’s clinical record review. Results: The SpA cohort (mean age 48 years, men: 63%) comprised 601 patients with the following diagnoses: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated SpA (16.1%), enteropathic arthritis (2.5%), others (1.3%). The prevalence of IBD (table) was 5.1% (95%CI: 3.7 7.2), and the specific diagnoses were Crohn’s disease (3.0%, 95%CI: 1.9 4.7), ulcerative colitis (1.0%, 95%CI: 0.5 2.2), and undifferentiated colitis (1.2%, 95%CI 0.6 2.4). The prevalence of IBD was 100% in those with enteropathic arthritis and upon removal of these patients, the prevalence of IBD in other SpA patients was 2.7% (95%CI: 1.7 4.4), with figures of 3.9%, 0.7% and 2.4% in patients with ankylosing spondylitis, psoriatic arthritis or undifferentiated SpA, respectively. The prevalence was similar in men and women (5.0% and 5.4%, p =NS), and in those with or without other extra-articular manifestations of SpA (4.9% and 6.7%, p =NS). It was slightly higher in those with SpA of longer duration (3.5%, 4.4% and 6.9% respectively for those with SpA of 8 years duration, P=NS), and in those without family history of SpA (6.4% versus 1.7%, p = 0.048). The multivariate analysis identified the absence of family history of SpA as the only variable associated to the presence of IBD (3.9 [95%CI: 1.1 16.7]). The psoriasis cohort comprised 528 patients, and only 7 had IBD (prevalence 1.3%, 95%CI: 0.6 2.7).

AB0904 Prevalence of different immune-mediated inflammatory diseases in patients with spondyloarthropaties. Aquiles study

BackgroundAQUILES is a 2-year follow-up observational prospective study in patients with spondyloarthritis (SpA), inflammatory bowel disease [IBD] or psoriasis, to assess: 1) the coexistence of immune-mediated inflammatory diseases (IMID); 2)...

FRI0566-PC Prevalence of arterial hypertension in outpatients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is associated with increased cardiovascular mortality due to myocardial infarction, stroke and heart failure. Both, chronic inflammation leading to arterial stiffness, and some of the drugs used...

AB1386 Rheumatologists play a key role in shared decision-making with patients in the choice to initiate biologic therapy for treatment of rheumatoid arthritis

BackgroundThere has been increasing focus on the importance of patients participating in the treatment decision-making process with their physicians. Previous research has demonstrated that effective physician-patient communication, a key component...

*Poster 98: Time to Get an Appointment to a Rheumatologist and for Rehabilitation Services: Is Rheumatoid Arthritis Prioritized?

Objective: (1) To determine delays from referral to rheumatology until rheumatology consultation; (2) to determine delays from referral to physiotherapy and occupational therapy until consultation in the public system; and (3) to explore whether these system-related obstacles are associated with other factors. Design: Cross-sectional observational study. Setting: All publicly accessible rheumatology, physiotherapy, and occupational therapy departments and offices in the province of Quebec, Canada.

American College of Rheumatology Office Has Moved

American College of Rheumatology Office Has Moved

The Uses of Disease Activity Scoring and the Physician Global Assessment of Disease Activity for Managing Rheumatoid Arthritis in Rheumatology Practice

To evaluate the uses of quantitative disease activity scoring and a physician global assessment of disease activity for managing rheumatoid arthritis (RA) in rheumatology practice. The Global Arthritis Score (GAS) and a physician global assessment (Physician Global) were determined during each office visit for a community practice RA population. The GAS was calculated from patients' self-reported pain, functional assessment, and tender joint count. The Physician Global was recorded on a 10-point visual analog scale. The correlation of these 2 disease activity measures was determined for the most recent office visit of 185 patients with RA, and the reasons for discordant results were identified by chart review. The GAS and Physician Global were concordant for active or inactive disease in 126 of 185 patients (68%) and were discordant in 59 (32%). Forty-five of these discordant patients had a high GAS while their Physician Global indicated inactive disease. Their GAS values were high because of osteoarthritis, back pain, soft tissue rheumatism, and/or prior joint damage rather than active RA. The other 14 patients had a low GAS with an uncontrolled Physician Global for a variety of reasons. (1) An RA disease activity score and a quantitative Physician Global can be measured during rheumatology office visits to document patients' disease status. (2) Disease activity scoring contributes valuable information, but should not replace the Physician Global in guiding RA patient management or reimbursement decisions.