At this year’s American College of Rheumatology Virtual Meeting, the Hospital for Special Surgery (HSS) showcased exciting research related to rheumatology and orthopedic surgery.
Research focuses on the diagnosis of kidney problems, the risk of venous thromboembolism after total knee arthroplasty (TKR) and the management of pediatric patients and young adults with rheumatologic diseases. There are also studies related to the management of rheumatology patients during the COVID-19 pandemic.
While there have been significant advances in science over the years, there are areas of unmet need that warrant continued investigation. HSS relentlessly focuses on improving patient care through innovation and discovery. By conducting multicenter studies, clinical trials and laboratory research, we continue to improve the quality of life of patients with rheumatic and musculoskeletal diseases.. “
S Louis Bridges, Jr., MD, PhD, Chief Medical Officer and Chairman, Department of Medicine and Chief, Division of Rheumatology, Hospital for Special Surgery
Here are some highlights from the meeting:
Geographic variations in perceptions of COVID-19 and patient care: a national survey of rheumatologists
A study led by rheumatologist HSS Bella Mehta, MBBS, MS, examined the perceptions and behaviors of rheumatologists in the United States regarding the risk of COVID-19 for patients with autoimmune diseases and how these patients have been managed with immunosuppressive and anti-inflammatory drugs.
The 271 respondents were asked if patients with rheumatic diseases were at a higher risk of COVID-19 and if the pandemic had caused them to reduce the use, dosage or frequency of biologics or steroids.
Overall, the survey found geographic variations in patients’ perceptions of COVID-19 risk, with significantly different responses in the northeastern region of the United States compared to other regions.
Can a Patient-Reported Joint Number Based Clinical Disease Activity Index (PT-CDAI) be used to inform targeted telemedicine care? an analysis of 2 early RA cohort studies
A team that included HSS rheumatologist Vivian P. Bykerk, BSc, MD, FRCPC, reviewed data from two cohort studies in patients with early-onset rheumatoid arthritis (RA) that compared patient and physician assessment of painful and swollen joints.
This research is important because COVID-19 has forced rheumatologists to make in-person clinical visits to telemedicine, limiting their ability to perform comprehensive joint exams. The study found that patient and physician ratings matched well when it came to identifying active versus controlled disease activity.
Additionally, the researchers reported that predictors of larger discrepancies between patient and physician ratings may help identify the subsets of patients who might benefit the most from more physician-guided training during self-testing. -joint assessments as well as more in-depth questions during telehealth visits to confirm active synovitis. .
Characterization of Antiphospholipid Antibody-Associated Nephropathy: An International Survey of Members of the Renal Pathology Society
An investigation by HSS rheumatologist Medha Barbhaiya, MD, MPH, sought to determine whether pathologists around the world use uniform criteria to distinguish antiphospholipid antibody (aPL-N) associated nephropathy from other forms of thrombotic microangiopathy.
The study was conducted in parallel with an international effort to develop new classification criteria for antiphospholipid syndrome.
The online survey included 780 members of an international renal pathology society; 111 renal pathologists responded, representing 33 countries.
Participants were asked to determine whether two characteristics of acute and eight chronic aPL-N were compatible with acute or chronic aPL-N without and were not given serological information.
The results of the survey indicated that over 90% of pathologists worldwide agreed that the most specific renal pathological features of aPL nephropathy are glomerular microthrombi or small non-inflammatory arteries and organized microvascular thrombi with recanalization.
In the absence of serological data, more than 75% of pathologists indicated a lack of specificity for chronic glomerular changes or small arteries. These results indicate the importance of serological test results in the interpretation of biopsies and suggest higher specificity for certain acute or chronic characteristics.
The risk of venous thromboembolism after a septic total knee replacement (TKA) revision is double the risk after aseptic revision of the TKA: an analysis of the administrative discharge data
A team led by HSS rheumatologist Anne R. Bass, MD, assessed the 90-day risk of postoperative venous thromboembolism (VTE) in people who have had revision surgery for PTK.
Although it is already known that infection can increase the risk of thrombosis by triggering clotting pathways, the impact of infection in this context was not well understood.
The study, which included 25,441 such surgeries performed between 1998 and 2014, used data from the New York Statewide Planning and Research Cooperative System. Overall, 69% of these revisions were for mechanical (aseptic) cause, 28% were for infection (septic) and 3% were related to a periprosthetic fracture.
The researchers found that the risk of VTE after septic revision surgery was double the risk after aseptic revision surgery and was 2.6 times higher after revision surgery for fracture. These results highlight the importance of considering infection and fracture status when planning VTE prophylaxis for patients with revision surgery.
Use a patient-centered approach to identify cross-cutting disease factors influencing mental health in young people with rheumatologic disease
A team including SSS Head of Pediatric Rheumatology Karen Brandt Onel, MD, looked at the mental health experiences of people with juvenile arthritis, juvenile dermatomyositis, or systemic lupus erythematosus.
It included patients aged 14 to 24 and parents of patients aged 8 to 24. The primary outcome measure was the presence of any clinical or self-diagnosed mental health problem.
The investigation included information on cross-cutting disease factors such as duration of disease, active disease status, current steroid medication, history of disease flare after remission, and co-morbidities affecting the disease. appearance (such as psoriasis, stretch marks, alopecia, skin ulceration and scarring).
The researchers also looked at the results by mental health problem (depression, anxiety and self-harm / suicidal ideation).
Overall, they found that certain rheumatologic disease factors, including those that alter appearance, are predictors of mental health problems such as depression or anxiety. The results will help identify targets for mental health screening in young people with rheumatologic diseases.
New Juvenile Idiopathic Arthritis Quality Measure Defined for Pediatric Rheumatology Care and Outcome Improvement Network
A team that included HSS pediatric rheumatologist Nancy Pan, MD, reported highlights of new quality measures for the treatment of juvenile idiopathic arthritis.
The study also provided information on the performance of these new measures, which were created by the Pediatric Rheumatology Care and Outcomes Improvement Network.
The measures take into account clinical health significance, scientific validity and feasibility, as well as best practice.
They include both clinical assessments based in part on the Juvenile Arthritis Disease Clinical Activity Score and patient-reported outcomes such as pain, physical function, and general well-being.
An analysis of the new measures found that they can be used on patients with juvenile idiopathic arthritis and can help maximize quality improvement efforts and optimize the delivery of care.
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