Arthritis, general [keywords]
- Disparities in Care by Insurance Status for Individuals With Rheumatoid Arthritis: Analysis of the Medical Expenditure Panel Survey, 2006-2009. [JOURNAL ARTICLE]
- Curr Med Res Opin 2016 Aug 23.:1-31.
Treatment guidelines for rheumatoid arthritis (RA) recommend early, aggressive treatment with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs) to minimize long-term disability. We aimed to assess differences in medical resource utilization, drug therapy, and health outcomes among RA patients by insurance type in the United States.Individuals with a self-reported diagnosis of RA were identified in the Medical Expenditure Panel Survey (MEPS) database, 2006-2009. Data regarding sociodemographic characteristics, insurance type and status, and outcomes (including health care resource utilization, prescription medication use, health status, and patient-reported barriers to health care) were extracted. Multivariable regression analyses were used to examine the impact of insurance type (private, Medicare, Medicaid, or uninsured) on outcome measures while controlling for age group, sex, and race/ethnicity.A total of 693 individuals with a self-reported diagnosis of RA during the study period were identified; 423 were aged 18-64 years and 270 were aged ≥65 years. Among patients aged 18-64, those with Medicaid or who were uninsured were less likely than those with private insurance to visit a rheumatologist (adjusted odd ratio [aOR] 0.13 and 0.17, respectively; p < 0.001) and to receive biologic DMARDS (aOR 0.09 [p<.001] and 0.16 [p<.01], respectively); those with Medicaid were also less likely to receive nonbiologic DMARDS (aOR 0.26 [p<.01]). Those with Medicaid were more likely than those with private insurance to be unable/delayed in getting prescription drugs (aOR 2.9 [p<.05]), to experience cognitive, social, and physical limitations (aOR 8.7 [p<.001], 4.7 [p<.001], and 2.5 [p<.05], respectively); they also reported significantly lower general health and HRQOL. Patients aged ≥65 experienced greater equity in care and outcomes.Younger RA patients with Medicaid (including those who receive coverage under the Medicaid expansion component of the Affordable Care Act) may be at risk for inadequate treatment.
- Secukinumab for the Treatment of Psoriatic Arthritis. [JOURNAL ARTICLE]
- Expert Rev Clin Immunol 2016 Aug 23.
Secukinumab (Cosentyx) is an interleukin-17A (IL-17A) inhibitor administered subcutaneously. Through 2016, it had received approval in a number of countries, including the USA, Japan and in the EU for the treatment of plaque psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS).This review addresses the mechanism of action, efficacy and safety of secukinumab observed in clinical studies of patients with PsA. Data from recent studies of secukinumab in psoriasis, PsA and AS are included. Expert Commentary: Secukinumab appears to be effective in improving various aspects of PsA, including improvements in psoriatic skin, enthesitis and dactylitis, as well as inhibition of the radiographic progression of peripheral arthritis. Secukinumab was in general well tolerated; the most common adverse events were nasopharyngitis, headache, and upper respiratory tract infection.
- Interleukin 26 suppresses receptor activator of nuclear factor κB ligand induced osteoclastogenesis via down-regulation of nuclear factor of activated T-cells, cytoplasmic 1 and nuclear factor κB activity. [JOURNAL ARTICLE]
- Rheumatology (Oxford) 2016 Aug 21.
IL-26 has been shown to have high expression in RA. However, the effects of IL-26 on bone destruction in RA have not been evaluated. The aim of this study was to investigate the effects and mechanisms of IL-26 on RANK ligand (RANKL)-induced osteoclastogenesis.We treated cells with IL-26 in RANKL-induced oseteoclastogenesis to monitor osteoclast formation by tartrate-resistant acid phosphatase (TRAP) staining. Osteoclast activity was assessed by pit formation assay and F-actin ring formation. The mechanism of the inhibition was studied by biochemical analyses such as RT-PCR, immunofluorescence staining and immunoblotting. In addition, cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.IL-26 inhibited RANKL-induced TRAP-positive multinucleated cells and inhibited RANKL-induced nuclear factor κB (NF-κB) activation and nuclear factor of activated T cells, cytoplasmic 1 (NFATc1) nuclear translocation in RAW264.7 cells. Also, IL-26 significantly inhibited the bone-resorbing activity and F-actin ring formation ability of mature osteoclasts. Moreover, IL-26 suppressed RANKL-induced mitogen-activated protein kinase activation and NFATc1 downstream gene expression.We suggest that the inhibitory activity of IL-26 on osteoclastogenesis is via down-regulation of RANKL-induced NF-κB and NFATc1 expression. Our results suggest IL-26 as a possible new remedy against osteolytic bone destruction.
- Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases. [JOURNAL ARTICLE]
- Int J Cardiol 2016 Aug 7.:331-336.
Cardiovascular disease (CVD) risk calculators developed for the general population have been shown to inaccurately predict CVD events in patients with inflammatory joint disease (IJD). European guidelines for CVD prevention recognize the presence of carotid plaques (CP) as a very high CVD risk factor, equivalent of coronary artery disease. Patients with IJD have a high prevalence of CP. We evaluated if CP resulted in reclassification of patients with IJD into a more appropriate CVD risk class and recommended lipid lowering treatment.CVD risk evaluation was performed in patients with IJD using SCORE and ACC/AHA risk calculators to predict CVD events.Of the 335 IJD patients evaluated (including rheumatoid arthritis n=201, ankylosing spondylitis n=85 and psoriatic arthritis n=49), 183 and 159 IJD patients had a calculated CVD risk by SCORE and ACC/AHA <5%, indicating no need of lipid lowering treatment (LLT). However, of patients with low to moderate risk calculated by SCORE and ACC/AHA, 67 (36.6%) and 48 (30.2%) had CP and should according to guidelines receive intensive LLT. For patients with high risk, in the LLT considered group, 54.9% and 58.1% were reclassified to correct treatment when adding information on the presence of CP. Our results reveal a considerable reclassification into correct CVD risk category when adding CP in female patients.The high frequency of asymptomatic atherosclerosis in patients with IJD has a notable impact on CVD risk stratification. Identification of CP will reclassify patients into recommended CVD preventive treatment group, which may be clinically important.
- "It's complicated" - talking about gout medicines in primary care consultations: a qualitative study. [JOURNAL ARTICLE]
- BMC Fam Pract 2016; 17(1):114.
Gout is the most common form of inflammatory arthritis. It is associated with substantial co-morbidity and often managed in primary care. A greater understanding of the communication process between patients and healthcare professionals provides one way of improving the management of this condition. This paper describes communication about gout medicines and treatment between patients and primary care health professionals during routine consultations.Video-recordings of 31 individual healthcare consultations between patients and a range of primary care practitioners (general practitioners, practice nurses, podiatrists, dietitians) from an archived database were reviewed. Consultations that encompassed any discussion about gout medicines and treatment were included (n = 27) and were not solely restricted to those where gout was the presenting complaint. Themes were derived from an inductive qualitative analysis, from clinical and linguistic perspectives, based on the conversation between patients and practitioners about medicines and visual observation of these interactions.A number of factors were identified that had the potential to impact on the optimal management of gout in primary care. These included level of patient knowledge, patient attitudes to medicines, and the attributes of practitioner communication with patients. The latter related to the style of delivery and content of the information provided, and the ability of practitioners to make use of opportunities that arose to discuss these issues.Patients with gout communicate at varying levels of complexity with a diverse range of primary care healthcare professionals about the treatment of their condition. It is important that all practitioners engaging with gout patients in this setting are knowledgeable about the current management of gout, provide clear, consistent and accurate messages, remain aware that these messages may need repeating over time, and are supportive of patients' medicine-taking preferences.
- A Pain in the Psoas: Groin Injury in a Collegiate Football Athlete. [JOURNAL ARTICLE]
- Sports Health 2016 Aug 19.
General medical conditions are an important part of the differential diagnosis in athletes presenting with pain or injury. A psoas abscess is a collection of pus in the iliopsoas muscle compartment and is a rare cause of hip, low back, or groin pain. Psoas abscesses may have significant morbidity and mortality, as 20% progress to septic shock. Presenting symptoms are generally nonspecific and the onset may be subacute. Clinical presentation may have features suggestive of other diagnoses, including septic hip arthritis, iliopsoas bursitis, and retrocecal appendicitis. Proper diagnosis and management is critical to prevent complications of septic shock and death. In this unique case, a 19-year-old Division 1 collegiate football player presented to the emergency department 4 days following injury to his right groin during football practice. He complained of severe right groin pain accompanied by fatigue, fevers, nausea, and diarrhea. He later developed septic shock with multisystem organ dysfunction, requiring advanced life support. Imaging revealed an abscess located in the right iliopsoas compartment. After proper treatment, the athlete eventually made a complete recovery, returning to collegiate football 4 months postinjury. A literature review found no described cases of psoas abscess related to athletes with acute hip flexor strain. This athlete had no known risk factors for psoas abscess. This case highlights the importance of maintaining a broad differential in an athlete presenting with pain after injury. Making the diagnosis of psoas abscess often requires a high degree of suspicion and timely acquisition of imaging studies. In this particular case, imaging was key to making a proper diagnosis and tailoring treatment not only to return him to sport but also to save his life.
- What Risks are Associated with Primary THA in Recipients of Hematopoietic Stem Cell Transplantation? [JOURNAL ARTICLE]
- Clin Orthop Relat Res 2016 Aug 19.
As patients who receive hematopoietic stem cell transplantation are at increased risk of avascular necrosis (AVN) and subsequent degenerative arthritis, THA may be considered in some of these patients, particularly as overall patient survival improves for patients undergoing stem-cell transplants. Patients receiving hematopoietic stem cell transplantation theoretically are at increased risk of experiencing complications, infection, and poorer implant survivorship owing to the high prevalence of comorbid conditions, immunosuppressive therapy regimens including corticosteroids, and often low circulating hematopoietic cell lines; however, there is a paucity of studies elucidating these risks.We asked: (1) What is the overall mortality of patients with hematopoietic stem cell transplantation who have undergone THA? (2) What is the complication rate for these patients? (3) What are the revision and reoperation rates and implant survivorship for these patients?Between 1999 and 2013, we performed 42 THAs in 36 patients who underwent stem-cell transplants. Other than those who died, all were available for followup at a minimum of 2 years; of the patients whose procedures were done more than 10 years ago and who are not known to have died, two (5%) had not been seen in the last 5 years and so are considered lost to followup. All patients underwent thorough evaluation by the transplant team before arthroplasty; general contraindications included active medical comorbidities or evidence of unstable end-organ damage, active rejection, and critically low circulating hematopoietic cell lines. Underlying primary diseases leading to hematopoietic stem cell transplantation included lymphoma (14/42; 33%), plasma cell disorders (10/42; 24%), leukemia (9/42; 21%), and amyloidosis (3/42; 7%). Complications, reoperations, revisions, and implant and patient survivorship, were recorded from chart review and data from the institutional total joint registry. Mean followup was 5 years (range, 2-15 years).Patient survivorship free of mortality was 91% (95% CI, 81%-100%) and 82% (95% CI, 68%-96%) at 2 and 5 years, respectively. Complications occurred in four of 42 THAs (10%); these complications included an intraoperative fracture and a venous thromboembolism. Revisions occurred in two of 42 (5%) THAs; there were no reoperations. Implant survivorship free of component revision for any reason or implant removal accounting for death as a competing risk was 93% (95% CI, 83%-100%) at 5 years.With appropriate medical evaluation and comanagement by transplant specialists, carefully selected patients with hematopoietic stem cell transplants may undergo elective primary THA, although complications do occur in this relatively fragile patient population. Although implant survivorship was modest at 93% at 5 years, there was not a high risk of revision for infection. Improved outcomes for these patients may be expected as their medical management advances and additional comparative studies may clarify other important patient factors.Level IV, therapeutic study.
- Poor mental health status and its associations with demographic characteristics and chronic diseases in Chinese elderly. [JOURNAL ARTICLE]
- Soc Psychiatry Psychiatr Epidemiol 2016 Aug 18.
Although poor mental health is associated with significant personal and societal burden, it is rarely reported in older Chinese populations. This study examined the mental health status of a large representative sample of Chinese elderly in relation to socio-demographic characteristics, lifestyle, and chronic diseases.Multistage stratified cluster sampling was used in this cross-sectional study. A total of 4115 people aged between 60 and 79 years were selected and interviewed with standardized assessment tools. The 12-item General Health Questionnaire (GHQ-12) was used to measure general mental health with the total score of ≥4 as the threshold for poor mental health status.The adjusted percentage of poor mental health status in the whole sample was 23.8 %; 18.5 % in men and 28.9 % in women. Multivariate logistic regression analysis revealed that female gender, widowed/separated marital status, rural abode, low income, poor diet, lack of physical exercise, and multi-morbidity were independently associated with poor mental health. The percentage of poor mental health status was significantly higher in patients with anemia, diabetes, hyperlipidemia, cataract/glaucoma, ischemic heart disease, cerebrovascular diseases, nasopharyngitis, chronic gastroenteritis/peptic ulcer, liver diseases, cholecystitis/gallstone, arthritis, or chronic low back pain.Given the high rate of poor mental health status among older Chinese population, policy makers and health professionals in China should address the mental health burden of its aging population.
- Utility of ultrasonography in guiding modification of disease modifying anti-rheumatic drugs and steroid therapy for inflammatory arthritis in routine clinical practice. [JOURNAL ARTICLE]
- Int J Rheum Dis 2016 Aug 19.
To determine the utility of ultrasonography in guiding modification of disease-modifying anti-rheumatic drug (DMARD) and steroid therapy for inflammatory arthritis (IA) in routine clinical practice.In this retrospective study, we analyzed DMARD and steroid use in IA patients referred to a rheumatologist-led ultrasound clinic. Power Doppler (PD) vascularity and greyscale (GS) synovial hypertrophy joint findings were categorized as positive/negative for each patient. The erythrocyte sedimentation rate (ESR) was used as a measure of disease activity.We assessed single visit data for 46 adult IA patients: 67.4% (n = 31) rheumatoid arthritis (RA), 15.2% (n = 7) psoriatic arthritis, 10.9% (n = 5) spondyloarthritis, and 6.5% (n = 3) undifferentiated IA. The mean ESR was 28.8 mm/h. Thirty-seven patients with both GS and PD ultrasound results were subsequently analyzed. All patients (n = 10) escalated and/or initiated on DMARD and 9/10 patients escalated or initiated on steroids were PD and GS positive. Six of seven patients with dose reduction and/or cessation of DMARDs and five of seven patients with dose reduction or cessation of steroids were PD negative. Of six patients who were GS positive and PD negative, three had dose reduction and/or cessation of DMARDs, while four had dose reduction of steroids; none of the six patients had DMARD/steroid escalation.By clarifying joint inflammation in an IA cohort with overall low ESR, ultrasonography of physician-selected joints can improve clinical assessment, resulting in treatment modification. Positive PD findings were particularly influential, while the clinical significance of GS positivity alone requires further investigation.
- Apremilast, an oral phosphodiesterase 4 inhibitor, improves patient-reported outcomes in the treatment of moderate to severe psoriasis: Results of two phase III randomized, controlled trials. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2016 Aug 18.
Apremilast, an oral phosphodiesterase 4 inhibitor, has an acceptable safety profile and is effective for treatment of plaque psoriasis and psoriatic arthritis.To evaluate the impact of apremilast on health-related quality of life (HRQOL), general functioning, and mental health, using patient-reported outcome (PRO) assessments among patients with moderate to severe plaque psoriasis in the ESTEEM 1 and 2 trials.1,255 patients were randomized (2:1) to apremilast 30 mg BID or placebo for 16 weeks; all received apremilast through Week 32. PRO assessments included the Dermatology Life Quality Index (DLQI), 36-Item Short-Form Health Survey version 2 mental/physical component summary scores (SF-36v2 MCS/PCS), Patient Health Questionnaire-8 (PHQ-8), EuroQol-5D (EQ-5D), and Work Limitations Questionnaire-25 (WLQ-25). Post hoc analyses examined relationships between Psoriasis Area and Severity Index (PASI) scores and PHQ-8 in the apremilast-treated population at Week 16.Treatment with apremilast improved all HRQOL PROs at Week 16 (vs. placebo), excepting the SF-36v2 PCS, and improvements were sustained to Week 32. Mean DLQI and SF-36v2 MCS improvements exceeded minimal clinically important differences. Changes at Week 16 in PHQ-8 and PASI were weakly correlated, and only 35.8% of patients who achieved a ≥ 75% reduction from baseline in PASI score (PASI-75) with apremilast treatment also achieved PHQ-8 scores of 0 to 4.Apremilast led to improvements in HRQOL PROs vs. placebo in patients with moderate to severe plaque psoriasis. This article is protected by copyright. All rights reserved.