Newsroom Hospital for Special Surgery

Your Guide to Psoriatic Arthritis Digital Tools

Mon, 07 Jul 2025 16:21:00 -0400

In an interview with Health Central, Theodore R. Fields, MD, FACP, rheumatologist at HSS, highlights digital tools that can help simplify daily life with psoriatic arthritis.

Apps and wearables aren’t substitutes for seeing your doctor regularly, explained Dr. Fields. But by helping you track your needs and making it easier to notice symptom changes, they offer insight into when you should be coming in, and what to share during your visit. “That can improve care and make visits more effective,” Dr. Fields said.

“Our orthopedic surgeons have been using electronic step-counters to follow their patients after joint surgery, and this can be helpful to see how psoriatic arthritis patients are getting around,” Dr. Fields noted.

Read the full article at healthcentral.com.

5 Things You Need to Know About Living with Rheumatic Disease

Mon, 07 Jul 2025 11:28:00 -0400

Experts including S. Louis Bridges, Jr., MD, PhD, physician-in-chief and chair of the Department of Medicine at HSS shares things patients should know when living with rheumatic disease.

Dr. Bridges explained that one of the most common misconceptions with rheumatic diseases is that patients with inflammatory arthritis, such as rheumatoid arthritis, should not exercise. But that could not be farther from the truth. “While it is true that patients should not perform exercises that may worsen their pain, there are many safe exercises for such patients, including water aerobics and low impact activities such as walking,” he said.

Additionally, appropriate lifestyle changes can make a huge difference for patients with rheumatic diseases. These include avoiding smoking, maintaining a healthy weight and eating a healthy diet.

“Evidence suggests that the Mediterranean diet, which has been shown to reduce cardiovascular disease, may have beneficial effects on rheumatic diseases,” Dr. Bridges said. For psoriatic arthritis specifically, it has been shown to decrease chronic inflammation that contributes to heart disease, type 2 diabetes, cancer and other conditions.

Read the full article at theflowspace.com.

6 Essential Tools for Getting Better Sleep if You Have Psoriatic Arthritis

Wed, 02 Jul 2025 16:30:00 -0400

Everyday Health reports that research has found that up to 85 percent of people with psoriatic arthritis experience sleep issues.

That’s partly because the disease causes pain that can wake you up, says Melanie Smith, MD, PhD, rheumatologist at HSS. And the longer you go without getting good sleep, the worse your quality of life may become, since a lack of good sleep may lead to more pain.

“There’s a cycle people get into where they have pain, so they don’t sleep. And then they feel more pain, and they don’t sleep well,” says Dr. Smith.

Read the full article at everydayhealth.com.

HSS Research at EULAR 2025 Congress Shows Routine Test Could Enable Faster, More-Effective Personalized Rheumatoid Arthritis Treatment

Thu, 12 Jun 2025 14:45:00 -0400

Hospital for Special Surgery (HSS) presented new findings at the European Alliance of Associations for Rheumatology (EULAR) Annual Meeting that could help pave the way for more personalized treatment for people with rheumatoid arthritis (RA) by analyzing the cellular composition of synovial fluid inside their joints.

RA is a chronic disease characterized by inflammation in the synovium, the tissue that covers the inner surface of the joint cavity. Although usually accompanied by joint pain, swelling and deterioration, the level of inflammation varies from patient to patient, potentially requiring customized treatment plans. “What is surprising to us is that there are some patients who have clinical remission, yet continue to experience pain and show radiographic progression of the disease with high levels of synovial inflammation, while others have high disease activity with many swollen and tender joints and little inflammation in the synovial tissue” said Susan M. Goodman, MD, rheumatologist at HSS and principal investigator of the study. She explained that even when standard tests suggest the disease is under control, the joint fluid can still show high levels of inflammation. “By analyzing synovial fluid characteristics, we expected it might give us some insight into the disparity between disease progression and apparent remission,” she added.

The team analyzed samples from 64 patients with RA, 90.6% of whom were women, and with a median age of 65.3 ±11.7 years. The physicians collected synovial fluid samples to analyze and compare with the synovial tissue biopsy counterpart, which defines the inflammatory profile of the disease.

Dr. Goodman and the team measured the total white blood cell count, as well as the percentage of neutrophils, lymphocytes and monocytes in each synovial fluid sample. They then compared those findings to two additional key pieces of clinical information: the patient’s disease activity (such as joint swelling, pain, etc.) and the level of inflammation seen in the tissue.

Their analysis revealed that the total white blood cell count in the synovial fluid did not correlate with disease activity, however, the counting of individual cell types gave insights into tissue inflammation. As such, a higher percentage of neutrophils was associated with increased inflammation in the tissue, while a higher percentage of monocytes was associated with lower inflammation in the tissue.

Because the white blood cell counts in synovial fluid provided distinct and different information from standard disease activity measures and correlated well with tissue inflammation, the team believes it could help guide the selection of personalized anti-inflammatory therapies more efficiently.

“Synovial fluid extraction is already a routine part of care, but until now, it has never been used to analyze disease state in this way,” explained Dr. Goodman. In other words, the approach could be adopted without placing additional burden on healthcare providers.

"It's important that we're gaining new methods of investigating patients with RA,” Dr. Goodman added, “since choosing the appropriate therapy and choosing it in an efficient way is clearly the best way to achieve the best outcomes.”

According to Dr. Goodman, the next phase of this study, led by HSS rheumatologists Melanie H. Smith, MD, MPH, and Dana Orange, MD, MS, will look at both the proteomics and genetics of the cells within the fluid with more molecular and immunologic techniques, with the goal of finding even more clinically relevant and important information.

Poster details

Title: Can synovial fluid features be used to predict synovial tissue pathotype?

Authors: Susan M. Goodman, Michael Parides, Solana Cushing, Daniel Ramirez, Edward DiCarlo, Rebecca B. Blank, Laura Donlin, Anna Helena Jonsson, Amit Lakhanpal, Bella Mehta, Dana Orange, Melanie Smith.

Abstract n°: 2057

Presentation: June 12^th, 2025. 2:45 PM CEST

Common Triggers for Psoriatic Arthritis

Wed, 01 May 2024 12:11:00 -0400

Melanie H. Smith, MD, PhD, rheumatologist at HSS shares common triggers for psoriatic arthritis and the importance of proactive treatment and maintaining overall health to mitigate symptoms.

“Lack of sleep may contribute to psoriatic arthritis flares, but we need more research in this area,” said Dr. Smith, adding that the cause and effect may not be a straightforward relationship. “With sleep, maybe it’s not necessarily about being a trigger for psoriatic arthritis, but when we get less sleep, we feel more pain.”

“Another trigger can be changing or discontinuing medication,” explained Dr. Smith. That’s because a different mechanism of action might not work as well—or not work at all if you suddenly stop taking your medication. All of this can lead to worse symptoms, she said.

Dr. Smith added that sometimes you will need to take the lead in shortening the time you are without treatment. “Sometimes it’s about making sure the doctor’s prior authorization is not running out anytime soon or if it is, letting the doctor know,” she explained. “I’m never upset about a patient advocating for themselves.”

Read the full article at healthcentral.com.

Understanding Psoriatic Arthritis Complications

Mon, 29 Apr 2024 14:02:00 -0400

Health Central reports on understanding psoriatic arthritis and it's potential complications according to experts including Melanie H. Smith, MD, PhD, rheumatologist at HSS.

Psoriatic arthritis (PsA) is a type of inflammatory arthritis usually linked with psoriasis. The cause of PsA isn’t yet known, but researchers believe factors such as genetics, gut biodiversity, lifestyle factors (smoking), and the environment may all play a role.

Dr. Smith explained metabolic syndrome (excess abdominal weight, high triglycerides, low HLD, elevated blood sugar and high blood pressure) and cardiovascular disease are the most common complications of PsA that she sees in her practice.

“Psoriatic arthritis is associated with metabolic syndrome and a higher risk of cardiovascular disease,” she explained. The increased risk of cardiovascular disease is due to more than untreated inflammation, Dr. Smith believes. “Something beyond inflammation is going on with psoriatic arthritis and cardiovascular health because cardiovascular issues are more associated with psoriatic arthritis than rheumatoid arthritis—another type of inflammatory arthritis,” she said.

Treating PsA does decrease the risk of cardiovascular disease, Dr. Smith explained. She said that it is also very important to stay on top of your overall health maintenance, making sure that a whole person approach to treatment is happening. “This relationship to cardiovascular disease also speaks to the importance of smoking cessation,” said Dr. Smith.

Read the full article at healthcentral.com.

Can RA Drugs Cause Cancer?

Fri, 12 Apr 2024 09:56:00 -0400

According to Health Central, despite some small increases in cancer risk, the benefits of RA medications largely outweigh any potential downside.

Possible side effects need to be carefully considered before deciding to take any medication, and if your doctor has suggested starting medications to treat rheumatoid arthritis (RA), the same applies. The risks of taking those medications need to be weighed against the risks of not taking them, which in the case of RA could result in uncontrolled inflammation. Then again, you may have read that some RA meds raise your risk of cancer. Confused, concerned, and wondering about your next steps?

Early studies of TNF inhibitors showed a higher risk of cancer but that really hasn’t panned out in the latest studies, says Anne R. Bass, MD. What happened? “When you tease apart the earlier studies, we see that people who received this treatment early on, were most likely the sickest of patients, which meant they also had a lot of cancer risk factors,” Dr. Bass explained.

Overall, the news is good. “Most RA medications are quite safe according to large studies,” said Dr. Bass. “And big studies are needed because cancer is relatively rare so you need to study large numbers of patients over many years,” she explained, adding that patients should feel reassured by these studies.

Read the full article at healthcentral.com.

Castle Connolly Releases 2024 Exceptional Women in Medicine

Tue, 12 Mar 2024 15:34:00 -0400

Castle Connolly announces the release of the 2024 Exceptional Women in Medicine. This list recognizes female Castle Connolly Top Doctors across the U.S. who have demonstrated outstanding leadership, expertise and dedication in their respective fields. There are over 8,300 doctors represented, across 77 different specialties and all 50 states.

The Exceptional Women in Medicine list is compiled through a rigorous selection process that includes peer nominations, extensive research, and evaluation by the Castle Connolly research team. In addition to meeting the criteria to be selected as a Castle Connolly Top Doctor, these physicians have qualifications including contributions to healthcare through volunteer work, awards and honors, training at top institutions, research and academics, and innovations in their field of specialty.

Read the full article at castleconnolly.com.

6 Types of Arthritis That Can Cause Back Pain

Wed, 06 Mar 2024 15:46:54 -0500

SELF.com highlights different types of arthritis that can cause back pain according to experts including Elizabeth Schulman, MD, rheumatologist at HSS.

Throbbing from Axial spondyloarthritis tends to center on your lower back, and it might be worse during the night or when you first wake up because you’ve been lying still in bed for so long, said Dr. Schulman. Important to note: Some primary care docs can mistakenly believe people with nonradiographic axSpA have mechanical back pain. That’s because there’s often no visible damage to your spine with the condition when viewed on an X-ray, Dr. Schulman says, and you have to spot it through an MRI. A lot of the time it takes a rheumatologist trained in treating axSpA to recognize (and accurately test for) it, Dr. Schulman explained.

If you have psoriasis, there’s a roughly 30% chance you’ll also develop psoriatic arthritis (PsA)—and then have a 20% chance of having spinal issues that stem from it, Dr. Schulman said. Because PsA is an inflammatory condition, your immune system kicks into high gear, and your body might mistakenly attack healthy cells and tissues all over your body—and that includes your back.

Read the full article at self.com.

Can Psoriatic Arthritis Affect Your Toes?

Fri, 12 Jan 2024 19:52:00 -0500

Health Central speaks to experts including Elizabeth Schulman, MD, rheumatologist at HSS about how psoriatic arthritis can affect your toes.

Psoriatic arthritis, (PsA) can affect your digits, causing joint aches, swelling, and permanent damage. It often affects distal interphalangeal joints (otherwise known as your toes) and can be really uncomfortable, making walking and mobility in general a challenge.

“Working with your provider to get your disease under control is the first step in managing PsA toe involvement,” explained Dr. Schulman. If you are waiting for a new treatment to work, non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce symptoms, she added.

“Switching to supportive footwear can help with the mechanical stress on the feet,” said Dr. Schulman. Give your toes a little extra breathing room by wearing, at least temporarily, a shoe with a wider toe box (possibly a man’s sneaker sized for a woman, for example). This may reduce further aggravation to the toes, which can compound their already inflamed state.

Read the full article at healthcentral.com.

Keeping a Positive Mindset With Psoriatic Arthritis

Tue, 12 Dec 2023 13:24:00 -0500

Health Central reports on how to keep a positive mindset with psoriatic arthritis with tips from Charis F. Meng, MD, rheumatologist at HSS.

If you’re living with psoriatic arthritis (PsA), you know this autoimmune disease causes issues ranging from back pain to joint tenderness and vision problems. Not to mention skin lesions, which likely came first by way of psoriasis. The condition is similar to rheumatoid arthritis, but without as many resources available to treat and manage it, according to the National Psoriasis Foundation. With so many symptoms wreaking havoc on your body, the challenge of managing PsA is major, but there are strategies to help you find the silver lining.

“In addition to medications, I also review lifestyle strategies with my patients to improve well-being and maintain a positive outlook,” said Dr. Meng. “I tell patients with psoriatic arthritis to stay physically active with some kind of exercise regimen that includes cardio and strength training.” Exercise is a known mood booster, releasing brain chemicals that make you feel good and help you relax. Moreover, “physical activity helps relieve stiffness and improves other conditions that are often associated with PsA,” she explained."

Read the full article at healthcentral.com.

Biggest Myths About Psoriatic Arthritis Treatment

Wed, 06 Dec 2023 09:35:00 -0500

Health Centraal speaks to Charis F. Meng, MD, rheumatologist at HSS about the biggest myths about psoriatic arthritis treatment.

Psoriatic arthritis (PsA) can be notoriously difficult to manage, since you’re essentially battling two diseases (psoriasis and arthritis) at once. On the other hand, there are more treatment options than ever to help you succeed at doing that. Another challenge? All of the different treatment protocols can create confusion—and even some untruths about what works, or doesn’t, in treating PsA.

Feeling better is no excuse for stopping your meds. “Most patients with psoriatic arthritis do best on treatment indefinitely—this is because psoriatic arthritis is a chronic systemic inflammatory condition,” explained Dr. Meng. “Many patients who stop their treatment may experience a disease flare up that puts them at risk for joint damage.” Dr. Meng added that a minority of patients who have their psoriatic arthritis well-controlled for a long time may be able to safely taper their medications under medical supervision.

Read the full article at healthcentral.com.

HSS Presents New Reproductive Health Research at the ACR Convergence 2023

Tue, 14 Nov 2023 12:05:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented a number of important studies focused on reproductive health for patients with systemic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases, including issues related to fertility, sexual function, use of contraception and HPV vaccination.

What follows are some highlights from the meeting:

Association of Menstrual Cycles and Disease Flare Activity in Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
In this study, researchers surveyed female rheumatology patients to determine whether the menstrual cycle affects the timing of disease flares. More than 300 patients responded to the survey, and the analysis reported at the meeting included data from 122 respondents with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) — 49 with SLE and 73 with RA.

Overall, 39% reported an association between their menstrual cycle and disease flares, with similar rates in both the SLE and RA groups. Those who experienced these flares usually had them within the week before or during their periods. The investigators say these findings could inform physician counseling and that closer monitoring of patients during vulnerable phases of the menstrual cycle could enable more timely intervention and better disease control. Additional research is planned to assess whether demographics, lifestyle and medical conditions may influence this potential association.

Authors: Lucy Masto, BS; Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Contraception Choices in Individuals with Inflammatory Arthritis and Lupus-like Disease Differ Based on Diagnosis and Teratogen Use
This study surveyed women of reproductive age with systemic rheumatic disease about their use of contraceptives. Certain drugs prescribed for rheumatic disease are teratogenic, or can damage a fetus. Data were collected on 249 women with reproductive capacity, including 147 with inflammatory arthritis and 102 with lupus-like disorders.

The 52 participants taking teratogenic medication were more likely to discuss contraception with their rheumatologist compared with those not taking teratogenic medication (44.2% vs. 21.8%), and more frequently reported using permanent contraception (8.0% vs. 1.1%). Those taking teratogenic medication were no more likely to use effective contraception than those who were not: 44.0% reported using less effective methods such as barrier methods and fertility awareness/withdrawal or using no contraception. Those with lupus were less likely to use more effective methods containing estrogen (31.5% vs. 14.7%), even though these methods are safe for some (but not all) lupus patients. The findings highlight the importance of using educational interventions to optimize safe and effective contraception use in patients with systemic rheumatic diseases, especially those taking teratogenic medications and those with lupus-like diseases.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS; Lisa A. Mandl, MD, MPH; Michael D. Lockshin, MD; Lisa R. Sammaritano, MD.

Demographic and Clinical Factors Associated with HPV Vaccination in Young Adults with Rheumatic Disease
Although the HPV vaccine is known to be safe and effective in people with rheumatic disease (RD), many do not get vaccinated. This study used data from the electronic health record of patients diagnosed with a rheumatic disease in adolescence, seen at HSS, to look at factors associated with HPV vaccination. Overall, the investigators found that among 321 individuals with rheumatic disease between the ages of 16 and 22, half were not fully vaccinated against HPV (2 or more doses).

Those who were white and non-Hispanic/Latino and those who had commercial insurance were less likely to be fully vaccinated —factors that are associated with lower vaccination rates in the general population. Those who were unvaccinated were more likely to have inflammatory arthritis versus other connective tissue diseases. Those who were fully vaccinated were also more likely to have received flu and COVID-19 vaccines. Further research is needed to identify and mitigate barriers to HPV vaccination in this high-risk group.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Educational Intervention to Increase Contraception Screening and Documentation for Reproductive-Aged Women Seen in an Academic Rheumatology Clinic

Only one-third of reproductive-aged women with rheumatic disease are prescribed effective contraception, despite the widespread use of teratogenic medications which can harm a fetus. This initiative aimed to increase the rate of provider screening and documentation of contraception use in the electronic health record for female rheumatology patients ages 18 to 45.

Interventions from the research team included educational presentations and motivating reminders for clinical staff. Over the 24-week study period, the rate of contraception documentation for these patients increased from 11% to 54%. Future phases of this initiative will focus on encouraging rheumatologists to provide contraceptive counseling and referrals to women’s health providers for patients taking teratogenic medications.

Authors: Caroline H. Siegel, MD, MS, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Erika Abramson (Weill Cornell Medicine), Nancy Pan, MD; Lisa R. Sammaritano, MD.

Experiences and Attitudes Related to Assisted Reproductive Technologies Among Women with Systemic Rheumatic Disease
Because systemic rheumatic diseases may be associated with decreased fertility in women, those with such diseases may pursue assisted reproductive technologies such as oocyte cryopreservation (OOC, or egg freezing). This study evaluated how sociodemographic factors and medical history influence OOC experiences and overall attitudes toward reproductive technologies among women with these conditions.

Among the 265 surveyed patients of reproductive age, 21 had done OOC (most before 35 years of age) and 102 had considered OOC. The factors that increased openness to OOC included having no previous pregnancies, having greater infertility concerns, lacking a spouse or partner, having a bachelor’s degree or higher, and having a history of taking certain immunosuppressive drugs. Among those who did not already have fertility issues, 64% reported that, if necessary, they would consider using these technologies only if their rheumatologist advised it was safe. The investigators say this study highlights the importance of studying the use of assisted reproductive technologies in women with systemic rheumatic diseases, and counseling patients regarding these options.

Authors: Sanjana Adurty (Weill Cornell Medical College), Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

HPV Vaccination in Adolescent and Young Adult Patients Seen in an Academic Rheumatology Center
This study looked at rates of HPV vaccination in adolescents and young adults living in New York State who had received care from a rheumatologist. The investigators reviewed data from the electronic health record, including vaccination information from a New York State database, for 534 HSS patients ages 16 to 22. Less than half of patients had been vaccinated for HPV. The study found that HPV vaccination was more common in people with a rheumatic disease diagnosis compared to those who did not have a rheumatic disease, but not after accounting for demographic variables and receipt of other elective vaccines. Additionally, those who had received flu and COVID-19 vaccines were more likely to have been vaccinated for HPV.

The overall low rate of HPV vaccination was concerning because young people with rheumatic diseases may be at increased risk for HPV infection and HPV-associated cancers due to immune dysregulation, immunosuppression, and gaps in preventive healthcare delivery. The researchers note that interventions are needed to improve HPV vaccination rates in this population and that targeting elective vaccine uptake in general may be a useful approach.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Knowledge and Misconceptions about Contraception Among Individuals with Inflammatory Arthritis and Lupus-like Diseases
This study looked at what patients with systemic rheumatic disease know about the use of contraceptives, comparing the knowledge of women with inflammatory arthritis to those with lupus-like diseases. This analysis included female patients aged 18-49 years who were seen by a rheumatologist at HSS two or more times between 2020 and 2022, excluding those who reported menopause, oophorectomy, hysterectomy, or other causes of infertility.

The participants were surveyed about the effectiveness of various contraceptives and about misconceptions related to specific methods in the context of having a rheumatic disease. The researchers found that despite being highly educated (93.2% held a bachelor’s degree or higher), about half of all patients responded incorrectly to questions about the effectiveness of various contraceptive methods. Those with lupus-like diseases were more likely to report that certain hormone-based methods have contraindications, in response to both accurate and inaccurate statements. The researchers say the results reveal the need for better counseling of patients with systemic rheumatic disease.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD.

Knowledge Related to Fertility and Infertility Treatments Among Women with Systemic Rheumatic Disease
Systemic rheumatic diseases can be associated with decreased fertility, but patients are not always aware of this connection. This study looked at patients’ understanding of these issues, taking into consideration the patient’s race, ethnicity, and socioeconomic status.

In an interim analysis of 142 reproductive-aged women treated at HSS for rheumatic disease who completed the Fertility & Infertility Treatment Knowledge Score (FIT-KS) test, the investigators found that — compared with women in the general population previously administered the FIT-KS — women with rheumatic diseases were more likely to be non-White, Hispanic/Latina and highly educated, and less likely to have had successful pregnancies. This population was more aware of the risks of infertility due to smoking, sexually transmitted infections and being underweight. These women also had a better understanding of success rates for vitro fertilization in older women but were less knowledgeable about the effectiveness of oocyte cryopreservation (OOC, or egg freezing). Future work will focus on highlighting important knowledge gaps among women with these diseases, particularly related to options for fertility preservation.

Authors: Sanjana Adurty (Weill Cornell Medical College); Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

Reproductive History and HPV Vaccination Awareness Among Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
Women with systemic rheumatic diseases, particularly those with systemic lupus erythematosus (SLE), may be more vulnerable to HPV infection and HPV-related cervical cancer, but HPV testing and vaccination rates are low in these patients. This study compared HPV vaccination status and awareness in female patients with SLE to female patients with rheumatoid arthritis (RA).

The analysis included 295 participants with similar demographics; notably, those with SLE were slightly younger than those with RA. Both groups were similarly likely to be sexually active and had similar rates of having regular Pap smears; however, women with lupus were more likely to have persistent abnormal smears (13.3% vs. 1.7%). While not statistically significant, two women with lupus reported a cervical cancer diagnosis compared to none with rheumatoid arthritis. HPV vaccination rates were similar for the two groups, with 37% of 158 women eligible for the vaccine (including those made eligible given extended eligibility approved in 2019 for those aged ≤45 years if clinically appropriate) reporting having received full vaccination. Among the 79 women who had never received the vaccine yet were eligible, 90% reported that it had never been offered. These findings underscore the importance of increasing HPV vaccination rates and discussions about cervical cancer screening in women with SLE and RA.

Authors: Amaya Smole, BA, Lucy Masto, BS, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Self-Reported Sexual Dysfunction and Perceptions of Rheumatologist Engagement on This Issue in Patients with Systemic Sclerosis
This study looked at the prevalence and risk factors of sexual dysfunction among people with systemic sclerosis (SSc). HSS researchers developed the Sexual Function in SSc Questionnaire (SFSScQ) to anonymously survey patients on whether they had problems with their sexual function and, if so, whether they had ever discussed it with their rheumatologist. Participants who completed the SFSScQ were also asked to complete the already-established Female Sexual Function Index or the International Index of Erectile Function Questionnaire.

More than half of those who completed both surveys (26 out of 41) reported that they had sexual problems. The researchers note that while the number of survey participants was small, age, sex, race, SSc subtype and time since SSc diagnosis did not appear to be predictors of sexual dysfunction. Importantly, although about half of participants agreed it was important to discuss problems of sexual function with their doctors, 64% of those who reported sexual problems had not done so.

Authors: Liza Morales, Robert F. Spiera, MD, Jessica K. Gordon, MD, Deanna Jannat-Khah, DrPH, Kimberly S. Lakin, MD, MS.

Study Finds People with Inflammatory Arthritis Face Significant Psychological Challenges in Maintaining Employment

Mon, 13 Nov 2023 12:05:00 -0500

Research from Hospital for Special Surgery (HSS) reveals a significant psychological impact related to inflammatory arthritis patients’ efforts to maintain employment while coping with the challenges of their illness. The study, titled “The Psychological Experience of Work for People with Inflammatory Arthritis (IA),” was presented at the American College of Rheumatology (ACR) Convergence 2023 on November 13 in San Diego.

“A large body of research indicates that people with inflammatory arthritis are at increased risk for work disability, which can profoundly affect their lives. Within 10 years of diagnosis, as many as 40% of those with IA will be unable to work,” said Joan Westreich, MSW, LCSW, social work coordinator, Early Arthritis Initiative at HSS. “While previous studies have described challenges in maintaining employment, they have largely focused on addressing concrete barriers and strategies. To our knowledge, none of these studies has adequately explored the nuanced psychological experience of working while living with the challenges of these diseases.”

Westreich and colleagues set out to explore the psychological experience of people with IA in the workplace. A clinical social work researcher conducted interviews from March 2021 to March 2022 with patients 18 years of age and older who were employed at the time or had worked within the past five years. The interviews, conducted via Zoom, averaged one hour in duration.

Researchers compiled a preliminary analysis of 20 interviews of racially and ethnically diverse participants. Seventy-five percent of respondents were female, with conditions including rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Westreich points to nine themes that emerged related to the impact of IA on employment:

• Challenges to identity and pride. (The vital role of work in sense of identity, pride in achievements, struggle coping with IA and its impact at work.)
• Guilt, shame and ableism. (Guilt, shame and internalized ableism about one’s diminished capacity and its impact at work.)
• Managing perceptions. (Attempts to process and cope with real or imagined perceptions of family and/or colleagues.)
• Grappling with disclosure. (Weighing decisions about whether to disclose condition at work and the potential consequences.)
• Pushing through. (Internal/external pressure to be productive at work, presenteeism, absenteeism.)
• Financial security. (The need to maintain employment to sustain living costs, medical insurance and health care.)
• Mental health impact. (Feelings of stress, anxiety, anger, depression.)
• Personal/professional support. (Support is complex, variable, vital to maintaining work and often inadequate.)
• New perspectives, transformations, meaning-making. (Evolving priorities and values, shift in perspective, prioritizing self-care and turning to spiritual practices and other forms of meaning-making.)

The study findings reveal key psychosocial areas to consider in a comprehensive health assessment of patients with inflammatory arthritis, Westreich said. “With a deeper understanding of patients’ experiences, the healthcare team is better able to provide interventions to meet their needs. Rheumatologists may want to think about collaborating early and often with other disciplines to support patients who wish to maintain healthy employment.”

Theodore R. Fields, MD, FACP, a rheumatologist and clinical director of the Early Arthritis Initiative at HSS, noted that the study also underscores the need for patients with IA to receive education about how to navigate their employment situation. “Patients may be unaware of accommodations that their employer is legally required to make, and some employers may be willing to go beyond the legal requirements to retain a good worker,” he said. “In view of possible accommodations such as more flexible schedules and ergonomic desk setups, the study of work issues can lead to major gains for people with inflammatory arthritis.”

Authors: Joan Westreich, MSW, LCSW (presenting author), Adena Batterman, MSW, LCSW, Anna Balakrishnan, MSW, LMSW, Roberta Horton, LCSW, ACSW, Minerva Nong, BA, Vivian P. Bykerk, BSc, MD, FRCPC, Theodore R. Fields, MD, FACP.

HSS Presents New Research at the ACR Convergence 2023

Sun, 12 Nov 2023 12:05:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedics.

Research highlights include studies that have found an initial high-risk antibody profile for antiphospholipid syndrome (APS) tended to remain high in pediatric patients, a correlation between obesity and more severe disease flare symptoms in patients with early rheumatoid arthritis (RA), people with inflammatory arthritis face challenges in maintaining employment, a link between aging and physical activity, and people with vasculitis frequently suffer from frailty, new research findings in antiphospholipid syndrome (APS) insights on improving communications with diverse patient populations, and and new research on reproductive health.

A High-Risk Antiphospholipid Antibody Profile Matters in Pediatric Patients with Antiphospholipid Syndrome

A new study by HSS investigators including Jheel Pandya, MD, Karen Onel, MD, Doruk Erkan, MD, MPH has found that an initial high-risk antibody profile for APS tended to remain high in pediatric patients.

HSS Research Shows Obesity Is Associated with Worse Flare Symptoms and Quality of Life in People with Early Rheumatoid Arthritis

A recent study from HSS and others has found a correlation between obesity and more severe disease flare symptoms that negatively affect quality of life in patients with early RA, a systemic, autoimmune, inflammatory disorder affecting multiple joints in the body.

Study Finds People with Inflammatory Arthritis Face Significant Psychological Challenges in Maintaining Employment

An HSS study presented by Joan Westreich, MSW, LCSW, social work coordinator, Early Arthritis Initiative at HSS reveals a significant psychological impact related to inflammatory arthritis patients’ efforts to maintain employment while coping with the challenges of their illness.

New Study Shows Perception of Aging is Linked to Level of Physical Activity in Arthritis Patients

People with arthritis who report more negative feelings about how they are aging tend to get less physical activity and perceive themselves as less healthy, according to a new study by researchers at HSS and Weill Cornell Medicine. However, self-perception of good health explained the effect of negative thinking – providing an opportunity for clinicians to focus on a patient’s outlook on aging as well as their overall health.

New Study Identifies Outcomes Associated With Frailty in Patients With Vasculitis

According to a new study from researchers at HSS and colleagues from the University of Pittsburgh and the University of Pennsylvania, people with vasculitis frequently suffer from frailty, a process that can affect our ability to recover after an illness or a fall, which in turn is linked to poor health outcomes.

New Antiphospholipid Syndrome Research Findings Presented at ACR Convergence 2023

Investigators from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) presented new research findings in antiphospholipid syndrome (APS) at the American College of Rheumatology (ACR) Convergence 2023, the ACR’s annual meeting.

HSS Shares Strategies to Enhance and Enable Communication with Language-Diverse Patients at Annual ACR Convergence

Bella Elogoodin, vice president, Service Excellence & Language Access at HSS, shared strategies to enhance and enable communication with language-diverse patients at the American College of Rheumatology (ACR) Convergence 2023 in a session titled, “Lost in Translation: Creating Access Pathways for Language-Diverse Patients in Rheumatic Care Settings.”

HSS Presents New Reproductive Health Research at the ACR Convergence 2023

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented a number of studies focused on reproductive health for patients with systemic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases, including issues related to fertility, sexual function, use of contraception and HPV vaccination.

What Integrated Treatment Looks Like For RA

Wed, 23 Aug 2023 16:35:00 -0400

Health Central discusses complementary steps you can take to help make life with rheumatoid arthritis (RA) even better.

When it comes to managing RA, experts have long agreed that complementary therapies can bring something extra to the table.

First, know that integrative therapies can support conventional prescribed RA treatments, not replace them. The ACR’s guidelines start off by emphasizing that RA should be treated with disease-modifying antirheumatic drugs (DMARDs), which slow joint damage progression by suppressing inflammation. “In a disease like RA where there are very well-proven benefits that result from conventional disease modifying therapy, it is not appropriate to forego medications,” said Susan M. Goodman, M.D., a rheumatologist at HSS.

That old adage about rusting from resting? It seems to be true when it comes to RA. “The strongest recommendation in the ACR’s guidelines is consistent engagement in exercise, because evidence demonstrated that regular exercise improves physical function and decreases pain,” Dr. Goodman says. Aerobic exercise (like walking or bicycling), resistance exercises, aquatic exercise (like swimming), and even mind-body exercise (like yoga or Tai Chi) can all help your joints (and the rest of you) feel good. So find what you enjoy—and what’s comfortable—and make it a point to move most days of the week.

Read the full article at healthcentral.com.

COULD INFLAMMATORY ARTHRITIS FALSELY INDICATE JOINT INFECTION?

Tue, 23 May 2023 16:35:00 -0400

Orthopedics This Week reports that a research team at HSS conducted a study evaluating how inflammatory arthritis could falsely indicate joint infection.

Their resulting work, “Clinical and Histological Features of Prosthetic Joint Infections May Differ in Patients With Inflammatory Arthritis and Osteoarthritis,” appears in the May 2023 edition of HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery.

“There are overlapping clinical and lab features of flares of inflammatory arthritis and prosthetic joint infection including fever and joint swelling and elevated synovial white blood cell counts that make rapid diagnosis and differentiation challenging,” explained Susan M. Goodman, M.D, co-author and rheumatologist at HSS. “We have been studying this to find ways to make a diagnosis more efficiently, as delays in appropriate therapy, including surgical debridement of infections, decrease the success rate.”

When asked if they were at all surprised by the results, Dr. Goodman stated, “No—we have been suspicious that there was overlap in the diagnosis of PJI and flares of inflammatory arthritis, and we have been very interested in improving our ability to discriminate between the two entities. This would enable us to avoid unnecessary surgery when the patient is actually flaring, as well as to make a rapid and accurate diagnosis in infected patients. We need to develop better diagnostic tests to use in this setting.”

Read the full article at ryortho.com.

Dream Big: Namaste Your Way to Better Mobility With Our #ChronicYogi

Sat, 03 Dec 2022 17:19:00 -0500

HealthCentral.com discusses the importance of improving balance and flexibility to help ease joint pain according to experts including Wai-Kwong Hui, PT, DPT, MS, physical therapist at HSS.

“When you sit around too much or do not move around enough, the muscles in your legs, trunk, and even the arms will become weaker and lose some of their flexibility,” explained Hui. That atrophy can make daily activities like climbing stairs or putting groceries away feel like workouts, he added.

Hui continued, ”Plus, in people with inflammatory arthritis, such as ankylosing spondylitis (AS) and rheumatoid arthritis (RA), lack of movement can translate to increased stiffness and pain in whatever joints are affected, be it knees, ankles, hips, feet, shoulders, wrists, hands, or the spine. And when one area is always stiff, it can cause additional tightness and pain elsewhere. Over time, you can also lose mobility and function.

Hui provided the publication with suggested low-impact strength and mobility exercises to improve function that will be featured and released in an article series in the weeks to come.

Read the full article at HealthCentral.com.

Study Examines Total Knee Replacement in Patients Under 21

Sun, 13 Nov 2022 11:00:00 -0500

A new study from researchers at Hospital for Special Surgery (HSS) has evaluated trends in the use of total knee arthroplasty (TKA) in patients under 21 in the United States. The study was reported at the American College of Rheumatology (ACR) Convergence 2022 meeting (abstract number 08780).

According to Cynthia A. Kahlenberg, MD, MPH, an orthopedic surgeon at HSS and a coauthor of the study, TKA is rarely performed in patients under 21 years old but may be done in this population due to conditions such as inflammatory arthritis or juvenile idiopathic arthritis (JIA), malignant or non-malignant tumors, or trauma. However, the number of patients under the age of 21 undergoing TKA in the U.S. is unknown. In one of the largest U.S. studies of an institutional arthroplasty registry, only 19 TKAs were performed in patients under the age of 21 out of approximately 30,000 primary TKAs over 34 years—a majority of which were for JIA.

The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years old in approximately 4,200 hospitals in 46 states. The researchers used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. Descriptive statistics such as means and percentages, along with their 95% confidence intervals (95% CI), were calculated using the appropriate sample weights as recommended by the Agency for Healthcare Research and Quality for use with the KID dataset.

The total weighted number of TKAs performed in patients younger than 21 from 2000-2016 was 1,331; the number of TKAs performed per year in this age group remained relatively stable. The mean age of patients undergoing TKA was 14.8 years (95% CI, 14.4-15.2); 48.8% of the cohort was female. Among tumor patients, a higher proportion identified as Hispanic (22.1%) or other race (12.6%) compared to the non-tumor cohort; 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / JIA decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis / JIA patients. The majority of TKAs were performed in urban teaching hospitals and in facilities with a large bed size, which likely reflects the complexity and rarity of these procedures.

“This was one of the first studies to take an in-depth look at TKA in this very young population,” said Dr. Kahlenberg. “Our study was able to confirm that tumors were the most common reason for knee arthroplasty in this population.”

“I think the biggest takeaway as a rheumatologist is that we are doing a good job treating these patients and over the years the treatments for inflammatory arthritis are really working well in this young population,” said Bella Mehta, MBBS, MS, rheumatologist at HSS and senior study author.

HSS Presents New Research at the ACR Convergence 2022

Sat, 12 Nov 2022 08:17:40 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedic surgery. Additionally, the ACR and the Association of Rheumatology Professionals (ARP) honored two rheumatologists and a social worker with distinguished awards.

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic, a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote.

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

How Often Are Very Young Patients Receiving THA?

Fri, 24 Sep 2021 14:59:00 -0400

Orthopedics This Week reports on HSS study findings published in The Journal of Arthroplasty by senior author Bella Mehta, MBBS, MS, MD, rheumatologist, which evaluated trends in total hip arthroplasty (THA) for patients under 21 years of age.

According to Dr. Mehta, “Over the years, with better disease control and biologics, these cases have gone down. We wanted to know if this was the case nationally in patients < 21 years of age. Also, we wanted to know if more procedures are done in these patients.”

The study found the number of THAs performed in this age group from the Kids’ Inpatient Database increased from 347 in 2000 to 551 in 2016, with the most frequent diagnoses being osteonecrosis, osteoarthritis, and inflammatory arthritis.

“Overall, the number of THAs are increasing even though the patients with inflammatory arthritis have a lower number of surgeries. Likely this is because joint damage even in young patients is recognized and instead of these patients being permanently disabled, we are able to observe and treat them with a THA,” she concluded.

Read the full article at Ryortho.com.

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Brain Fog, Mental Clarity & Arthritis

Tue, 30 Mar 2021 11:02:00 -0400

In this Live Yes! podcast episode, experts including HSS rheumatologist Susan M. Goodman, MD discuss the effects of inflammatory arthritis on mental clarity and ways to deal with “brain fog”.

Dr. Goodman explained how certain arthritis medications can have an effect on mental clarity and “brain fog”, advising patients to be open with their rheumatologist. “I might think it’s the greatest medication on earth. And in fact, by many criteria it might be. But it may not be working for you. You have to have that open relationship,” said Dr. Goodman. She noted, “We don’t have specific treatments for brain fog itself. It’s a matter of eliminating things that may be aggravating it and trying to control the underlying disease.”

Dr. Goodman concluded, “Brain fog is very, very common. Sometimes it melts away when the disease comes under good control. I think it’s worth paying close attention to the simple things – it’s what everybody’s mother told them. Get a good night’s sleep, get plenty of exercise, and eat healthy food.”

Listen to the episode at liveyeswitharthritis.fireside.fm/32.

Your Period, Menstrual Cycle, and Inflammatory Arthritis Flares: What’s the Connection?

Thu, 17 Dec 2020 08:15:00 -0500

CreakyJoints reports the link between menstrual cycles and inflammatory arthritis flares remains scientifically unclear. Experts including HSS rheumatologist Lisa R. Sammaritano, MD, agree that more research is needed and discuss some theories.

Research suggests that variations in hormone levels that occur during the menstrual cycle may influence arthritis disease activity and the severity of symptoms. “It seems likely that hormones may impact disease activity directly, such as by promoting or alleviating inflammation,” said Dr. Sammaritano. They may have a systemic effect on the immune system, as well as within the joint.

Another potential connection between flares in arthritis symptoms and your period is pain perception. When estrogen levels are low, women may report more pain, according to some literature. “It may be that a change in pain threshold contributes to pain and fatigue during the premenstrual phase, in addition to a true increase in inflammation,” explained Dr. Sammaritano.

If a woman suspects their approaching period exacerbates arthritis symptoms, there are ways to ease flares such as nonsteroidal anti-inflammatory drugs (NSAIDs) — such as over-the-counter ibuprofen and naproxen sodium — which can relieve pain and reduce inflammation. If these medications aren’t already being taken regularly for arthritis-related pain, a doctor may suggest adding it to your regimen the week before your period, said Dr. Sammaritano, advising to speak with a health care provider to determine if it is appropriate and safe.

Read the full article at Creakyjoints.org.

Investigators Discover Unique Immune Cells in Patients with Checkpoint Inhibitor-Induced Arthritis

Sun, 08 Nov 2020 12:00:00 -0500

Since doctors began treating cancer patients with immunotherapy drugs called checkpoint inhibitors nearly a decade ago, they have observed that a subset of these patients experience a side effect that clinically looks like inflammatory arthritis. These drugs, which take the natural brake off immune cells called T cells and allow them to attack cancer, can result in T cells also attacking healthy tissues, including the joints.

Now a study from investigators at Hospital for Special Surgery (HSS) and Brigham and Women’s Hospital in Boston has found that the synovial fluid and blood of people experiencing checkpoint inhibitor-induced arthritis is populated by a type of T cells rarely seen in people with other types of inflammatory arthritis. The findings are being presented at the virtual American College of Rheumatology/Association of Rheumatology Professionals annual meeting.

“Although checkpoint inhibitor-induced arthritis looks like other forms of inflammatory arthritis, our findings suggest that they’re not the same,” says study co-author Karmela Kim Chan, MD, a rheumatologist at HSS. “These findings are preliminary, but they are very interesting.”

Checkpoint inhibitor-induced arthritis occurs in about 5% of people taking immunotherapy drugs. The researchers looked at synovial fluid and blood from 10 cancer patients who had experienced this side effect; all of them were being treated with drugs that target the immune checkpoint CTLA-4 and/or PD-1. The team also analyzed blood and synovial fluid from 11 people with rheumatoid arthritis (RA) and nine people with spondyloarthropathies (SpA).

The analysis revealed a unique population of CD38^hiCD127^- CD8 T cells. This designation means that they expressed high levels of a marker called CD38 and did not express a marker called CD127. These T cells were expanded in both the blood and joint fluid of people with checkpoint inhibitor-induced arthritis.

Flow cytometry and RNA sequencing analysis demonstrated these cells to be both cytotoxic and actively proliferating. Furthermore, RNA sequencing suggested that these cells may respond to the immune-related protein interferon, but more research is needed to confirm the significance.

“We don’t yet know if this population of T cells is causing checkpoint inhibitor-induced arthritis or if it’s a common feature of a larger population of people being treated with checkpoint inhibitor drugs,” notes Dr. Chan. “Our next step is study the blood and synovial fluid of more people being treated with these drugs and not limit our analysis only to those who are experiencing these side effects.”

She adds that eventually researchers may be able to develop drugs targeted to the T cells that cause joint inflammation, which could be used to treat this side effect.

Co-authors of this study include HSS rheumatologist Anne R. Bass, MD, and HSS scientist Laura Donlin, PhD.

The Pneumonia Vaccine and Inflammatory Arthritis: What Patients Need to Know

Wed, 30 Sep 2020 10:37:00 -0400

CreakyJoints discusses what patients with inflammatory arthritis should know when getting the pneumonia vaccine, according to experts including HSS rheumatologist Sarah B. Lieber, MD, MS.

Pneumococcal vaccines are designed to reduce the risk of infection from Streptococcus pneumoniae, explained Dr. Lieber. Pneumococcal vaccines are inactivated (non-live) and generally considered safe for people with inflammatory arthritis who are on immunosuppressive medications. “People with inflammatory arthritis such as rheumatoid arthritis have been shown to be able to develop protective antibodies after pneumococcal vaccination,” said Dr. Lieber. “However, since some immunosuppressive medications may be associated with dampened immune response to vaccines, your doctor may consider the timing of pneumococcal vaccination relative to your immunosuppressive regimen to maximize immune response," she added.

Read the full article at Creakyjoints.org.