Author Interviews, Cancer Research, Immunotherapy, Pediatrics, Rheumatology / 16.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29722" align="alignleft" width="170"]Timothy Beukelman, MD, MSCE Associate Professor of Pediatrics Division of Rheumatology and Division of Clinical Immunology & Rheumatology University of Alabama at Birmingham Dr. Timothy Beukelman[/caption] Timothy Beukelman, MD, MSCE Associate Professor of Pediatrics Division of Rheumatology and Division of Clinical Immunology & Rheumatology University of Alabama at Birmingham MedicalResearch.com: What is the background for this study? Response: In 2009 the US FDA issued a boxed warning about malignancies reported in children treated with TNF inhibitors but their analysis did not account for a possible malignancy risk from other medications of from the Juvenile idiopathic arthritis (JIA) disease process itself.
Author Interviews, Diabetes, Heart Disease, Rheumatology / 16.11.2016

MedicalResearch.com Interview with: Prof.dr. M.T. Nurmohamed, MD, PhD and Rabia Agca MD Dept. of Rheumatology | VU University Medical Center Amsterdam Rheumatology & immunology Center EULAR center of excellence in rheumatology MedicalResearch.com: What is the background for this study? Response: About 20 years ago the increased mortality in rheumatoid arthritis (RA) was well known, but not the causes. In daily clinical practice it seemed that RA patients more frequently suffered from myocardial infarctions than general population persons. Therefore, we started this study more than 15 years ago as at that time there were only sparse data with respect to cardiovascular morbidity in rheumatoid arthritis.
Author Interviews, Rheumatology / 01.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29310" align="alignleft" width="124"]Marie Hudson, MD MPH FRCPC Jewish General Hospital and Lady David Research Institute Montreal, QC Dr. Marie Hudson[/caption] Marie Hudson, MD MPH FRCPC Jewish General Hospital and Lady David Research Institute Montreal, QC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Statins are widely used to treat hypercholesterolemia. In addition to their effect on cholesterol levels, statins also attenuate inflammation and have immunomodulatory properties. Whether this translates into meaningful differences in health outcomes, though, remains uncertain. We therefore undertook this study to determine whether people exposed to high doses of statins were at a lower risk of developing rheumatoid arthritis compared to those at lower doses. We studied a large population-based cohort of over half a million people exposed to statins for the first time and followed them on average for 3 years. We found that those exposed to the highest intensity statin quintile had a 33% lower risk of developing rheumatoid arthritis compared to those in the lowest intensity quintile (adjusted HR 0.77; 95% CI: 0.63-0.95). We conducted several additional secondary analyses that all pointed in the same direction and suggested that statins reduce the risk of rheumatoid arthritis.
Author Interviews, JAMA, Pharmacology, Rheumatology / 23.09.2016

MedicalResearch.com Interview with: Jacques-Eric Gottenberg, MD, PhD Department of Rheumatology National Reference Center for Systemic Autoimmune Diseases Strasbourg University Hospital, Université de Strasbourg Strasbourg, FranceJacques-Eric Gottenberg, MD, PhD Department of Rheumatology National Reference Center for Systemic Autoimmune Diseases Strasbourg University Hospital, Université de Strasbourg Strasbourg, France MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is no recommendation for the choice of the second biologic in patients with rheumatoid arthritis and insufficient response to a first anti-TNF, which is a common situation in our daily practice (approximately one third of patients treated with anti-TNF). We therefore conducted the first randomized trial to date to investigate the best strategy in such a setting.
Author Interviews, Hematology, Rheumatology / 17.08.2016

MedicalResearch.com: Nisha Jain, Director Global Medical at Biogen Regarding: Post Hoc Analysis to Evaluate the Effect of Recombinant Factor IX Fc Fusion Protein (rFIXFc) Prophylaxis in Adults and Adolescents with Target Joints and Hemophilia B being presented at the World Federation of Hemophilia (WFH) 2016 World Congress MedicalResearch.com: What is the background for this study? Response: People with hemophilia B experience prolonged bleeding episodes that can cause pain, irreversible joint damage and life-threatening hemorrhages. For people with severe hemophilia, most bleeding events occur in joints, with joint damage being the most common complication of the condition.(1) Over time, joints can become severely damaged and an individual can suffer from acute pain as well as restricted range of motion in those joints.(1) MedicalResearch.com: What are the main findings? Response: The B-LONG and B-YOND trials evaluated ALPROLIX® [Coagulation Factor IX (Recombinant), Fc Fusion Protein] in hemophilia B patients. In this post-hoc analysis of 37 patients with target joints in B-LONG and B-YOND, most (98.9%) target joints were considered resolved using the International Society on Thrombosis and Haemostasis (ISTH) definition of resolution as ≤ 2 bleeds into the joint within a consecutive 12-month period.
Author Interviews, Blood Pressure - Hypertension, Gout, Johns Hopkins, Nutrition, Rheumatology / 16.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27021" align="alignleft" width="155"]Stephen P. Juraschek, MD, PhD Fellow, Division of General Internal Medicine Johns Hopkins Hospital Dr. Stephen Juraschek[/caption] Stephen P. Juraschek, MD, PhD Fellow, Division of General Internal Medicine Johns Hopkins Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Diet has long been viewed as an important way to lower uric acid levels to prevent gout attacks; however, there is little evidence about whether a particular dietary pattern might be effective for lowering uric acid. For the first time we show that the DASH diet, an effective diet for lowering blood pressure, it lowers uric acid levels substantially in people with abnormally high uric acid levels.
Author Interviews, Genetic Research, Microbiome, Rheumatology / 15.07.2016

MedicalResearch.com Interview with: [caption id="attachment_26144" align="alignleft" width="166"]Veena Taneja, Ph.D Immunologist Mayo Clinic Rochester MN Dr. Veena Taneja[/caption] Veena Taneja, Ph.D Immunologist Mayo Clinic Rochester MN MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gut bacteria have been suggested to be involved in pathogenesis of rheumatoid arthritis. We used new technology to sequence the bacteria in patients with rheumatoid arthritis and first degree relatives and healthy individuals. We found that patients had lower diversity of bacteria than healthy individuals and the composition of the gut microbiota differed between patients and healthy people. We could identify some bacteria that have expanded in patients though those are generally observed with low numbers in healthy individuals. We could define certain metabolic signatures that associated with microbial profile. For the first time, we could show a direct link between the arthritis-associated bacteria we identified and enhancement of arthritis using a mice carrying the RA-susceptible HLA gene.
Author Interviews, BMJ, Immunotherapy, Johns Hopkins, Rheumatology / 27.06.2016

MedicalResearch.com Interview with: [caption id="attachment_25574" align="alignleft" width="146"]Laura C. Cappelli, M.D Johns Hopkins University School of Medicine Dr. Laura Cappelli[/caption] Laura C. Cappelli, M.D Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: We had been referred several patients with inflammatory arthritis or dry mouth and dry eyes after being treated with immune checkpoint inhibitors. When searching the literature for information on how to evaluate and treat these patients, we realized that there was minimal information available. We wanted to describe our experience and inform the medical community about these events so that recognition could increase.
Author Interviews, NEJM, Rheumatology / 02.06.2016

MedicalResearch.com Interview with: Chih-Hung Kuo, M.B., B.S. Peter McCluskey, M.D. Clare L. Fraser, M.B., B.S. University of Sydney Sydney, NSW, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Giant cell arteritis is a life and sight threatening systemic inflammatory condition, which remains difficult to diagnose. Jaw claudication (cramping of muscle from ischemia) is a highly specific symptom with significant diagnostic and prognostic (risk of permanent blindness) values. The reporting of jaw symptoms may be affected by many factors, such as diet. There remains no standardized clinical test available for clinicians. We study the use of chewing gum as a standardized test (like a stress test for angina pain) to better characterize this critical symptom. The pilot study of two cases with abnormal results were published in the New England Journal of Medicine. Chewing gum at a rate of 1 chew/second can reproduce the jaw claudication symptom around 2-3 minutes. In one case, the jaw claudication was unmasked by the test with a subsequent positive biopsy result. The test result became negative after corticosteroid treatment.
Alzheimer's - Dementia, Author Interviews, Rheumatology / 16.05.2016

MedicalResearch.comcom Interview with: Hui-Wen Lin MD, PHD Department of Mathematics, Soochow University Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan MedicalResearch.com: What is the background for this study? Dr. Hui-Wen Lin: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder that affects multiple organ systems and it predominantly affects women aged 20 to 40 years, and clinical symptoms caused by autoantibody deposition that triggers subsequent inflammatory reactions vary between individuals. There were 30~80% of SLE patients present neurological symptoms, and it is referred to as neuropsychiatric SLE (NPSLE). However there is no research about risk of dementia for SLE patients. Therefore we investigated this issue by analyzing the National Health Insurance Research Database in Taiwan.
Author Interviews, Dermatology, Heart Disease, Rheumatology / 04.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24005" align="alignleft" width="196"]Lihi Eder, MD, PhD Assistant Professor of Medicine, University of Toronto Scientist, Women’s College Research Institute,Room 6326 Women’s College Hospital Toronto, ON, Canada Dr. Lihi Eder[/caption] Lihi Eder, MD, PhD Assistant Professor of Medicine University of Toronto Scientist, Women’s College Research Institute,Room  6326 Women’s College Hospital Toronto, ON, Canada  MedicalResearch.com: What is the background for this study? Dr. Eder: Psoriasis is a chronic immune-mediated skin disease affecting 2-3% of the general population. Psoriatic arthritis (PsA) affects 15-30% of patients with psoriasis. Until recently, only few studies assessed the risk of developing cardiovascular events in patients with PsA and while most studies found a higher cardiovascular risk in these patients, others reported cardiovascular rates that were similar to the general population.
Author Interviews, Hearing Loss, Rheumatology / 28.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23868" align="alignleft" width="149"]Dr-Amir-Emamifar Dr. Emamifar[/caption] Dr. Amir Emamifar, MD Department of Rheumatology Odense university Hospital Svendborg Hospital, Denmark [caption id="attachment_23869" align="alignleft" width="139"]Associate Professor Inger Marie Jensen Hansen, PhD, DMsci Department of Rheumatology, Odense university Hospital, Svendborg Hospital, Denmark. University of Southern Denmark. Dr. Hansen[/caption]   Associate Professor Dr. Inger Marie Jensen Hansen, PhD, DMsci Department of Rheumatology Odense university Hospital Svendborg Hospital University of Southern Denmark   MedicalResearch.com: What is the background for this study? Response: Rheumatoid arthritis is a systemic, inflammatory disease that affects 1% of the general population. Apart from main articular manifestations, rheumatoid arthritis may involve other organs including heart, lung, skin, and eye. The auditory system can be affected during the course of the disease as well; however the association between rheumatoid arthritis and hearing impairment has not been clearly defined. It seems that hearing impairment in rheumatoid arthritis is a multifactorial disease affecting by environmental factors and disease and patient characteristics. We did a comprehensive review of all published data to reveal the potential link between rheumatoid arthritis and hearing impairment.
Author Interviews, Heart Disease, Rheumatology / 22.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23716" align="alignleft" width="200"]Nicola Veronese, MD University of Padova Department of Medicine (DIMED)-Geriatrics Section Padova, Italy Dr. Nicola Veronese[/caption] Nicola Veronese, MD University of Padova Department of Medicine (DIMED)-Geriatrics Section Padova, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Veronese: Osteoarthritis (OA) is the most common rheumatic disease. Although an increasing research is showing that OA, particularly of lower limbs, is associated with an increased risk of cardiovascular diseases (CVD) the association with overall mortality seems to be less clear.
Author Interviews, JAMA, Rheumatology, Vitamin D / 10.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22335" align="alignleft" width="195"]Changhai Ding, MBBS, MMED, MD Australian Research Council Future Fellow Associate Director (International), Menzies Institute for Medical Research Professor, University of Tasmania, Australia Honorary Professor, University of Sydney, Australia Dr. Changhai Ding[/caption] Changhai Ding, MBBS, MMED, MD Australian Research Council Future Fellow Associate Director (International), Menzies Institute for Medical Research Professor,  University of Tasmania, Australia Honorary Professor, University of Sydney, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ding: Vitamin D can reduce bone turnover and cartilage degradation, thus potentially preventing the development and progression of knee osteoarthritis. Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current evidence from clinical trials is contradictory. We  conducted a randomised clinical trial in Hobart, Tasmania and Melbourne, Victoria in Australia. We randomly assigned 413 patients with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years. Of 413 enrolled participants (average age, 63 years; 50 percent women), 340 (82 percent) completed the study. Vitamin D supplementation significantly increased blood 25-hydroxyvitamin D levels over 2 years compared with placebo treatment; however, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or a measure of knee pain over 2 years. There were also no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Post-hoc analyses indicated that vitamin D supplementation might improve knee physical function and reduce another measure of knee pain and increases in bone marrow lesion.
Author Interviews, OBGYNE, Rheumatology, Stanford / 03.02.2016

MedicalResearch.com Interview with: Dr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of MedicineDr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of Medicine  Medical Research: What is the background for this study? What are the main findings? Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population.  These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum.
Author Interviews, Immunotherapy, NEJM, Rheumatology / 24.12.2015

MedicalResearch.com Interview with: Prof. dr. D.L.P. Baeten MD Clinical Immunology and Rheumatology Academic Medical Center University of Amsterdam Amsterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Prof. Baeten: Ankylosing spondylitis is a debilitating rheumatic condition which affects young adults and with NSAIDS and TNF inhibitors as only therapeutic option. Over the last years, we generated evidence that IL-17 is an important inflammatory mediator in this condition. In the two studies reported here in the NEJM, we demonstrate that IL-17 inhibition with secukinumab has a very profound and long-lasting effect on signs and symptoms as well as inflammation in ankylosing spondylitis patients, even in those patients that failed a TNF blocker before.
Author Interviews, Rheumatology, UCSF, Weight Research / 07.12.2015

[caption id="attachment_19866" align="alignleft" width="131"]Alexandra S. Gersing, MD Department of Radiology and Biomedical Imaging University of California, San Francisc Dr. Gersing[/caption] MedicalResearch.com Interview with: Alexandra S. Gersing, MD Department of Radiology and Biomedical Imaging University of California, San Francisco Medical Research: What is the background for this study? What are the main findings? Dr. Gersing:  This study is part of a larger NIH-funded project focusing on the effects of weight change in individuals at risk for and with osteoarthritis. Our group has previously shown that weight gain causes substantial worsening of knee joint degeneration in patients with risk factors for osteoarthritis and now we aimed to show that weight loss could protect the knee joint from degeneration and osteoarthritis. Osteoarthritis is one of the major causes of pain and disability worldwide; and cartilage plays a central role in the development of joint degeneration. Since cartilage loss is irreversible, we wanted to assess whether lifestyle interventions, such as weight loss, could make a difference at a very early, potentially reversible stage of cartilage degradation and whether a certain amount of weight loss is more beneficial to prevent cartilage deterioration. To measure these early changes we used a novel Magnetic Resonance Imaging (MRI) technique, called T2 mapping, which allows us to evaluate biochemical cartilage degradation in the patient on a molecular level. The most relevant finding of this study is that patients with more that 10% of weight loss benefited significantly more from losing weight compared to the obese controls that did not lose weight or only lost little weight.
Author Interviews, Rheumatology, Smoking / 13.11.2015

Jasvinder Singh MD MPH Professor of Medicine UAB Division of Clinical Immunology and Rheumatology MedicalResearch.com Interview with: Jasvinder Singh MD MPH Professor of Medicine UAB Division of Clinical Immunology and Rheumatology  Medical Research: What is the background for this study? What are the main findings? Dr. Singh: A systematic review of the effect of smoking on outcomes after total joint replacement showed that current smoking increased the risk of overall post-operative complications but that there were scarce data for smoking and specific surgical outcomes of arthroplasty. We performed a study using data from an institutional Total Joint Registry to answer this question.   In a study of for 7,926 patients who underwent hip or knee arthroplasty, 7% were current tobacco users. We found that compared to current non-users, current tobacco users had higher hazard ratios (95% CI) for deep infection, 2.37 (1.19, 4.72; p=0.01) and implant revision, 1.78 (1.01, 3.13; p=0.04) after total hip or knee arthroplasty. No significant differences were noted for periprosthetic fractures or superficial infections.
Author Interviews, Biomarkers, Rheumatology / 13.11.2015

MedicalResearch.com Interview with: Ron Rogers Executive Vice President, Corporate Communications Spokesman, Myriad Genetics, Inc. Salt Lake City, Utah 84108 Medical Research: What is the background for the MBDA test? What types of biomarkers are included in the score? Response: Vectra DA is an advanced blood test for adults with rheumatoid arthritis (RA). It helps you and your doctor better understand your rheumatoid arthritis disease activity.  Vectra DA blood test for RA gives physicians a more complete look at your disease activity by measuring 12 markers of RA disease activity. Some other tests, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR or “sed rate”), only measure one marker. Vectra DA test scores can help track your disease activity over time with an objective measure that complements your doctor’s exam and your own assessment.  Patients with high Vectra DA scores have 7-fold higher risk for rheumatoid arthritis-related joint damage than patients with low or moderate Vectra DA scores.
Author Interviews, Gout, Rheumatology / 10.11.2015

MedicalResearch.com Interview with: Paras Karmacharya, MD Internal Medicine Reading Health System West Reading, PA 19611 Co-Authors: Ranjan Pathak MD, Madan Raj Aryal MD, Smith Giri MD, Anthony A Donato MD MHPE Medical Research: What is the background for this study? Response: Studies describing seasonal variations in acute gouty arthritis note a seasonal trend, but disagree on timing, with most showing a peak in spring months while others showing peaks later in the year. However, serum uric acid (SUA) levels seem to peak in the summer months. This disparity has led to the hypothesis that the flares might be related to factors other than elevated serum uric acid levels. Various theories on the effects of weather and immune system changes on the chronobiology of the equilibrium and precipitation of monosodium urate crystals have been proposed. We aimed to shed light on this question by examining the seasonal variation in the incidence of acute gouty arthritis in the US using a large inpatient database. Medical Research: What are the main findings? Response: We used the Nationwide Inpatient Sample (NIS) database, a large national database that represents 20% of all hospital admissions, to identify adult patients with a primary diagnosis of acute gouty arthritis from 2009-2011 during their hospitalization. A total of 28,172 hospitalizations with primary diagnosis of acute gouty arthritis were reported from 2009-11. The peak incidence of acute gout was seen in the month of November (peak/low ratio 1.34, 95% CI 1.29-1.38, p<0.05) (Figure 1). The highest number of hospitalizations was observed in autumn months, while the lowest incidence was observed in spring (28.12% vs. 23.13%, p<0.001). Medical Research: What should clinicians and patients take away from your report? Response: Unlike previous studies, our analysis found the peak incidence of acute gout in the fall with its peak in the month of November. Various environmental (temperature, humidity, diet, physical activity) and biochemical factors (low cortisol levels, high absolute neutrophil counts and plasminogen activator inhibitor-1) have been implicated for the seasonal variation, but the data on this is conflicting. Whether our findings are reflective of purine and alcohol intake over the US holidays in November and December is a hypothesis that requires further testing.
Author Interviews, Biomarkers, Lyme, Rheumatology / 10.11.2015

MedicalResearch.com Interview with: Robert B. Lochhead PhD Clinical Fellow in Medicine  Division of Rheumatology, Allergy & Immunology Massachusetts General Hospital Harvard Medical School, Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Lochhead: Lyme arthritis (LA), caused by the tick-borne spirochete Borrelia burgdorferi, usually resolves appropriately with antibiotic treatment, called antibiotic-responsive Lyme arthritis. However, in some patients, arthritis persists for months or years after spirochetal killing with oral and IV antibiotic therapy, called antibiotic-refractory Lyme arthritis. Synovial lesions in these patients show marked synovial proliferation, inflammation, and vascularization, accompanied by autoimmune T and B cell responses. MicroRNAs (miRNAs) regulate many biological processes including inflammation, immune responses, and cell proliferation, and are effective biomarkers that may reveal molecular mechanisms of disease. Our objective here was to identify extracellular miRNAs (ex-miRNAs) in synovial fluid (SF) that distinguish regulated (responsive) from dysregulated (refractory) immune responses in Lyme arthritis, thereby providing insights into underlying biological processes and potential diagnostic biomarkers to distinguish between  these disease courses.
Author Interviews, Exercise - Fitness, Rheumatology / 06.10.2015

Anja Bye, PhD, Senior Researcher Cardiac Exercise Research Group (CERG) K.G. Jebsen Center of Exercise in Medicine National Council of Cardiovascular Disease Department of Circulation and Medical Imaging Medical Faculty Norwegian University of Science and TechnologyMedicalResearch.com Interview with: Anja Bye, PhD, Senior Researcher Cardiac Exercise Research Group (CERG) K.G. Jebsen Center of Exercise in Medicine National Council of Cardiovascular Disease Department of Circulation and Medical Imaging Medical Faculty Norwegian University of Science and Technology Medical Research: What is the background for this study? What are the main findings? Dr. Bye: The background was that we know that this type of training is superior to exercise at lower intensities in cardiovascular risk reduction in several patients groups. As it was not tested in patients with rheumatic disease, we set out to determine if this type of exercise would be tolerated in these patients, and of they would experience the same benefits on the cardiovascular system as other patients groups, and healthy young and elderly individuals. Hence the main goal was not to treat the rheumatic disease, but to study whether the exercise training would be tolerated, as we assumed they would have equal benefits from this type of exercise as everyone else. I think the most interesting findings were that all of the participants were capable of participating in this type of high-intensity exercise program, without reporting any negative side-effects. Of course the great increase in VO2max, and  the trend towards a reduction in the inflammation after the exercise intervention was very interesting.
Author Interviews, Biomarkers, OBGYNE, Rheumatology / 30.09.2015

Jane E. Salmon, MD Division of Rheumatology Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY MedicalResearch.com Interview with: Jane E. Salmon, MD Division of Rheumatology Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY  Medical Research: Background on lupus and antiphospholipid antibodies - what are they? Dr. Salmon: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that predominantly affects women and presents during their childbearing years. In SLE, the immune system which normally protects one from infection, turns reacts against the self and can cause damage of multiple organs. Antiphospholipid antibodies (APL) occur in some people with SLE and some without SLE. They are autoantibodies that can damage the placenta and cause arterial and venous thromboses. Patients with APL can have fetal deaths, miscarriages, preeclampsia and/or growth restricted babies. Pregnancy in patients with SLE, particularly those with antiphospholipid antibodies (APL), and in patients with APL alone, is associated with an increased risk for maternal and fetal morbidity due to preeclampsia (PE) and insufficient placental support of the developing fetus. PE and placental insufficiency are, in turn, associated with adverse pregnancy outcomes (APOs), including maternal complications of PE, intrauterine fetal death, and fetal growth restriction, as well as indicated preterm delivery. Given that APOs affect over one fifth of pregnancies in SLE and/or APL, the ability to identify patients early in pregnancy who are destined for poor outcomes would significantly impact care of this high risk population. Medical Research: Two bullets about your PROMISSE study: Dr. Salmon: The PROMISSE Study (Predictors of pRegnancy Outcome: bioMarker In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus). PROMISSE is the largest multi-center, multi-ethnic and multi-racial study to prospectively assess the frequency of APO, clinical, laboratory and biomarker variables that predict APO, in women with SLE and/or APL with inactive or mild/ moderate activity at conception. Pregnant patients with SLE and/or APL were enrolled at <12 weeks gestation into PROMISSE between September 2003 and August 2013 at 7 sites (n=497) along with matched healthy controls (n=207) and followed every month of pregnancy. 
Author Interviews, Rheumatology, Supplements / 29.09.2015

Prof. Andrew B Lemmey School of Sport, Health and Exercise Sciences Bangor University Bangor, Gwynedd, Wales, UKMedicalResearch.com Interview with: Prof. Andrew B Lemmey School of Sport, Health and Exercise Sciences Bangor University Bangor, Gwynedd, Wales, UK Medical Research: What is the background for this study? Prof. Lemmey: Substantial loss of lean mass (LM; mostly skeletal muscle) is common in patients with rheumatoid arthritis (RA), as we and others have shown that even amongst patients with well-controlled disease approximately 67% are significantly muscle wasted. This loss of muscle, termed “rheumatoid cachexia”, is a major contributor to the decreased strength and impaired physical function which continues to characterise RA. Unfortunately, current drug treatments for RA, including use of biologics and the ‘treat-to-target (T2T)’ strategy, do not reverse this LM loss, nor fully restore physical function (Lemmey et al., “Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients”. Submitted to Rheumatology (Oxford), currently under review). Whilst high-intensity exercise (specifically, progressive resistance training (PRT)) has been shown to be highly effective in restoring both  lean mass and function in  rheumatoid arthritis patients (Lemmey et al., Arthritis Care & Research 2009;61(12):1726-34), the lack of uptake and adherence to sufficiently intense training (Lemmey et al., Arthritis Care & Research 2012;64(1):71-5) means this form of therapy is not widely adopted. Anabolic nutritional supplementation offers a potential adjunct treatment intervention for increasing LM, and thereby improving physical function, that could be widely accepted. Indeed, our group (Marcora et al., Clinical Nutrition 2005;24(3):442-54) has previously demonstrated that 12 weeks of daily oral protein supplementation improved lean mass and some measures of strength and function in  rheumatoid arthritis patients. Creatine (Cr) is a popular dietary supplement generally shown to have greater benefits on both lean mass and physical function than generic protein supplementation. One study (Willer et al., Rheumatology 2000;39(3):293-8) has investigated the efficacy of Cr supplementation in rheumatoid arthritis patients. In this short uncontrolled trial, twelve patients underwent 3 weeks of supplementation, and although strength increased, no changes in function were found, and body composition changes were not investigated. Using a double-blind, placebo controlled design, the current study aimed to investigate the effects of 12 weeks of oral Cr supplementation on body composition (by DXA; dual energy X-ray absorptiometry), strength (knee-extensor and handgrip) and objectively-assessed physical function (chair and walk tests) in patients with RA. Thirty-five patients (Cr=15, Pl=20) completed the study. 
Author Interviews, Exercise - Fitness, Orthopedics, Rheumatology / 14.09.2015

Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital TrustMedicalResearch.com Interview with: Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital Trust Medical Research: What is the background for this study? Dr. Heiberg: This study is a long term follow-up of 60 patients who suffered from hip osteoarthritis and were treated with total hip arthroplasty (THA) approximately 5 years earlier. In a prior study, the patients participated in a RCT study, examining the effects of a supervised walking skill training program on physical functioning, pain and self-efficacy (1). The training program was performed between three and five months after surgery, and it was compared to a control group without supervised physiotherapy in the same time span. The results showed that immediately after the walking skill training intervention was completed, several outcome variables were statistically significant more improved in the training group than in the control group, and at one year after surgery the statistically significant effect on walking capacity (measured by the 6-min walk test) still sustained. Few long-term follow-up of RCTs regarding physical functioning in patients after total hip arthroplasty are previously published. Furthermore in another prior study, we examined the recovery of the total group of the same patients from preoperatively to one year after surgery (2). The results showed that the patients were statistically significant improved in all outcomes of physical functioning, pain and self-efficacy during the first year, but they still did not quite reach the level of healthy peers in walking capacity. In line with this, they also reported one year after surgery that they wanted to further improve their ability to walk and to participate in recreational activities (3). However, it seems that patients’ desires regarding physical activity are poorly understood and have received relatively little evaluation, although regular physical activity is considered to be one of the most important lifestyle behaviors affecting health. Only few prior studies have examined the long term recovery of physical functioning and the impact on physical activity. Therefore, in this present 5-year follow-up study after total hip arthroplasty the aims were threefold.
  • First, to examine the long-term effect from the supervised walking skill training program on physical functioning, pain and self-efficacy;
  • Second, to examine the long-term recovery of physical functioning from one to five years; and
  • Third, to identify predictors of physical activity outcome five years after THA among personal and preoperative variables (4).
Annals Internal Medicine, Author Interviews, Pain Research, Rheumatology / 30.07.2015

MedicalResearch.com Interview with: Raveendhara R Bannuru MD, PhD, FAGE Director, Center for Treatment Comparison and Integrative Analysis (CTCIA) Asst Professor of Medicine, Tufts University School of Medicine Special & Scientific Staff, Center for Arthritis and Rheumatic Diseases Tufts Medical Center Boston, MA Medical Research: What is the background for this study? Dr. Bannuru: Placebos are used to determine the efficacy of a wide variety of treatments for medical conditions such as osteoarthritis. A sound understanding of potential differences among placebos is essential for determining the relative efficacy of such treatments. Medical Research: What are the main findings? Dr. Bannuru: Our results indicate that different types of placebos do in fact differ in efficacy. Placebo injections and topical placebos were both found to be more effective than orally administered placebos for reducing knee osteoarthritis pain.
Author Interviews, Genetic Research, Heart Disease, PNAS, Rheumatology / 27.07.2015

MedicalResearch.com Interview with: Philippe Bouillet, PhD Walter and Eliza Hall Institute Parkville, Vic Australia Medical Research: What is the background for this study? What are the main findings? Dr. Bouillet: This study was initiated when we discovered mice that developed rheumatoid arthritis as a result of what was obviously a spontaneous dominant genetic mutation. Using several approaches, we identified the mutation as the insertion of a mobile genetic element called retrotransposon into the regulatory sequences of the gene encoding tumor necrosis factor (TNF). The mutation caused excessive amounts of TNF to be produced, a known cause of rheumatoid arthritis. The surprise came when some mice with the mutation died prematurely and suddenly with from heart disease. We showed that excess TNF also led to inflammation of the aortic and mitral valves, causing aortic regurgitation. Depending on the genetic background of the mice, the disease could also culminate in aortic aneurysm and death. We also investigated the regulatory region of the TNF gene and identified novel regulators and a new genetic element that normally make sure that levels of serum TNF are kept within reasonable limits, high enough to ensure its numerous physiological functions, low enough to prevent its harmful effects such as those described here.
Author Interviews, Connective Tissue Disease, Genetic Research, Rheumatology / 20.07.2015

MedicalResearch.com Interview with: Dr. Changfu Kuo MD PhD Division of Rheumatology, Orthopaedics, and Dermatology School of Medicine, University of Nottingham, Nottingham, England Division of Rheumatology, Allergy, and Immunology Chang Gung Memorial Hospital, Taoyuan, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Kuo: Systemic lupus erythematosus (SLE) is a prototype of autoimmune disease with features like autoantibody production and multiple target organ damage. SLE can affect any part of the body and the course of the disease is highly diverse and unpredictable. SLE can occur at any age and affect both females and males with a sex ratio of 9 to 1. Familial predisposition has been recognised as a risk factor previously and heritability of SLE has been estimated to be 66%. However, previous reports are often based on less robust sampling strategies and case ascertainment which generally depend on hospital records, self-reported diagnosis and disease registries, therefore limiting generalisability. The previous estimates of heritability are overestimated, due to a lack of consideration of shared environmental contribution. This study utilised a unique health insurance database that provides information on the whole population of Taiwan and permits determination of spouse and first-degree relatives. Over 23 million people were included in this study. Furthermore, through inclusion of SLE status of the spouse in our analyses the study is also able to examine how much of familial clustering results from genetic versus shared environmental factors. Overall the familial relative risk is 16.92. The genetic contribution to SLE susceptibility is estimated to be 44%. In addition to SLE, other autoimmune diseases are also more prevalent in individuals with a family history of SLE.
Author Interviews, Outcomes & Safety, Rheumatology / 15.06.2015

MedicalResearch.com Interview with: Cécile Gaujoux-Viala, MD, PhD Université Montpellier I Chef de Service de Rhumatologie CHU de Nîmes Carémeau France Medical Research: What is the background for this study? Response: Chronic inflammatory rheumatic diseases – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)  – confer significant patient and economic burdens : 1/5 of people with rheumatic conditions has been forced to change career, 1/3 will have stopped working within two years of onset and 1/2 will be unable to work within ten years. The addition of biological agents in treatment strategies for rheumatic diseases have improved the possibility of controlling disease activity and slowing the progression of joint damage. But these treatments are very expensive and their effect on work participation remains unclear.