New American College of Rheumatology initiatives aim to close the gap on racial disparities in lupus clinical trials

James Lind - the father of clinical trials
James Lind – the father of clinical trials

The American College of Rheumatology (ACR) is launching two new initiatives to reduce racial disparities in lupus clinical trials: Training to Increase Minority Enrollment in Lupus Clinical Trials with CommunitEngagement (TIMELY) and new Continuing Medical Education (CME) targeted towards dermatologists and nephrologists.

“Systemic lupus erythematosus, commonly known as lupus, is more common in African American and Hispanic populations. Additionally, these patients manifest more severe symptoms, accrue greater disease related organ damage, and have a higher mortality rate than other racial and ethnic populations,” said Starla H. Blanks, Senior Director of Collaborative Initiatives for the American College of Rheumatology. “However, African American and Hispanic patients are greatly under-represented in lupus clinical trials. The ACR is aiming to change that.”

TIMELY is a two-year, $500,000 grant funded through the U.S. Department of Health and Human Services Office of Minority Health (OMH) that will run through September 2023. The program combines the ACR’s Materials to Increase Minority Involvement in Clinical Trials (MIMICT) model and its Community Health Worker Lupus Clinical Trials Training (LuCTT) model to operate collaboratively with practicing rheumatologists, nephrologists, and dermatologists, and community health workers serving African American and Hispanic patients. The combined intervention will address both provider- and patient-reported barriers to lupus clinical trial participation.

“Lupus patients routinely receive care from multiple specialty care teams, but those teams may face barriers to making clinical trial referrals,” said Blanks. “TIMELY trained providers and community health workers will receive education on addressing both patients and provider reported barriers to clinical trial enrollment and will gain an increased awareness of the mutually beneficial ways health professionals can collectively impact clinical trial literacy, diversity, and enrollment.”

The program will be launched in Raleigh-Durham, NC and Rochester, NY, under the leadership of Dr. Saira Sheikh at the University of North Carolina at Chapel Hill and Dr. Allen Anandarajah at the University of Rochester Medical Center. Dr. Sheikh and Dr. Anandarajah have a track record of success, also leading the ACR’s MIMICT project that was funded by OMH. The ACR aspires to develop an effective model to expand this program to centers throughout the country.

“We define success as a dynamic state influenced by how well we design and deliver information that matches patients’ abilities, needs and preferences”, said Dr. Saira Sheikh. 

“We anticipate that a successful program will help develop a patient-centered approach in lupus clinical trials and bring it to line with aspirations for everyday patient care,” added Dr. Anandarajah.

In addition to TIMELY, new CME content is being developed that is tailored to dermatologists and nephrologists, who are key partners in the care of lupus patients  

“While these providers are not rheumatologists, they may see patients who are exhibiting rheumatic disease symptoms,” said Blanks. “This education will arm them with information they need for diagnosis and treatment.”

“My Disease May Be Invisible, But I’m Not”: Rheumatoid Disease Patients Tell Their Stories

My Disease May Be Invisible, But I’m Not
My Disease May Be Invisible, But I’m Not

The American College of Rheumatology (ACR) and Simple Tasks™ will recognize the fifth annual Rheumatic Disease Awareness Month (RDAM) this September with an awareness campaign that focuses on amplifying patient voices and experiences.

The campaign theme, “My Disease May Be Invisible, But I’m Not,” will spotlight the diverse experiences of individuals who live with chronic and sometimes debilitating rheumatic diseases that affect more than 54 million adults and an estimated 300,000 children in the U.S. In a recent survey, two-thirds of Americans living with rheumatic disease reported their disease sometimes feels invisible because they “don’t look sick” to those around them – a finding that illustrates the continued need to increase awareness and end the stigma surrounding chronic diseases.

“During this September’s awareness month and beyond, we encourage all Americans living with rheumatic disease to share their stories, join our community, and participate in the ACR’s ongoing efforts to enact policies that promote safe, effective, affordable and accessible care and treatments,” said Ellen Gravallese, MD, President of the ACR. “Your voices and perspectives are incredibly important.”  

The month’s activities include a national patient survey, spotlight videos and blog posts from three patient spokespeople, a satellite media tour, and an interactive “Tell Your Story” feature on the Simple Tasks website.

2020 National Patient Survey

Released during Rheumatic Disease Awareness Month, the survey of more than 1,100 Americans living with rheumatic diseases was conducted to gain a better understanding of the quality of life issues associated with these diseases. Notable survey findings include:

  • 68% of respondents reported their disease sometimes feels invisible because they don’t “look sick” to most people.
  • The vast majority — approximately 83% — reported at least one activity limitation as a result of their disease, including the ability to exercise, work and perform physical activities.
  • Out-of-pocket treatment costs more than doubled from 2019. The median annual out-of-pocket treatment cost in 2020 was $1,000 — up from $475 last year.
  • About 66% of patients reported having a telehealth appointment with their rheumatologist within the past year, with COVID-19 reported as the most common reason.

See the complete 2020 survey findings and more information on the survey methodology. 

“Living with an invisible disease is not the end of the road.”

Throughout the month, three patient spokespeople will share their stories and experiences of what it is like to live with an invisible disease.

Georgia State Representative Kim Schofield, of Atlanta, has spent the past 20 years living with lupus and advocating for the lupus patient community. After losing her job because they told her she “didn’t look sick,” Schofield mobilized patient advocates to pass legislation at the state level, in 2014, recognizing lupus as a cause of disability. In 2017, she ran for state office – and won. During her first year in office, Rep. Schofield was able to get appropriations money for lupus research and educate school nurses across the state about lupus.

“Living with an invisible disease is not the end of the road. It is an opportunity for you to explore things in yourself that have not been created or done. It is like rediscovering yourself,” said Rep. Schofield.

An estimated 1.5 million Americans have a form of lupus.

“To me, having an invisible disease is the call to educate the world.”

J. Chandler Woods, of Kingsport, Tennessee, was diagnosed with juvenile idiopathic arthritis when he was 14 years old. When he learned he had arthritis, he was worried he would not be able to continue doing the things he loved, like performing in his high school marching band. Thanks to early diagnosis and access to treatment from a rheumatologist, Woods has been able to manage his symptoms and stay active.

“To me, having an invisible disease is the call to educate the world about what it’s like to live with a disease that may not be identifiable just by looking at somebody,” said Woods.

An estimated 300,000 children in the U.S. live with a form of arthritis.

“Because people can’t always see the signs and symptoms, it’s hard for them to know these are real conditions that impact millions of people.”

Like many with Sjögren’s syndrome, Jill Abbott, of Fargo, North Dakota, experienced fatigue, dry mouth and eyes and joint pain before her diagnosis. Learning to manage a chronic condition while also being a mom is not an easy feat, but Jill has learned that patience and persistence, as well as having healthy habits, are keys to managing her invisible rheumatic disease.

“Because people can’t always see the signs and symptoms of rheumatic diseases, it’s hard for them to know that these are real conditions that impact millions of people,” said Abbott.

An estimated 4 million Americans live with Sjögren’s syndrome.

Along with telling their stories, Schofield, Woods and Abbott will be encouraging others to tell their story to raise awareness during RDAM.

Tell Your Story

The Simple Tasks website will feature opportunities for patients to tell their own stories throughout September. Patients can submit a photovideo or a few of their own words describing their experiences living with an invisible disease, or submit a letter to the editor of their local newspaper discussing this year’s survey findings. Patient submissions will be posted in the “Tell Your Story” gallery at RDAM.org and shared on social media throughout the month using #RDAM.

Hydroxychloroquine Not Linked to Longer Heart Rhythm Intervals in Rheumatoid Arthritis or Lupus Patients

Heart attack

 

New research presented at ACR Convergence, the American College of Rheumatology’s annual meeting, discovers that use of hydroxychloroquine, a generic drug, does not cause any significant differences in QTc length or prolonged QTc, key measures of heart rate, in people with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) (abstract #0431).

Rheumatoid arthritis is the most common type of autoimmune arthritis. It is caused when the immune system (the body’s defense system) is not working properly. RA causes pain and swelling in the wrist and small joints of the hand and feet. SLE is a chronic disease that causes systemic inflammation which affects multiple organs.

Hydroxychloroquine is a cornerstone treatment for SLE, and patients with RA may also take the drug either alone or in combination with other treatments. However, there are concerns about its possible heart-related side effects: the prolongation of QTc, or the time span the heart takes to contract and relax, and the development of arrhythmia (irregular heartbeats). This new study assessed QTc lengths in patients with RA and SLE and its association with hydroxychloroquine use.

Hydroxychloroquine remains the foundation of disease-modifying antirheumatic drug therapy in rheumatic disease patients. Given recent concerns surrounding hydroxychloroquine’s use in COVID-19 patients and subsequent arrhythmic events, we wanted to examine the associations between its use and the QTc length on electrocardiograms in a large, asymptomatic cohort of RA and SLE patients,” says study co-author Elizabeth Park, MD, Rheumatology Fellow at Columbia University Irving Medical Center.

The study analyzed data on 681 RA and SLE patients without clinical cardiovascular disease, including two prospective RA cohorts of 307 patients and a retrospective SLE cohort of 374patients, that included electrocardiogram (EKG) results. The researchers explored the association between QTc length and hydroxychloroquine use by these patients, and they adjusted the data for disease-specific characteristics and cardiovascular disease (CVD) risk factors. Of the whole study group (RA and SLE), 54% used hydroxychloroquine and 44% had QTc lengths of more than 440 milliseconds. They found that the adjusted QTc length among hydroxychloroquine users was comparable to those who did not use the drug.

Their results also showed that hydroxychloroquine use did not significantly predict prolonged QTc for either the whole cohort or the RA and SLE patient cohorts. However, nine out of 11 of the SLE patients who did have a prolonged QTc were taking hydroxychloroquine. Yet these observations were too small to detect statistically significant differences between the hydroxychloroquine groups.

Prolonged QTc, or more than 500 milliseconds, was not associated with arrhythmias or deaths among these patients. The study also did not find any significant interactions between hydroxychloroquine and other QTc-prolonging medications in the patients. Hydroxychloroquine use combined with other QTc-prolonging medications resulted in a comparable QTc interval to hydroxychloroquine alone. In the SLE group, hydroxychloroquine combined with anti-psychotic drugs did result in longer QTc compared to using hydroxychloroquine alone, however.

“Overall, the use of hydroxychloroquine did not predict QTc length, even while adjusting for critical confounding factors, namely the use of other QTc-prolonging medications,” says Dr. Park. “Our findings reinforce the fact that hydroxychloroquine remains a safe, effective long-term disease-modifying drug for our rheumatic disease patients. It’s important to remember that COVID-19 patients who received hydroxychloroquine were likely critically ill. Therefore, the effect of COVID-19 itself on the heart and subsequent arrhythmia must be considered. They also likely concurrently received azithromycin, another QTc-prolonging medication. Our next steps are to stratify data by length and cumulative dose of hydroxychloroquine therapy and analyze the associations with QTc length.”

Physical activity and sleep in adults with rheumatoid arthritis, lupus, and osteoarthritis

A new study published in Arthritis Care & Research has examined patterns of 24-hour physical activity and sleep among patients with rheumatoid arthritis, lupus, and knee osteoarthritis. Image credit: Lynne Feehan

A new study published in Arthritis Care & Research has examined patterns of 24-hour physical activity and sleep among patients with rheumatoid arthritis, lupus, and knee osteoarthritis.

In the 172-participant study, four profiles were apparent with differences characterized by variations in time spent sleeping (High and Low sleepers), non-ambulatory activities (High Sitters), and ambulatory activities (Balanced Activity).

Younger age, not having a job that involved a lot of sitting, and having outside walking as a habit were each associated with Balanced Activity relative to High Sitters.

Considering these profiles may be useful in efforts to help individuals with arthritis modify their activity or sleep behaviors.

“We all live our daily lives over 24 hours, and our study found that people with arthritis are likely to have one of four distinctly different patterns for how they allocate time in sleep and a variety of activities throughout their day,” said lead author Lynne Feehan, PT, PhD, Department of Physical Therapy, University of British Columbia. “This suggests that a one-size-fits-all approach to supporting people with arthritis to modify their daily sleep or physical activity choices may not be appropriate.”

Alison Hoens a patient partner on this study, noted, “As a patient living with rheumatoid arthritis and as a physical therapist, the findings of this study resonate strongly with me. The recognition that patients, even with similar diagnoses, are ‘not all the same’ speaks to the potential of tailoring support from healthcare providers to encourage healthy sleep, rest, and activity that align with a patient’s habits and needs.”

Update on Coronavirus and Rheumatology drugs Dr F Khan Ireland

Image result for youtubeCorona virus and Rheumatology drugs Dr F Khan Ireland

Dr Fahim Khan Consultant Rheumatologist talks about latest update on Corona virus COVID 19 and drugs used to treat Rheumatologic conditions Rheumatoid Arthritis, Psoriatic Arthritis, other inflammatory Arthritis, Lupus and other connective tissue disorders, Polymyalgia Rheumtica, Giant Cell Arteritis etc