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Tate M. Johnson

Bio: Tate M. Johnson is an academic researcher from University of Nebraska Medical Center. The author has contributed to research in topics: Rheumatoid arthritis & Medicine. The author has an hindex of 3, co-authored 7 publications receiving 45 citations.

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Journal ArticleDOI
TL;DR: This article comprehensively summarizes in a narrative fashion, to the best of the abilities, the characteristics and performance of RA disease activity measures to serve as an updated guide to clinicians and researchers.
Abstract: A treat-to-target management approach remains the standard of care in rheumatoid arthritis (RA) (1). To effectively implement this strategy, regular assessment of RA disease activity is required. Numerous RA disease activity measures have been developed for this purpose, varying widely in their components, calculation, psychometric performance, and feasibility for use. In 2011, Anderson et al (2) summarized the psychometric performance of RA disease activity measures in a single publication to serve as a reference for providers and to inform American College of Rheumatology (ACR) recommendations on RA disease activity measures (3). Since that time, additional disease activity measures have been developed and further evaluation of existing measures has been completed. For this reason, the ACR recently convened a working group to provide an update on recommendations for RA disease activity measures (4). Following an updated systematic literature review and assessment of psychometric performance using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) tools, the working group selected RA disease activity measures that met a minimum criteria for regular use as well as the following preferred disease activity measures recommended for regular use: the Clinical Disease Activity Index (CDAI), Disease Activity Score with 28-joint counts (DAS28), Patient Activity Scale (PAS) II, Routine Assessment of Patient Index Data 3 (RAPID3), and Simplified Disease Activity Index (SDAI). In this article, we comprehensively summarize in a narrative fashion, to the best of our abilities, the characteristics and performance of RA disease activity measures to serve as an updated guide to clinicians and researchers (Table 1). We include all disease activity measures that were selected as preferred by the ACR working group or that fulfilled minimum criteria for regular use (4). Most currently used RA disease activity measures have been derived from the ACR core measures set, which includes swollen and tender joint counts, provider global assessment of disease activity (PrGA) and patient global assessment of disease activity (PtGA), pain, physical function, and acute-phase reactants (5). Because composite indices outperform individual components for the longitudinal assessment of RA disease activity (6,7), we have not detailed the performance of individual ACR core measures. Furthermore, although there is increased use of advanced imaging modalities, such as ultrasound and magnetic resonance imaging, their inclusion was beyond the scope of this review. Included studies were identified by the initial systematic literature review conducted by Anderson et al (2), the recent systematic literature review informing updated ACR recommendations (4), and focused literature searches. Critically assessing the performance of RA disease activity measures is inherently challenging because a gold standard does not exist. Initial disease activity measures developed on the basis of clinician assessment of disease activity that resulted in treatment changes have subsequently served as the standard for validation of newer measures. Comparing composite measures against each other is further complicated by various cutoffs proposed to define disease activity categories, which may influence the degree of agreement between measures. Additionally, there is significant variability in the number and quality of studies, as well as the specific approach used to assess psychometric performance, for each measure. The psychometric properties assessed included floor and ceiling effects, reliability, validity, responsiveness, and generalizability (Table 2). Because studies vary in the reporting of the different types of validity (content, criterion, and construct), we present the definitions used in this review. Content validity included face validity, inclusion of ACR core measures (5), and the degree to which each component of a composite measure contributed to the variance of the measure. We defined criterion validity as how well the scores correlated with other established RA disease

26 citations

Journal ArticleDOI
TL;DR: A systematic review of the MBDA and a meta‐analysis of the correlation between theMBDA and other RA disease activity measures are performed.
Abstract: Objective There are conflicting reports on the validity of the multi-biomarker disease activity (MBDA) score for assessing rheumatoid arthritis (RA) disease activity. Our aim was to perform a systematic review of the MBDA and a meta-analysis of the correlation between the MBDA and other RA disease activity measures. Methods A systematic review was performed by searching Medline, Embase, Scopus, Google Scholar, and the Cochrane Library from inception to March 7, 2017. Study details, MBDA performance, and study quality were assessed by independent reviewers. Correlations of the MBDA with composite RA disease activity measures were pooled using random-effects meta-analyses. Results A total of 22 studies were identified in the systematic review, of which 8 (n = 3,242 assays) reported correlations of the MBDA with RA disease activity measures. Pooling results from these 8 studies in the meta-analysis, the MBDA demonstrated modest correlations with the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP; r = 0.41, 95% confidence interval [95% CI] 0.36-0.46) and the Disease Activity Score using the erythrocyte sedimentation rate (DAS28-ESR; r = 0.48, 95% CI 0.38-0.58), with weaker correlations observed with the Simplified Disease Activity Index (SDAI; r = 0.35, 95% CI 0.26-0.43), Clinical Disease Activity Index (CDAI; r = 0.26, 95% CI 0.19-0.33), and Routine Assessment of Patient Index Data 3 (RAPID3; r = 0.23, 95% CI 0.19-0.27). Correlations between change in MBDA and change in disease activity measures ranged from r = 0.53 for the DAS28-ESR to r = 0.26 for the CDAI. Conclusion The MBDA demonstrates moderate convergent validity with the DAS28-CRP and the DAS28-ESR but weaker correlations with the SDAI, CDAI, and RAPID3. While it appears to complement existing RA disease activity measures, further assessment of the performance characteristics of the MBDA is warranted.

26 citations

Journal ArticleDOI
TL;DR: Preliminary results suggest that live, structured patient interactions in the pre-clinical years of medical education may not only promote the learning of important educational objectives but also foster professional development, empathy, reflection, leadership, agency, and interpersonal skills.
Abstract: Despite a paucity of evidence to support a multitude of educational innovations, curricular leaders are pressured to find innovative solutions to better prepare medical students for an evolving twenty-first century health care system. As part of this effort, this study directly compared student-rated effectiveness scores of six different learning modalities. Study participants included 286 medical students enrolled in the second-year rheumatology core at a single academic medical center between 2013 and 2017. Students were surveyed at the end of the core with a 15-item questionnaire, and student perceived effectiveness of six different learning modalities were compared. The modality that outperformed all others was Live Patient Encounters (LPE), with significantly higher student-rated effectiveness scores when compared to the referent modality of Problem-Based Learning (PBL). Using a 5-point Likert scale with responses ranging from “not effective” to “highly effective,” LPE received a mean effectiveness score of 4.77 followed by Augenblick (4.21), PBL (4.11), Gout Racer video game (3.49), Rheumatology Remedy e-module (3.49), and simulation knee injection (3.09). Technologically advanced novel learning strategies were outperformed in this study by the more traditional active learning modality of LPE. This finding highlights the importance of testing innovative learning strategies at the level of the learner. Three additional conclusions can be drawn from this result. First, conflation of technology with innovation may lead to a myopic view of educational reform. Second, human factors seem to be responsible for the success of LPE and may have far-reaching educational rewards. Third, further applications of LPE should be tested in non-rheumatologic curricula. The relevance of this study is innately tied to the humanities-based application. While a formal qualitative analysis was not performed in this study, preliminary results suggest that live, structured patient interactions in the pre-clinical years of medical education may not only promote the learning of important educational objectives but also foster professional development, empathy, reflection, leadership, agency, and interpersonal skills. This “win-win” scenario (if true) would stand out as a rarity among strategic educational initiatives.

18 citations

Journal ArticleDOI
TL;DR: MTX use in RA was associated with a reduced risk of CVD events, particularly HF-related hospitalisations, suggesting alternative MTX-related mechanisms may modify CVD risk in this population.
Abstract: Objective Examine the association of methotrexate (MTX) use with cardiovascular disease (CVD) in rheumatoid arthritis (RA) using marginal structural models (MSM) and determine if CVD risk is mediated through modification of disease activity. Methods We identified incident CVD events (coronary artery disease (CAD), stroke, heart failure (HF) hospitalisation, CVD death) within a multicentre, prospective cohort of US Veterans with RA. A 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) was collected at regular visits and medication exposures were determined by linking to pharmacy dispensing data. MSMs were used to estimate the treatment effect of MTX on risk of incident CVD, accounting for time-varying confounders between receiving MTX and CVD events. A mediation analysis was performed to estimate the indirect effects of methotrexate on CVD risk through modification of RA disease activity. Results Among 2044 RA patients (90% male, mean age 63.9 years, baseline DAS28-CRP 3.6), there were 378 incident CVD events. Using MSM, MTX use was associated with a 24% reduced risk of composite CVD events (HR 0.76, 95% CI 0.58 to 0.99) including a 57% reduction in HF hospitalisations (HR 0.43, 95% CI 0.24 to 0.77). Individual associations with CAD, stroke and CVD death were not statistically significant. In mediation analyses, there was no evidence of indirect effects of MTX on CVD risk through disease activity modification (HR 1.03, 95% CI 0.80 to 1.32). Conclusions MTX use in RA was associated with a reduced risk of CVD events, particularly HF-related hospitalisations. These associations were not mediated through reductions in RA disease activity, suggesting alternative MTX-related mechanisms may modify CVD risk in this population.

17 citations

Journal ArticleDOI
TL;DR: It is suggested that adipokines effectively predict clinically important outcomes in RA perhaps through an association with body composition and metabolic health.
Abstract: To assess whether circulating levels of adiponectin, leptin, and fibroblast growth factor 21 (FGF‐21) are associated with incident cardiovascular disease (CVD) in rheumatoid arthritis (RA).

6 citations


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Journal ArticleDOI
TL;DR: To provide updated American College of Rheumatology recommendations on rheumatoid arthritis disease activity measurements to facilitate a treat‐to‐target approach in routine clinical care.
Abstract: Objective To provide updated American College of Rheumatology (ACR) recommendations on rheumatoid arthritis (RA) disease activity measurements to facilitate a treat-to-target approach in routine clinical care. Methods A working group conducted a systematic literature review from the time of the prior ACR recommendations literature search. Properties of disease activity measures were abstracted, and study quality was assessed using the Consensus-Based Standards for the selection of Health Measurement Instruments 4-point scoring method, allowing for overall level of evidence assessment. Measures that fulfilled a minimum standard were identified, and through a modified Delphi process preferred measures were selected for regular use in most clinic settings. Results The search identified 5,199 articles, of which 110 were included in the review. This search identified 46 RA disease activity measures that contained patient, provider, laboratory, and/or imaging data. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 11 measures fulfilled a minimum standard for regular use in most clinic settings, and 5 measures were recommended: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II. Conclusion We have updated prior ACR recommendations for preferred RA disease activity measures, identifying 11 measures that met a minimum standard for regular use and 5 measures that were preferred for regular use in most clinic settings.

131 citations

Journal ArticleDOI
TL;DR: In this paper, the authors developed evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA).
Abstract: Objective: To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). Methods: A EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies, D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree, 10 completely agree) of the PtCs were determined by the Task Force members. Results: Two overarching principles and eleven PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and nonpharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). Conclusions: These points to consider for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.

55 citations

Journal ArticleDOI
TL;DR: The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.
Abstract: Background: Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective: The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions: Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases. [JMIR Mhealth Uhealth 2018;6(1):e1]

39 citations

Journal ArticleDOI
TL;DR: This article comprehensively summarizes in a narrative fashion, to the best of the abilities, the characteristics and performance of RA disease activity measures to serve as an updated guide to clinicians and researchers.
Abstract: A treat-to-target management approach remains the standard of care in rheumatoid arthritis (RA) (1). To effectively implement this strategy, regular assessment of RA disease activity is required. Numerous RA disease activity measures have been developed for this purpose, varying widely in their components, calculation, psychometric performance, and feasibility for use. In 2011, Anderson et al (2) summarized the psychometric performance of RA disease activity measures in a single publication to serve as a reference for providers and to inform American College of Rheumatology (ACR) recommendations on RA disease activity measures (3). Since that time, additional disease activity measures have been developed and further evaluation of existing measures has been completed. For this reason, the ACR recently convened a working group to provide an update on recommendations for RA disease activity measures (4). Following an updated systematic literature review and assessment of psychometric performance using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) tools, the working group selected RA disease activity measures that met a minimum criteria for regular use as well as the following preferred disease activity measures recommended for regular use: the Clinical Disease Activity Index (CDAI), Disease Activity Score with 28-joint counts (DAS28), Patient Activity Scale (PAS) II, Routine Assessment of Patient Index Data 3 (RAPID3), and Simplified Disease Activity Index (SDAI). In this article, we comprehensively summarize in a narrative fashion, to the best of our abilities, the characteristics and performance of RA disease activity measures to serve as an updated guide to clinicians and researchers (Table 1). We include all disease activity measures that were selected as preferred by the ACR working group or that fulfilled minimum criteria for regular use (4). Most currently used RA disease activity measures have been derived from the ACR core measures set, which includes swollen and tender joint counts, provider global assessment of disease activity (PrGA) and patient global assessment of disease activity (PtGA), pain, physical function, and acute-phase reactants (5). Because composite indices outperform individual components for the longitudinal assessment of RA disease activity (6,7), we have not detailed the performance of individual ACR core measures. Furthermore, although there is increased use of advanced imaging modalities, such as ultrasound and magnetic resonance imaging, their inclusion was beyond the scope of this review. Included studies were identified by the initial systematic literature review conducted by Anderson et al (2), the recent systematic literature review informing updated ACR recommendations (4), and focused literature searches. Critically assessing the performance of RA disease activity measures is inherently challenging because a gold standard does not exist. Initial disease activity measures developed on the basis of clinician assessment of disease activity that resulted in treatment changes have subsequently served as the standard for validation of newer measures. Comparing composite measures against each other is further complicated by various cutoffs proposed to define disease activity categories, which may influence the degree of agreement between measures. Additionally, there is significant variability in the number and quality of studies, as well as the specific approach used to assess psychometric performance, for each measure. The psychometric properties assessed included floor and ceiling effects, reliability, validity, responsiveness, and generalizability (Table 2). Because studies vary in the reporting of the different types of validity (content, criterion, and construct), we present the definitions used in this review. Content validity included face validity, inclusion of ACR core measures (5), and the degree to which each component of a composite measure contributed to the variance of the measure. We defined criterion validity as how well the scores correlated with other established RA disease

26 citations