News and Features

Stay Tuned-

BWH SCS Dr. Dan Solomon’s group investigating the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor.

Citation: DH Solomon, J Kay, J Duryea, B Lu, MB Bolster, RA Yood, R Han, S Ball, C Coleman, E Lo, A Wohlfahrt, M Sury, M Yin, Z Yu, A Zak, EM Gravallese. Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol, In Press.

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Stay Tuned—

Drs. Barbhaiya, Costenbader, and others from the BWH Section of Clinical Sciences demonstrate racial/ethnic variation in risk of MI and stroke among Medicaid patients. Paper in press at Arthritis & Rheumatology

Citation: Barbhaiya M, Feldman CH, Guan H, Gomez-Puerta JA, Fischer MA, Solomon DH, Everett B, Costenbader KH. Race/Ethnicity and Cardiovascular Events among Patients with Systemic Lupus Erythematosus. Arthritis Rheum. 2017. (In Press).

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Stay Tuned—

In a randomized controlled trial led by Dr. Daniel Solomon, teriparatide treatment for one year did not significantly reduce erosion volume in the hands or wrists of patients with established RA and osteopenia, controlled on TNFi treatment.

Citation: DH Solomon, J Kay, J Duryea, B Lu, MB Bolster, RA Yood, R Han, S Ball, C Coleman, E Lo, A Wohlfahrt, M Sury, M Yin, Z Yu, A Zak, EM Gravallese. Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol, In Press.

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Sustained Smoking Cessation Reduces Mortality Risk in RA

A study led by Drs. Jeffrey Sparks and Beth Karlson showed that sustained smoking cessation within four years of RA diagnosis reduced mortality risk. Smoking >5 pack-years after RA diagnosis significantly increased mortality risk compared to comparators without RA.

Read the full abstract here.

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SCS's Dr. Liao featured in Dell Technologies Video

SCS Investigator Dr. Kat Liao was featured in a video by Dell Technologies, discussing her passion for clinical research and her innovative work using analytical tools to treat rheumatic disease patients. Check out the video below.

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Clinical patient registry recruitment and retention: a survey of patients in two chronic disease registries

Today we are highlighting the results of a survey regarding patient experiences while participating in chronic disease registries. Two groups of patients, one with rheumatoid arthritis and one with inflammatory bowel disease, were surveyed from an academic medical center. Both groups reported very similar motivations for participation: desire to help others, desire to improve care of own disease, and ease of volunteering. Age was an important correlate of patients’ preferred survey methods, with those over 65 favoring mail surveys and those under 45 favoring email or online surveys. Overall, telephone surveys were not preferred. Respondents preferred surveys either every 1–3 months or every 4–6 months. The two disease groups differed in payment preferences. Sixty-eight percent with RA answered that no payment was necessary, but only 36.1% with IBD felt similarly. Patients engaged in clinical registries demonstrate a high level of commitment to improve care and many report a willingness to answer questions relatively frequently.

Read the full article here.

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Patients with multiple comorbidities report worse RA disease activity

Today we are highlighting an article by Drs. Helga Radner and Daniel Solomon that aimed to assess the differences in how patients with rheumatoid arthritis (RA) among other diseases rate their disease activity as compared to those with RA only. Based on data from patients followed in a longitudinal cohort of 1,040 patients, those with RA and other conditions reported higher (or worse) RA disease activity, with more conditions associated with higher reported activity. The factors that uniquely contributed to reported disease activity were fatigue (18%), pain (17%), and functional status (9%). In RA patients with multiple morbidities, the perception of RA disease activity might be impacted by the burden of multiple diseases in one individual.

Find the article here.

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Dr. Jay Lin investigates the practice pattern of Hepatitis B in RA patients

Dr. Jay Lin and Dr. Daniel Solomon, along with colleagues from BWH and National Cheng Kung University in Taiwan, conducted a retrospective cohort study investigating Hepatitis B Virus (HBV) testing rates and patterns in rheumatoid arthritis (RA) patients starting disease modifying anti-rheumatic drugs. Their study demonstrated that the overall HBV testing rate was similarly low in the U.S. (20.3%) and Taiwan (24.5%). Although the rate gradually increased in the past decade, it remained low in both countries. These results suggest that current practice patterns for HBV testing in RA patients need to be updated.

View abstract on Pubmed here.

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Design and Rationale of the CIRT-AE Study

The Cardiovascular Inflammation Reduction Trial (CIRT) is an ongoing NIH-funded, randomized, double-blind, placebo-controlled trial of low-dose methotrexate in the secondary prevention of cardiovascular disease. BWH SCS Rheumatology Investigators, Drs. Sparks, Barbhaiya, and Solomon, describe the rationale and design of the CIRT-Adverse Events (CIRT-AE) ancillary study which aims to investigate adverse events within CIRT. The CIRT-AE study may yield important information about methotrexate adverse events.

 

View the article here.

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Drs. Barbhaiya and Costenbader reveal how moderate alcohol intake may reduce the risk of SLE in women

 

In a prospective cohort study, SCS investigators Drs. Barbhaiya and Costenbader demonstrate that moderate long-term alcohol intake is associated with a 39% decreased risk of systemic lupus erythematosus among women. These findings have implications for SLE prevention in that identifying risk factors, and those associated with decreased risk, may enable risk factor modification.

 

View ACR eNews Rheum feature here

View article here

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Denosumab and zoledronic acid have comparable clinical safety and effectiveness

 

In a large population-based cohort study led by Brigham and Women's Dr. Seoyoung Kim, denosumab and zoledronic acid have comparable clinical safety and effectiveness with regard to the risk of serious infection, CVD, and osteoporosis fracture among patients 50 years or older within 365 days after initiation of these medications.

 

Read the abstract here.

 

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SCS Faculty Dr. Sparks Speaks at March Digital Research Forum

Join Dr. Sparks this Tuesday 3/14 at 8am as he discusses the role of bioinformatics in identifying pneumonia in the electronic medical record.

Location: Building for Transformative Medicine, 3rd Floor Conference Room

Register here.

 

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CV Risk Factors Prevalent in PsA, RA, and Psoriasis

 

Dr. Helga Radner, formerly of the BWH SCS division and currently at the Medical University of Vienna in Austria, along with a team led by Dr. Dan Solomon, demonstrated an increased prevalence of traditional cardiovascular disease risk factors in Psoriatic Arthritis patients even compared to rheumatoid arthritis patients, who are also known to have a substantially elevated inflammatory and CVD burden. Their findings have implications related to the importance of CVD risk factor monitoring and prevention among patients with PsA, psoriasis, and RA.

 

See their news feature in Medpage Today.

Their original article can be found here.

 

 

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Congratulations to SCS Project Manager Alyssa Wohlfahrt on her well-deserved Brigham and Women’s Partners in Excellence award in the category of operational efficiency!

View the full list of award recipients here.

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Gout and the risk of Non-Vertebral Fracture

 

Today we are highlighting a study by Drs. Kim and Solomon on the risk of non-vertebral fracture in gout patients.  Using data from a US commercial health plan, they evaluated the risk of non-vertebral fracture in patients with gout compared with those without gout. Their results showed that gout was not associated with a risk of non-vertebral fracture. Among patients with gout, serum uric acid was not associated with the risk of non-vertebral fracture.

 

Read the article here.

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Dr. Tedeschi Featured in Rheumatology News

Today we are highlighting two articles, one in Rheumatology News and the other on Med Page Today, featuring Dr. Sara Tedeschi’s recent publication on Rheumatoid Arthritis (RA) symptoms and diet. In a survey of 217 participants in the Brigham RA Sequential Study, 24% of patients reported that certain foods affect their RA symptoms. Foods that improved symptoms included blueberries (11.1%) and fish (10.9%); foods associated with worsened symptoms were desserts (12.7%) and soda with sugar (12.4%). These results point to a potential link between inflammation and sugar consumption that may call for closer investigation.

Find the article in Rheumatology News here and the Med Page Today article here.

Read the full paper here.

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SCS Investigator Video Series- Dr. Lee

 

Over the next year, meet the BWH Section of Clinical Sciences faculty by video and learn first-hand about their research and recent publications. This month we are featuring Dr. Yvonne Lee, Assistant Professor of Medicine, who describes her research focused on the inflammatory and non-inflammatory components of pain in the rheumatic diseases. She also discusses her recent publication https://goo.gl/GX0wXX

This study used innovative statistical modeling techniques to show that bodily pain increases during the time surrounding menopause and then decreases after menopause.  It is important because it points to potential differences in the underlying mechanisms of pain in women as they undergo the menopause transition.

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SCS Faculty Dr. Candace Feldman, M.D.,M.P.H. has K23 grant approved for research in Lupus

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has approved a K23 grant application by SCS faculty Dr. Candace Feldman, M.D.,M.P.H. titled "Avoidable Acute Care Use among Patients with Lupus". Dr. Feldman hopes to understand predictors, outcomes and costs associated with potentially avoidable acute care use among vulnerable patients with lupus. Congratulations to Dr. Feldman for all her hard work and dedication!

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An Update on the Matthew H. Liang Distinguished Chair in Arthritis and Population Health

 

Message from Daniel Solomon, MD, MPH from Brigham and Women's Hospital on Vimeo.

In a new video message from Daniel Solomon, MD, MPH, the inaugural incumbent of the Matthew H. Liang Distinguished Chair in Arthritis and Population Health, Dr. Solomon explains how resources provided by the Liang Chair have allowed him to advance key efforts in education, research, and training in the Division of Rheumatology and the Section of Clinical Sciences at Brigham and Women’s Hospital. These efforts—made possible through the generosity of our patients, colleagues, and friends—are critical to fostering the careers of our bright young investigators, furthering knowledge in the field, and translating the discoveries we make into life-changing advances in patient care.

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The SQIL Model for Quality Improvement in Healthcare

Today we are highlighting an article by Dr. Sonali Desai about her Harvard Medical School course that aims to improve healthcare quality. The program, called Safety, Quality, Informatics, and Leadership (SQIL) provides continuing education to professionals across disciplines and emphasizes active learning. Through collaboration, it aims to foster a culture of constant improvement to drive healthcare forward.

Read the article here.

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PRECISION Trial Results: Celecoxib just as safe as naproxen or ibuprofen in OA and RA

During this year’s American College of Rheumatology annual meeting, Dr. Daniel Solomon presented on the safety of celecoxib relative to other NSAIDs. The PRECISON (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen) trial enrolled about 24,000 patients with osteoarthritis or rheumatoid arthritis. The patients were randomized to celecoxib, naproxen, or ibuprofen and were followed for about 24 months. The study found celecoxib was just as safe as naproxen or ibuprofen in patients with osteoarthritis and rheumatoid arthritis. Patients taking celecoxib were found to have lower incidence of cardiovascular events as well as lower risk of both gastrointestinal and renal adverse events. These findings were released November 13th in the New England Journal of Medicine.

Read the article here.

Watch Dr. Solomon’s interview here.

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Phenome-wide association study of autoantibodies in rheumatoid arthritis

Today we are highlighting a recently published Phenome-wide association study (PheWAS) by Dr. Katherine Liao examining the relationships between autoantibodies and clinical symptoms of rheumatoid arthritis (RA). The study tested for the presence of 36 autoantibodies and used electronic medical record data to associate these antibodies with clinical disease categories. The study successfully applied these PheWAS methods to RA and showed potentially clinically significant associations. Among the associations found, the strongest links were anti-fibronectin antibodies with obesity and anti-fibronectin antibodies with pneumonopathy.

Read the full abstract here.

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Cost-Effectiveness and Clinical Effectiveness of NSAIDs in Osteoarthritis

Today we are highlighting a study by Dr. Jeff Katz, MD and Dr. Elena Losina, PhD that analyzes the cost-effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in older patients with osteoarthritis. Their analyses found that the over-the-counter NSAIDs ibuprophen (Motrin/ Advil) and naproxen (Aleve) are not only more cost-effective but also more effective at relieving pain in osteoarthritis, as compared to celecoxib (Celebrex), an NSAID available by prescription only, and tramadol (Ultram), a low-potency opioid. These results were spotlighted on the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) website.

Read the NIAMS article here.

Read the PubMed abstract here

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Risk Factors Associated with RA Symptoms in Relatives of RA Patients

Today we are highlighting a study by Drs. Sparks and Karlson examining the links between age and smoking history with signs of joint inflammation among parents, siblings, and children of rheumatoid arthritis patients. Using data from a cohort of first-degree relatives (FDRs) of RA patients, genetic, environmental, and serological risk factors were analyzed and compared to signs of join inflammation. Smoking was associated with joint inflammation upon study entry and at follow-up two years later. Furthermore, there was an interaction between smoking and age such that FDRs under age 50 who have smoked for more than 10 pack-years were at the highest risk for showing signs of joint inflammation 

Read their abstract and full article.

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FDA's Announcements Impact the Use of Bisphosphonates

This study by Seoyoung Kim, MD, ScD, looks at the declining use of bisphosphonates among patients who have had a prior hip fracture. Three announcements from the FDA in 2005, 2007, and 2010 warned of potential osteonecrosis of the jaw, atrial fibrillation, and atypical femur fracture, respectively. Dr. Kim’s study used claims data from a US commercial health plan to evaluate a patient’s chance over time of receiving bisphosphonate therapy following a hip fracture. According to Dr. Kim’s analyses, the 2007 announcement regarding atrial fibrillation significantly reduced the use of bisphosphonates among this population.

Read the abstract on PubMed.

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Environmental exposures and the development of SLE

A new review by Drs. Barbhaiya and Costenbader examines the role of environmental factors in the development of systemic lupus erythematosus (SLE). The article explores established risk factors, such as cigarette smoking and oral contraceptives, together with newly proposed and unsubstantiated factors, such as pollution and infections. These environmental agents may act via biologic mechanisms that include increased oxidative stress, systemic inflammation, and hormonal triggers in addition to epigenetic modifications. Understanding the role that the environment plays in SLE incidence will facilitate SLE prevention. 

View their abstract here (e-published ahead of print).

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Dr. Shadick recognized for innovation in Lyme Disease Prevention

Dr. Nancy Shadick was recognized at the MIT Hacking Medicine Grand Hack this past weekend. The event brings together engineers, physicians, programmers, and business people with the aim of finding solutions to problems within public health and medicine. Dr. Shadick received her award at the Hackathon for innovation in Lyme Disease Prevention Education. In a recent article, Dr. Shadick described her study in which elementary school students either received in-class Lyme Disease education or were waitlisted for the program. Later, both groups were surveyed for their knowledge of the disease and their behaviors toward prevention. The results demonstrated that children who received Lyme Disease education in the classroom go on to have more knowledge of the disease, report more precautionary behavior, and view precautionary behavior more favorably.

For the article's abstract, click here.

 

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Rationale and design of the TRACTION trial

This month we are highlighting a trial led by Dr. Daniel Solomon, which aimed to facilitate the implementation of Treat-to-Target (TTT) through the use of a Learning Collaborative. The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had nine learning sessions, collaborated using a web-based tool, and shared results of plan-do-study-act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is the implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. Currently, all intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review and will be disseminated in future publications.

For more information, read the PubMed abstract.  

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PTSD and Risk for Incident Rheumatoid Arthritis

This study led by Dr. Yvonne Lee, in collaboration with BWH colleagues, which examines the association between symptoms of post-traumatic stress disorder (PTSD) and rheumatoid arthritis (RA) risk in a prospective cohort and to characterize the role of smoking in this relationship. A subset of the Nurses’ Health Study II, a prospective cohort of female nurses, completed the Brief Trauma Questionnaire and a screen for PTSD symptoms. Participants were categorized based on trauma exposure and number of PTSD symptoms. Incident RA cases from 1989 to 2011 were identified. The study found that compared to no history of trauma/PTSD symptoms, the HR for ≥4 PTSD symptoms and incident RA was 1.76 (95% CI 1.16–2.67) in models adjusted for age, race, and socioeconomic status. The risk for RA increased with an increasing number of PTSD symptoms. When smoking was added to the model, the HR for RA remained elevated. This study suggests that women with high PTSD symptomatology have an elevated risk for RA, independent of smoking, adding to emerging evidence that stress is an important determinant of physical health.

To read the full article, click here.

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Intensification to triple therapy non-biologic DMARDs for RA in the US

This study led by Dr. Jeff Sparks and colleges from BWH, which investigated intensification to triple therapy after initial non-biologic DRMARD prescription among patients with rheumatoid arthritis (RA). The study used US insurance claims from 2009-2014 to evaluate triple therapy use. During the study period 2,739 patients intensified treatment to a biologic DMARD compared to 181 who intensified to triple therapy, from a cohort of 24,576. Despite reports suggesting equivalent efficacy of triple therapy and biologic DMARDs for RA, the use of triple therapy was infrequent and did not increase over time in this large nationwide study. 

To read the MedPage Today article, click here.

For more information, read the PubMed abstract.

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Tumor necrosis factor inhibitor use and risk of hypertension in patients with rheumatoid arthritis 

This study led by Dr. Desai, with several BWH collaborators, which compared the risk of incident hypertension between initiators of TNF-α inhibitors and initiators of non-biologic disease modifying anti-rheumatic drugs in rheumatoid arthritis patients taking methotrexate monotherapy. The study used insurance claims data from 2001-2012 to identify use of either TNF-α inhibitors or non-biologics. The outcome of interest was incident hypertension, defined by a diagnosis and a prescription for an anti-hypertensive drug. Investigators identified 4,822 initiations of TNF-α inhibitor use and 2,400 of non-biologic use. Treatment with TNF-α inhibitors was not associated with a reduced risk of incident hypertension compared with non-biologics in rheumatoid arthritis patients.

For more information, read the PubMed abstract.

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Uptake of the First Biosimilar Infliximab since its Approval in South Korea

This study led by Dr. Seoyoung Kim, which aimed to examine the utilization patterns of both branded and biosimilar infliximab and other TNF in South Korea before and after the introduction of biosimilar infliximab. The study used claims data from the Korean Health Insurance Review and Assessment Service database (4/2009-3/2014), which includes the entire South Korean population. A segmented linear progression model examined utilization patterns. After 15 months of its introduction in Korea, one-fifth of all infliximab claims were for the biosimilar.

To read the full article, click here.

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Cartilage Thickness as Imaging Biomarkers of Knee OA Progression

A brief report in Arthritis & Rheumatology from BWH researchers Drs. Jeff Katz and Elena Losina, investigated the association of cartilage thickness change over 24 months, as determined by MRI, with knee osteoarthritis (OA) progression at 24-48 months. This nested case-control study included 600 knees with a baseline Kellgren/Lawrence grade of 1-3 from 600 Osteoarthritis Initiative participants. Medial and lateral femorotibial cartilage was segmented from sagittal 3T MRIs at baseline, 12 months, and 24 months. Logistic regression was used to assess the association of change in cartilage thickness, with a focus on the central medial femorotibial compartment, and OA progression. Findings indicate that loss of medial femorotibial cartilage thickness over 24 months is associated with the combination of radiographic and pain progression in the knee, with a stronger association for radiographic progression.

To read the full article, click here.

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RA and mortality among women during 36 years of prospective follow-up

This study led by Dr. Jeffrey Sparks and collaborators, aimed to evaluate rheumatoid arthritis (RA) and mortality risk among women enrolled in the Nurses’ Health Study (NHS). Over 100,000 women in NHS were analyzed; comorbidity and lifestyle data were collected through biennial questionnaires. Cox regression models estimated hazard ratios and 95% confidence intervals for all-cause, cardiovascular disease, cancer, and respiratory mortality for women with RA compared to those without RA. The study found that women with RA had significantly increased mortality compared to those with RA.

For more information, read the PubMed abstract.

To access the HealthDay article about this study, click here.

To listen to the WBUR Radio Report, click here.

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To the Editor: Individuals with Type 2 Diabetes Mellitus

Dr. Lindsey MacFarlane's Letter to the Editor, published in Medicine, responds to the Wijnands et al article, "Individuals with Type 2 Diabetes Mellitus Are at an Increased Risk of Gout But This Is Not Due to Diabetes: A Population-Based Cohort Study".  

You can read the full letter on the Medicine Correspondence Blog.  

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Cardiovascular events in RA compared to non-RA patients

This study led by Dr. Kat Liao aimed to determine whether complex relationships between levels of LDL and HDL cholesterol and cardiovascular (CV) risk is different in patients with RA compared to non-RA patients. Using data from a US health insurance plan (2003-2012), investigators conducted a cohort study that included patients with RA and non-RA control subjects matched with regard to age, sex, and index date. The nonlinearity of associations between lipid levels and incidence of major adverse CV events (MACE) was tested. The relationship between LDL cholesterol levels and incidence of MACE was nonlinear and similar between RA patients and non-RA controls. The complex relationship between LDL cholesterol levels, HDL cholesterol levels, and risk of MACE was nonlinear in RA patients and also not statistically significantly different from that in an age- and sex-matched non-RA cohort.

For more information, read the PubMed abstract

To read the MedPage article, click here

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Treatment Patterns of Multimorbid Patients with RA

This study led by Dr. Radner sets out to describe the treatment profile of multimorbid patients with rheumatoid arthritis (RA) in contrast to patients with RA only. A cross-sectional, international study assessing morbidities, outcome, and treatments of patients with RA was designed. Patients were grouped according to their multimorbidity profile assessed by a counted multimorbidity index. Treatment for RA was categorized as use of biologic DMARD (in particular TNFs), synthetic DMARD, NSAID, and corticosteroid. In this study, the odds of biologic DMARD use decreased 11% for each additional chronic morbid condition after adjustment for regional differences, disease activity, and other covariates.

For more information, read the PubMed abstract. 

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Comparison of Care in Practices with NPs and PAs vs. Rheumatologists Only

This study led by Dr. Daniel Solomon and BWH collaborators compares the outcomes of care for patients with RA seen in practices with nurse practitioners (NPs) or physician assistants (PAs) and rheumatologists versus practices with rheumatologist only. Standardized measures were abstracted from medical records at seven rheumatology practices in the US – four with NPs or PAs and three without. A repeated measure analysis using generalized linear regression was preformed to compare disease activity for visits to practices with NPs and PAs versus rheumatologists only, adjusting for disease duration, serologic status, RA treatments, and disease activity measures. The study found that patients seen in practices with NPs or PAs had lower RA disease activity over 2-years compared with those seen in rheumatologist only practices; no differences were observed in the change in disease activity between visits either within or between type of provider practice. 

For more information, read the PubMed abstract.  

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The Vital Role of Randomized Trials in Arthritis & Rheumatology

This editorial by Drs. Solomon, Weinblatt, and Bucala highlights the important role that RCTs have on defining standard of care for inflammatory arthritides. Major RCTS facilitate scientific investigation such as the use of TNF antagonists in rheumatoid arthritis and cyclophosphamide and belumumab in systemic lupus erythematosus, to name a few.

For a full PDF of the editorial, click here.

 

 

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Risk of cervical dysplasia and cervical cancer in women with SID

This article by Dr. Kim, and BWH collaborators, assesses the risk of high-grade cervical dysplasia in women with systemic inflammatory disease (SID). Previous studies have suggested that patients with SID such as inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE), psoriasis, and rheumatoid arthritis (RA) might be at potential risk of cervical cancer. Using US insurance data, researchers conducted a cohort study of 133,333 women with SID and 533,332 women without SID. High-grade cervical dysplasia and cervical cancer was defined by a validated algorithm. The study found that the risk of high-grade cervical dysplasia and cervical cancer was 1.5 times higher in women with RA and SLE than in those without SID. This risk may be increased in IBD with use of systemic immunosuppressive drugs or steroids.

For more information, click here

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Serious infections among adult medicaid beneficiaries with SLE and LN

This study led by Dr. Candace Feldman, along with BWH collaborators, which examines the epidemiology of serious infections in a nationwide cohort of systemic lupus erythematosus (SLE) and lupus nephritis (LN) patients. Serious infections are a significant cause of morbidity and mortality in this patient population. In this diverse, nationwide cohort of SLE patients, researchers observed a substantial burden of serious infections with many subsequent deaths, particularly among those with LN.

For more information, read the PudMed abstract.  

 

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Impact of bariatric surgery on patients with RA

This study led by Dr. Jeff Sparks and BWH collaborators, which examines the effects of weight loss after bariatric surgery among rheumatoid arthritis (RA) patients. Researchers conducted a retrospective cohort study of RA patients who underwent bariatric surgery at two medical centers. The study showed that substantial weight loss from bariatric surgery had effects on disease activity, inflammatory markers, and RA-related medication usage.

For more information, click here.

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Reductions in Use of Colchicine after FDA Enforcement of Market Exclusivity in a Commercially Insured Population

This study led by Dr. Kesselheim et al, analyzes the impact of new single-source colchicine product on prescribing and patient spending as well as incidence rates of potentially dangerous concomitant use of clarithromycin and cyclosporine after formal FDA approval. Using a retrospective cohort of newly diagnosed patients with gout or familial Mediterranean fever, investigators concluded that the FDA’s actions were associated with a reduction in colchicine initiation and an increase in patient spending. Furthermore, there were not any observed associations with improvements in avoidance of potentially dangerous co-prescriptions.

For a PDF of this article, click here.

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Bisphosphonates and Risk of Cardiovascular Events: A Meta-Analysis

A study led by Dr. Dae Kim and BWH collaborators, examines the effects of biphosphonates on total adverse cardiovascular (CV) events in adults with or at risk for low bone density. It was shown that biphosphonates do not have beneficial or harmful effects on atherosclerotic CV events, but zoledronic acid may modestly increase the risk of atrial fibrillation.

For a PDF of this article, click here.

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Lupus activity during pregancy

This article from The Lupus Foundation of American that features Dr. Sara K. Tedeschi who discusses her recent study about lupus activity during pregnancy. The study was presented at the 2014 American College of Rheumatology (ACR) Annual Scientific Meeting. Dr. Tedeschi and colleagues evaluated five types of organ-specific lupus activity before and during pregnancy in 147 pregnancies. The team plans on further analyzing data by incorporating lupus-related medications and studying adverse pregnancy outcomes, such as preterm delivery or pre-eclampsia.

For the full article, click here.

For the ACR presentation, click here.

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Disease activity in RA and the risk of cardiovascular events

This article by Dr. Solomon et al studies patients with RA followed in a longitudinal US-based registry to assess whether time-averaged disease activity in RA correlates with cardiovascular (CV) events. Cox proportional hazards regression models were examined to determine the risk of a composite CV endpoint that included MI, stroke, and CV death. It was concluded that reduced time-averaged disease activity in RA is associated with fewer CV events.

For more information, read the PubMed abstract. 

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Active-comparator and new-user design

This article by Drs. Yoshida, Solomon and Kim describes the use of active-comparator and new-user designs, highlighting the strengths that these have in overcoming biases inherent in many observational studies of drug effects.  In an active-comparator study, the drug of interest is compared with another agent commonly used for the same indication, rather than with no treatment (a ‘nonuser’ group). This principle helps to ensure that treatment groups have similar treatment indications, attenuating both measured and unmeasured differences in patient characteristics. The new-user study includes a cohort of patients from the time of treatment initiation, enabling assessment of patients’ pretreatment characteristics and capture of all events occurring during follow-up.

For a PDF of this article, click here.

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HPV vaccine uptake low in SID patients

A study led by Drs. Feldman and Kim, investigating the uptake of the human papillomavirus (HPV) vaccine in patients with systemic inflammatory diseases (SID). HPV vaccine uptake among SID and non-SID patients was compared using an U.S. insurance claims database. In this nationwide cohort, HPV uptake was extremely low at 20.6% in females with SID. Despite the heightened risk of persistent HPV infection among those with SID, there were no increases in HPV vaccine uptake observed signaling the potential need for public health efforts to promote vaccination.

For more information, read the PubMed abstract.

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Racial and ethnic differences in mortality and CV risk among patients with LN ESRD

A study published in Arthritis Care & Research, led by Drs. Gomez-Puerta, Barbhaiya and Costenbader investigated the racial and ethnic differences in mortality and cardiovascular (CV) risk in patients with end-stage renal disease (ESRD) due to lupus nephritis (LN).  This study was conducted using data from the US ESRD registry and inpatient Medicare claims.  Among patients with ESRD and LN, Asians and Hispanics experienced lower mortality and CV event risk compared to Whites, while African Americans had higher mortality and CV risks.  Ongoing studies are underway to determine why these differences may exist.

For more information, read the PubMed abstract.

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Treat to Target Learning Collaborative

Dan Solomon, MD, MPH, and his team at Brigham and Women’s Hospital are working to improve use of Treat to Target for Rheumatoid Arthritis care.  This NIH-sponsored Learning Collaborative had its kickoff meeting on January 31, 2005 with five teams from all over the US participating.  Josef Smolen, Ted Pincus, Liana Fraenkel, Leslie Harrold, Helga Radner, Asaf Bitton, and Elena Losina helped facilitate as faculty.  Keep an eye out for updates on this effort.

For more information about this project, please contact Agnes Zak

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Drs. Solomon and Kim recieve BWH mentoring awards

Drs. Solomon and Kim were honored at the Department of Medicine Grand Rounds on January 23 for their service as research mentors.  Dr. Solomon is a recipient of the prestigious Kenneth L. Baughman Faculty Mentoring Award.  His mentee, Dr. Seoyoung Kim, now with mentees of her own, is a recipient of the Early Career Mentoring Award. 

Please join us in congratulating them both.

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"HDL works better when inflammation is reduced in RA"

High-density lipoprotein (HDL) is called the “good cholesterol” because it removes cholesterol from atherosclerotic plaques in the blood vessels.  This function of HDL, called the HDL cholesterol efflux capacity is impaired in Rheumatoid Arthritis (RA) patients, a population with 1.5 higher risk of heart disease than the general population.  In collaboration with investigators at the National Heart, Blood, and Lung Institute, Drs. Liao, Coblyn, Shadick and Weinblatt investigated the link between inflammation and HDL cholesterol efflux function in the Brigham and Women's RA Sequential Study (BRASS).  They found that HDL cholesterol efflux improved significantly among RA patients who experienced a reduction in inflammation.  Greater reduction in inflammation was correlated with greater improvements in HDL cholesterol efflux capacity, providing a potential link between inflammation and elevated risk for heart disease. 

Their study was published in the Journal of the American Heart Association.

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Dr. Solomon Honored as Incumbent Matt Liang Distinguished Chair

On Monday, December 10, 2014 the BWH community celebrated the establishment of the Matthew H. Liang Distinguished Chair in Arthritis and Population Health, honoring Dr. Solomon, as the first incumbent. The Matthew H. Liang Chair was created through the generous support of Ms. Ann Garthwaite and Dr. Liang’s patients to promote investigative research in the epidemiology of rheumatic diseases. During the ceremony, BWH President Dr. Betsy Nabel and Rheumatology Division Chief Dr. Michael Brenner spoke about the leadership of Drs. Solomon and Liang in the development and success of the Section of Clinical Sciences. Dr. Solomon’s mentors and colleagues, Drs. Matt Liang and Jeff Katz emphasized Dr. Solomon’s intellectual curiosity and dedication to patient care as a driving force to his research, and Dr. Solomon’s mentee, Dr. Yvonne Lee, highlighted his strong support of the new generation of population scientists.

For more information, click here.

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Interview with Dr. Sparks

Dr. Jeffrey Sparks comments on his study highlighting comparing causes of mortality in Rheumatoid Arthritis compared to the general population.  This study conducted in the Nurses' Health Study, suggests pulmonary disease is a major and under recognized cause of death in RA.

The following link provides a video of the interview: Rheumatology News

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Risk Models for Rheumatoid Arthritis Using Genetics, Environment, and Family History

A  study led by Drs. Sparks, Costenbader and Karlson developed rheumatoid arthritis (RA) risk models in a nested case-control study within the Nurses’ Health Study, utilizing family history, genetics, and pre-clinical environmental factors (smoking, obesity, parity, breastfeeding, and alcohol intake and replicated in a Swedish incident RA cohort (EIRA). Models using genetics and environment performed best among those who had family history, identifying individuals at 22-fold higher RA risk. These results suggest that RA prevention strategies can be targeted to at risk populations using family history, environment, and genetic factors.

For more information, read the PubMed Abstract.

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Contributions of Family History and Environment to RA Risk

A study led by Drs. Sparks, Costenbader and Karlson, investigated contributions of family history and environment to rheumatoid arthritis risk among 65,457 women prospectively followed in the Nurses’ Health Study. Women with family history had 3.6-fold increased RA risk, independent of known RA environmental factors. RA population attributable risk (PAR) from family history was 21%, while environmental PAR was 41%, suggesting that environment is important in RA development even among those who have family history.

For more information, read the PubMed Abstract.