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1.
J Clin Rheumatol ; 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31985721

RESUMO

BACKGROUND/OBJECTIVE: The objective of this prospective cohort study was to understand the positive and negative effects of glucocorticoids (GCs) in patients with systemic lupus erythematosus and myositis from the patients' perspective with the aim of developing a patient-reported outcome measure. METHODS: Included patients were asked to participate in 1 of 5 nominal groups where demographic information and a quality-of-life questionnaire were collected. Patients were asked 2 open-ended questions on (1) benefits and (2) harms related to GC use. We used the Nominal Group Technique, a highly structured consensus method in which responses are generated, shared, and ranked. Descriptive statistics were used to summarize the results. Nominal group sessions took place from April to May 2019. RESULTS: Of 206 patients who were approached, 21 patients participated, 17 with systemic lupus erythematosus and 4 with myositis, predominantly women with more than 10 years of steroid use. The domains ranked highest for GC benefits were disease control (55 votes), fast onset of action (30 votes), increased energy (10 votes), and pain relief (10 votes). The highest-ranked negative effects were bone loss (38 votes) and weight gain (16 votes); psychological effects and damaged internal organs each received 12 votes. CONCLUSIONS: The top-ranked GC effects-both benefits and harms-among patients with systemic rheumatic disease are consistent with the top domains associated with GC use reported with other inflammatory diseases. This study informs the development of a comprehensive patient-reported outcome measure that can be used across inflammatory diseases.

2.
J Rheumatol ; 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31787606

RESUMO

OBJECTIVE: To perform a qualitative study to define the patient perspective of what constitutes a failure of total joint replacement (TJR). METHODS: We used the nominal group technique (NGT) with participants who had undergone elective total hip replacements (THR) and/or total knee replacements (TKR) to answer the question "When would you consider a knee or hip replacement to be a failure?" RESULTS: We performed eight nominal groups with 42 participants, all of whom had undergone THR and/or TKR between 2016 and 2018. Of these, 48% were male, 17% black, 79% had college education or above, and 76% had had osteoarthritis as the underlying diagnosis. The nominated responses/themes that were ranked the highest by the participants were: (1) refractory index joint pain (80 votes); (2) occurrence of post-operative adverse events (54 votes); (3) Unable to resume normal activities or go back to work (38 votes); (4) little or no improvement in quality of life (QOL; 35 votes); (5) early revision surgery (35 votes); (6) death (7 votes); and (7) other including nurse or physician negligence (2 votes) and expectation-outcome mismatch (1 vote). CONCLUSION: Lack of relief of pain or restoration of function or quality of life or the occurrence of surgical complications after TJR were defined as TJR failure by participants. Functional TJR failure seems as or more important than surgical failure. This patient perspective of TJR failure further confirmed their inclusion in core domain set for TJR clinical trials in people undergoing knee or hip replacements.

3.
Arthritis Rheumatol ; 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612614

RESUMO

BACKGROUND: Morning stiffness is a hallmark symptom of rheumatoid arthritis (RA), but its etiology is poorly understood. We sought to determine whether any histologic features of synovium associate with this symptom. METHODS: Patient reports of morning stiffness duration, stiffness severity and disease activity scores (DAS28) were collected from 176 patients with RA undergoing arthroplasty. Histopathology of synovium was scored for 10 features: synovial lining hyperplasia, lymphocytes, plasma cells, Russell bodies, binucleate plasma cells, fibrin, synovial giant cells detritus, neutrophils and mucin. Fibrinolysis of clots seeded with various cell types was measured in turbidimetric lysis assays. RESULTS: Stiffness severity and morning stiffness duration were both significantly associated with DAS28 (p=0.0001 and p=0.001 respectively). None of the synovial features examined were associated with patient-reported stiffness severity. The presence of neutrophils and fibrin in RA synovial tissue were significantly (P<0.0001) associated with patient report of greater than one hour of morning stiffness, such that 73% of patients with both synovial fibrin and neutrophils report more than one hour of morning stiffness. Further, neutrophils and fibrin deposits colocalized along the synovial lining. In in vitro analyses, fibrin clots seeded with necrotic neutrophils were more resistant to fibrinolysis than those seeded with living neutrophils or no cells (p=0.008). DNase1 treatment of necrotic neutrophils abrogated the delay in fibrinolysis. CONCLUSION: In RA, prolonged morning stiffness may be related to impaired fibrinolysis of neutrophil enmeshed fibrin deposits along the synovial membrane. Our findings also suggest that morning stiffness severity and duration may reflect distinct pathophysiological phenomena.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31609524

RESUMO

OBJECTIVE: Most RA patients undergoing total hip(THA) and total knee arthroplasty(TKA) have active RA and report post-operative flares; whether RA disease activity or flares increase risk of worse pain and function scores 1 year later is unknown. METHODS: RA patients were enrolled before THA/TKA. Patient Reported Outcomes (PROS) including Hip and Knee Osteoarthritis/disability and injury Outcome Scores (HOOS/KOOS) and MD assessments of disease characteristics and activity (DAS 28, CDAI) were collected before surgery. PROS were repeated at 1 year. Post-operative flares were identified using RA Flare Questionnaire weekly for 6 weeks, and defined by concordance between patient report plus MD assessment. We compared baseline characteristics and HOOS/KOOS scores using two-sample t-test/Wilcoxon rank-sum and Chi-squared/Fisher's exact tests. We used multivariate linear and logistic regression to determine association of baseline characteristics, disease activity, and flares, with 1-year outcomes. RESULTS: One-year HOOS/KOOS scores were available for 122 patients (56THA/66TKA). Although HOOS/KOOS pain was worse for patients who flared within six weeks of surgery; absolute improvement was not different. In multivariable models, baseline DAS28 predicted 1-year HOOS/KOOS pain and function; each 1 unit increase in DAS28 worsened 1-year pain by 2.41 (SE=1.05, p=.02) and 1-year function by 4.96 (SE=1.17, p=.0001). Post-operativeerative flares were not independent risk factors for pain or function scores. CONCLUSION: Higher disease activity increased risk of worse pain and function one year after arthroplasty, post-operative flares did not.

5.
J Rheumatol ; 46(9): 1064-1066, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474613
6.
Arthritis Care Res (Hoboken) ; 71(11): 1488-1494, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31309739

RESUMO

OBJECTIVE: To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. METHODS: Black and white New York state residents, enrolled in a prospective single-institution TKR registry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR (n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts. Multivariable Cox regression was used to assess predictors of TKR revision. Multivariable logistic regression was used to analyze predictors of TKR failure, defined as TKR revision in New York state ≤2 years after surgery, or as Hospital for Special Surgery (HSS) TKR quality of life score "not improved" or "worsened" 2 years after surgery. RESULTS: The mean ± SD age was 68.4 ± 10 years, 64% of patients were female, 8% lived in census tracts with >20% of the population under the poverty line, and 9% were black. Median follow-up time was 5.3 years. A total of 3% of patients (122 of 4,062) required revision a median 454 days (interquartile range 215-829) after surgery. TKR revision risk was higher in blacks than whites, with a hazard ratio of 1.69 (95% confidence interval 1.01-2.81), but in multivariable analysis, only younger age, male sex, and constrained prosthesis were predictors of TKR revision. TKR failure occurred in 200 of 2,832 cases (7%) with 2-year surveys. Risk factors for TKR failure were non-osteoarthritis TKR indication, low surgeon volume, and low HSS Expectations Survey score, but not black race. Community poverty was not associated with TKR revision or failure. CONCLUSION: There was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.

7.
Knee ; 26(5): 1096-1101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262633

RESUMO

BACKGROUND: Benefits of simultaneous bilateral total knee replacement (TKR) include lower costs, decreased hospital stay, and shorter rehabilitation. This study evaluated complications associated with simultaneous versus staged bilateral TKR within 12 months. We hypothesized that after controlling for comorbidities, the simultaneous group would have the highest rate of complications. METHODS: This retrospective study analyzed the Humana subset of the PearlDiver Patient Records Database. CPT 27447 and associated modifiers were used to identify patients who underwent simultaneous or staged bilateral primary TKRs. Staged bilateral TKRs were performed within 12 months and were stratified by the time between procedures. Primary outcomes were the Centers for Medicare & Medicaid Services' publicly reported complications. Risks of complications were compared using multivariate logistic regression controlling for age, gender, and comorbidities. RESULTS: Seven thousand seven hundred forty-seven patients underwent simultaneous or staged bilateral TKRs between January 2007 and April 2015. There were lower odds of transfusion and all-cause 90-day readmission but higher odds of mechanical complications and infection for all staged groups compared to the simultaneous. Patients whose staged surgeries were ≪3 months apart had significantly higher odds of undergoing manipulation under anesthesia (MUA). CONCLUSIONS: Higher rates of blood transfusion and readmission were associated with simultaneous bilateral TKR, while higher rates of mechanical complications and infection were associated with staged bilateral TKR. MUA risk was highest in patients staged ≪3 months apart. While there are inherent risks to simultaneous bilateral TKR, surgeons and patients should also be aware of risks associated with staging the procedures. LEVEL OF EVIDENCE: III.

8.
J Arthroplasty ; 34(9): 1946-1952.e2, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255405

RESUMO

BACKGROUND: We hypothesized that patients undergoing primary total knee arthroplasty (TKA) for rheumatoid arthritis (RA) would have different preoperative expectations compared to osteoarthritis (OA) patients, and that postoperative satisfaction would correlate with specific postoperative pain and functional domains. METHODS: This is a retrospective cohort study of RA patients matched based on age, gender, American Society of Anesthesiologists score, and Charlson Comorbidity Index score 1:2 with OA patients (76 RA, 152 OA) who underwent primary TKA. The Hospital for Special Surgery Knee Replacement Expectations Survey, Visual Analogue Scale for Pain (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short Form-12 (SF-12) were compared at baseline and at 2 years postoperatively. Minimum clinically important differences (MCIDs) were calculated for KOOS and SF-12 subdomains. RESULTS: Preoperatively, RA patients had lower expectations, worse VAS Pain, and worse KOOS Pain, Symptoms, and Activities of Daily Living (P < .05). However, at 2 years, RA patients had significantly larger improvements in VAS (P = .01) and these 3 KOOS subdomains (P < .05), achieving comparable absolute scores to OA patients. Overall, 86.1% of RA and 87.1% of OA patients were either somewhat or very satisfied with their TKA. Patient satisfaction correlated with VAS Pain and KOOS outcome scores in both groups. RA and OA patients had high rates of achieving MCID in SF-12 physical component scores and all 5 KOOS subdomains. A higher proportion of RA patients achieved MCID in KOOS Symptoms (98.4% vs 77.2%, P < .001). CONCLUSION: RA patients had lower baseline expectations compared to OA patients. However, RA patients had greater improvements in KOOS and SF-12 subdomains, and there was no difference in satisfaction compared to OA patients after TKA.

9.
Nat Immunol ; 20(7): 928-942, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31061532

RESUMO

To define the cell populations that drive joint inflammation in rheumatoid arthritis (RA), we applied single-cell RNA sequencing (scRNA-seq), mass cytometry, bulk RNA sequencing (RNA-seq) and flow cytometry to T cells, B cells, monocytes, and fibroblasts from 51 samples of synovial tissue from patients with RA or osteoarthritis (OA). Utilizing an integrated strategy based on canonical correlation analysis of 5,265 scRNA-seq profiles, we identified 18 unique cell populations. Combining mass cytometry and transcriptomics revealed cell states expanded in RA synovia: THY1(CD90)+HLA-DRAhi sublining fibroblasts, IL1B+ pro-inflammatory monocytes, ITGAX+TBX21+ autoimmune-associated B cells and PDCD1+ peripheral helper T (TPH) cells and follicular helper T (TFH) cells. We defined distinct subsets of CD8+ T cells characterized by GZMK+, GZMB+, and GNLY+ phenotypes. We mapped inflammatory mediators to their source cell populations; for example, we attributed IL6 expression to THY1+HLA-DRAhi fibroblasts and IL1B production to pro-inflammatory monocytes. These populations are potentially key mediators of RA pathogenesis.


Assuntos
Artrite Reumatoide/genética , Artrite Reumatoide/metabolismo , Perfilação da Expressão Gênica , Membrana Sinovial/metabolismo , Transcriptoma , Artrite Reumatoide/patologia , Autoimunidade/genética , Biomarcadores , Biologia Computacional/métodos , Estudos Transversais , Citocinas/metabolismo , Fibroblastos/metabolismo , Citometria de Fluxo , Expressão Gênica , Perfilação da Expressão Gênica/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe II/imunologia , Humanos , Leucócitos/imunologia , Leucócitos/metabolismo , Monócitos/imunologia , Monócitos/metabolismo , Transdução de Sinais , Análise de Célula Única/métodos , Membrana Sinovial/patologia , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Fluxo de Trabalho
10.
Sci Transl Med ; 11(491)2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068444

RESUMO

Macrophages tailor their function according to the signals found in tissue microenvironments, assuming a wide spectrum of phenotypes. A detailed understanding of macrophage phenotypes in human tissues is limited. Using single-cell RNA sequencing, we defined distinct macrophage subsets in the joints of patients with the autoimmune disease rheumatoid arthritis (RA), which affects ~1% of the population. The subset we refer to as HBEGF+ inflammatory macrophages is enriched in RA tissues and is shaped by resident fibroblasts and the cytokine tumor necrosis factor (TNF). These macrophages promoted fibroblast invasiveness in an epidermal growth factor receptor-dependent manner, indicating that intercellular cross-talk in this inflamed setting reshapes both cell types and contributes to fibroblast-mediated joint destruction. In an ex vivo synovial tissue assay, most medications used to treat RA patients targeted HBEGF+ inflammatory macrophages; however, in some cases, medication redirected them into a state that is not expected to resolve inflammation. These data highlight how advances in our understanding of chronically inflamed human tissues and the effects of medications therein can be achieved by studies on local macrophage phenotypes and intercellular interactions.

11.
J Arthroplasty ; 34(6): 1150-1154.e2, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30853155

RESUMO

BACKGROUND: Patients with inflammatory arthritis (IA) are likely at higher risk of postoperative complications following total hip arthroplasty (THA), from the underlying disease, the degree of articular deformity, and immunosuppressive medications. The purpose of this study was to perform a comparative study of the risk of complications after THA between IA and osteoarthritis. METHODS: A national private insurance database was used to select patients undergoing unilateral primary THA. Patients were categorized to the inflammatory cohort if they had a diagnosis of IA and treatment with an IA-specific medication within the year before surgery. Patients with no diagnosis of IA were considered osteoarthritis. Risk of Centers for Medicare and Medicaid Services-reportable complications and 90-day readmission was compared between cohorts using multivariate logistic regression controlling for age, gender, length of stay, comorbidities, and corticosteroid use. RESULTS: A total of 68,348 patients were included; 2.12% met criteria for IA. Patients with IA were found to have higher risk of transfusion (odds ratio [OR], 1.29; P < .01), mechanical complications (OR, 1.35; P = .01), infection (OR, 1.96; P < .01), and 90-day readmission (OR, 1.35; P < .01). There were no differences in risk of venous thromboembolism or medical complications. CONCLUSION: Patients with IA have significantly higher risk of transfusion, mechanical complications, infection, and readmission following THA. Efforts should be made to optimize their health and medications before THA to minimize their complication risk. Additionally, hospitals should receive commensurate resources to maintain access to THA for patients with IA who are prone to higher resource utilization. LEVEL OF EVIDENCE: III.

12.
Curr Rheumatol Rep ; 21(5): 20, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30868279

RESUMO

PURPOSE OF REVIEW: Osteoporosis in axial spondyloarthritis may be modified by therapy. The purpose of this systematic review is to describe (i) the effect of TNFi on BMD, (ii) the effect of secukinumab on BMD, and (iii) the effect of secukinumab on radiographic disease progression in axSpA. RECENT FINDINGS: We searched PubMed, Embase, and Cochrane using the following retrieval languages: spondyloarthritis, ankylosing spondylitis, TNF, IL-17, x-rays, and osteoporosis. Twenty-nine studies were included; 27 re: TNFi and BMD, and 2 re: IL-17 blockers and x-ray progression. TNFi over 2-4 years increased BMD of the lumbar spine (3.2-14.9%) and hip (2.26-4.7%) without reducing vertebral fractures. Secukinumab reduced radiographic progression; none (73%) and minimal (79%) at 4 years. No data on IL-17 blockade and bone were found. TNFi therapy improves bone density but not vertebral fracture rates. Secukinumab improves symptoms and may slow radiographic progression. Data is lacking regarding the effects of secukinumab on BMD and fractures. These are important questions which may impact the choice of therapy.

13.
J Arthroplasty ; 34(5): 1032-1036.e2, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30846314

RESUMO

BACKGROUND: Patients with inflammatory arthritis (IA) are at increased risk of prosthetic joint infections (PJI), yet differentiating between septic and aseptic failure is a challenge. The aim of our systematic review is to evaluate synovial biomarkers and their efficacy at diagnosing PJI in patients with IA. METHODS: A comprehensive literature search was performed in the following databases from inception to January 2018: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library. Searches across the databases retrieved 367 results. Two of 5 reviewers independently screened a total of 298 citations. Discrepancies were resolved by a third reviewer. Twenty articles fit our criteria, but due to methodological differences findings could not be pooled for meta-analysis. For 5 studies, raw data were provided, pooled, and used to derive optimal diagnostic cut points. RESULTS: Our final analysis included 1861 non-IA patients, including 426 patients with PJI, and 90 IA patients of whom 26 had PJI. There was a significant difference among the 4 groups for serum C-reactive protein (CRP), erythrocyte sedimentation rate, and synovial CRP, polymorphonuclear neutrophil percent, white blood cells, interleukin (IL)-6, IL-8, and IL-1b. Polymorphonuclear neutrophil percent had the highest sensitivity (95.2%) and specificity (85.0%) to detect infections with an optimum threshold of 78%. CONCLUSION: While levels of synovial white blood cells, IL-6, IL-8, and serum CRP appear higher in patients with IA, there is overlap with those who are not infected. Further studies are needed to explore diagnostic tests that will better detect PJI in patients with IA.


Assuntos
Artrite/diagnóstico , Artroplastia de Substituição/efeitos adversos , Biomarcadores/análise , Infecções Relacionadas à Prótese/diagnóstico , Artrite/sangue , Artrite/etiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Diagnóstico Diferencial , Humanos , Interleucina-6/sangue , Interleucinas/sangue , Contagem de Leucócitos , Neutrófilos , Infecções Relacionadas à Prótese/sangue , Infecções Relacionadas à Prótese/etiologia , Líquido Sinovial/química , Líquido Sinovial/microbiologia
14.
Arthritis Rheumatol ; 71(7): 1034-1041, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30835943

RESUMO

OBJECTIVE: Patients with rheumatoid arthritis (RA) in clinical remission may have subclinical synovial inflammation. This study was undertaken to determine the proportion of patients with RA in remission or with low disease activity at the time of arthroplasty who had histologic or transcriptional evidence of synovitis, and to identify clinical features that distinguished patients as having subclinical synovitis. METHODS: We compared Disease Activity Score in 28 joints (DAS28) to synovial histologic features in 135 patients with RA undergoing arthroplasty. We also compared DAS28 scores to RNA-Seq data in a subset of 35 patients. RESULTS: Fourteen percent of patients met DAS28 criteria for clinical remission (DAS28 <2.6), and another 15% met criteria for low disease activity (DAS28 <3.2). Histologic analysis of synovium revealed synovitis in 27% and 31% of samples from patients in remission and patients with low disease activity, respectively. Patients with low disease activity and synovitis also exhibited increased C-reactive protein (CRP) (P = 0.0006) and increased anti-cyclic citrullinated peptide (anti-CCP) antibody levels (P = 0.03) compared to patients without synovitis. Compared to patients with a "low inflammatory synovium" subtype, 183 genes were differentially expressed in the synovium of patients with subclinical synovitis. The majority of these genes (86%) were also differentially expressed in the synovium of patients with clinically active disease (DAS28 ≥3.2). CONCLUSION: Thirty-one percent of patients with low clinical disease activity exhibited histologic evidence of subclinical synovitis, which was associated with increased CRP and anti-CCP levels. Our findings suggest that synovial gene expression signatures of clinical synovitis are present in patients with subclinical synovitis.


Assuntos
Artrite Reumatoide/patologia , Membrana Sinovial/patologia , Sinovite/patologia , Idoso , Anticorpos Anti-Proteína Citrulinada/imunologia , Artrite Reumatoide/genética , Artrite Reumatoide/imunologia , Artrite Reumatoide/cirurgia , Artroplastia de Quadril , Artroplastia do Joelho , Doenças Assintomáticas , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Análise de Sequência de RNA , Membrana Sinovial/metabolismo , Sinovite/genética
16.
J Arthroplasty ; 34(5): 954-958, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30733073

RESUMO

BACKGROUND: Rheumatoid arthritis patients are at increased risk for periprosthetic joint infection after arthroplasty. The reason is multifactorial. Nasal colonization with Staphylococcus aureus is a modifiable risk factor; carriage rates in RA patients are unknown. The goal of this study is to determine the S aureus nasal carriage rates of RA patients on biologics, RA patients on traditional disease-modifying anti-rheumatic drugs (DMARDs), and osteoarthritis. METHODS: Consecutive patients with RA on biologics (±DMARDs), RA on non-biologic DMARDs, or OA were prospectively enrolled from April 2017 to May 2018. One hundred twenty-three patients were determined necessary per group to show a difference in carriage rates. Patients underwent a nasal swab and answered questions to identify additional risk factors. S aureus positive swabs were further categorized using spa typing. Logistic regression evaluated the association with S aureus colonization between the groups after controlling for known risk factors. RESULTS: RA patients on biologics, 70% of whom were on DMARDs, had statistically significant increase in S aureus colonization (37%) compared to RA on DMARDs alone (24%), or OA (20%) (P = .01 overall). After controlling for glucocorticoids, antibiotic use, recent hospitalization, and diabetes, RA on biologics had a significant increased risk of S aureus nasal colonization (Odds ratio 1.80, 95% confidence interval 1.00-3.22, P = .047). CONCLUSION: S aureus colonization risk was increased for RA on biologics compared to RA not on biologics and OA. Nasal S aureus carriage increases the risk of surgical site infection; this modifiable risk factor should be addressed prior to total joint arthroplasty for this higher risk patient group.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Portador Sadio/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/microbiologia , Terapia Biológica , Portador Sadio/microbiologia , Testes Diagnósticos de Rotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/microbiologia , Osteoartrite/cirurgia , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia
17.
BMC Musculoskelet Disord ; 20(1): 67, 2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30738438

RESUMO

BACKGROUND: Community characteristics such as poverty affect total knee arthroplasty (TKA) outcomes. However, it is unknown whether other community factors such as immigrant proportion (IP) also affect outcomes. Our objective was to determine the association of neighborhood IP on preoperative (pre-op) and 2-year postoperative (post-op) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function after elective TKA. METHODS: Patients in a high volume institutional TKA registry between May 2007 and February 2011 were retrospectively analyzed. Demographics, pre-op and 2-year post-op WOMAC pain and function scores, and geocodable addresses were obtained. Patient-level variables were linked to US Census Bureau census tract data. The effect of patient and neighborhood-level factors on WOMAC scores were analyzed using linear mixed effects models. RESULTS: 3898 TKA patients were analyzed. Pre-op and 2-year post-op WOMAC pain and function scores were between 2.75-4.88 WOMAC points worse in neighborhoods with a high IP (≥ 40%) compared to low IP (< 10%). In multivariable analyses, these differences were not statistically significant. Women had worse pre-op and 2-year post-op WOMAC scores (all p ≤ 0.04), but this difference was not influenced by neighborhood IP (all pinteraction NS). CONCLUSIONS: Patients living in high (≥40%) IP neighborhoods do not have worse pre-op or 2-year post-op pain and function outcomes after TKA compared to those living in low (< 10%) IP neighborhoods. Although sex differences favoring males are notable, these differences are not associated with IP. High neighborhood IP do not appear to affect outcomes after TKA.


Assuntos
Artroplastia do Joelho , Emigrantes e Imigrantes , Hospitais com Alto Volume de Atendimentos , Articulação do Joelho/cirurgia , Características de Residência , Idoso , Artroplastia do Joelho/efeitos adversos , Fenômenos Biomecânicos , Avaliação da Deficiência , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Determinantes Sociais da Saúde , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
J Rheumatol ; 46(9): 1179-1182, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30647165

RESUMO

OBJECTIVE: To understand the effects of glucocorticoids (GC), which are of importance to patients. METHODS: The results of 2 literature reviews, a patient survey, and a qualitative study were presented. RESULTS: No validated instrument exists to evaluate GC effect on patients. Survey data revealed skin thinning/bruising, sleep disturbance, and weight gain as the most frequent adverse effects. The qualitative research yielded rich data covering rapid benefits and physical and emotional consequences of GC. CONCLUSION: It was agreed that a patient-reported outcome to measure GC effect was required and a research agenda was developed for this goal.

19.
J Rheumatol ; 46(8): 1053-1058, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30647191

RESUMO

OBJECTIVE: Outcome Measures in Rheumatology (OMERACT) convened a premeeting in 2018 to bring together patients, regulators, researchers, clinicians, and consumers to build upon previous OMERACT drug safety work, with patients fully engaged throughout all phases. METHODS: Day 1 included a brief introduction to the history of OMERACT and methodology, and an overview of current efforts within and outside OMERACT to identify patient-reported medication safety concerns. On Day 2, two working groups presented results; after each, breakout groups were assembled to discuss findings. RESULTS: Five themes pertaining to drug safety measurement emerged. CONCLUSION: Current approaches have failed to include data from the patient's perspective. A better understanding of how individuals with rheumatic diseases view potential benefits and harms of therapies is essential.

20.
J Arthroplasty ; 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31952945

RESUMO

BACKGROUND: Total hip replacement (THR)/total knee replacement (TKR) studies do not uniformly measure patient centered domains, pain, and function. We aim to validate existing measures of pain and function within subscales of standard instruments to facilitate measurement. METHODS: We evaluated baseline and 2-year pain and function for THR and TKR using Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), with primary unilateral TKR (4796) and THR (4801). Construct validity was assessed by correlating HOOS/KOOS pain and activities of daily living (ADL), function quality of life (QOL), and satisfaction using Spearman correlation coefficients. Patient relevant thresholds for change in pain and function were anchored to improvement in QOL; minimally clinically important difference (MCID) corresponded to "a little improvement" and a really important difference (RID) to a "moderate improvement." Pain and ADL function scores were compared by quartiles using Kruskal-Wallis. RESULTS: Two-year HOOS/KOOS pain and ADL function correlated with health-related QOL (KOOS pain and Short Form 12 Physical Component Scale ρ = 0.54; function ρ = 0.63). Comparing QOL by pain and function quartiles, the highest levels of pain relief and function were associated with the most improved QOL. MCID for pain was estimated at ≥20, and the RID ≥29; MCID for function ≥14, and the RID ≥23. The measures were responsive to change with large effect sizes (≥1.8). CONCLUSION: We confirm that HOOS/KOOS pain and ADL function subscales are valid measures of critical patient centered domains after THR/TKR, and achievable thresholds anchored to improved QOL. Cost-free availability and brevity makes them feasible, to be used in a core measurement set in total joint replacement trials.

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