Faculty Bibliography

OBJECTIVE:Transparency of disclosure in publication is necessary for readers to be aware of any potential conflicts of interest (PCOIs). Past studies of accuracy of disclosure in rheumatology journals have focused exclusively on clinical practice guidelines and not research works. We assessed discrepancy in reporting PCOIs in clinically oriented manuscripts published in the three top-ranked (by impact factor) US-based general rheumatology journals. METHODS:We reviewed disclosures provided by first, second, and last authors of 50 published clinically oriented articles in each of the three top-ranked general US rheumatology journals. For each author, we extracted payment reports from the Open Payments Database (OPD) related to consulting fees, honoraria, and speaker or faculty compensation. We defined a PCOI as a payment received from a company with an ongoing clinical trial or a medication on the market related to the manuscript's subject matter within the 36 months before the online publication date. We additionally analyzed each author individually to determine whether their reported disclosures matched PCOIs from the OPD. RESULTS:Of 150 articles analyzed, 101 included authors with PCOIs. Ninety-two of these 101 publications (92%) contained inaccurate (non- or under-) disclosures. Among 135 authors with PCOIs, 118 reported inaccurately (87%). All 14 articles that published clinical trial results (and all 23 of their qualifying authors) had disclosure inaccuracies. CONCLUSION/CONCLUSIONS:Inaccurate financial disclosure by authors remains an issue in clinically oriented research studies reported in top rheumatology journals. Improved community education and firmer expectations would permit readers to better assess any possible impact of PCOIs on publications.

Introduction: Inflammatory bowel disease (IBD) has been associated with large-vessel vasculitis (LVV), with the diagnosis of IBD preceding that of LVV by years. We present for the first time in known literature a triad of concurrent ulcerative colitis (UC), aortitis and celiac disease. Case Description/Methods: A 58 year old Hispanic man with a history of hypertension and gout presented with two weeks of intractable temporomandibular headaches, and two months of non-bloody diarrhea and weight loss. Physical exam was unremarkable. Labs showed hemoglobin 6.9 g/dL, erythrocyte sedimentation rate 120 mm/hr, C-reactive protein 281 mg/dL and IgA tissue transglutaminase antibody 23 U/mL. ANA, C3, C4, proteinase-3 and myeloperoxidase antibodies were within normal limits. Colonoscopy showed pancolitis from rectum to ascending colon. The terminal ileum was normal. Abdominal MRI found aortic wall hyperintensity from the renal arteries to common iliac bifurcation. CT angiogram showed wall thickening of the left carotid artery, aortic arch, descending thoracic and abdominal aorta, consistent with vasculitis. Patient was given stress dose steroids with improvement in headache and normalization of ESR and CRP. Temporal artery biopsy was unremarkable. Four months after hospitalization, repeat colonoscopy with duodenal biopsies for celiac disease revealed mild increase in intraepithelial lymphocytes with preserved villous architecture. He was started on a gluten free diet and adalimumab in combination with methotrexate for UC and LVV.
Discussion(s): About 10 case reports of patients with both UC and either Takayasu (TAK) or giant cell arteritis (GCA) have been described, with UC typically diagnosed 15-45 years before the vasculitis. Vasculitis in the GI tract can mimic IBD, making colonoscopy and biopsy crucial for diagnosis. HLA haplotypes A24, B52, and DR2 are associated with both UC and aortitis and Interleukin-9, observed in temporal arteritis lesions, may be implicated in the pathogenesis of UC. Shared chromosomal variants between patients with UC and celiac disease may explain why IBD risk is up to 9-fold higher in patients with celiac disease. Our patient may have presented with isolated aortitis or an early form of GCA. Methotrexate is used to treat LVV and is combined with an anti-TNF agent to treat UC, as in our case. This is the first known report of co-occurring UC, celiac disease and aortitis; however, whether the three inflammatory conditions are mechanistically related warrants further research

LEARNING OBJECTIVE #1: Recognize the presentation of autoimmune disease following recent viral illness, particularly SARS-CoV-2. LEARNING OBJECTIVE #2: Diagnose and manage scleroderma renal crisis. CASE: A 35-year-old G3P1 woman with hypertension and iron deficiency anemia presented with one week of headache, dyspnea and vaginal bleeding after elective first trimester abortion. Physical exam notable for blood pressure of 266/144 mmHg. Creatinine was 5.16 mg/dL, elevated from 0.9 mg/dL one year prior. Hemoglobin was 9.4 g/dL, platelet count 49,000/uL and peripheral blood smear showed moderate schistocytes. Lactate dehydrogenase (LDH) was 1,829 IU/L and haptoglobin was undetectable. Direct antiglobulin test was negative. Patient was positive for SARS-CoV-2 by nasopharyngeal swab. She was started on nicardipine drip for hypertensive emergency. Plasmapheresis exchange therapy was initiated for empiric treatment of thrombotic thrombocytopenic purpura (TTP). Platelet count and LDH improved, although haptoglobin remained low. On hospital day three, ADAMTS13 activity returned as 72 percent, excluding TTP. She developed diffuse facial and anterior chest telangiectasias (Figure 1). Given refractory hypertension, elevated creatinine, and diffuse telangiectasias, scleroderma renal crisis was suspected (1, 2, 3). Notably, patient had no autoimmune disease history. Captopril was initiated and plasmapheresis exchange therapy continued for five days, after which platelet count recovered. Autoimmune work-up demonstrated positive ANA with titer of 1:640, nucleolar pattern on immunofluorescence and positive Sjogren's antibody Anti-SS-A greater than 8 AI. Anti-double-strand DNA antibody and anti-Smith antibody were negative. Repeat creatinine two months after admission was 1.8 mg/dL. IMPACT/DISCUSSION: The temporal nature of hypertensive emergency following SARS-CoV-2 infection implicates SARS-CoV-2 as a causal factor in triggering scleroderma renal crisis. Despite testing positive for SARS-CoV-2 infection during admission, the patient remained asymptomatic throughout her hospital course, without respiratory complaints, fever or anosmia. Infectious diseases have been hypothesized in the pathogenesis of autoimmune conditions. Parvovirus B19 and CMV serve as potential triggers for scleroderma by causing defects in vasculogenesis and bone marrow suppression (4). SARS-CoV-2 disrupts the endothelium, leading to both a pro- coagulative state and increased inflammation (5). It may drive autoimmune syndromes in genetically susceptible individuals, correlating with reports of atypical Kawasaki disease in children with concomitant SARS-CoV-2 infection (6, 7, 8). Perhaps an underlying autoimmune condition such as scleroderma was unmasked in the pro-inflammatory state instigated by our patient's SARSCoV-2 infection.
CONCLUSION(S): It is critical to recognize initial manifestations of autoimmune conditions following acute SARS-CoV-2 infection. Our case emphasizes the need for further research into a link between SARS-CoV-2 infection and autoimmune disease

LEARNING OBJECTIVE #1: Recognize the presentation of spontaneous coronary artery dissection (SCAD). LEARNING OBJECTIVE #2: Recognize amphetamine use as a potential risk factor for SCAD. CASE: A 33-year-old woman with a history of anxiety and ADHD on dextroamphetamine and amphetamine presented with acute onset sharp, substernal chest pain radiating to her left arm and neck since the morning. It felt similar to a "heartburn" episode a month ago. While in EMS, she felt nauseous, vomited, and described a "sensation of doom." She denied any dyspnea, cough, or lightheadedness. She endorsed a remote history of cocaine use and recent stressors at work causing increased anxiety. Her physical exam was unremarkable. EKG showed 0.5-mm STdepression in leads V4-V6, III and aVF with T-wave inversions in leads V1-V3. She received aspirin 325mg, aluminum-magnesium hydroxidesimethicone, and famotidine 20mg. Initial troponin I was 0.11ng/mL. Ddimer, urine drug screen, chest x-ray, and echocardiogram were normal. Repeat troponin 6 hours later was 11.3 and the EKG remained unchanged. Cardiac catheterization revealed a spontaneous coronary artery dissection (SCAD) in her distal left circumflex artery causing a 95% occlusion. No intervention was performed. She was discharged on aspirin and clopidogrel. Dextroamphetamine and amphetamine was discontinued. IMPACT/DISCUSSION: SCAD is a common cause of nonatherosclerotic coronary artery disease in women under age 50, accounting for 24% of myocardial infarctions [1] and recurrence is common. Young women with anxiety or GERD are often assumed to have noncardiac chest pain and may not be considered for coronary catheterization [2]. This may lead to underdiagnosis of SCAD. Pathophysiology of SCAD is not completely understood, but the proposed mechanism is an intimal tear or bleeding of vasa vasorum, causing a false lumen with an intramural hematoma. Early coronary angiography is critical for diagnosis. Risk factors include connective tissue disease, pregnancy, physical and emotional stress. Our patient was not pregnant and did not have a connective tissue disorder. While cocaine is typically associated with SCAD [3,4], her use was remote and urine test was negative. Interestingly, there are a few case reports showing an association between amphetamine use and risk of SCAD [5,6]. The scarcity of data could be due to rarity of the condition as well as under-diagnosis from lack of awareness that amphetamine use is a risk factor for SCAD. Appreciating amphetamine use as a possible risk factor for SCAD may prompt earlier recognition and treatment. Furthermore, heightening awareness among providers may trigger education of patients on the dangers of misusing or overusing amphetamines.
CONCLUSION(S): Patients with SCAD typically do not have risk factors for coronary artery disease; they are young, healthy and predominantly female. It is critical to maintain a high level of suspicion for SCAD in healthy patients who present with cardiac chest pain and to recognize stimulant medication use as a potential risk factor

BACKGROUND & AIMS:Hepatitis B virus (HBV) infection carries substantial stigma in China. We surveyed HBV knowledge and stigma among chronic hepatitis B (CHB) patients and persons without HBV infection in Beijing, China. METHODS:Four hundred and thirty five CHB patients and 801 controls at Peking University People's Hospital were surveyed. RESULTS:Chronic hepatitis B patients were older (mean 46 vs. 39 years) and more often men (71 vs. 48%) than controls. Mean knowledge score was 11.9/15 for CHB and 9.3/15 for control patients (P < 0.001). Average stigma score was 22.1/39 for CHB and 19.2/30 for control patients. Controls expressed discomfort with close contact (45%) or sharing meals with CHB patients (39%) and believed CHB patients should not be allowed to work in restaurants (58%) or childcare (44%). Chronic hepatitis B patients felt that they were undesirable as spouses (33 vs. 17%) and brought trouble to their families (58 vs. 34%) more often than controls. Despite legal prohibitions, 40% of CHB patients were required to undergo pre-employment HBV testing, and 29% of these individuals thought that they lost job opportunities because of their disease status. 16% of CHB patients regretted disclosing their HBV status and disclosure was inversely associated with stigma. Higher stigma was associated with older age, lower education and lower knowledge score among controls; and with lower education, younger age, having undergone pre-employment HBV testing and regret disclosing their HBV status among CHB patients. CONCLUSION:Despite high prevalence of CHB in China, our study shows knowledge is limited and there is significant societal and internalized stigma associated with HBV infection.

Hydrothermal liquefaction of algae biomass is a promising technology for the production of sustainable biofuels, but the non-oil, aqueous co-product of the process has only been examined to a limited extent. The aqueous phase from liquefaction of the alga Nannochloropsis oculata (AqAl) was used to make growth media for model heterotrophic microorganisms Escherichia coli, Pseudomonas putida, and Saccharomyces cerevisiae. Growth rates, yields, and carbon/nitrogen/phosphorus uptake were measured. E. coli and P. putida could grow using AqAl as the sole C, N, and P source in media containing 10 vol.%-40 vol.% AqAl with the best growth occurring at 20 vol.%. S. cerevisiae could grow under these conditions only if the media were supplemented with glucose. The results indicate that in a biorefinery utilizing algae liquefaction, the aqueous co-product may be recycled via microbial cultures with significantly less dilution than previously published methods.