Check out our Fellow's impressive contributions. 

Festina lente: Hydroxychloroquine, COVID-19 and the Role of the Rheumatologist

Elizabeth R Graef Jean W Liew Michael S Putman Julia F Simard Emily SirotichFrancis BerenbaumAlí Duarte-GarcíaRebecca GraingerCarly HarrisonMaximilian F KonigPeter KorstenLaurie ProulxDawn P RichardsPhilip C RobinsonSebastian E SattuiManuel Francisco Ugarte-GilKristen J YoungAlfred Hj KimJeffrey A SparksCOVID-19 Global Rheumatology Alliance

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A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19

Liew JWWard MMReveille JDWeisman MBrown MALee MRahbar MHeckbert SRGensler LS.

Abstract

Hydroxychloroquine, an essential treatment for many patients with rheumatologic conditions, has recently garnered widespread attention as a potential treatment for COVID-19 infection. The authors appraise the study generating this interest and highlight the potential consequences of rapid dissemination of overinterpreted data, particularly for people with conditions for which hydroxychloroquine has demonstrated benefits in preventing organ damage and life-threatening disease flares.

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Characteristics Associated With Hospitalisation for COVID-19 in People With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance Physician-Reported Registry

Milena Gianfrancesco Kimme L Hyrich Sarah Al-AdelyLoreto CarmonaMaria I DanilaLaure GossecZara IzadiLindsay JacobsohnPatricia KatzSaskia Lawson-ToveyElsa F MateusStephanie RushGabriela SchmajukJulia SimardAnja StrangfeldLaura TrupinKatherine D Wysham Suleman Bhana Wendy Costello Rebecca GraingerJonathan S HausmannJean W LiewEmily SirotichPaul SufkaZachary S WallaceJinoos YazdanyPedro M MachadoPhilip C RobinsonCOVID-19 Global Rheumatology Alliance

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Baseline Use of Hydroxychloroquine in Systemic Lupus Erythematosus Does Not Preclude SARS-CoV-2 Infection and Severe COVID-19 

Maximilian F Konig Alfred Hj KimMarc H ScheetzElizabeth R GraefJean W Liew  Julia SimardPedro M MachadoMilena GianfrancescoJinoos YazdanyDaman LangguthPhilip C RobinsonCOVID-19 Global Rheumatology Alliance

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Refractory, Recurrent Idiopathic Pulmonary Capillaritis Successfully Treated With Tacrolimus

Irvin J Huang Trevor Pugh Haodong Xu Bridget F Collins Gregory C Gardner Jean W Liew

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Treat to Target in Axial Spondyloarthritis: Pros, Cons, and Future Directions

Jean W Liew Maureen Dubreuil 

Abstract

Treat to target describes a management paradigm that involves choosing a clinically relevant target, assessment with validated measures at a prespecified frequency, and a change in therapy if the target is not met. Although guidelines recommend treating to target in axial spondyloarthritis (axSpA), ideal methods to reach this target remain controversial. This review focuses on background for a treat-to-target strategy in axSpA. Potential targets of treatment, association of targets with outcomes, evidence of treatment impact on outcomes, and how treat to target has been incorporated into treatment guidelines are discussed. Treat-to-target trials and the research agenda for studies in axSpA are discussed.

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Nonsteroidal Anti-inflammatory Drug use is Associated with Incident Hypertension in Ankylosing Spondylitis.

Liew JW, Ward MM, Reveille JD, Weisman M, Brown MA, Lee M, Rahbar M, Heckbert SR, Gensler LS.

OBJECTIVE:

Nonsteroidal anti-inflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort.

METHODS:

Adults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; anti-hypertensive medication use; or, on two consecutive visits, systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models.

RESULTS:

Of the 1282 patients in the cohort, 628 patients without baseline hypertension had at least one year of follow up, and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio (HR) of 1.12 for incident hypertension (95% CI, 1.04-1.20), compared to non-continuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity.

CONCLUSION:

 

In our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to non-continuous or no NSAID use.

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Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis.

Liew JW, Ramiro S, Gensler LS.

The cardiovascular burden in inflammatory rheumatic diseases is well recognized. Recently, this burden has been highlighted in ankylosing spondylitis (also known as radiographic axial spondyloarthritis) and psoriatic arthritis. We review the cardiovascular morbidity and mortality in these diseases, as well as the prevalence and incidence of traditional cardiovascular risk factors. We examine the contribution of anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and TNF inhibitors on the cardiovascular risk profile. Finally, we examine the available recommendations for the management of cardiovascular comorbidity, as they apply to the spondyloarthritis population.

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Not so crystal clear: observations from a case of crystalline arthritis with cytokine release syndrome (CRS) after chimeric antigen receptor (CAR)-T cell therapy.

Chung SH, Hughes G, Koffman B, Turtle CJ, Maloney DG, Acharya UH.

CAR-T cell therapy is currently FDA-approved for the treatment of subsets of relapsed/refractory patients with non-Hodgkin lymphoma and acute lymphocytic leukemia.  We describe a case of crystalline arthritis observed in the context of cytokine release syndrome (CRS) after CAR T-cell therapy and discuss potential mechanistic links.

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Determinants of Positive Temporal Artery Biopsies in the Veterans Health Administration National Database Cohort.

Chung SH, Morcos MB, Ng B.

OBJECTIVE:

This study sought to determine the effect of temporal artery biopsy (TAB) post-fixation length, laterality, age, and prior prednisone exposure on TAB positivity utilizing the Veterans Health Administration national database.

METHODS:

Subjects with procedure code for TAB between 1999-2017 were queried and pathology reports were reviewed manually. Demographic, laboratory, and prescription data were extracted. Multivariate analyses and logistic regression were run using Stata 13.0.

RESULTS:

A total of 3,057 pathology reports were reviewed; 306 (10%) biopsies were designated positive. The likelihood of a positive TAB significantly correlated with TAB post-fixation length greater than 3.0 cm (OR 1.58, CI 1.06-2.36, p<0.05) as well as with bilateral biopsy in one sitting (OR 1.83, CI 1.29-2.59, p<0.01). Positive TAB also significantly correlated with age greater than 71 years. Prednisone administration up to and beyond 42 days prior to TAB did not influence TAB result.

CONCLUSION:

This retrospective study examines predictors of positive TAB utilizing national data on United States veterans over the span of eighteen years. The results suggest consideration of pursuing initial bilateral TAB or achieving a TAB post-fixation length of at least 3 cm to improve yield. The results also agree with prior studies showing that pre-TAB steroid exposure does not appear to affect yield, even up to and beyond 42 days prior to biopsy. This article is protected by copyright. All rights reserved.

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