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1.
J Clin Rheumatol ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32049897

RESUMO

OBJECTIVE: To assess whether insurance payer, comorbidity, and income are associated with total elbow arthroplasty (TEA) outcomes. METHODS: We used the 1998-2014 US National Inpatient Sample. Multivariable logistic regression adjusted for demographics and underlying diagnosis to estimate odds ratio (OR) and 95% confidence intervals (CI) of insurance payer, comorbidity, and income with TEA outcomes. RESULTS: The mean age was 60 (SE, 0.29) years, 68% were female, and 62% were white among the 7992 TEA procedures. Compared with private insurance, Medicaid was associated with significantly higher ORs (95% CI) of (1) hospital charges above the median, 1.25 (95% CI, 1.01-1.53); (2) discharge to a rehabilitation facility, 1.64 (95% CI, 1.16-2.31); (3) hospital stay >2 days, 1.63 (95% CI, 1.32-2.00); (4) fracture, 1.71 (95% CI, 1.14-2.56). Medicare payer was associated with higher ORs (95% CI) of (1) discharge to a rehabilitation facility, 1.80 (95% CI, 1.42-2.28); and (2) hospital stay >2 days, 1.29 (95% CI, 1.12-1.50). Compared with Deyo-Charlson score of zero, odds of health care utilization outcomes were higher by 14% to 20% for score of 1 and by 62% to 146% for score of 2 or higher, and by 36% to 257% for transfusion. The lowest income quartile had significantly higher OR of 1.51 (95% CI, 1.31-1.73) of hospital charges above the median versus the highest quartile. CONCLUSIONS: Payer type, comorbidity, and income were associated with higher health care utilization and complications post-TEA. Further investigation into potentially modifiable mediators is needed.

2.
Ann Rheum Dis ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024648

RESUMO

OBJECTIVE: To assess the risk of hypersensitivity reactions (HSRs) with allopurinol and febuxostat in a population-based study. METHODS: We used the 5% Medicare beneficiary sample (≥65 years) from 2006 to 2012 to identify people with a newly filled prescription for allopurinol, febuxostat or colchicine. We used multivariable-adjusted Cox regression analyses to compare the hazard ratio (HR) of incident HSRs with allopurinol or febuxostat use versus colchicine use; separate analyses were done in people exposed to allopurinol. Propensity-matched analyses (5:1) compared hazards with allopurinol versus febuxostat. RESULTS: Crude incidence rates of HSRs were as follows: allopurinol, 23.7; febuxostat, 30.7; and colchicine, 25.6 per 1000 person-years. Compared with colchicine, allopurinol, febuxostat and febuxostat+colchicine were associated with significantly higher HRs of HSRs, 1.32 (95% CI: 1.10 to 1.60) and 1.54 (95% CI: 1.12 to 2.12) and 2.17 (95% CI: 1.18 to 3.99), respectively. In propensity-matched analyses, febuxostat did not significantly differ from allopurinol; HR for HSRs was 1.25 (95% CI: 0.93 to 1.67). Compared with allopurinol start dose <200 mg/day, allopurinol start dose ≥300 mg/day, diabetes and female sex were associated with significantly higher hazard of HSRs, 1.27 (95% CI: 1.12 to 1.44), 1.21 (95% CI: 1.00 to 1.45) and 1.32 (95% CI: 1.17 to 1.48), respectively. The majority (69%) of HSRs occurred in the outpatient setting. CONCLUSIONS: Compared with colchicine, allopurinol and febuxostat similarly increased the risk of HSRs. Allopurinol and febuxostat did not differ from each other. In allopurinol users, starting dose, female sex and diabetes increased this risk, findings that need further study.

3.
Clin Rheumatol ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897955

RESUMO

To assess whether polymyositis is associated with more complications and higher healthcare utilization after total knee or hip arthroplasty (TKA/THA). Using the 1998-2014 U.S. National Inpatient Sample data, we performed multivariable-adjusted logistic regression analyses to assess the association of polymyositis with in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), controlling for important covariates and confounders. Sensitivity analyses additionally adjusted the main models for hospital location/teaching status, bed size, and region. Of the 4,116,485 THAs and 8,127,282 TKAs, 853 people with polymyositis had THAs (0.02%) and 1038 had TKAs (0.01%). In multivariable-adjusted analyses, compared to people without polymyositis, people with polymyositis had similar odds of hospital charges above the median, hospital stay > 3 days, and discharge to non-home setting post-TKA and post-THA. Polymyositis was associated with significantly lower odds ratio (OR; 95% confidence interval [CI]) of revision and mortality post-THA, 0.44 (0.36, 0.55) and 0.63 (0.48, 0.84), but not post-TKA, 2.98 (0.47, 18.95) and 4.40 (0.61, 31.64), respectively. Findings from the main analyses were confirmed in the sensitivity analyses. People with polymyositis had no increase in healthcare utilization post-TKA/THA. A lower revision rate and mortality post-THA in people with polymyositis need further confirmation. Study findings should reassure the key stakeholders about the benefits of TKA/THA, including people with polymyositis.

4.
Clin Rheumatol ; 39(1): 85-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31444650

RESUMO

OBJECTIVE: To assess whether systemic sclerosis (SSc) is associated with total knee arthroplasty (TKA) outcomes. METHODS: We used the 1998-2014 US National Inpatient Sample. We conducted multivariable-adjusted logistic regression analyses to examine the association of a diagnosis of SSc with post-TKA in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, hospital stay, non-home vs. home discharge). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. RESULTS: Our cohort included 8,123,388 people without SSc and 3894 people with SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher odds of transfusion, hospital stay > 3 days and non-home discharge with higher OR of 1.42 (95 % CI, 1.20, 1.69), 1.29 (95 % CI, 1.11, 1.49), and 1.29 (95 % CI, 1.11, 1.49), respectively. No differences were seen in revision, 0.68 (95 % CI, 0.10, 4.69) or hospital charges above the median, 1.01 (95 % CI, 0.70, 1.46). Differences in implant infection or mortality were not estimable, since none of the patients with SSc had implant infection or died. Sensitivity analyses that adjusted the main analysis additionally for hospital-level variables confirmed study findings with minimal or no attenuation of OR. CONCLUSION: SSc was associated with higher risk of transfusion and increased healthcare utilization after TKA. Future studies should examine if interventions can address modifiable factors to further optimize these outcomes.Key Points• Systemic sclerosis was independently associated with higher healthcare utilization after TKA.• The adjusted odds of transfusion was higher in people with systemic sclerosis compared to those without systemic sclerosis who underwent TKA.

5.
Hypertension ; 75(1): 246-256, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786980

RESUMO

Previous studies do not widely support hyperuricemia as a risk factor for stroke and other cardiovascular diseases. We assessed the relationship between hyperuricemia and ischemic stroke (≈900 cases) using a large data set from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). We employed a case-cohort design (incident stroke cases and randomly selected cohort participants) and weighted Cox-proportional hazard models to estimate the association of serum urate level ≥6.8 mg/dL (ie, hyperuricemia) and 6.0 to <6.8 mg/dL versus <6.0 mg/dL (reference) with incident stroke. Analyses were stratified by race, gender, and age. Mediation of cardiovascular disease comorbidities on the serum urate-stroke association was tested. Hyperuricemia was associated with stroke (hazard ratio, 1.40 [95% CI, 1.10-1.78]) after adjustment for demographic variables and systolic and diastolic blood pressure. This association was substantially attenuated (hazard ratio, 1.17 [95% CI, 0.90-1.51]) by additional covariate adjustment. In particular, apparent treatment-resistant hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg on 3 antihypertensive medications or use of ≥4 antihypertensive medications) and the count of antihypertensive medication classes significantly reduced the effect of hyperuricemia on ischemic stroke. Specifically, apparent treatment-resistant hypertension and number of antihypertensive, respectively, mediate 45% and 43% of the association. There was no effect modification in the association between hyperuricemia and stroke by age, race, or gender. We conclude that hyperuricemia may be a risk factor for stroke. The substantial attenuation of this association by apparent treatment-resistant hypertension and number of antihypertensive suggests that severe hypertension may be a mediator.

6.
Joint Bone Spine ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31811933

RESUMO

OBJECTIVES: To examine if health insurance payer type and income are associated with higher healthcare utilization after primary total knee arthroplasty (TKA). METHODS: We used multivariable-adjusted logistic regression to examine the association of the insurance payer type (Medicare, Medicaid, private insurance, self-pay or other), and annual household income (based on zip code; quartiles) with healthcare utilization for index TKA hospitalization, using the 1998-2014 U.S. National Inpatient Sample data. We adjusted for demographics, underlying diagnosis, comorbidity, and hospital characteristics. RESULTS: The U.S. national cohort consisted of 8,127,282 primary TKA procedures performed between 2002-2014 in the U.S. In multivariable-adjusted analyses, compared to private insurance, Medicaid and other insurance payer status were each associated with significantly higher odds ratio (OR) of hospital charges above the median of 1.11 and 1.07; Medicare, Medicaid, self-pay and other insurance with significantly higher OR of hospital stay>3 days with OR of 1.22, 1.68, 1.43, and 1.32; and Medicare, Medicaid, and other insurance with significantly higher OR of discharge to a rehabilitation facility, with OR of 1.77, 1.40, and 1.14, respectively. Compared to the highest income quartile, patients in the lowest income quartile had a significantly higher OR of 1.34 of hospital charges above the median; income quartiles 1-3 with significantly lower ORs of length of hospital stay>3 days, 0.87, 0.97, and 0.94, and discharge to a rehabilitation facility at 0.73, 0.77, and 0.83, respectively. CONCLUSIONS: Future studies should examine modifiable mediators of differences in healthcare utilization by insurance payer, and income to target them to reduce utilization.

7.
J Rheumatol ; 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839595

RESUMO

OBJECTIVE: Non-adherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. METHODS: We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with pre-specified extraction and analysis protocols. RESULTS: Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains) and adherence-related factors (e.g. medication knowledge) (32 domains). We subdivided adherence into three phases: initiation (n=13 studies, 25%); implementation (n=32, 60%); persistence (n=27, 51%); phase unclear (n=20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were: medication adverse events (n=24, 45%); disease activity (n=11, 21%); bone turnover markers/physical function/quality of life (each n=10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were: medication beliefs (n=8, 15%); illness perception/medication satisfaction/satisfaction with medication information (each n=5, 9%); condition knowledge/medication knowledge/trust in doctor (each n=3, 6%). CONCLUSION: The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.

8.
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.

10.
JAMA Netw Open ; 2(11): e1915105, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31722026

RESUMO

Importance: Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. Objectives: To examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA. Design, Setting, and Participants: This prospective cohort study combined data from a national US TKA cohort with ancillary pain severity data at 2 weeks and 8 weeks after the index TKA using a numeric rating scale. All participants received primary, unilateral TKA within the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) national network of community sites in 22 states or at the lead site (University of Massachusetts Medical School). Participants had a date of surgery between May 1, 2013, and December 1, 2014. The data analysis was performed between January 13, 2015, and July 5, 2016. Exposures: Pain trajectories in the postoperative period (8 weeks). Main Outcomes and Measures: Index knee pain at 6 months after TKA using the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale. Group-based trajectory methods examined the presence of pain trajectories in the postoperative period (8 weeks) and assessed whether trajectories were independently associated with longer-term pain (6 months). Results: The cohort included 659 patients who underwent primary TKA with complete data at 4 points (preoperative, 2 weeks, 8 weeks, and 26 weeks). Their mean (SD) age was 67.1 (8.0) years, 64.5% (425 of 659) were female, the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 30.77 (5.66), 94.5% (613 of 649) were white, and the mean (SD) preoperative 36-Item Short Form Health Survey physical component summary and mental component summary scores were 34.1 (8.2) and 53.8 (11.4), respectively. Two pain trajectory subgroups were identified at 8 weeks after TKA: patients who experienced fast pain relief in the first 8 weeks after TKA (fast pain responders, composing 72.4% [477 of 659] of the sample) and patients who did not (slow pain responders, composing 27.6% [182 of 659] of the sample). After adjusting for patient factors, the pain trajectory at 8 weeks after TKA was independently associated with the mean KOOS pain score at 6 months, with a between-trajectory difference of -11.3 (95% CI, -13.9 to -8.7). Conclusions and Relevance: The trajectory among slow pain responders at 8 weeks after surgery was independently associated with improved but greater persistent index knee pain at 6 months after TKA compared with that among fast pain responders. Early identification of patients with a trajectory of slow pain response at 8 weeks after TKA may offer an opportunity for interventions in the perioperative period to potentially improve the long-term pain outcomes after TKA.

11.
Clin Rheumatol ; 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31741131

RESUMO

OBJECTIVE: To assess whether age, race/ethnicity, comorbidity, and insurance payer status are associated with outcomes after total ankle arthroplasty (TAA). METHODS: Using the US National Inpatient Sample (NIS) data and multivariable-adjusted logistic regression, we assessed the association of age, race/ethnicity, comorbidity ,and insurance payer status, with healthcare utilization and in-hospital complications (infection, transfusion, and revision surgery) after TAA. We calculated odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The cohort consisted of 6280 TAAs with a mean age of 62 years; 52% were female, 70% White, and 62% had osteoarthritis as the underlying diagnosis. Compared to age < 50 years, older age categories had higher ORs of total hospital charges above the median, length of hospital stay above the median (>2 days) and discharge to a rehabilitation facility, 1.26-19.41, and a lower OR of in-hospital infection, 0.07-0.09. Compared to Whites, Blacks had higher OR (95% CI) of: discharge to a rehabilitation facility, 1.45 (1.06, 1.98); length of hospital stay >2 days, 2.21 (1.37, 3.57); in-hospital transfusion, 4.39 (1.87, 10.30); and in-hospital revision, 8.25 (1.06, 64.21); and Hispanics were more likely to have total hospital charges above the median, OR 1.49 (1.10, 2.02), and infection, 9.30 (1.27, 68.05). Higher comorbidity and Medicare payer status were each associated with higher ORs of healthcare utilization, ORs ranging 1.20-2.57 and 1.74-2.19, respectively. CONCLUSIONS: Age, race/ethnicity, comorbidity, and insurance payer status were independently associated with post-TAA outcomes. Further insight into modifiable mediators of these associations can pave the way for improving these outcomes in the future.Key Points• Older age was associated with higher healthcare utilization post-ankle arthroplasty.• Compared to Whites, Blacks or Hispanics had higher healthcare utilization and in-hospital complications post-ankle arthroplasty.• Higher comorbidity and Medicare payer status were each associated with higher healthcare utilization post-ankle arthroplasty.

12.
J Rheumatol ; 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615909

RESUMO

OBJECTIVE: To assess whether outcomes after primary total hip arthroplasty (THA) differ in Systemic Sclerosis (SSc). METHODS: We used the 1998-2014 U.S. National Inpatient Sample. THA and SSc were identified using procedure and diagnostic codes, respectively. Multivariable-adjusted logistic regression analyses assessed the association of SSc with in-hospital complications (implant infection, revision, transfusion, mortality) post-THA and associated healthcare utilization (hospital charges, hospital stay, discharge to non-home setting), adjusting for age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis for THA, household income, and insurance payer.. RESULTS: Of the 4,116,485 primary THAs performed in the U.S. 1998-2014, 2,672 (0.06%) had SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher adjusted odds ratios [OR] (95% confidence interval [CI]) of the following post-primary THA: (1) non-home discharge, 1.25 (95% CI, 1.03, 1.50); (2) hospital stay >3 days, 1.61 (95% CI, 1.35, 1.92); (3) transfusion, 1.54 (95% CI, 1.28, 1.84); and (4) revision, 9.53 (95% CI, 6.75, 13.46). Differences in mortality had a nonsignificant trend, 2.19 (95% CI, 0.99, 4.86). There were no differences in total hospital charges or implant infection rates. CONCLUSION: SSc was associated with higher rate of in-hospital complications and healthcare utilization post-primary THA. Future studies should examine whether pre- or post-operative interventions can reduce the risk of post-THA complications in people with SSc.

13.
JAMA Netw Open ; 2(10): e1914259, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31664446

RESUMO

Importance: Total knee arthroplasty (TKA) is one of the most common elective procedures performed in adults with end-stage arthritis. Racial disparities in TKA outcomes have been described in the literature. Objectives: To assess the association of race/ethnicity with discharge disposition and hospital readmission after elective primary TKA and to assess the association of nonhome discharge disposition with hospital readmission risk. Design, Setting, and Participants: This retrospective cohort study used data from the Pennsylvania Health Care Cost Containment Council Database, a large regional database that included demographic data from all discharges of patients who underwent elective primary TKA in 170 nongovernmental acute care hospitals in Pennsylvania from April 1, 2012, to September 30, 2015. Data analyses were conducted from September 29, 2017, to November 29, 2017. Exposures: Patient race/ethnicity and discharge disposition. Main Outcomes and Measures: Discharge disposition and 90-day hospital readmission. Results: Among 107 768 patients, 7287 (6.8%) were African American, 68 372 (63.4%) were women, 46 420 (43.1%) were younger than 65 years, and 60 636 (56.3%) were insured by Medicare. In multivariable logistic regression, among patients younger than 65 years, African American patients were more likely than white patients to be discharged to inpatient rehabilitation facility (IRF) (adjusted relative risk ratio [aRRR], 2.49 [95% CI, 1.42-4.36]; P = .001) or a skilled nursing facility (SNF) (aRRR, 3.91 [95% CI, 2.17-7.06]; P < .001) and had higher odds of 90-day hospital readmission (adjusted odds ratio [aOR], 1.30 [95% CI, 1.02-1.67]; P = .04). Compared with white patients 65 years or older, African American patients 65 years or older were more likely to be discharged to SNF (aRRR, 3.30 [95% CI, 1.81-6.02]; P < .001). In both age groups, discharge to an IRF (age <65 years: aOR, 3.62 [95% CI, 2.33-5.64]; P < .001; age ≥65 years: aOR, 2.85 [95% CI, 2.25-3.61]; P < .001) or SNF (age <65 years: aOR, 1.91 [95% CI, 1.37-2.65]; P < .001; age ≥65 years: aOR, 1.55 [95% CI, 1.27-1.89]; P < .001) was associated with higher odds of 90-day readmission. Conclusions and Relevance: This cohort study found that race/ethnicity was associated with higher odds of discharge to an IRF or SNF for postoperative care after primary TKA. Among patients younger than 65 years, African American patients were more likely than white patients to be readmitted to the hospital within 90 days. Discharge to an IRF or SNF for postoperative care and rehabilitation was also associated with a higher risk of readmission to an acute care hospital.

14.
Cochrane Database Syst Rev ; 9: CD004849, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31553478

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, autoimmune disease that results in joint deformity and immobility of the musculoskeletal system. The major goals of treatment are to relieve pain, reduce inflammation, slow down or stop joint damage, prevent disability, and preserve or improve the person's sense of well-being and ability to function. Tai Chi, interchangeably known as Tai Chi Chuan, is an ancient Chinese health-promoting martial art form that has been recognized in China as an effective arthritis therapy for centuries. This is an update of a review published in 2004. OBJECTIVES: To assess the benefits and harms of Tai Chi as a treatment for people with rheumatoid arthritis (RA). SEARCH METHODS: We updated the search of CENTRAL, MEDLINE, Embase, and clinical trial registries from 2002 to September 2018. SELECTION CRITERIA: We selected randomized controlled trials and controlled clinical trials examining the benefits (ACR improvement criteria or pain, disease progression, function, and radiographic progression), and harms (adverse events and withdrawals) of exercise programs with Tai Chi instruction or incorporating principles of Tai Chi philosophy. We included studies of any duration that included control groups who received either no therapy or alternate therapy. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Adding three studies (156 additional participants) to the original review, this update contains a total of seven trials with 345 participants. Participants were mostly women with RA, ranging in age from 16 to 80 years, who were treated in outpatient settings in China, South Korea, and the USA. The majority of the trials were at high risk of bias for performance and detection bias, due to the lack of blinding of participants or assessors. Almost 75% of the studies did not report random sequence generation, and we judged the risk of bias as unclear for allocation concealment in the majority of studies. The duration of the Tai Chi programs ranged from 8 to 12 weeks.It is uncertain whether Tai Chi-based exercise programs provide a clinically important improvement in pain among Tai Chi participants compared to no therapy or alternate therapy. The change in mean pain in control groups, measured on visual analog scale (VAS 0 to 10 score, reduced score means less pain) ranged from a decrease of 0.51 to an increase of 1.6 at 12 weeks; in the Tai Chi groups, pain was reduced by a mean difference (MD) of -2.15 (95% confidence interval (CI) -3.19 to -1.11); 22% absolute improvement (95% CI, 11% to 32% improvement); 2 studies, 81 participants; very low-quality evidence, downgraded for imprecision, blinding and attrition bias.There was very low-quality evidence, downgraded for, blinding, and attrition, that was inconclusive for an important difference in disease activity, measured using Disease Activity Scale (DAS-28-ESR) scores (0 to 10 scale, lower score means less disease activity), with no change in the control group and 0.40 reduction (95% CI -1.10 to 0.30) with Tai Chi; 4% absolute improvement (95% CI 11% improvement to 3% worsening); 1 study, 43 participants.For the assessment of function, the change in mean Health Assessment Questionnaire (HAQ; 0 to 3 scale, lower score means better function) ranged from 0 to 0.1 in the control group, and reduced by MD 0.33 in the Tai Chi group (95% CI -0.79 to 0.12); 11% absolute improvement (95% CI 26% improvement to 4% worsening); 2 studies, 63 participants; very low-quality evidence, downgraded for imprecision, blinding, and attrition. We are unsure of an important improvement, as the results were inconclusive.Participants in Tai Chi programs were less likely than those in a control group to withdraw from studies at 8 to 12 weeks (19/180 in intervention groups versus 49/165 in control groups; risk ratio (RR) 0.40 (95% CI 0.19 to 0.86); absolute difference 17% fewer (95% CI 30% fewer to 3% fewer); 7 studies, 289 participants; low-quality evidence, downgraded for imprecision and blinding.There were no data available for radiographic progression. Short-term adverse events were not reported by group, but in two studies there was some narrative description of joint and muscle soreness and cramps; long-term adverse events were not reported. AUTHORS' CONCLUSIONS: It is uncertain whether Tai Chi has any effect on clinical outcomes (joint pain, activity limitation, function) in RA, and important effects cannot be confirmed or excluded, since all outcomes had very low-quality evidence. Withdrawals from study were greater in the control groups than the Tai Chi groups, based on low-quality evidence. Although the incidence of adverse events is likely to be low with Tai Chi, we are uncertain, as studies failed to explicitly report such events. Few minor adverse events (joint and muscle soreness and cramps) were described qualitatively in the narrative of two of the studies. This updated review provides minimal change in the conclusions from the previous review, i.e. a pain outcome.


Assuntos
Artrite Reumatoide/terapia , Tai Ji , Artralgia , Técnicas de Exercício e de Movimento , Humanos , Manejo da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Ann Rheum Dis ; 78(11): 1592-1600, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31501138

RESUMO

OBJECTIVE: There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS: A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS: The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION: Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.

16.
Nat Rev Rheumatol ; 15(10): 578-580, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31406335
17.
J Rheumatol ; 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416925

RESUMO

OBJECTIVE: To assess factors associated with the ability to achieve and maintain target serum urate (SU) with allopurinol in patients with gout. METHODS: We used National VA national databases from 2002-2012. Eligible patients had ≥1 inpatient or ≥2 outpatient visits with a diagnostic code for gout, filled a new index allopurinol prescription, had at least one post-treatment SU measured, and met 12-month observability rule. Treatment successes were defined as the achievement of post-index SU <6 mg/dl (success 1) and post-index SU <6 mg/dl that was sustained (success 2). RESULTS: Of the 198,839 unique patients with allopurinol use, 41,153 unique patients (with 47,072 episodes) and 17,402 unique patients (with 18,323 episodes) were eligible for analyses for success 1 and success 2; 42% each achieved (success 1) or achieved and maintained post-index SU <6 mg/dl (success 2). In multivariable-adjusted models, factors associated with significantly higher odds of both outcomes were: older age, normal BMI, Deyo-Charlson index score of 0, rheumatologist as the main provider rather than non-rheumatologist, Midwest U.S. location for the healthcare facility, a lower hospital bed size, military service-connection for medical conditions of 50% or more (a measure of healthcare access priority), longer distance to the nearest VA facility, and lower pre-index SU. CONCLUSION: We identified novel factors associated with maintaining SU <6 mg/dl based on a theoretical model. Several potentially modifiable factors can be targeted by individual/provider/systems interventions for improving successful achievement and maintenance of target SU in patients with gout.

19.
Clin Rheumatol ; 38(9): 2651-2653, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31359295

RESUMO

The above article originally published with an error present in Table 1. The data "Home" on the first column of the Table 1 should be interchange with the previous data "Inpatient facility†". This is presented correctly in this article.

20.
Ther Adv Musculoskelet Dis ; 11: 1759720X19847018, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205513

RESUMO

Despite the availability of effective urate-lowering therapy (ULT) and anti-inflammatory drugs for the treatment of gout, there is considerable interest in novel treatment approaches. Patients with gout often have a multitude of comorbidities, leading to concern over drug-drug interactions and medication adverse events. The cherry is a small nutrient-rich fruit that has garnered a great deal of attention in recent years as a nonpharmacologic option for the treatment of a multitude of disease manifestations. Perhaps a quarter of patients with gout try cherries or cherry products to treat their gout, which have antioxidant and anti-inflammatory (IL-6, TNF-α, IL-1ß, IL-8, COX-I and -II) properties, hypouricemic effects, and the ability to downregulate NFkB-mediated osteoclastogenesis. Based on these properties, cherries may reduce both the acute and chronic inflammation associated with recurrent gout flares and its chronic destructive arthropathy. In this review, we explore the potential benefits of cherries and cherry products as a nonpharmacologic option for the treatment of gout.

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