Artificial intelligence, osteoporosis and fragility fractures
Purpose of review
Artificial intelligence tools have found new applications in medical diagnosis. These tools have the potential to capture underlying trends and patterns, otherwise impossible with previous modeling capabilities. Machine learning and deep learning models have found a role in osteoporosis, both to model the risk of fragility fracture, and to help with the identification and segmentation of images.
Recent findings
Here we survey the latest research in the artificial intelligence application to the prediction of osteoporosis that has been published between January 2017 and March 2019. Around half of the ...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research
Application of machine learning in the diagnosis of axial spondyloarthritis
Purpose of review
In this review article, we describe the development and application of machine-learning models in the field of rheumatology to improve the detection and diagnosis rates of underdiagnosed rheumatologic conditions, such as ankylosing spondylitis and axial spondyloarthritis (axSpA).
Recent findings
In an attempt to aid in the earlier diagnosis of axSpA, we developed machine-learning models to predict a diagnosis of ankylosing spondylitis and axSpA using administrative claims and electronic medical record data. Machine-learning algorithms based on medical claims data predicted the diagnosis of ankylosing...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
The promise and perils of ‘Big Data’: focus on spondyloarthritis
Purpose of review
This review will describe the available large-scale data sources to study spondyloarthritis (SpA), enumerate approaches to identify SpA and its disease-related manifestations and outcomes, and will outline existing and future methods to collect novel data types [e.g. patient-reported outcomes (PRO), passive data from wearables and biosensors].
Recent findings
In addition to traditional clinic visit-based SpA registries, newer data sources, such as health plan claims data, single and multispecialty electronic health record (EHR) based registries, patient registries and linkages between data sources, h...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
The use of biologics for uveitis associated with spondyloarthritis
Purpose of review
The term spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease, juvenile SpA and undifferentiated SpA. These diseases can also present with uveitis, or intraocular inflammation, which can be controlled with biologics.
Recent findings
Profound success has occurred with the tumor necrosis factor-α inhibitors infliximab and adalimumab, moderate success with certolizumab pegol and golimumab and less encouraging results with etanercept. Promising results have also b...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
Treat-to-target in axial spondyloarthritis: gold standard or fools’ gold?
Purpose of review
Treat-to-target (T2T) is an emerging management strategy in axial spondyloarthritis (axSpA). The concept was originally based on evidence from other chronic conditions, such as hypertension, diabetes and hypothyroidism, as well as some rheumatic diseases, such as rheumatoid arthritis and gout. The purpose of this review is to discuss the arguments against and in favour of adopting a T2T strategy in the management of axSpA.
Recent findings
International groups have recommended a T2T strategy in axSpA. Inactive disease according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) has been sugg...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
Mimics of axial spondyloarthritis
We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a ‘positive MRI’ as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial proportion o...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
Psoriatic spondylitis or ankylosing spondylitis with psoriasis: same or different?
Purpose of review
Of the four musculoskeletal domains of psoriatic arthritis (PsA), the axial domain is the least studied. With the advent of targeted therapy that is efficacious in some but not all manifestations of spondyloarthritis (SpA), there is interest in understanding the similarities and differences between axial PsA (axPsA) and ankylosing spondylitis. Moreover, there is also interest in evaluating the axial domain in PsA clinical trials, domain that has traditionally been ignored in such studies. This review aims to summarize the current understanding of the differences between ankylosing spondylitis and axPsA....
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
Harnessing the power of social media: how can it help in axial spondyloarthritis research?
This article discusses four areas in the biomedical field that social media has infused with novel ideas: (i) the use of patient-generated health data from social media to learn about their disease experience, (ii) delivering health education and interventions, (iii) recruiting study participants, and (iv) reform, transfer, and disseminate medical education. We conclude with promising studies in rheumatology that have incorporated social media and suggestions for future directions.
Summary
Rheumatologists now have the opportunity to use social media and innovate on many aspects of their practice. We propose further expl...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Changing rates in fracture trends are temporally associated with declining testing and treatment: reality or ecologic fallacy?
Purpose of review
The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a ‘crisis in the osteoporosis.’ We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data.
Recent findings
Declines in hip fracture rates have been shown in studies from around the world. However, recently, using national Medicare data, Michael Lewiecki and colleagues show a plateau in the decline of hip fracture incidence in the United States from 2012 to 2015. Population-based data is integral for evaluating temporal trends; how...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: SPECIAL COMMENTARIES Source Type: research
Pathogenesis and treatment of autoimmune rheumatic diseases
Purpose of review
Autoimmune diseases are of unknown origin, and they represent significant causes of morbidity and mortality. Here, we review new developments in the understanding of their pathogenesis that have led to development of well tolerated and effective treatments.
Recent findings
In addition to the long-recognized genetic impact of the HLA locus, interferon regulatory factors, PTPN22, STAT4, and NOX have been implicated in pathogenesis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Smoking, ultraviolet light, diet, and microbiota exert strong environmental influence on development of R...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: SPECIAL COMMENTARIES Source Type: research
Perioperative management of immunosuppression in patients with rheumatoid arthritis
Purpose of review
Patients with rheumatoid arthritis are at increased risk of infection after surgery. Recent literature has provided more data and updated guidelines to guide the management of immunosuppression in the perioperative period.
Recent findings
Studies over the past few years have confirmed that patients with rheumatoid arthritis are at increased risk of infection after surgery. Patients treated with biologics are at greater risk of postoperative infection, but this risk might be explained by the comorbidities and greater disease severity often seen in these patients. Recent observational studies have sugg...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research
Arthritis risk with immune checkpoint inhibitor therapy for cancer
Purpose of review
This review summarizes the current evidence on inflammatory arthritis following cancer treatment with immune checkpoint inhibitors (ICI), and the effects of these therapies in patients with preexisting autoimmune arthritis.
Recent findings
As the use of ICI for cancer therapy continues to expand, a myriad of immune-related adverse events (irAE) caused by these therapies are being recognized. Arthritis has been increasingly reported as a de novo irAE, presenting sometimes as a well defined disorder, such as rheumatoid arthritis or psoriatic arthritis, and in other occasions as undifferentiated monoart...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research
Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?
Purpose of review
There are currently several available biologics for rheumatoid arthritis (RA) with similar efficacy in most trials. A major consideration therefore in choosing a biologic, continues to be safety concerns such as infection. Considerable advances have been made in the understanding of biologic safety on a population level; however, how close are we to stratifying risk for individual patients? This review discusses evidence published in the last year, with reference to key previous literature.
Recent findings
Comparative safety of biologics has been studied in observational cohorts, with a possible incr...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research
Depression and the risk of rheumatoid arthritis
Purpose of review
Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression.
Recent findings
Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with R...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research
