By Beth Gilbert HealthDay Reporter
The annual meeting of the American College of Rheumatology was held this year from Nov. 10 to 15 in San Diego, and attendees included rheumatology specialists, physicians, scientists, and other health professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.
In one study, Carol Hitchon, M.D., of the University of Manitoba in Winnipeg, Canada, and colleagues found that a computer-based model can be effective in identifying and predicting joint space narrowing and erosions in hand radiographs of patients with rheumatoid arthritis (RA).
The authors aimed to develop a computer-based model to score joints in hand X-rays of patients with RA for joint erosions and joint space narrowing and to evaluate how this performs compared to standards of care, including the well-validated Sharp/van der heidje (SvH) method. The model was developed using the pediatric bone age dataset and then validated with 54 radiographs from adult RA X-rays. The model successfully detected joints and assigned joint names in pediatric and adult X-rays. A vision transformer model was used to develop a computer-based model to predict SvH scores of the joints detected in the joint detection model. The computer-generated damage scores were validated with radiographs from the Canadian Early Arthritis Cohort. The researchers included more than 2,000 X-rays from 381 patients followed for up to three years (up to five films/person) and found that the computer-based model was able to score erosion and joint space narrowing with very high accuracy and precision.
“We compared our model (based on a vision transformer) with other models recently used for detecting RA joint damage in X-rays. Our model outperformed these other models for scoring hand joints. Although our model performed reasonably well for individual wrist joint damage, it was not as good as the previously studied EfficiencyNet models,” Hitchon said. “When validated and further refined, these models will allow more feasible monitoring (and quantifying) of joint damage in radiographs/X-rays from people with RA and may inform treatment decisions. This will complement, but not replace, expert radiologist interpretation.”
In a matched-cohort study, Sara Tedeschi, M.D., of Brigham and Women’s Hospital in Boston, and colleagues found that the risk for fracture is double among individuals with acute calcium pyrophosphate (CPP) crystal arthritis compared with those without the condition.
The authors evaluated more than 1,100 patients who had at least one episode of acute CPP crystal arthritis between 1991 and 2017. The researchers found that the risk for fracture was nearly twice as high in patients with acute CPP crystal arthritis compared with patients without acute CPP crystal arthritis, after adjusting for traditional risk factors for fracture such as age, sex, race, and glucocorticoids.
“The increased risk for fracture was not surprising, but the magnitude of difference was surprising. Fracture rates differed from the first few months of follow-up onward, suggesting a preexisting difference in bone health between cohorts, such as a shared pathobiology between acute CPP crystal arthritis and low bone mineral density,” Tedeschi said. “We hope that clinicians consider assessing bone mineral density in patients with calcium pyrophosphate deposition to determine if osteoporosis treatment is needed.”
Jinoos Yazdany, M.D., of San Francisco General Hospital, and colleagues developed quality measures for treating systemic lupus erythematosus (SLE) in an effort to help improve health care quality, safety, and outcomes and address long-standing inequities.
This collaborative effort between the U.S. Centers for Disease Control and Prevention and the American College of Rheumatology is addressing health disparities in the management of SLE. Current health care falls short of delivering evidence-based care consistent with quality measures. The initiative has developed quality measures to improve the care and outcomes of patients with SLE. By 2030, the authors hope that all people with SLE will have health care that provides five quality measures consistently, including proper use of hydroxychloroquine, reductions in steroid use, regular screening for SLE, and using patient-reported outcome measures to detect functional status decline and depression.
“If all primary care physicians and other specialists in the United States ensured that people with SLE had these five things, we could have a significant public health impact on the outcomes of this severe disease,” Yazdany said. “The ‘Healthy People with Lupus 2030’ campaign sets goalposts for national implementation of these five measures. We’ve known about health disparities in this disease for decades. Now is the time for action.”
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