dissertation topics in rheumatoid arthritis

VIVO Weill Cornell Medical College

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Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A Synopsis. Academic Article

• Rheumatoid arthritis (RA) is one of the more common autoimmune disorders, affecting approximately 1% of the population worldwide. The exact cause of RA is not known; however, initiation of disease seems to result from an interaction among genetic susceptibility, environmental triggers, and chance. RA is characterized by dysregulated inflammatory processes in the synovium of the joint that eventually leads to the destruction of both cartilaginous and bony elements of the joint, with resulting pain and disability. Systemic inflammation associated with RA is associated with a variety of extra-articular comorbidities, including cardiovascular disease, resulting in increased mortality in patients with RA. RA is also associated with several psychosocial disorders. Classification criteria for RA that were promulgated jointly by the American College of Rheumatology and the European League Against Rheumatism in 2010 emphasize early detection of RA so that effective management can be initiated before pathological changes become irreversible.
• Gibofsky, Allan

publication date

• May 1, 2014

published in

• The American journal of managed care   Journal
• Arthritis, Rheumatoid
• Practice Guidelines as Topic

Scopus Document Identifier

• 84905647565

Additional Document Info

Has global citation frequency.

Rheumatoid arthritis patients' perspective on the use of prediction models in clinical decision-making

Affiliations.

• 1 Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
• 2 Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.
• 3 Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
• PMID: 38547392
• DOI: 10.1093/rheumatology/keae202

Objectives: A rapidly expanding number of prediction models is being developed aiming to improve rheumatoid arthritis (RA) diagnosis and treatment. However, few are actually implemented in clinical practice. This study explores factors influencing the acceptance of prediction models in clinical decision-making by RA patients.

Methods: A qualitative study design was used with thematic analysis of semi-structured interviews. Purposive sampling was applied to capture a complete overview of influencing factors. The interview topic list was based on pilot data.

Results: Data saturation was reached after 12 interviews. Patients were generally positive about the use of prediction models in clinical decision-making. Six key themes were identified from the interviews. First, patients have the need for information on prediction models. Second, factors influencing trust in model-supported treatment are described. Third, patients envision the model to have a supportive role in clinical decision-making. Fourth, patients hope to personally benefit from model-supported treatment in various ways. Fifth, patients are willing to contribute time and effort to contribute to model input. And lastly, we discuss the theme on effects of the relationship with the caregiver in model-supported treatment.

Conclusion: Within this study RA patients were generally positive about the use of prediction models in their treatment given some conditions were met and concerns addressed. The results of this study can be used during the development and implementation in RA care of prediction models in order to enhance patient acceptability.

Keywords: clinical decision support; machine learning; patient perspective; prediction models; qualitative research; rheumatoid arthritis.

© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.

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Why Psoriatic Arthritis May Make You Dizzy (and What to Do About It)

By Amy Norton

Medically reviewed by Petros Efthimiou, MD

There’s nothing quite like vertigo—the sensation that the world is suddenly spinning around you and basically trying to knock you over (and maybe succeeding). It can be a frightening experience and, if you have psoriatic arthritis (PsA), not uncommon.

Elizabeth Madeiros, 27, vividly remembers her first vertigo spell. It hit her in the middle of a busy train station when she was heading home from a long work day—tired and already not feeling great because of a PsA flare. “I remember very specifically, I was looking up at the board with all the train numbers,” Madeiros tells SELF. “And as I moved my head down, that was the first time I got vertigo.”

It’s not completely clear why this happens. However, the autoimmune condition, which tends to strike people who have the skin condition psoriasis , may cause inflammation in the inner ear, and the result can be balance problems that disrupt your equilibrium. The good news is that there are ways of managing these symptoms and feeling more confident as you move around.

Your body’s balancing act

Standing and walking are typically skills you nail so early in life that it’s easy to take them for granted. But your body actually has an elaborate system to keep you steady on your feet, Jennifer Kelly, DPT , the director of vestibular rehabilitation at New York Eye and Ear Infirmary at Mount Sinai, in New York City tells SELF.

It all hinges on your brain integrating a constant stream of signals from three places: your muscles and joints, eyes, and a vestibular (balance) system in your inner ears. These tiny labyrinths of fluid-filled canals and “organs” feed your brain information on your movements and position (as in, are you making a beeline down the street, doing jumping jacks, or standing still?). If any part of this body-brain loop is disturbed—from an injury, disease, or simply aging—that can sometimes create that feeling that you’re about to slide off the planet.

Studies suggest that people with autoimmune conditions like lupus, thyroid disease, multiple sclerosis , and rheumatoid arthritis may be at increased risk of inner ear problems, including vertigo and hearing loss. Less is known about people with PsA, specifically. But in a 2022 research review , Habib Rizk, MD , an associate professor of otolaryngology-head and neck surgery at the Medical University of South Carolina, in Charleston, and colleagues found that 16% of people with psoriasis and/or PsA had test results that indicated problems with their inner-ear balance system, versus less than 1% of other people.

Oftentimes, Kelly says, people use the words “vertigo” and “dizziness” interchangeably. But they’re not the same, she explains, and knowing the difference might help you figure out what’s happening to you. As Madeiros experienced, vertigo is a false sense of motion: You feel like you’re moving when you’re actually still, or it might look like the world is whirling, which can make you feel sick to your stomach. With dizziness , you might feel lightheaded, faint, or unsteady—but without that false sense of movement. It can be a result of dehydration, medications, or a lot of other things.

By Julia Craven

By Maressa Brown

By Ali Finney

Problems in the balance system may cause either sensation as well as other symptoms, per the Vestibular Disorders Association (VeDA), like ringing in the ears, impaired hearing, brain fog, blurry vision, and feeling detached from your surroundings, other people, or even yourself.

As you might suspect, it all adds up to a serious problem. Because it’s hard to move around in the world—especially in places filled with lights, noise, and crowds—you may start to avoid the things that make you feel off-kilter. That could be dangerous (if, say, you’re not looking up at the traffic lights) or keep you from fully enjoying life (like skipping a party because it might be too much sensory stimulation). Luckily for Madeiros, during her scary moment at the station, she was able to navigate to her train and find a seat without falling or getting hurt.

What can you do about it?

As Madeiros puts it, vertigo is not something you can just “deal with” on your own. “Always talk to your doctor, try to get to the bottom of it,” she says. After her train station scare, Madeiros realized that her vertigo might be related to her PsA flares at the time—which were concentrated in her neck and upper back. She says she later confirmed with her doctor that was likely the case. (There is, in fact, a specific form of vertigo, called cervical vertigo , related to neck injury and inflammation.)

Dr. Rizk echoes that advice on pushing for answers. If you have balance-related problems , he advises first talking to your primary PsA doctor. One thing to rule out, he notes, is whether any of your medications could be causing side effects like dizziness.

If there’s no clear-cut explanation for your symptoms, Dr. Rizk says, then you need further evaluation—possibly a referral to an ear-nose-throat (ENT) specialist, who can dig deeper into what is going on.

One option for managing balance problems (including inner ear issues and the aforementioned cervical vertigo) is vestibular rehab —Kelly’s specialty. The goal there is to address the specific glitches in a person’s balance system and create an exercise plan to alleviate them.

As Kelly explains, vestibular rehab exercises generally fall into three buckets:

• Balance training: This improves your steadiness in situations that are literally tripping you up—like walking on uneven ground or in the dark.
• Gaze stabilization: This is about better control of your eye movements if they are contributing to balance problems.
• Habituation: These exercises are for people who get symptoms when they move in certain ways, like bending over or looking up, or when they’re hit with too much visual stimulation, like walking in a brightly lit store or watching an action-packed movie. The goal is to train your brain to ignore faulty signals coming from your inner ear in those situations.

The tough part may be finding a healthcare provider in your area who specializes in balance disorders (for help, VeDA maintains a list .) But if you don’t have access to vestibular rehab, Kelly says that all is not lost: Seeing a physical therapist for general balance training “could help a lot,” she says.

For Madeiros, that initial bout with vertigo took a while to “shake off” because she was in the middle of a pretty bad arthritis flare.

“I just really had to take it slow,” she says. “I had to take my medication on time and make sure I was doing everything I could to get out of that flare and get the inflammation to reduce.”

These days, Madeiros gets vertigo only “very occasionally,” which she thinks might be related to her occasional sinus infections, not PsA. When it’s timed to her PsA flares, she says, it’s when she specifically has symptoms centered around her neck and back.

Her advice to others who find themselves in the same rocky boat is straightforward. “I think the biggest thing is, just being your own advocate when it comes to vertigo—because of how dangerous it can be and how much of an impact it can have on your life,” Madeiros says. “This is not one of those symptoms where you can just put on a brave face and live life with it.”

• 5 Ways to Sleep Better If You Have Psoriatic Arthritis
• What to Know If You Have Psoriatic Arthritis and (Might) Want to Get Pregnant
• 6 People on What Life Is Like With Psoriatic Arthritis

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Investigating the Effects of the Digital App Rheumabuddy4.0 in a Clinical Set-up in Patients With Rheumatoid Arthritis

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Rheumatoid arthritis (RA) is one of the most frequently occurring autoimmune rheumatic diseases, affecting an estimated 1% of the global population (1). RA is a chronic inflammatory disease that leads to the development of synovial inflammation and effusion, ultimately followed by joint destruction and permanent disability.

There is a discrepancy in the understanding of what's of importance when living a life with a chronic disease.

The importance of patients' perspectives concerning disease- and treatment related impacts, is of crucial importance when involving patients in decisions about treatment, and to support the patients in optimal medication-taking behaviour to ensure patient health and reduce health care costs. There are still unmet needs that have a huge impact on quality of life (QoL) such as fatigue, pain, sleep and psychological issues, etc, which need to be taken seriously as these can have severe and debilitating consequences for the individual.

The aim of this study is to investigate and evaluate the effects of the digital app RheumaBuddy4.0 (RB4.0) and the ability to provide support and increase quality of life in patients with RA

Rheumatoid arthritis (RA) incurs a substantial socioeconomic burden which has been supported by the Global Burden of Disease studies. The substantial socioeconomic burden and the challenge of RA patients adhering to treatment is an important factor of this disease and its impact on both patients and society.

An innovative approach is needed in order to find new ways to assist and truly empower patients to understand their disease, increase compliance and thereby increase quality of life.

Many RA patients experience a gap between the health care professionals (HCPs) and the patients regarding the understanding of living a life with a chronic disease - it is more than just blodsamples and swollen/tender joints.This trial addresses a critical, previously not well addressed, question of patient- and clinical importance about the support of using electronically patient reported outcomes (ePROs) ensuring high-quality life living with a chronic disease in patients with RA.

Digital health technology, as adjunct to standard routine care, provides a big opportunity to deliver continuous relevant, timely and cost-effective support to patients including support behavioural changes, improve quality of life and optimize treatment. Many (86%) of patients with RA agree that RA self-management apps can be very helpful, but the lack of high-quality and scientifically validated apps are needed.

The trial will create an evidence base covering the implications of disease- and treatment related concerns as well as non-adherence on quality of life (QoL), patient empowerment, clinical symptoms, and use of medication. Decision and policy makers need a transparent evidence base to substantiate the judgment behind any rational clinical rheumatology practice. The methodology is based on a 'bottom up' approach that hopefully will provide a state-of-the-art model for ensuring patient value in health care settings.

Altogether it is very likely that the use of data collected in RB4.0 will be of significant benefit to both patients with RA and HCPs.

Patient Global Assessment Score. PGA is scored using a visual analogue scale (VAS) range from 0-100 mm. Higher scores represent a higher level of disease activity or a worse global health.

The PGA is one of the most widely reported PROs in RA. The considerable burden of RA on the individual is related to both inflammation and damage but also to broader aspects of disease, including psychological and societal impact. The way PGA is used in clinical practices covers, in fact, two very different concepts, one related to global health and the other to overall disease activity They are both usually used under the heading of PGA without further specification for which is being assessed.

The EQ-5D questionnaire is developed by the EuroQoL (18). The EQ-5D is a five-dimensional health state classification. The five dimensions are mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It is a preference-based measure that can be regarded as a continuous outcome scored on a -0.59 to 1.00 scale, with 1.00 indicating 'full health' and 0 representing dead.

The negative EQ-5D scores represent certain health states valued as worse than dead. Each topic is rated on a 3-point Likert scale: 1) no problems, 2) some problems, and 3) extreme problems. Instructions on how to response is included in the questionnaire. In addition, a VAS scale functions as a 6-question to report on self-reported overall health on a 0-100 scale where 100= best imaginable health and 0=worst health you can imagine. The VAS can be used as a quantitative measure of the patient's own judgement of overall health.

Inclusion Criteria:

An individual must meet all of the following criteria to be enrolled in the study:

• Diagnosed with RA according to the EULAR & American College of Rheumatology
• PGA level >= 40mm
• Age ≥ 18 years and < 75 years
• Motivated for the intervention
• Willing and able to understand and participate in the study
• Ability to use the RB4.0 app

Exclusion Criteria:

An individual will be excluded from the study if she meets any of the following criteria:

• Dementia or other linguistic/cognitive/physical deficiency that prevents participation
• Vision impairment that prevents the use of the devices and computer
• Change in DMARD (within 8 weeks)
• > CDAI 15
• Any comorbid condition, that in the opinion of the investigator would interfere with the conduction of the trial or the interpretation of the study outcome
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Welcome to "Thriving with Arthritis," the podcast that dives deep into the world of arthritis and autoimmune diseases. Hosted by Dr. Diana Girnita, a rheumatologist with over 20 years of research and clinical experience, this podcast is your go-to resource for understanding and managing conditions like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, lupus, Sjogren disease and so much more. Each episode of "Thriving with Arthritis" is packed with valuable insights, actionable strategies, and the latest advancements in lifestyle and treatment options. We explore integrative medicine approaches, including the scientific evidence behind dietary recommendations, mindfulness practices, exercise routines, and sleep strategies to help you thrive despite the challenges of arthritis. Join me as I bring on experts in rheumatology, nutrition, exercise, and mindfulness to share their knowledge and expertise. We'll discuss cutting-edge research, new medications on the market, and the risks and benefits associated with different treatment options. I'll also provide updates on the newest advances in the field of rheumatology as they emerge, ensuring you stay informed and empowered on your journey. You will hear the stories and challenges of real patients.  In addition to discussing treatment options, we'll focus on managing chronic pain, preventing complications, and sharing practical tips for everyday life.  From navigating the healthcare system to connecting with others who understand your journey, "Thriving with Arthritis" covers it all. Whether you're newly diagnosed or have been living with arthritis for years, this podcast is here to support you every step of the way. Tune in to "Thriving with Arthritis" and discover how to live your best life despite the challenges of arthritis.

Thriving with Arthritis Dr. Diana Girnita MD, PhD

• MAR 27, 2024

Why Women Develop More Rheumatoid Arthritis?

Join Dr. Diana Girnita on the 'Thriving with Arthritis' podcast, where she delves into the topic of why women develop more rheumatoid arthritis. Through poignant patient stories like Sarah's, Dr. Girnita elucidates the genetic, hormonal, and lifestyle factors contributing to autoimmune diseases in women.  With a focus on empowerment and resilience, 'Thriving with Arthritis' equips individuals with the knowledge and mindset needed to live life to the fullest despite a diagnosis. Together, we can thrive, not just survive, with arthritis."  Stay tuned for the next episode! What was covered: Explanation of the unique challenges women face with autoimmune diseases like rheumatoid arthritis.Presentation of a case study involving a woman named Sarah who was diagnosed with rheumatoid arthritis.Factors contributing to the increased risk of rheumatoid arthritis in women:   - Genetics, specifically X chromosome and HLA genes.    - Influence of estrogen hormone on inflammation and the immune system.    - Fluctuations in estrogen levels during puberty, pregnancy, and menopause.    - Higher production of inflammatory proteins by the female immune system.    - Impact of chronic stress, anxiety, and depression on inflammation and autoimmune diseases.    - Effects of sleep quality and quantity on inflammation and pain. Recommendations for managing rheumatoid arthritis:Emphasis on taking control of one's health and maintaining a positive mindset.Encouragement for women with rheumatoid arthritis to support each other and thrive together.

• MAR 20, 2024

Uncommon Signs of Rheumatoid Arthritis

Join Dr. Diana Girnita, an experienced rheumatologist dedicated to unraveling the complexities of arthritis and autoimmune diseases. In this episode, Dr. Garnita delves into various facets of rheumatoid arthritis, shedding light on its lesser-known symptoms often overlooked by patients. From distinctive signs like Raynaud's phenomenon and bilateral carpal tunnel syndrome to the profound impacts on multiple organs, Dr. Girnita offers invaluable guidance, empowering you with the knowledge to manage your condition better.  Whether you're newly diagnosed or a seasoned warrior against arthritis, 'Thriving with Arthritis' is your companion on the journey to understanding, managing, and ultimately thriving despite the challenges of autoimmune diseases. Don't let Rheumatoid arthritis go unnoticed. Stay tuned! What was covered: Explanation of rheumatoid arthritis and autoimmune diseases.Common symptoms of rheumatoid arthritis.Uncommon signs and symptoms of rheumatoid arthritis.Importance of consulting a rheumatologist for diagnosis and management.Advice on seeking medical attention for symptoms associated with rheumatoid arthritis.Encouragement to stay informed, seek support, and remain proactive in managing their condition.

• MAR 15, 2024

What is Rheumatoid Arthritis?

Join Dr. Diana Girnita, an experienced rheumatologist, in the "Thriving with Arthritis" podcast as she delves into the world of arthritis and autoimmune diseases. From exploring various types of arthritis to discussing cutting-edge research and offering valuable insights, this podcast is your essential guide. Whether you're new to the condition or a seasoned warrior, Dr. Girnita provides support and knowledge to help you thrive despite the challenges. If you or someone you know is struggling with rheumatoid arthritis or autoimmune diseases, subscribe to the "Thriving with Arthritis" podcast for valuable insights, support, and guidance. Together, let's learn, grow, and thrive in the face of these challenges. Stay tuned for the next episode! What was covered: Introduction to Rheumatoid ArthritisExplanation of different arthritis types: degenerative, inflammatory, autoimmune.Focus on rheumatoid arthritis prevalence in the US.Introduction to patient Georgia's experience.Explanation of rheumatoid arthritis as an autoimmune disease attacking joint tissue.Discussion on symptoms: inflammation, pain, swelling, stiffness, deformities.Exploration of systemic nature and associated complications.Causes and risk factors: genetics, environment, smoking, dental hygiene, obesity, lifestyle.Three key teaching points: autoimmune nature, age/gender impact, and importance of early diagnosis/treatment.Encouragement for continued learning and anticipation for future episodes.

• FEB 28, 2024

Understanding and Conquering Joint Challenges

In this episode of Thriving with Arthritis, Dr. Diana Girnita, a seasoned rheumatologist, explores the intricate world of arthritis. From differentiating types of arthritis to understanding symptoms and seeking the right diagnosis, Dr. Gonita guides you through a journey of knowledge, empowering you to live a better life despite the challenges posed by arthritis. Whether you're grappling with arthritis or seeking knowledge for a loved one, this episode provides valuable insights into the complexities of arthritis. Dr. Gonita's expertise shines through as she encourages listeners to take charge of their journey, armed with information and a resilient spirit. Subscribe, review, and join the thriving community – because together, we can learn, grow, and conquer arthritis. Stay tuned for the next episode, where Dr. Gonita dives deeper into unraveling the mysteries of rheumatoid arthritis. Keep thriving! What was covered: The importance of accurate diagnosis and treatment.Definition of arthritis, covering over 100 types affecting joints and the spine.Different types of arthritis, including osteoarthritis, inflammatory arthritis, and reactive arthritis, are explained.Common symptoms – pain, tenderness, swelling, and stiffness – experienced by arthritis patients.Practical advice on maintaining a symptom diary to aid in proper diagnosis.Distinctions between various types of arthritis, such as gout, rheumatoid arthritis, lupus, and psoriatic arthritis, are clarified.The importance of consulting a rheumatologist for accurate diagnosis and personalized treatment.

Introduction to Thriving with Arthritis: Your Guide with Dr. Diana Girnita MD, PhD

Welcome to the first episode of "Thriving with Arthritis" with the incredible Dr. Diana Girnita MD, PhD. She's not just a seasoned rheumatologist; she's your guide to living a fuller life despite the hurdles of arthritis and autoimmune diseases.  In this episode, Dr. Diana Girnita lays it all out – the staggering impact of arthritis on one in four Americans, the struggle patients face, and the limited time they get with their doctors. But here's the game-changer – Dr. Girnita is not just another voice; she's a compassionate physician with over 20 years of hands-on experience. She's on a mission to share evidence-backed insights, bust myths, and explore real solutions. And get this – she's building a community right here, bringing in experts to join the conversation. It's not just a podcast; it's a support system.  If you enjoy this episode, you don't wanna miss the next one,  where she'll unravel the mysteries of different arthritis types. Subscribe, leave a review, and let's learn, grow, and thrive together on this journey with "Thriving with Arthritis." What was covered: Purpose of the podcast: Empowering listeners to live better with arthritis and autoimmune diseasesFocus on holistic approaches: Food as medicine, mindfulness, exercise, and sleep strategiesTypes of arthritis and autoimmune diseasesThe healthcare system and connecting with a supportive communityReal patient stories and expert insightsStatistics on arthritis prevalence and its significant impactChallenges in accessing rheumatologists and limited time during appointmentsDebunking myths and exploring natural remediesCommitment to providing evidence-based information and creating awareness

• © 2024 Thriving with Arthritis

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RSC Medicinal Chemistry

A new class of 7-deazaguanine agents targeting autoimmune diseases: dramatic reduction of synovial fibroblast il-6 production from human rheumatoid arthritis patients and improved performance against murine experimental autoimmune encephalomyelitis †.

* Corresponding authors

a School of Chemistry, Trinity College, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin, Ireland E-mail: [email protected] , [email protected]

b School of Biochemistry & Immunology, Trinity College, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin, Ireland E-mail: [email protected]

c School of Medicine, Trinity College, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin, Ireland

A simple in vitro assay involving the measurement of IL-6 production in human synovial fibroblasts from rheumatoid arthritis patients has been utilised to select candidates from a targeted library of queuine tRNA ribosyltransferase (QTRT) substrates for subsequent in vivo screening in murine experimental autoimmune encephalomyelitis (EAE – a model of multiple sclerosis). The in vitro activity assay discriminated between poor and excellent 7-deazaguanine QTRT substrates and allowed the identification of several structures which subsequently outperformed the previous lead in EAE. Two molecules were of significant promise: one rigidified analogue of the lead, and another considerably simpler structure incorporating an oxime motif which differs structurally from the lead to a considerable extent. These studies provide data from human cells for the first time and have expanded both the chemical space and current understanding of the structure–activity relationship underpinning the remarkable potential of 7-deazguanines in a Multiple Sclerosis disease model.

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A new class of 7-deazaguanine agents targeting autoimmune diseases: dramatic reduction of synovial fibroblast IL-6 production from human rheumatoid arthritis patients and improved performance against murine experimental autoimmune encephalomyelitis

M. Cotter, S. M. Quinn, U. Fearon, S. Ansboro, T. Rakovic, J. M. Southern, V. P. Kelly and S. J. Connon, RSC Med. Chem. , 2024, Advance Article , DOI: 10.1039/D4MD00028E

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