Arthritis Care & Research最新文献

Objective: This work describes the demographics and practice characteristics of physician assistants/associates (PAs) practicing in rheumatology.

Methods: We examined 2022 cross-sectional data from the National Commission on Certification of PAs. The investigation included demographics and practice characteristics of PAs working in rheumatology compared to those working in all other specialties. We analyzed data using descriptive and bivariate statistics comparing the two groups.

Results: In 2022, 430 PAs self-reported practicing in rheumatology. The median age of these PAs was 39 years, and 84.7% self-identified as female. They primarily (78.8%) worked in office-based private practices and were more likely to engage in telemedicine services (62.5%) than their colleagues in all other specialties. PAs in rheumatology typically worked similar hours as their peers in other medical disciplines but saw a higher proportion of patients in the 61 to 80 range. At the same time, PAs in rheumatology reported slightly higher job satisfaction and lower burnout symptom rates compared to PAs practicing in other disciplines.

Conclusion: Understanding the characteristics and employment settings of PAs in rheumatology is crucial to estimating the health workforce supply and demand in this discipline. Further research should explore the economics of PAs in rheumatology, including aspects of teamwork, scope of practice, patient outcomes, and satisfaction.

Objective: To assess changes in gene expression following tofacitinib treatment and investigate transcription patterns as potential predictors of treatment response in patients with active juvenile idiopathic arthritis (JIA).

Methods: Whole-blood samples were collected from patients with JIA at baseline and after 18 weeks of open-label tofacitinib treatment. Patients who achieved a JIA-American College of Rheumatology (ACR) response of 70% or above at week 18 were classified as treatment responders (TRs), whereas those with at most a JIA-ACR30 were classified as poor responders (PRs). Differential gene expression and gene ontology overrepresentation analyses were performed to compare RNA expression between week 18 and baseline samples, as well as between PR and TR samples at baseline.

Results: Samples from 67 patients at baseline and 60 patients at week 18 were analyzed. After 18 weeks of tofacitinib treatment across all patients with JIA, 883 genes showed significant differential expression (week 18 to baseline). The most strongly down-regulated genes were overrepresented within interleukin-7 (IL-7) and type I and type II interferon pathways, whereas up-regulated genes were enriched in ontologies related to neuronal cell processes and cell signaling. Comparing PRs and TRs at baseline, 663 genes showed differential expression. Up-regulated genes were overrepresented within ontologies including activation of MAPK activity (P = 9.40 × 10^-5), myeloid cell development (P = 8.13 × 10^-5), activation of GTPase activity (P = 0.00015), and organelle transport along microtubules (P = 0.00021).

Conclusion: Tofacitinib treatment in JIA down-regulated genes in interferon and IL-7 signaling pathways regardless of effectiveness. Furthermore, baseline up-regulation of MAPK signaling may predict poor response to tofacitinib treatment in JIA.

Objective: Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are chronic life-threatening vasculitides requiring substantial immunotherapy. Adult trials identified rituximab (RTX) as an alternative to cyclophosphamide (CYC) for remission induction of GPA and MPA. Disease rarity has limited feasibility of similar trials with pediatric patients. We aim to evaluate the relative efficacy and toxicity of CYC and RTX for patients with childhood GPA and MPA through registry-based comparative evaluation.

Methods: From A Registry of Childhood Vasculitis, we identified patients with GPA and MPA who received induction with RTX or CYC. Pediatric Vasculitis Activity Score (PVAS) and Pediatric Vasculitis Damage Index (pVDI) score evaluated disease activity and damage. Descriptive statistics summarized patient characteristics. RTX and CYC comparisons used logistic regression for primary outcomes of postinduction remission (PVAS = 0) or low disease activity (PVAS ≤ 2). Hospital admission for adverse events and pVDI scores were compared using logistic regression and ordinal regression, respectively.

Results: Among 104 patients, 43% received RTX, 46% CYC, 11% both. Treatment groups did not significantly differ for diagnosis PVAS and onset age. There was no difference in remission among the groups (63% overall; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.45-2.52). Hospitalizations occurred in 22% of patients receiving RTX versus 10% patients receiving CYC (OR 2.27, 95% CI 0.73-7.05). The median 12-month pVDI score was 1 in both groups (OR 0.98, 95% CI 0.43-2.22).

Conclusion: This is the first study comparing CYC and RTX for induction in pediatric GPA and MPA. No significant differences were shown in rates of remission, severe adverse events, or organ damage. Limitations included lack of standardized treatment regimens, retrospectivity, and lack of longitudinal adverse drug-related event data.

Objective: The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best evidence osteoarthritis (OA) care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritize the barriers, and generate strategies to address them.

Methods: This study provides a worked example of a seven-step theory-informed codesign framework. We invited OACCP coordinators to participate in semistructured interviews (analyzed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, and researchers) to prioritize the barriers via a short survey (survey 2). We held five codesign workshops in which we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them.

Results: Sixteen coordinators were interviewed, and the main barriers identified were as follows: (1) patients often have beliefs that are inconsistent with best evidence care, (2) there are aspects of clinical care that are not delivered optimally, and (3) system-level factors are a barrier to optimal patient care and sustainability of the OACCP. We codesigned a plan for action with patient educational materials, shared decision-making tools, and health professional education and training.

Conclusion: Our worked example of codesign used a theory-based, data-driven approach with key stakeholders, identified and prioritized barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.