Faculty Bibliography

OBJECTIVE:The relationship between physical activity and sleep with inflammatory arthritis (IA) is understudied, and existing research has relied largely on self-report or short-term assessments. The NIH All of Us database provides long-term accelerometry data, enabling more precise estimation of the association between lifestyle behaviors and IA. METHODS:Participants from the All of Us database who shared electronic health record and Fitbit data were included. Daily activity and sleep metrics were compared between individuals with and without IA using multiple linear regression. Cox proportional hazards regression was used to examine the association of activity and sleep patterns with incident IA in a 10-year follow-up period. RESULTS:A total of 23,855 participants were included, 200 of whom had IA. Participants with IA took fewer daily steps (P < 0.001) and had greater sleep variability (P < 0.001) compared to those without IA. 122 individuals had incident IA. Every 1,000 extra daily steps were associated with a 7% lower risk of IA (hazard ratio [HR] 0.93 [95% confidence interval (CI) 0.87-0.99], P = 0.02). Compared to those who walked <5,000 steps daily, those who walked 5,000 to 10,000 steps and 10,000+ steps had a 41% (HR 0.59 [95% CI 0.39-0.91], P = 0.02) and 50% (HR 0.50 [95% CI 0.29-0.86], P = 0.01) reduction in risk of IA. CONCLUSION/CONCLUSIONS:Individuals with IA had reduced step counts and more sleep variability compared to those without IA, highlighting how physical activity and sleep contribute to IA. Additionally, increased daily step count was associated with decreased risk of incident IA, suggesting a possible research intervention for those at high risk of IA.

Shifting human subjects research from research sites to participants' homes removes barriers to participation. Previously, we developed homeRNA, a kit for stabilization of RNA in self-collected blood using a custom-engineered tube containing RNA stabilizer fluid. The stabilized RNA is extracted and used for downstream gene expression analysis. Here, we introduce homeRNAmax, which improves our original design by interfacing with a commercially available blood collection tube (BD Microtainer), allowing homeRNAmax to be used with any blood collection method that uses this tube and doubling the possible sample volume that can be collected and stabilized compared to the original homeRNA. Through a pilot study (n = 19 participants), we show that homeRNAmax (with the Tasso+ blood collection device) produces RNA samples of sufficient quality (mean RIN = 7.8) and yield (mean yield = 1.93 μg) for downstream analysis and can reach participants across the United States, who generally (n = 17/19) found the homeRNAmax kit easy to use. We also present RNA integrity data from an ongoing longitudinal clinical study using homeRNAmax in rheumatology (mean RIN = 7.1). A key aspect of the homeRNA and homeRNAmax platforms is a fluidic feature that prevents the RNA stabilizer from spilling, for which we developed a theoretical model. In brief, fluid in the tube is suspended due to a balance of pressures; an increase in air volume within the tube reduces the air pressure above the fluid, creating a small vacuum, and preventing fluid leakage. Overall, we show that homeRNAmax is a user-friendly, effective tool for remote blood RNA stabilization.

OBJECTIVES/OBJECTIVE:Obesity is highly prevalent in psoriatic arthritis (PsA) and associates with worse disease outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used for weight loss and diabetes, but their impact on PsA outcomes remains unclear. We aimed to characterize patients with PsA initiating GLP-1RAs and assess longitudinal changes in weight, PsA activity and cardiometabolic parameters. METHODS:We conducted a retrospective analysis of patients with PsA who initiated GLP-1RAs. PsA disease activity data and cardiometabolic parameters from clinical visits within 1 year before and after GLP-1RA initiation along with demographics and comorbidities were collected. RESULTS:48 patients with a median BMI 34.9 were included. Significant weight loss was observed post-treatment (-6.43 kg (95% CI -9.5, -2.0), p< 0.0001), with 60% losing ≥5 % of their baseline bodyweight. CRP levels (-1.1 mg/L, p=0.002), pain scores (-1.0, p=0.01), and triglyceride levels (-0.35 mmol/L, p=0.02) decreased significantly. Each 1% reduction in body weight was associated with significant improvements in DAPSA [β=-0.49 (95% CI: -0.94, -0.03)], tender joint count [β=-0.18 (95% CI: -0.32, -0.05)], EQ-5D [β=0.0016 (95% CI: 0.008, 0.023)], LDL [β=-0.05 (95% CI: -0.10, -0.003)], and systolic blood pressure [β=-0.67 (95% CI: -1.18, -0.15)]. CONCLUSION/CONCLUSIONS:In this real-world study, GLP-1RA therapy in PsA was associated with clinically meaningful weight loss and improvements in systemic inflammation, pain, and cardiometabolic markers. Improvements in psoriatic outcomes were proportional to the degree of weight loss. These findings warrant further investigation in prospective controlled studies to evaluate the role of GLP-1RAs in PsA management and comorbidities.

Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis are types of inflammatory arthritis (IA) characterized by joint pain and stiffness that, despite therapeutic advances, remain difficult to treat. Changes in physical activity (PA) and sleep patterns may provide insights into IA disease course and activity. Wearable accelerometers have been validated as reliable, objective measures of PA and have provided insight into IA disease activity and progression through both PA and sleep metrics. Furthermore, the granular nature of accelerometry data may provide the opportunity to identify early signals of treatment response or disease flares, leading to more effective and personalized therapeutic regimens in patients with IA. In this review, we summarize the current state of wearable technology in IA and explore the potential of wearables to bridge gaps in care.

Obesity constitutes a substantial burden in psoriatic disease that affects approximately half of patients. Importantly, increased adiposity and psoriatic disease are strongly linked, with obesity functioning as both a possible trigger and a disease modifier. Obesity predisposes individuals to develop psoriasis and is likely to drive, at least partially, the progression from psoriasis to psoriatic arthritis. For people with psoriasis or psoriatic arthritis, obesity is associated with lower rates of remission and poorer responses to treatment. Several mechanisms probably underlie this relationship, including systemic and local pro-inflammatory properties of adipose tissue, increased biomechanical stress on joints and entheses, gut dysbiosis and synergistic effects of osteoarthritis. Notably, weight loss can improve both psoriatic disease course and response to therapy; however, current approaches (such as dietary interventions or bariatric surgery) are difficult to implement. Glucagon-like peptide-1-based therapies are an effective strategy for weight loss in psoriatic disease and might even have additive disease-modifying effects to conventional immunomodulators. Although often overlooked, weight loss intervention and obesity management should be included as an integral part of psoriatic disease treatment algorithms.

BACKGROUND/UNASSIGNED:In order to apply current treatment recommendations for psoriatic arthritis (PsA), a complete assessment of psoriatic disease domains must be completed by the clinician. This includes a musculoskeletal examination (including tender and swollen joints, dactylitis, enthesitis, and axial disease) as well as skin and nail examination. Documentation in the clinician's note serves as a proxy for disease assessment. OBJECTIVE/UNASSIGNED:To explore differences in documentation of psoriatic domains between PsA specialist and general rheumatologists at 2 academic centers. METHODS/UNASSIGNED:We identified PsA patients seen by either general rheumatologists or by PsA combined clinic specialist providers at 2 established PPACMAN (Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network) sites. Records were assessed for the presence (and extent) of documentation for musculoskeletal and cutaneous PsA domains. We also examined accuracy of ICD coded diagnoses to understand the extent to which discrete data from the electronic medical record can be used to evaluate completeness of assessment. RESULTS/UNASSIGNED:< 0.001). Additionally, PsA specialists more consistently coded for both psoriasis (PsO) and PsA. CONCLUSIONS/UNASSIGNED:In this multicenter, retrospective study, compared to generalists, PsA combined-clinic specialist providers more thoroughly documented both musculoskeletal and cutaneous psoriatic disease domains and ICD coding of PsO for patients, highlighting gaps in assessment and documentation. These findings underscore the need for improved training in psoriatic disease assessment and simplified modalities for documentation.

OBJECTIVE/UNASSIGNED:To assess the psychosocial impact of axial spondyloarthritis (axSpA). METHODS/UNASSIGNED:A literature search was conducted in two stages: stage 1 included all patients with axSpA and stage 2 focused on patients with inadequate response to prior TNF inhibitor treatment. Selection criteria included population (adults with axSpA), outcomes of interest (psychosocial factors potentially impacted by axSpA, e.g. quality of life, mental health and work productivity) and context [disease-related (disease activity, pain) and -unrelated (gender, race, ethnicity, behaviour) factors potentially affecting psychosocial outcomes). Search results were categorized based on the core domains of disease activity, pain, morning stiffness, fatigue, physical function and overall functioning and health in patients with axSpA. RESULTS/UNASSIGNED:A total of 197 articles were included in this review, most of which were observational, with only one randomized controlled trial (RCT). The evidence suggests an association between greater disease burden and poorer psychosocial outcomes as well as a bidirectional relationship between disease components and psychosocial outcomes, both contributing to the overall disease burden. However, while many studies reported on psychosocial outcomes, potential relationships with disease domains or activity were not evaluated. Furthermore, there were inconsistencies across studies in how these outcomes were measured, such as the use of different tools and/or scales. CONCLUSION/UNASSIGNED:Given the paucity of RCTs examining psychosocial outcomes in axSpA, future research should focus on standardizing assessment of psychosocial impairments experienced by patients and establishing appropriate interventions and management strategies to ensure the holistic treatment of patients with axSpA and to optimize treatment response and outcomes.