Combating Rheumatologist Burnout: Use of Protocol Driven Medication Refill by Pharmacists
Eva Rottmann, Jonida Cote, Swana Thomas et. al.

Nov 9th, 2020 - Background/Purpose: Increased electronic health record (EHR) administrative workload is a great source of physician dissatisfaction. We embedded pharmacists into our Rheumatology team in 2019. This study explored the impact of pharmacist integration on reducing physician workload and burnout. Methods: The monthly volume of medication refills by rheumatologists was measured as a baseline from 1/...

Development of a Deep Learning Algorithm to Predict Positive MRI of the Sacroiliac Joints According to the ASAS Definition in Patients with Recent Axial Spondyloarthritis
Théodore Aouad, Clementina Lopez-Medina, Anna Molto et. al.

Nov 9th, 2020 - Background/Purpose: The magnetic resonance imaging (MRI) of the sacroiliac joints (MRI-SIJ) represents an essential tool in the evaluation of patients with spondyloarthritis (SpA). However, despite a clear definition of positive and negative MRI-SIJ formulated by the ASAS/OMERACT working group, the inter-reader agreement between readers is never perfect. Moreover, in daily practice, the radiolo...

Development of Candidate Criteria for Axial Disease in Juvenile Spondyloarthritis: An International Collaboration
Pamela F. Weiss, Timothy G. Brandon, Amita Aggarwal et. al.

Nov 9th, 2020 - Background/Purpose: The lack of pediatric classification criteria for axial disease is a major impediment to the conduct of clinical trials for juvenile spondyloarthritis (SpA). Classification criteria for axial disease in children with SpA are being developed. The objective of this study was to identify and grade a set of items that maximizes the likelihood of accurate classification of childr...

Distinct T Cell Responses in Inflammatory Arthritis Associated with Combined CTLA-4 and PD-1 Inhibitor Therapy
Sang Kim, Jean Tayar, Maria Suarez-Almazor et. al.

Nov 9th, 2020 - Background/Purpose: Despite of unprecedented clinical success in cancer therapeutics, immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs), including arthritis (arthritis-irAE). Arthritis-irAE can not only cause bone erosions but also warrant early termination of ICI treatment. Further, treatment for the arthritis-irAE can mitigate anti-tumor immunity re...

Disease Modifying Anti-rheumatic Drug and Biologic Therapy in Pregnancy: A Single-center Mixed Methods Study
Lauren Glick, Justin Shamis, Taneisha McGhie3 and Dharini Mahendira et. al.

Nov 9th, 2020 - Background/Purpose: Rheumatic diseases including rheumatoid arthritis, seronegative inflammatory arthritis and systemic lupus erythematosus can be associated with significant morbidity in women of child-bearing age. Both these diseases themselves and their treatments have been shown to impact fetal and maternal outcomes.  Although there is growing evidence outlining safety of many anti-rheumati...

Development and Delivery of Continuing Education Interventions Promoting Shared Decision Making in Rheumatoid Arthritis
Richard Martin, Marianna Shershneva2 and Lily Zurkovsky, Michigan State University College of Human Medicine et. al.

Nov 9th, 2020 - Background/Purpose: A core CMS policy goal is to improve patient experience by encouraging patient-centered care and shared decision making (SDM).  However, SDM techniques are underutilized in rheumatology practice1.  We created two continuing medical education (CME) activities that present ACR guidelines, treat-to-target (T2T) concepts, and SDM as vehicles to increase the equity of the provisi...

Development and Validity Evidence for a Tool to Assess the Performance of Shoulder Injections
Andrea Ramirez-Gomez, Amber Deptola, Colin Diffie et. al.

Nov 9th, 2020 - Background/Purpose: Shoulder pain is common.  Subacromial bursa and intra-articular glucocorticoid injections can provide pain relief while avoiding the risks associated with systemic therapies.  The American Board of Internal Medicine recommends internists achieve competence in arthrocenteses, but medicine residents at our institution report little practice doing them.  Furthermore, validated ...

Definitions and Reliability Assessment of Chronic Ultrasound Lesions of the Axillary Artery in Giant Cell Arteritis: A Study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group
Valentin Schaefer, Stavros Chrysidis, Greta Carrara et. al.

Nov 9th, 2020 - Background/Purpose: The OMERACT Ultrasound (US) large vessel vasculitis task force has recently defined the US appearance of normal axillary arteries (AA) and the key elementary US lesions in acute giant cell arteritis (GCA) of the AA (i.e.:“non-compressible halo sign”). The aim of the present study was to assess the reliability of a new OMERACT definition for the US appearance of chronic GCA l...

Documentation of Pregnancy Counseling in SSA-Positive Patients of Childbearing Potential: A Cross-Sectional Study
Heinrich-Karl Greenblatt1 and Elena Weinstein, University of Colorado School of Medicine, Aurora et. al.

Nov 9th, 2020 - Background/Purpose: Systemic lupus erythematosus (SLE) and primary Sjogren’s Syndrome (SS) are highly associated with anti-SSA (anti-Ro) seropositivity. Anti-SSA autoantibodies may cross the placenta, causing a range of cutaneous and cardiac manifestations in the neonate. Approximately 2% of SSA-positive pregnancies result in complete congenital heart block, which is often fatal. Echocardiograp...

Effects of Abatacept and Tumor Necrosis Factor Inhibitor on the Normal Glycosylated Hemoglobin Level in Patients with Rheumatoid Arthritis
Yusuke Miwa1 and Yuko Mitamura, Division of Rheumatology, Department of Medicine et. al.

Nov 9th, 2020 - Background/Purpose: Rheumatoid arthritis (RA) and diabetes mellitus (DM) are associated with inflammation. Abatacept has been reported to be effective for type 1 diabetes. We aimed to investigate the influence of tumor necrosis factor inhibitors (TNFi) and abatacept (ABT) on the glucose metabolism of patients with RA. Methods: Patients with RA treated with TNFi or ABT from 2008 to 2018 were stu...

Efficacy and Safety of Upadacitinib versus Placebo and Adalimumab in Patients with Active Psoriatic Arthritis and Inadequate Response to Non-Biologic Disease-Modifying Anti-Rheumatic Drugs: A Doubl...
Iain McInnes, Jaclyn K Anderson, Marina Magrey et. al.

Nov 9th, 2020 - Background/Purpose: Upadacitinib (UPA), an oral, reversible, JAK inhibitor approved to treat rheumatoid arthritis (RA), is under evaluation for psoriatic arthritis (PsA). We assess efficacy and safety of UPA vs placebo (PBO) and adalimumab (ADA) in patients (pts) with PsA and prior IR or intolerance to ≥1 non-biologic DMARD (non-bDMARD). Methods: Pts with active PsA (≥3 swollen and ≥3 tender jo...

Effect of Knee Aspiration and Intra-articular Corticosteroid Injection on Gait Biomechanics and Strength Impairment in Patients with Signs of Inflammation Due to Knee Osteoarthritis
Ryan Pinto, Trevor Birmingham, Holly Philpott et. al.

Nov 9th, 2020 - Background/Purpose: Synovial inflammation in knees with OA can be measured with musculoskeletal ultrasound (MSK US), is associated with increased pain and disease progression, and may adversely affect joint biomechanics. Knee effusion has been associated with quadriceps avoidance gait (decreased external knee flexion moment (KFM) during walking, altered quadriceps and hamstring activation) in p...

Efficacy and Safety of Tocilizumab in Patients with Giant Cell Arteritis and Visual Impairment
Andrea Rubbert Roth, Scott Tschuppert, Thomas Neumann et. al.

Nov 9th, 2020 - Background/Purpose: Tocilizumab (TCZ) represents a potent new therapeutic principle for patients with GCA, however, data on efficacy and safety in patients who present with visual affection is still limited. We sought to study the outcome of patients with GCA and visual affection treated with TCZ. Methods: This retrospective analysis was performed on all patients with GCA and visual disturbance...

Elevated Calprotectin Levels Reveal Loss of Vascular Pattern and Atrophy of Villi in Ileum Using Digital Chromo-endoscopy and Magnification Colonoscopy in Patients with Spondyloarthritis Without In...
Consuelo Romero-Sanchez, Cristian Florez-Sarmiento, Valerie Khoury-Rosas et. al.

Nov 9th, 2020 - Background/Purpose: Fecal calprotectin (FC) is a well bio-marker related to mucosal inflammation. Digital chromo-endoscopy (DCE) with magnification is a technique to identify microscopic inflammation. The objective of the study is to establish the association between FC levels and DCE/histology for the detection of early bowel lesions related to structural inflammatory changes in patients with ...

Exploring Novel Tenosynovitis and Combined Inflammation Imaging Outcomes: Results from a Randomized Controlled Trial in Early Rheumatoid Arthritis
Philip G Conaghan, Mikkel Østergaard, Orrin Troum et. al.

Nov 9th, 2020 - Background/Purpose: MRI trial outcomes have largely focused on synovitis, bone marrow edema (BME), and erosions. Tenosynovitis is a common manifestation of RA, but is relatively understudied; a combined inflammation score (CIS) that sums the 3 inflammatory markers (synovitis, BME, and tenosynovitis) may be a highly responsive outcome measure. We have previously demonstrated the responsiveness o...

Etiologies and Management of Hemophagocytic Lymphohistiocytosis: Is It Time for an Updated Protocol and Targeted Treatments?
Therese Posas-Mendoza, Cara McLeod, William Davis2 and Robert Quinet et. al.

Nov 9th, 2020 - Background/Purpose: Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease characterized by immune-overstimulation and a hyperinflammatory response resulting in cytokine storm and multi-organ failure.1 Secondary HLH usually occurs in adults in the setting of malignancy, infection, or a rheumatic condition. It is often triggered by an infection such as Epstein-Barr virus (EB...

Intestinal Permeability in the Adjuvant Induced Arthritis Model: Preliminary Study and Impact of NSAIDs
Sophie Hecquet, Romain Bordy, Clement Prati et. al.

Nov 9th, 2020 - Background/Purpose: The gut is no longer considered as a simple element associated with spondyloarthritis but as a real actor of the disease. In patients with spondyloarthritis, the presence of intestinal inflammation and an increase in digestive permeability responsible for bacterial translocation has been described. No data are available on the effect of non-steroidal anti-inflammatory drugs ...

Intracellular Homocysteine and Homocysteine Metabolites in Systemic Lupus Erythematosus (SLE)
George Stojan, Jessica Li, Amrita Raj et. al.

Nov 9th, 2020 - Background/Purpose: In SLE, homocysteine has been shown to be a potentially modifiable, independent risk factor for stroke and thrombotic events. All previous epidemiological studies used total plasma homocysteine as a disease marker, but it remains unclear whether plasma or intracellular homocysteine is causing detrimental effects. Folic acid (0.5 mg/day) supplementation does lower homocystein...

IL-11 Expression in Systemic Sclerosis Pulmonary Fibroblasts Is Mediated by Caspase-1
Caya McFalls1 and Carol Artlett, Drexel University College of Medicine, Philadelphia

Nov 9th, 2020 - Background/Purpose: Interleukin-11 (IL-11) has been shown to be associated with idiopathic pulmonary fibrosis, cardiac and kidney fibrosis. However, conflicting data shows IL-11 can be either pro- or anti-fibrotic. Scleroderma (SSc) is a fatal fibrotic disease of the vasculature, skin, and internal organs. Patients die of scarring and dysfunction of organs due to uncontrolled deposition of coll...

Improving Pneumococcal Vaccination in Veterans with Rheumatic Diseases
Sarah Homann, Michelle Ormseth, Christianne Roumie2 and Robert Dittus et. al.

Nov 9th, 2020 - Background/Purpose: Patients with rheumatic diseases are at increased risk of invasive pneumococcal disease. Both pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) are recommended for patients on immunosuppressant medications. However, under-vaccination of this population is common. The aim of this quality improvement project was to decrease the percent of ...