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1. High Interleukin-13 level is associated with disease stability in interstitial Lung disease

Author

Elena K. Joerns, David Karp, Song Zhang, Jeffrey A. Sparks, Traci N. Adams, Una E. Makris, and Chad A. Newton

Subjects
Interstitial lung disease, Cytokines, Progression of lung disease, Inflammatory interstitial lung disease, idiopathic pulmonary fibrosis, Unclassifiable interstitial lung disease, Science (General), Q1-390, Social sciences (General), H1-99
Abstract

Abstract (144/150 words): Purpose: Cytokines can help predict prognosis in interstitial lung disease (ILD) and to differentiate between ILD subtypes. The objectives of our study were to evaluate association of baseline cytokine levels with time to ILD progression and to compare baseline cytokine levels between ILD subtypes. Methods: We quantified 27 cytokines using a multiplex assay in peripheral blood samples from 77 patients. Cox proportional hazards regression analysis was performed to evaluate cytokine impact on the time to progression in the total cohort and within each ILD type. We evaluated for significant differences in cytokine levels between ILD types using ANOVA, Wilcoxon signed-rank test and Tukey method. Results: Higher IL-13 level was associated with longer time to progression (hazard ratio 0.52 [0.33–0.81], p-value 0.004). FGF-β, GM-CSF, and IL-17 levels differed significantly between fibrotic and inflammatory ILD subgroups. Conclusion: IL-13 may be a useful biomarker predicting ILD stability.

Published
2024
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5. Coupled Effect of Electronic Medical Record Modifications and Lean Six Sigma Methodology on Rheumatoid Arthritis Disease Activity Measurement and Treat‐to‐Target Outcomes

Author

Puneet Bajaj, Usha Kollipara, Rama Koganti, Dan (Claire) Wang, Navreet Chennu, Deepa Bhat, Jacqueline Mutz, Duwayne Willett, Jason Fish, and David Karp

Subjects
Diseases of the musculoskeletal system, RC925-935
Abstract

Objective Rheumatoid arthritis (RA) disease activity assessment is critical for treatment decisions and treat to target (T2T) outcomes. Utilization of the electronic medical record (EMR) and techniques to improve the routine capture of disease activity measures in clinical practice are not well described. We leveraged a Lean Six Sigma (LSS) approach, a data‐driven five‐step process improvement and problem‐solving methodology, coupled with EMR modifications to evaluate improvement in disease activity documentation and patient outcomes. Methods A RA registry was established, and structured fields for Routine Assessment of Patient Index Data (RAPID3) and Clinical Disease Activity Index (CDAI) were built in the EMR, along with a dashboard to display provider performance rates. An initial rapid‐cycle improvement intervention was launched, and subsequent LSS improvement cycles helped in standardization of clinic workflow, modifying provider behaviors, and motivating better documentation practices. Trends related to CDAI score categories were compared over time using run charts. Results Our project included 1322 patients with RA and 10 241 encounters between April 2016 and December 2019. Initially, RAPID3 completion rates increased from 16% to 50%, and CDAI from 15% to 44% from the RCI intervention. Post LSS intervention, the RAPID3 rate increased to more than 90% (sustained at 85%), and CDAI rate increased to more than 80% (sustained at 72%). The patients in the low disease/remission category increased from 54% to 66% (p < 0.001), and those in the high disease category decreased from 15% to 7% (p < 0.001), demonstrating improved T2T outcomes. Conclusion Combining EMR modifications with systems redesign utilizing LSS approach led to impressive and sustained improvement in disease activity documentation and T2T outcomes.

Published
2021
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15. Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

Author

Zara Izadi, Milena A Gianfrancesco, Gabriela Schmajuk, Lindsay Jacobsohn, Patricia Katz, Stephanie Rush, Clairissa Ja, Tiffany Taylor, Kie Shidara, Maria I Danila, Katherine D Wysham, Anja Strangfeld, Elsa F Mateus, Kimme L Hyrich, Laure Gossec, Loreto Carmona, Saskia Lawson-Tovey, Lianne Kearsley-Fleet, Martin Schaefer, Samar Al-Emadi, Jeffrey A Sparks, Tiffany Y-T Hsu, Naomi J Patel, Leanna Wise, Emily Gilbert, Alí Duarte-García, Maria O Valenzuela-Almada, Manuel F Ugarte-Gil, Lotta Ljung, Carlo A Scirè, Greta Carrara, Eric Hachulla, Christophe Richez, Patrice Cacoub, Thierry Thomas, Maria J Santos, Miguel Bernardes, Rebecca Hasseli, Anne Regierer, Hendrik Schulze-Koops, Ulf Müller-Ladner, Guillermo Pons-Estel, Romina Tanten, Romina E Nieto, Cecilia N Pisoni, Yohana S Tissera, Ricardo Xavier, Claudia D Lopes Marques, Gecilmara C S Pileggi, Philip C Robinson, Pedro M Machado, Emily Sirotich, Jean W Liew, Jonathan S Hausmann, Paul Sufka, Rebecca Grainger, Suleman Bhana, Monique Gore-Massy, Zachary S Wallace, Jinoos Yazdany, Brahim Dahou, Gimena Gómez, Karen Roberts, Roberto M Baez, Vanessa V Castro Coello, María J Haye Salinas, Federico N Maldonado, Alvaro A Reyes, Gelsomina Alle, Hernán Maldonado Ficco, Romina Nieto, Carla Gobbi, Yohana Tissera, Cecilia Pisoni, Alba Paula, Juan A Albiero, Maria M Schmid, Micaela Cosatti, Maria J Gamba, Carlevaris Leandro, María A Cusa, Noelia German, Veronica Bellomio, Lorena Takashima, Mariana Pera, Karina Cogo, Maria S Gálvez Elkin, María A Medina, Veronica Savio, Romina Rojas Tessel, Rodolfo P Alamino, Marina L Werner, Sofía Ornella, Luciana Casalla, Maria de la Vega, María Severina, Mercedes García, Luciana Gonzalez Lucero, Cecilia Romeo, Sebastián Moyano, Tatiana Barbich, Ana Bertoli, Andrea Baños, Sandra Petruzzelli, Carla Matellan, Silvana Conti, Maria A Lazaro, Gustavo F Rodriguez Gil, Fabian Risueño, Maria I Quaglia, Julia Scafati, Natalia L Cuchiaro, Jonathan E Rebak, Susana I Pineda, María E Calvo, Eugenia Picco, Josefina G Yanzi, Pablo Maid, Debora Guaglianone, Julieta S Morbiducci, Sabrina Porta, Natalia Herscovich, José L Velasco Zamora, Boris Kisluk, Maria S Castaños Menescardi, Rosana Gallo, María V Martire, Carla Maldini, Cecilia Goizueta, Sabrina S de la Vega Fernandez, Carolina Aeschlimann, Gisela Subils, Eva Rath, Yves Piette, Mieke Devinck, Bea Maeyaert, Francinne Machado Ribeiro, Sandra L Euzebio Ribeiro, Marcelo Pinheiro, Sebastián Ibáñez, Anne-Marie Chassin Trubert, Lingli Dong, Lui Cajas, Marko Barešić, Branimir Anić, Melanie-Ivana Ćulo, Tea A Pavelić, Kristina K Stranski, Boris Karanovic, Jiri Vencovsky, Marta Píchová, Maria Filkova, Hesham Hamoud, Dimitrios Vassilopoulos, Gabriela M Guzman Melgar, Ho So, Márta Király, Mahdi Vojdanian, Alexandra Balbir Gurman, Fatemah Abutiban, Julija Zepa, Inita Bulina, Loreta Bukauskiene, Beatriz E Zazueta Montiel, Angel A Castillo Ortiz, Erick Zamora Tehozol, David Vega Morales, Diana Cervántes Rosete, Eduardo Martín Nares, Tatiana S Rodriguez Reyna, Marina Rull Gabayet, Deshiré Alpízar Rodríguez, Fedra Irazoque, Xochitl Jimenez, Lenny Geurts van Bon, Theo Zijlstra, Monique Hoekstra, Nasra Al Adhoubi, Babur Salim, Enrique Giraldo, Ariel Salinas, Manuel Ugarte Gil, Jarosław Nowakowski, Richard Conway, Rachael Flood, Geraldine McCarthy, Ioana Felea, Ileana Filipescu, Simona Rednic, Laura Groseanu, Maria M Tamas, Vanda Mlynarikova, Martina Skamlova, Martin Zlnay, Dagmar Mičeková, Lubica Capova, Zelmira Macejova, Emőke Šteňová, Helena Raffayova, Gabriela Belakova, Eva Strakova, Marieta Senčarová, Soňa Žlnayová, Anna Sabová, Daniela Spisakova, Mária Oetterová, Olga Lukacova, Martina Bakosova, Alojzija Hocevar, Natalia de la Torre Rubio, Juan J Alegre Sancho, Montserrat Corteguera Coro, Juan C Cobeta Garcia, Maria C Torres Martin, Jose Campos, Jose A Gomez Puerta, Gozd K Yardimci, Servet Akar, Ozan C Icacan, Selda ÇELİK, Viktoriia Vasylets, Su-Ann Yeoh, Claire Vandevelde, Sasha Dunt, Jane Leeder, Elizabeth Macphie, Rosaria Salerno, Christine Graver, Katie Williams, Sheila O'Reilly, Kirsty Devine, Jennifer Tyler, Elizabeth Warner, James Pilcher, Samir Patel, Elena Nikiphorou, Laura Chadwick, Caroline M Jones, Beverley Harrison, Lucy Thornton, Diana O'Kane, Lucia Fusi, Audrey Low, Sarah Horton, Shraddha Jatwani, Sara Baig, Hammad Bajwa, Vernon Berglund, Angela Dahle, Walter Dorman, Jody Hargrove, Maren Hilton, Nicholas Lebedoff, Susan Leonard, Jennifer Morgan, Emily Pfeifer, Archibald Skemp, Jeffrey Wilson, Anne Wolff, Eduardo Cepeda, Derrick Todd, Denise Hare, Cassandra Calabrese, Christopher Adams, Arezou Khosroshahi, Adam Kilian, Douglas White, Melanie Winter, Theodore Fields, Caroline Siegel, Nicole Daver, Melissa Harvey, Neil Kramer, Concetta Lamore, Suneya Hogarty, Karen Yeter, Faizah Siddique, Byung Ban, Tamar Tanner, Eric Ruderman, William Davis, Robert Quinet, Evangeline Scopelitis, Karen Toribio, Tameka Webb Detiege, Jerald Zakem, Khurram Abbass, Gilbert Kepecs, Lilliam Miranda, Michael Guma, Ammar Haikal, Sushama Mody, Daric Mueller, Arundathi Jayatilleke, JoAnn Zell, Alison Bays, Kathryn Dao, Fatemeh Ezzati, Deborah Parks, David Karp, Guillermo Quiceno, Izadi, Z, Gianfrancesco, M, Schmajuk, G, Jacobsohn, L, Katz, P, Rush, S, Ja, C, Taylor, T, Shidara, K, Danila, M, Wysham, K, Strangfeld, A, Mateus, E, Hyrich, K, Gossec, L, Carmona, L, Lawson-Tovey, S, Kearsley-Fleet, L, Schaefer, M, Al-Emadi, S, Sparks, J, Hsu, T, Patel, N, Wise, L, Gilbert, E, Duarte-Garcia, A, Valenzuela-Almada, M, Ugarte-Gil, M, Ljung, L, Scire, C, Carrara, G, Hachulla, E, Richez, C, Cacoub, P, Thomas, T, Santos, M, Bernardes, M, Hasseli, R, Regierer, A, Schulze-Koops, H, Muller-Ladner, U, Pons-Estel, G, Tanten, R, Nieto, R, Pisoni, C, Tissera, Y, Xavier, R, Lopes Marques, C, Pileggi, G, Robinson, P, Machado, P, Sirotich, E, Liew, J, Hausmann, J, Sufka, P, Grainger, R, Bhana, S, Gore-Massy, M, Wallace, Z, Yazdany, J, Dahou, B, Gomez, G, Roberts, K, Baez, R, Castro Coello, V, Haye Salinas, M, Maldonado, F, Reyes, A, Alle, G, Maldonado Ficco, H, Gobbi, C, Paula, A, Albiero, J, Schmid, M, Cosatti, M, Gamba, M, Leandro, C, Cusa, M, German, N, Bellomio, V, Takashima, L, Pera, M, Cogo, K, Galvez Elkin, M, Medina, M, Savio, V, Rojas Tessel, R, Alamino, R, Werner, M, Ornella, S, Casalla, L, de la Vega, M, Severina, M, Garcia, M, Gonzalez Lucero, L, Romeo, C, Moyano, S, Barbich, T, Bertoli, A, Banos, A, Petruzzelli, S, Matellan, C, Conti, S, Lazaro, M, Rodriguez Gil, G, Risueno, F, Quaglia, M, Scafati, J, Cuchiaro, N, Rebak, J, Pineda, S, Calvo, M, Picco, E, Yanzi, J, Maid, P, Guaglianone, D, Morbiducci, J, Porta, S, Herscovich, N, Velasco Zamora, J, Kisluk, B, Castanos Menescardi, M, Gallo, R, Martire, M, Maldini, C, Goizueta, C, de la Vega Fernandez, S, Aeschlimann, C, Subils, G, Rath, E, Piette, Y, Devinck, M, Maeyaert, B, Machado Ribeiro, F, Euzebio Ribeiro, S, Pinheiro, M, Ibanez, S, Chassin Trubert, A, Dong, L, Cajas, L, Baresic, M, Anic, B, Culo, M, Pavelic, T, Stranski, K, Karanovic, B, Vencovsky, J, Pichova, M, Filkova, M, Hamoud, H, Vassilopoulos, D, Guzman Melgar, G, So, H, Kiraly, M, Vojdanian, M, Balbir Gurman, A, Abutiban, F, Zepa, J, Bulina, I, Bukauskiene, L, Zazueta Montiel, B, Castillo Ortiz, A, Zamora Tehozol, E, Vega Morales, D, Cervantes Rosete, D, Martin Nares, E, Rodriguez Reyna, T, Rull Gabayet, M, Alpizar Rodriguez, D, Irazoque, F, Jimenez, X, Geurts van Bon, L, Zijlstra, T, Hoekstra, M, Al Adhoubi, N, Salim, B, Giraldo, E, Salinas, A, Ugarte Gil, M, Nowakowski, J, Conway, R, Flood, R, Mccarthy, G, Felea, I, Filipescu, I, Rednic, S, Groseanu, L, Tamas, M, Mlynarikova, V, Skamlova, M, Zlnay, M, Micekova, D, Capova, L, Macejova, Z, Stenova, E, Raffayova, H, Belakova, G, Strakova, E, Sencarova, M, Zlnayova, S, Sabova, A, Spisakova, D, Oetterova, M, Lukacova, O, Bakosova, M, Hocevar, A, de la Torre Rubio, N, Alegre Sancho, J, Corteguera Coro, M, Cobeta Garcia, J, Torres Martin, M, Campos, J, Gomez Puerta, J, Yardimci, G, Akar, S, Icacan, O, Celik, S, Vasylets, V, Yeoh, S, Vandevelde, C, Dunt, S, Leeder, J, Macphie, E, Salerno, R, Graver, C, Williams, K, O'Reilly, S, Devine, K, Tyler, J, Warner, E, Pilcher, J, Patel, S, Nikiphorou, E, Chadwick, L, Jones, C, Harrison, B, Thornton, L, O'Kane, D, Fusi, L, Low, A, Horton, S, Jatwani, S, Baig, S, Bajwa, H, Berglund, V, Dahle, A, Dorman, W, Hargrove, J, Hilton, M, Lebedoff, N, Leonard, S, Morgan, J, Pfeifer, E, Skemp, A, Wilson, J, Wolff, A, Cepeda, E, Todd, D, Hare, D, Calabrese, C, Adams, C, Khosroshahi, A, Kilian, A, White, D, Winter, M, Fields, T, Siegel, C, Daver, N, Harvey, M, Kramer, N, Lamore, C, Hogarty, S, Yeter, K, Siddique, F, Ban, B, Tanner, T, Ruderman, E, Davis, W, Quinet, R, Scopelitis, E, Toribio, K, Webb Detiege, T, Zakem, J, Abbass, K, Kepecs, G, Miranda, L, Guma, M, Haikal, A, Mody, S, Mueller, D, Jayatilleke, A, Zell, J, Bays, A, Dao, K, Ezzati, F, Parks, D, Karp, D, Quiceno, G, and Repositório da Universidade de Lisboa

Subjects
health care disparity, Immunology, air pollution, cohort analysi, mortality rate, Autoimmune Disease, Article, coronavirus disease 2019, biocontainment, Rheumatology, male, cardiovascular disease, environmental factor, death, geographic distribution, Immunology and Allergy, follow up, controlled study, human, population density, outcome assessment, rheumatic disease, diabetes mellitu, adult, Prevention, market, temperature, mortality, United Kingdom, Europe, aged, female, workplace, Good Health and Well Being, human development, particulate matter 2.5, statistical analysi, North America, incidence, life expectancy, social aspect, COVID-19 Global Rheumatology Alliance Registry, observational study, demographic
Abstract

Published by Elsevier Ltd., Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p, MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).

Published
2022

18. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study

Author

Maria Sol Castaños Menescardi, Mercedes García, Elena Nikiphorou, Ulf Müller-Ladner, Rita Pinheiro Torres, Cassandra Calabrese, Nasra Al-Adhoubi, Sandra Lucia Euzebio Ribeiro, Kaley Beins, Puja Mehta, José Luis Velasco Zamora, Lorena Takashima, Loreta Bukauskiene, Derrick Todd, Gozd Kubra Yardimci, Samia Araujo de Sousa Studart, Ariel Salinas, Babur Salim, Martin Schaefer, Sarah Horton, Bea Maeyaert, Andrea M Seet, Beverley Harrison, Vernon Berglund, Douglas White, Archibald Skemp, Vanessa Castro Coello, Susan Leonard, Guillermo Quiceno, Geraldine McCarthy, Neil Kramer, Reinhard E. Voll, Helena Raffayova, Lianne Kearsley-Fleet, Hernán Maldonado Ficco, Emily L Gilbert, Samir Patel, Arezou Khosroshahi, Boris Karanovic, Jaroslaw Nowakowski, Dagmar Miceková, Márta Király, Saskia Lawson-Tovey, Alison Bays, Katie Williams, Pablo Maid, Montserrat Corteguera Coro, Anna Anna Sabová, Noelia German, Rosana Gallo, María Alejandra Cusa, Philip Robinson, Natalia Herscovich, Branimir Anic, Lorna Neill, Sara Baig, James Pilcher, Lucia Fusi, Jerald Zakem, Eugenia Picco, Monique Hoekstra, Michael S. Putman, Veronica Bellomio, Martina Skamlova, Daniela Spisakova, Caroline Mulvaney Jones, Ezzati Fatemeh, Sona Žlnayová, Silvana Conti, Eva Strakova, Jose A Gomez Puerta, Kristin M D’Silva, Marko Barešic, Yohana Tissera, Roberto Miguel Baez, Theodore Fields, Rachael Flood, Josefina Gallino Yanzi, Fatemah Abutiban, Henrique Ataide Mariz, Martin Zlnay, Mariana Luís, Mariana Pera, Robert Quinet, Claire Vandevelde, Richard Conway, Lubica Capova, Rodolfo Perez Alamino, Romina Nieto, Deborah Parks, Denise Hare, Audrey Low, Faizah Siddique, Zachary S. Wallace, Tiffany Y-T Hsu, Tameka Webb-Detiege, Sheila O'Reilly, Tatiana Barbich, Theo Zijlstra, Kathryn Dao, Luca Quartuccio, Cecilia Pisoni, Maria Isabel Quaglia, Zelmira Macejova, Laure Gossec, Jean W Liew, JoAnn Zell, Tiffany Y.T. Hsu, Rebecca Hasseli, Zara Izadi, Francinne Machado Ribeiro, Christopher Adams, Laura Chadwick, Naomi J Patel, Maria Carmen Torres Martin, Emoke Štenová, Fedra Irazoque, Natalia Lili Cuchiaro, Selda Çelik, Maria Isabel Haye Salinas, Alexandra Balbir-Gurman, Lucy Thornton, Shraddha Jatwani, Jane Leeder, Jeffrey A. Sparks, Pedro Machado, Elizabeth Macphie, Alojzija Hocevar, Melanie Winter, Christopher Hill, Carolina Aeschlimann, Loreto Carmona, Viktoriia Vasylets, Jose Campos, Jiri Vencovsky, Romina Tanten, Karina Cogo, Emily Pfeifer, Zachary S Wallace, Erick Zamora Tehozol, David F L Liew, Christine Graver, Cecilia Romeo, Lenny Geurts-van Bon, Alvaro Andres Reyes Torres, Arundathi Jayatilleke, Lui Cajas, Ana Bertoli, María Victoria Martire, Pascal Chazerain, Boris Kisluk, Anne Wolff, Alba Paula, Maria Marcela Schmid, Marieta Sencarová, Manuel F. Ugarte-Gil, Concetta Lamore, Veronica Savio, Emily Sirotich, Nicole Daver, Inita Bulina, Maria Filkova, Samar Al-Emadi, Jennifer Tyler, Ho So, Anne-Marie Chassin-Trubert, Leanna Wise, Davide Rozza, Yves Piette, Sabrina Solange de la Vega Fernandez, Eva Rath, Angel Alejandro Castillo Ortiz, Simona Rednic, Stéphane Bally, Kimme L Hyrich, Eric Ruderman, Gabriela Maria Guzman Melgar, Diana Cervántes Rosete, Alí Duarte-García, Juan Carlos Cobeta Garcia, Vanda Mlynarikova, Byung Ban, David Karp, Juan José Alegre Sancho, Carlevaris Leandro, Tamar Tanner, Gisela Subils, Susana Isabel Pineda, Ileana Filipescu, Lilliam Miranda, Karen Toribio Toribio, Karen Roberts, María Severina, Maria Valenzuela Almada, Kristin M. D’Silva, Tea Ahel Pavelic, Federico Nicolas Maldonado, Lingli Dong, Kirsty Devine, Ammar Haikal, Sebastian E Sattui, María J. Haye Salinas, Karen Yeter, Jennifer Morgan, Maria Julieta Gamba, Carla Matellan, Juan Alejandro Albiero, Angela Dahle, Martina Bakosova, Julija Zepa, Luciana Casalla, Jonathan S. Hausmann, Andrea Baños, William Davis, Elsa F Mateus, Kristina Kovacevic Stranski, Lindsay Jacobsohn, Milena A. Gianfrancesco, Daric Mueller, Eduardo Cepeda, Tatiana Sofia Rodriguez-Reyna, Sarah L. Mackie, Mahdi Vojdanian, Julieta Silvana Morbiducci, Enrique Giraldo, Gustavo Fabián Rodriguez Gil, Ivana Romina Rojas Tessel, Laura Groseanu, Carla Gobbi, Anja Strangfeld, Maria Soledad Gálvez Elkin, Alexandre Tj Maria, Adam Kilian, Marina Laura Werner, Sebastián Ibáñez, Sushama Mody, Melissa Harvey, Sofía Ornella, Melanie-Ivana Culo, Gabriela Belakova, Luciana Gonzalez Lucero, Marcelo Pinheiro, Natalia de la Torre-Rubio, Sasha Dunt, Khurram Abbass, Jeffrey A Sparks, Beatriz Zaueta, Elizabeth Warner, Servet Akar, Maren Hilton, Evangeline Scopelitis, Julia Scafati, Jeffrey Wilson, Marta Píchová, Rosana Quintana, Mária Oetterová, Diana O'Kane, Paul Sufka, Jinoos Yazdany, Mieke Devinck, Eduardo Martín Nares, Michael Guma, Gimena Gomez, Nicholas Lebedoff, Su-Ann Yeoh, Suneya Hogarty, Sandra Petruzzelli, Ma. Alicia Lazaro, Marina Rull Gabayet, Nafice Costa Araujo, Bimba F Hoyer, Maria Magdelena Tamas, Cecilia Goizueta, María Alejandra Medina, David Vega, Xochitl Jimenez, Rebecca Grainger, Micaela Cosatti, Gilbert Kepecs, Jonathan Eliseo Rebak, Walter Dorman, Dimitrios Vassilopoulos, Ann Knight, Maria de la Vega, Deshiré Alpízar-Rodríguez, Caroline Siegel, Ozan Cemal Icacan, María Elena Calvo, Sabrina Porta, Hesham Hamoud, Sandra Lucia Euzebio Ribeirio, Maxime Samson, Suleman Bhana, Gelsomina Alle, Ioana Felea, Sebastián Moyano, Rosaria Salerno, Carla Maldini, Jody Hargrove, Brahim Dahou, Fabian Risueño, Debora Guaglianone, Olga Lukacova, and Hammad Bajwa

Subjects
Aging, medicine.medical_specialty, Immunology, Autoimmune Disease, Polymyalgia rheumatica, Rheumatology, Clinical Research, Internal medicine, medicine, Immunology and Allergy, Global Rheumatology Alliance, business.industry, Arthritis, Inflammatory and immune system, Evaluation of treatments and therapeutic interventions, Retrospective cohort study, Articles, Odds ratio, medicine.disease, Comorbidity, Giant cell arteritis, 6.1 Pharmaceuticals, business, Vasculitis, Systemic vasculitis
Abstract

Summary Background Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behcet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behcet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31–1·57]), were male compared with female (1·38 [1·05–1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23–1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50–3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49–3·02]). Risk factors varied among different disease subtypes. Interpretation Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding American College of Rheumatology and the European Alliance of Associations for Rheumatology.

Published
2021
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19. Humoral and cellular correlates of a novel immune-related adverse event and its treatment

Author

Amrit S Gonugunta, Mitchell S von Itzstein, Hong Mu-Mosley, Farjana Fattah, J David Farrar, Angela Mobely, Sawsan Rashdan, Sunny Lai, Salman F Bhai, Bonnie L Bermas, David Karp, Quan-Zhen Li, Edward K Wakeland, and David E Gerber

Subjects
Pharmacology, Cancer Research, tumor, Lung Neoplasms, Drug-Related Side Effects and Adverse Reactions, Brain Neoplasms, Immunology, autoimmunity, biomarkers, Case Report, Middle Aged, Antibodies, Monoclonal, Humanized, cytokines, 2518 1619, Antineoplastic Agents, Immunological, Oncology, Carcinoma, Squamous Cell, Molecular Medicine, Immunology and Allergy, Humans, antibodies, Female, immunotherapy, neoplasm
Abstract

Immune-related adverse events (irAE) may affect almost any organ system and occur at any point during treatment with immune checkpoint inhibitors (ICI). We present a patient with advanced lung cancer receiving antiprogrammed death 1 checkpoint inhibitor who developed a delayed-onset visual irAE treated with corticosteroids. Through assessment of longitudinal biospecimens, we analyzed serial autoantibodies, cytokines, and cellular populations. Months after ICI initiation and preceding clinical toxicity, the patient developed broad increases in cytokines (most notably interleukin-6 (IL-6), interferon-γ (IFNγ), C-X-C motif chemokine ligand 2 (CXCL2), and C–C motif chemokine ligand 17 (CCL17)), autoantibodies (including anti-angiotensin receptor, α-actin, and amyloid), CD8 T cells, and plasmablasts. Such changes were not observed in healthy controls and ICI-treated patients without irAE. Administration of corticosteroids resulted in immediate and profound decreases in cytokines, autoantibodies, and inflammatory cells. This case highlights the potential for late-onset changes in humoral and cellular immunity in patients receiving ICI. It also demonstrates the biologic effects of corticosteroids on these parameters. Application of humoral and cellular immune biomarkers across ICI populations may inform toxicity monitoring and management.

Published
2021

20. Hydroxychloroquine: An Old Drug With New Tricks

Author

Nancy Olsen, David Karp, and Niels Olsen Saraiva Camara

Subjects
medicine.medical_specialty, Anti-nuclear antibody, Immunology, Disease, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, immune system diseases, Internal medicine, Humans, Immunology and Allergy, Medicine, 030212 general & internal medicine, skin and connective tissue diseases, 030203 arthritis & rheumatology, Lupus erythematosus, business.industry, Therapeutic effect, Autoantibody, Retrospective cohort study, Hydroxychloroquine, medicine.disease, Pharmaceutical Preparations, Antirheumatic Agents, Joint pain, medicine.symptom, business, medicine.drug
Abstract

Hydroxychloroquine (HCQ) is widely used in the treatment of systemic lupus erythematosus (SLE). The drug’s origins lie in the preparation of the cinchona bark, which was used for centuries to treat febrile maladies. HCQ is still classified as an antimalarial, though it is rarely used for that purpose1. In the present era, with many new therapeutics showing promise for improving outcomes in SLE, HCQ nevertheless has retained its central role in treatment, and is recommended for all patients with SLE whenever there are no contraindications to its use. In clinical practice, HCQ is also often used in patients who have some features of SLE but who do not satisfy classification criteria for SLE. The SLE spectrum is now recognized to extend into early stages of disease that are characterized by the presence of autoantibodies and cytokines along with symptoms such as joint pain or skin rashes2,3. Some of these patients are designated as having incomplete lupus erythematosus (ILE), with antinuclear antibody (ANA) positivity and other clinical or laboratory findings suggestive of SLE that are not present in sufficient number to satisfy classification criteria. The patients with ILE include a subset at increased risk for transition to classifiable SLE4,5. Factors contributing to risk of progression include female sex, younger age, and germline genetic variation5,6. One retrospective study has shown that starting treatment with HCQ in ILE patients delays the onset of SLE7, a finding that has generated interest in the idea that this medication may modify early disease stages and have long-term effects to reduce the severity of subsequent disease. The mechanisms by which HCQ exerts its therapeutic effects on the spectrum of SLE disease are only partially understood, despite the many years of clinical … Address correspondence to Dr. N.J. Olsen, Penn State MS Hershey Medical Center, 500 University Drive, Hershey, PA 17033-0850, USA. Email: nolsen{at}pennstatehealth.psu.edu.

Published
2021
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21. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Author

Anja, Strangfeld, Martin, Schäfer, Milena, A Gianfrancesco, Saskia, Lawson-Tovey, Jean, W Liew, Lotta, Ljung, Elsa, F Mateus, Christophe, Richez, Maria, J Santos, Gabriela, Schmajuk, Carlo, A Scirè, Emily, Sirotich, Jeffrey, A Sparks, Paul, Sufka, Thierry, Thomas, Laura, Trupin, Zachary, S Wallace, Sarah, Al-Adely, Javier, Bachiller-Corral, Suleman, Bhana, Patrice, Cacoub, Loreto, Carmona, Ruth, Costello, Wendy, Costello, Laure, Gossec, Rebecca, Grainger, Eric, Hachulla, Rebecca, Hasseli, Jonathan, S Hausmann, Kimme, L Hyrich, Zara, Izadi, Lindsay, Jacobsohn, Patricia, Katz, Lianne, Kearsley-Fleet, Philip, C Robinson, Jinoos, Yazdany, Pedro, M Machado, COVID-19 Global Rheumatology Alliance, COVID-19 Global Rheumatology Alliance Consortium Collaborators: COVID-19 Global Rheumatology Alliance Consortium, Brahim, Dahou, Marcelo, Pinheiro, Francinne, M Ribeiro, Anne-Marie, Chassin-Trubert, Sebastián, Ibáñez, Lingli, Dong, Lui, Cajas, Hesham, Hamoud, Jérôme, Avouac, Véronique, Belin, Raphaël, Borie, Pascal, Chazerain, Xavier, Chevalier, Pascal, Claudepierre, Gaëlle, Clavel, Marie-Eve, Colette-Cedoz, Bernard, Combe, Elodie, Constant, Nathalie, Costedoat-Chalumeau, Marie, Desmurs, Valérie, Devauchelle-Pensec, Mathilde, Devaux, Robin, Dhote, Yannick, Dieudonné, Fanny, Domont, Pierre-Marie, Duret, Mikaël, Ebbo, Esther, Ebstein, Soumaya El Mahou, Bruno, Fautrel, Renaud, Felten, René-Marc, Flipo, Violaine, Foltz, Antoine, Froissart, Joris, Galland, Véronique, Gaud-Listrat, Sophie, Georgin-Lavialle, Aude, Giraud-Morelet, Jeanine, S Giraudet-Le Quitrec, Philippe, Goupille, Sophie, Govindaraju-Audouard, Franck, Grados, Séverine, Guillaume-Czitrom, Marion, Hermet, Ambre, Hittinger-Roux, Christophe, Hudry, Isabelle, Kone-Paut, Sylvain La Batide Alanore, Pierre, Lafforgue, Sophie, Lahalle, Isabelle, Lambrecht, Vincent, Langlois, Jean-Paul, Larbre, Emmanuel, Ledoult, Christophe, Leroux, Frédéric, Liote, Alexandre TJ Maria, Hubert, Marotte, Arsène, Mekinian, Isabelle, Melki, Laurent, Messer, Catherine, Michel, Gauthier, Morel, Jacques, Morel, Marie-Noelle, Paris-Havard, Edouard, Pertuiset, Thao, Pham, Myriam, Renard, Sabine, Revuz, Sébastien, Rivière, Clémentine, Rousselin, Christian, Roux, Diane, Rouzaud, Jérémie, Sellam, Raphaele, Seror, Amelie, Servettaz, Vincent, Sobanski, Christelle, Sordet, Lionnel, Spielmann, Nathalie, Tieulié, Alice, Tison, Sophie, Trijau, Alexandre, Virone, Ursula, Warzocha, Daniel, Wendling, Frederik, N Albach, Peer, Aries, Elvira, Decker, Urs, Hartmann, Joerg, Henes, Bimba, F Hoyer, Andreas, Krause, Klaus, Krüger, Hanns-Martin, Lorenz, Ulf, Müller-Ladner, Alexander, Pfeil, Anne, Regierer, Jutta, G Richter, Markus, Rihl, Tim, Schmeiser, Hendrik, Schulze-Koops, Christof, Specker, Reinhard, E Voll, Stephanie, Werner, Gabriela MG Melgar, Mahdi, Vojdanian, Andreoli, Laura, Elena, Bartoloni-Bocci, Maurizio, Benucci, Francesco, Campanaro, Marta, Caprioli, Davide, Carboni, Greta, Carrara, Edoardo, Cipolletta, Chiara, Crotti, Gloria, Dallagiacoma, Paola, Faggioli, Rosario, Foti, Franceschini, Franco, Fredi, Micaela, Giacomo, Guidelli, Florenzo, Iannone, Gianpiero, Landolfi, Caludia, Lomater, Ceciclia, Nalli, Simone, Parisi, Luca, Quartuccio, Bernd, Raffeiner, Rossella, Reggia, Marta, Riva, Nicoletta, Romeo, Cinzia, Rotondo, Ettore, Silvagni, Luigi, Sinigaglia, Ilaria, Tinazzi, Anna, Zanetti, Giovanni, Zanframundo, Fatemah, Abutiban, Deshiré, Alpízar-Rodríguez, Marina, R Gabayet, Fedra, Irazoque, Xochitl, Jimenez, Eduardo, Martín, Angel AC Ortiz, Tatiana, S Rodriguez-Reyna, Diana, C Rosete, Erick AZ Tehozol, David, Vega, Beatriz, Zaueta, Nasra, Al-Adhoubi, Babur, Salim, Enrique, Giraldo, Ariel, Salinas, Manuel, Ugarte-Gil, Diogo, Almeida, Miguel, Bernardes, Rita, C Machado, Maria, Rato, Samar, Al-Emadi, Richard, Conway, Rachael, Flood, Juan, J Alegre-Sancho, Montserrat, C Coro, Natalia de la Torre-Rubio, Jose, C Esteban, Maria del Martin, Jose, G Puerta, Johan, Back, Maryam, Dastmalchi, Brigitte, Dupré, Emma, Grenholm, Aase, Hensvold, Ann, Knight, Servet, Akar, Ozan, C Icacan, Laura, Chadwick, Kirsty, Devine, Sasha, Dunt, Lucia, Fusi, Caroline, M Jones, Elizabeth, Macphie, Elena, Nikiphorou, Diana, O'Kane, Sheila, O'Reilly, Samir, Patel, Rosaria, Salerno, Lucy, Thornton, Jenny, Tyler, Claire, Vandevelde, Elizabeth, Warner, Su-Ann, Yeoh, Sara, Baig, Hammad, Bajwa, Byung, Ban, Vernon, Berglund, Cassandra, Calabrese, Kristin, D'Silva, Angela, Dahle, Kathryn, Dao, Nicole, Daver, William, Davis, Walter, Dorman, Ezzati, Fatemeh, Theodore, Fields, Jody, Hargrove, Melissa, Harvey, Maren, Hilton, Tiffany, Hsu, Arundathi, Jayatilleke, David, Karp, Gilbert, Kepecs, Neil, Kramer, Concetta, Lamore, Nicholas, Lebedoff, Susan, Leonard, Sushama, Mody, Jennifer, Morgan, Emily, Pfeifer, Guillermo, Quiceno, Robert, Quinet, Elliot, Rosenstein, Eric, Ruderman, Evangeline, Scopelitis, Naomi, Serling-Boyd, Faizah, Siddique, Archibald, Skemp, Jeffrey, Sparks, Derrick, Todd, Karen, T Toribio, Rachel, Wallwork, Tameka, Webb-Detiege, Douglas, White, Jeffrey, Wilson, Melanie, Winter, Leanna, Wise, Anne, Wolff, Kristen, Young, Jerald, Zakem, Joann, Zell, and Kurt Zimmerman, Leibniz Forschungsinstitut für Molekulare Pharmakolgie = Leibniz Institute for Molecular Pharmacology [Berlin, Allemagne] (FMP), Leibniz Association, University of California, University of Manchester [Manchester], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), Umeå University, EULAR standing committee of People with Arthritis/Rheumatism in Europe (PARE), CHU Bordeaux [Bordeaux], Club Rhumatismes et Inflammation, Faculdade de Medicina [Lisboa], Universidade de Lisboa (ULISBOA), Università degli Studi di Ferrara (UniFE), McMaster University [Hamilton, Ontario], Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Universidad de Alcalá - University of Alcalá (UAH), Service de rhumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Otago [Dunedin, Nouvelle-Zélande], Université de Lille, Technische Hochschule Mittelhessen - University of Applied Sciences [Giessen] (THM), University of Queensland [Brisbane], University College of London [London] (UCL), Repositório da Universidade de Lisboa, University of California (UC), Universidade de Lisboa = University of Lisbon (ULISBOA), Università degli Studi di Ferrara = University of Ferrara (UniFE), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Strangfeld, A, Schafer, M, Gianfrancesco, M, Lawson-Tovey, S, Liew, J, Ljung, L, Mateus, E, Richez, C, Santos, M, Schmajuk, G, Scire, C, Sirotich, E, Sparks, J, Sufka, P, Thomas, T, Trupin, L, Wallace, Z, Al-Adely, S, Bachiller-Corral, J, Bhana, S, Cacoub, P, Carmona, L, Costello, R, Costello, W, Gossec, L, Grainger, R, Hachulla, E, Hasseli, R, Hausmann, J, Hyrich, K, Izadi, Z, Jacobsohn, L, Katz, P, Kearsley-Fleet, L, Robinson, P, Yazdany, J, Machado, P, and HAL-SU, Gestionnaire

Subjects
Male, 0301 basic medicine, Aging, antirheumatic agents, Epidemiology, Azathioprine, Comorbidity, Disease, Global Health, Cardiovascular, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Odds Ratio, Immunology and Allergy, Registries, AcademicSubjects/MED00360, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, glucocorticoids, Middle Aged, health care, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Letter to the Editor (Other), 6.1 Pharmaceuticals, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Public Health and Health Services, Female, epidemiology, Rituximab, medicine.drug, medicine.medical_specialty, Clinical Sciences, Immunology, autoimmune disease, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Autoimmune Disease, General Biochemistry, Genetics and Molecular Biology, Antibodies, Antineutrophil Cytoplasmic, 03 medical and health sciences, Rheumatology, Sulfasalazine, Rheumatic Diseases, Internal medicine, medicine, Humans, autoimmune diseases, outcome assessment, Aged, Rheumatology and Autoimmunity, 030203 arthritis & rheumatology, Reumatologi och inflammation, SARS-CoV-2, business.industry, Arthritis, Evaluation of treatments and therapeutic interventions, COVID-19, Odds ratio, medicine.disease, Arthritis & Rheumatology, Good Health and Well Being, 030104 developmental biology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, COVID-19 Global Rheumatology Alliance, antirheumatic agent, glucocorticoid, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ., Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Published
2021
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22. Register of New Fruit and Nut Cultivars List 49

Author

John E. Preece, Ksenija Gasic, and David Karp

Subjects
0106 biological sciences, Nut, Crop yield, Horticulture, Biology, Plant disease resistance, 01 natural sciences, Register (music), Plant morphology, 010608 biotechnology, Cultivar, Rootstock, 010606 plant biology & botany, Hybrid
Published
2018
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23. Abstract 248: Geographic Variability in Population Outcomes for Out-of-Hospital Cardiac Arrest

Author

Alexis Zebrowski, Douglas J Wiebe, David Karp, David G Buckler, Manqing Liu, David F Gaieski, Benjamin S Abella, and Brendan G Carr

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Introduction: Significant work has described patient and hospital level variability in survival after out-of-cardiac arrest (OHCA). OHCA requires a population based systems response in order to optimize regional outcomes, but no regional or systems level incentives exist. We used population based claims data to empirically describe geographic utilization patterns for OHCA and then benchmarked and compared population level outcomes. Methods: OHCA cases were identified from the Healthcare Cost and Utilization Project’s State Emergency Department Databases and State Inpatient Databases for 2011 in 3 states, (NY, NE, FL). Patient cohorts were identified using an ICD-9-CM code of 427.5 for the principal (outpatient) or admitting (inpatient) diagnosis. Exclusion criteria included living outside of the study area and no valid residential ZIP code. Geographic clusters were identified based on hospital utilization patterns at the ZIP code tabulation area level using hierarchical clustering. Boundary zip codes could belong to more than one regional cluster. Adjusted survival was calculated using multi-level logistic regression controlling for demographic, hospital, and community-level variables for each cluster. Results: In 2011, there were 17,086 OHCA treated in the study region, with a mean survival rate to admission of 18.2%; 5.1% to discharge. Hospitals and ZIP codes were grouped into 26 regions (OHCA cases per region: range 7-4,698). Regional unadjusted survival to admission ranged from 0-26.6% and adjusted from 2.8-25.0%. Crude survival to discharge rates ranged from 0-12.8%, and adjusted rates ranged from 1.7-7.6% (Figure 1). Conclusions: This novel approach demonstrates a method by which to measure regional variability in OHCA survival. Because the region is determined empirically based on a utilization based attribution method, population based incentives (or penalties) could be created by payers.

Published
2018
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24. The Citron (Citrus medicaL.) in China

Author

David Karp and Xulan Hu

Subjects
0106 biological sciences, food, Traditional medicine, Biology, China, Medicinal plants, 010603 evolutionary biology, 01 natural sciences, Citrus taxonomy, food.food, 010606 plant biology & botany, Citrus medica
Published
2018
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25. Luther Burbank’s Plums

Author

David Karp

Subjects
Horticulture, Biology
Abstract

The 113 named varieties of plums introduced by Luther Burbank (1849–1926) were by far the most numerous and arguably the most significant of his horticultural accomplishments. He began by importing 12 seedlings from Japan in 1885, including ‘Abundance’ and ‘Satsuma’ (Prunus salicina). The cultivars he released in the late 19th and early 20th centuries played a crucial role in developing commercial cultivation of Asian-type plums in California, the United States, and much of the world; they also served as founding clones for later breeders. His crowning achievement was ‘Santa Rosa’ (introduced 1906), which in 1945, ‘Santa Rosa’ accounted for 36% of the California plum harvest. Many of Burbank’s other cultivars of primarily P. salicina ancestry were extensively cultivated in California in the early and middle 1900s, including ‘Beauty’ (introduced 1911), ‘Burbank’ (1888), ‘Duarte’ (1911), ‘Eldorado’ (1904), ‘Formosa’ (1907), and ‘Wickson’ (1895). His most important introductions of European plum (P. domestica) were ‘Improved French’ prune (1898), ‘Sugar’ prune (1899) and ‘Standard’ prune (1911). Some of Burbank’s more obscure introductions never received general distribution and have disappeared; others such as ‘Santa Rosa’, ‘Shiro’ (1899), and ‘Elephant Heart’ (released posthumously in 1929) still are commonly cultivated today in home gardens and for sale at local markets.

Published
2015
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30. Chemotaxonomic investigations of peel and petitgrain essential oils from 17 citron cultivars

Author

Franck Curk, Jean-Marie Desjobert, Nicolas Venturini, Jean Costa, David Karp, Julien Paolini, Université de Corse Pasquale Paoli (UCPP), Station de recherches agronomiques de San Giuliano, Institut National de la Recherche Agronomique (INRA), University of California [Riverside] (UCR), University of California, Sciences pour l'environnement (SPE), Centre National de la Recherche Scientifique (CNRS)-Université Pascal Paoli (UPP), and Renucci, Franck

Subjects
0106 biological sciences, [SDV]Life Sciences [q-bio], citron cultivars, Bioengineering, 01 natural sciences, Biochemistry, Gas Chromatography-Mass Spectrometry, essential oil, citrus, law.invention, chemistry.chemical_compound, food, law, Botany, Nerol, Oils, Volatile, huile essentielle, petitgrain, Molecular Biology, intraspecific variability, Essential oil, chimie, GC, Limonene, beta-Pinene, Principal Component Analysis, Chemotype, [CHIM.ORGA]Chemical Sciences/Organic chemistry, GC/MS, 010401 analytical chemistry, General Chemistry, General Medicine, Petitgrain, [CHIM.ORGA] Chemical Sciences/Organic chemistry, food.food, 0104 chemical sciences, Citrus medica, Horticulture, chemotaxonomy, Phenotype, chemistry, Fruit, [SDE]Environmental Sciences, Molecular Medicine, Geraniol, 010606 plant biology & botany, cultivar
Abstract

International audience; Chemical compositions of essential oils from 17 citron cultivars were studied using GC and GC/MS. To the best of our knowledge, chemical compositions of peel and petitgrain oils from seven of them were reported for the first time. Combined analysis of peel and petitgrain essential oils led to the identification of 37 components (amounting to 98.2-99.9% of the total oil) and 42 components (97.0-99.9%), respectively. Statistical analysis was applied to identify possible relationships between citron cultivars. The levels of seven components, i.e., limonene, beta-pinene, gamma-terpinene, neral, geranial, nerol, and geraniol, indicated that the cultivars could be classified in four main chemotypes for peel and petitgrain oils. Chemotaxonomic investigations were carried out to establish relations between the morphological characteristics of citron cultivars and their corresponding oil compositions.

Published
2010
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31. Sequences in both class II major histocompatibility complex alpha and beta chains contribute to the binding of the superantigen toxic shock syndrome toxin 1

Author

Ned S. Braunstein, Eric O. Long, Xiao Cun Wang, Dominique A. Weber, and David Karp

Subjects
T cell, Bacterial Toxins, Immunology, chemical and pharmacologic phenomena, Biology, Transfection, Major histocompatibility complex, Cell Line, Enterotoxins, Mice, L Cells, Antigen, MHC class I, medicine, Superantigen, Animals, Immunology and Allergy, Genetics, Superantigens, T-cell receptor, Histocompatibility Antigens Class II, Toxic shock syndrome toxin, Articles, Recombinant Proteins, Cell biology, medicine.anatomical_structure, biology.protein, CD8
Abstract

Class II major histocompatibility complex (MHC) molecules present peptides derived from processed antigen to antigen-specific CD4-positive T cells. In addition, class II molecules bind with high affinity another class of antigens, termed superantigens. T cell stimulation by superantigens depends almost exclusively on the V beta segment expressed by the T cell receptor (TCR). Mapping of the superantigen binding site on class II molecules should provide valuable information on how MHC and TCR molecules interact. Recombinant mouse I-A class II molecules expressed on transfected L cells were analyzed for their ability to bind the toxic shock syndrome toxin 1. Polymorphic residues in the alpha helices of both the alpha and beta chains of I-A contributed to quantitative toxin binding, suggesting that the toxin binds to either a combinatorial or a conformational site on class II MHC molecules.

Published
1992
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33. Malpractice Prevention for Pediatricians

Author

David Karp

Subjects
medicine.medical_specialty, business.industry, Family medicine, Malpractice, Pediatrics, Perinatology and Child Health, medicine, Humans, Liability, Legal, business, Pediatrics, United States
Published
1991
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35. Dealing with an impaired colleague

Author

David, Karp

Subjects
Physician Impairment, Practice Management, Medical, Group Practice, Humans, Personnel Management, United States
Published
2007

37. Keep tabs on what you've ordered

Author

David, Karp

Subjects
Radiography, Risk Management, Lung Neoplasms, Malpractice, Practice Management, Medical, Humans, Documentation, Continuity of Patient Care, Truth Disclosure, Medical Records, United States
Published
2007

38. Altered soluble mediator levels and systemic lupus erythematosus-specific Connective Tissue Disease Screening Questionnaire (CSQ) scores differentiate unaffected relatives of lupus patients from healthy individuals with no family history of SLE (CCR4P.214)

Author

Melissa Munroe, Kendra Young, Jennifer Fessler, Dustin Fife, Diane Kamen, Joel Guthridge, Timothy Niewold, Michael Weisman, Mariko Ishimori, Daniel Wallace, David Karp, John Harley, and Judith James

Subjects
Immunology, Immunology and Allergy
Abstract

Identifying populations at risk of SLE who remain unaffected would provide insights for potential disease prevention. Using a unique resource of SLE patient family members, first degree relatives (FDRs) of SLE patients (n = 154) with plasma samples available from previous genetic studies and who remained unaffected at follow-up evaluation (mean time = 6.8 years) were matched to healthy individuals unrelated to SLE patients (Controls). FDRs and Controls provided clinical and demographic information, and completed screening questionairres at baseline (BL) and follow-up (FU). BL and FU plasma samples were assessed for autoantibody production and soluble mediators. FDRs had significantly higher BL and FU CSQ scores (p

Published
2015
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39. Soluble mediators and clinical features predict transition to systemic lupus erythematosus classification in previously unaffected relatives of SLE patients (HUM3P.243)

Author

Melissa Munroe, Kendra Young, Diane Kamen, Joel Guthridge, Timothy Niewold, Michael Weisman, Mariko Ishimori, Daniel Wallace, Gary Gilkeson, Nancy Olsen, David Karp, John Harley, Jill Norris, and Judith James

Subjects
Immunology, Immunology and Allergy
Abstract

Healthy relatives of lupus patients have an increased risk of developing SLE, but predictors and mechanisms of disease transition are unknown. Unaffected relatives of SLE patients (n=409) were enrolled in this follow-up study to identify factors associated with transition to SLE. Participants provided detailed demographic and clinical information, including the Connective Tissue Disease Screening Questionnaire (CSQ). Medical records were reviewed for ACR classification criteria. Plasma samples were tested for the presence of autoantibodies and soluble mediators. Forty-five relatives (11%) transitioned to classified SLE during follow-up (mean time = 6.4 years) who had more autoantibodies (p

Published
2015
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40. Genetic risk alleles associated with serologic autoimmunity in normal individuals (BA3P.113)

Author

Prithvi Raj, Quanzhen Li, David Karp, Nancy Olsen, K. Sivils, Igor Dozmorov, Ran Song, J. James, J Kelly, Bernard Lauwerys, Peter Gregersen, and Edward Wakeland

Subjects
Immunology, Immunology and Allergy
Abstract

We screened 2628 normal individuals for antibodies binding to the mix of antigens in a human nuclear extract and identified 579 (26.05%) individuals with significant levels of IgG antibodies to self-antigens. Next, we analyzed 639 representative sera from ANA-, ANA+, ILE and SLEs on an autoantigen proteomic array, which identified 33 antigens strongly recognized by IgG autoantibodies in ANA+ group as compared to ANA- normals. Of these 33, 19 antigens were non-nuclear or cytoplasmic proteins and 14 were nuclear proteins, including known SLE associated antigens such as dsDNA and Histones. Antigen cluster analysis showed that DNA and RNA clusters are more frequent in SLE and ILE group, while matrix proteins and antiphospholipid antibodies clusters are more frequent in ANA+ normals. Next, all the individuals were genotyped with immunochip and subset by target sequencing. Quantitative genetic association test identified SNPs associated with ANA and auto-antigens. The strongest association signal was observed at HLA, where SNP rs3117103 near BTNL2, rs9268832 near HLA-DRA and rs2395252 in HLA-DQA2 gene showed strongest (10-7) association. Other signals were in/near BANK1, PTTG1 and CR1L genes. RNA sequencing analysis identified ANA risk alleles associated with up regulation of HLA-DRB1 in monocytes and BANK1 in B cells. Our data suggest that functional variations in or near HLA DRB1 and BANK1 gene may be associated with development of humoral autoimmunity in general population.

Published
2015
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41. Should you sign a 'consent to settle'?

Author

David, Karp

Subjects
Negotiating, Compensation and Redress, Malpractice, Practice Management, Medical, Humans, United States
Published
2006

42. Can I pay a patient's bills?

Author

David, Karp

Subjects
Reimbursement Mechanisms, Financing, Personal, Physician-Patient Relations, Fees and Charges, Malpractice, Humans, United States
Published
2006

45. The risk of hospitalist hand-offs

Author

David, Karp

Subjects
Time Factors, Clinical Laboratory Techniques, Hospitalists, Malpractice, Humans, Interdisciplinary Communication, Continuity of Patient Care, Patient Discharge
Published
2006

46. Document reminders, reduce risk

Author

David, Karp

Subjects
Practice Management, Reminder Systems, Documentation, Risk Reduction Behavior, United States
Published
2006

47. Refusing a difficult patient

Author

David, Karp

Subjects
Physician-Patient Relations, Humans, Refusal to Treat, United States
Published
2006

48. After-hours answering machines

Author

David, Karp

Subjects
After-Hours Care, Malpractice, Practice Management, Medical, Humans, Liability, Legal, Emergencies, Family Practice, Medical Records, United States, Answering Services
Published
2006

49. After-hours answering services

Author

David, Karp

Subjects
After-Hours Care, Practice Management, Medical, Humans, United States, Telephone
Published
2006

50. Liability for referrals

Author

David, Karp

Subjects
Interprofessional Relations, Liability, Legal, Referral and Consultation, United States
Published
2006

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