Warrenbowling4668

OBJECTIVE Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. Ademetionine order We describe patterns of rheumatology/nephrology care and changes in health care utilization and medication adherence during transfer. METHODS We identified youth ages 15-25 with SLE using US private insurance claims from Optum's de-identified Clinformatics® Data Mart. Rheumatology/nephrology visit patterns were categorized as 1) unilateral transfers to adult care within 12 months, 2) overlapping pediatric and adult visits, 3) lost to follow-up, or 4) continuing pediatric care. We used negative binomial regression and paired t-tests to estimate changes in health care utilization and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPRs between youth who transferred and age-matched peers continuing pediatric care. RESULTS 184 youth transferred out of pediatric care, of which 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to follow-up. We matched 107 youth continuing pediatric care. Overall ambulatory utilization decreased among those lost to follow-up. Acute care utilization decreased across all groups. MPRs after the index date were lower in youth lost to follow-up (mean 0.24) compared to peers in pediatric care (0.57, p less then 0.001). CONCLUSION Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.OBJECTIVE Physical function in axial spondyloarthritis patients (axSpA) is currently evaluated through questionnaires. The Ankylosing Spondylitis Performance Index (ASPI) is a performance-based measure for physical functioning, which has been validated in Dutch patients with radiographic (r-)axSpA. The inter-rater reliability was not yet determined. This study is the first to evaluate the validity, reliability and feasibility of the ASPI in another patient population, including both radiographic- and non-radiographic axSpA patients. METHODS AxSpA patients were recruited from Rheumatology clinics in Santiago, Chile. Dutch instructions were translated to Spanish via a forward-backward procedure. Study visits were performed at baseline and 1-4 weeks later. Four ASPI observers were involved, measuring the performance times of the three ASPI tests. Validity was assessed through a patient questionnaire (NRS 0-10 ≥6 'sufficient'). For reliability, intra class correlation (ICC) coefficients were calculated (with 95% CI). Correlations between the ASPI and disease parameters were tested with regression analyses. RESULTS Sixty-eight patients were included (57% male, 52% r-axSpA). All patients understood the Spanish instructions and considered the ASPI to reach its aim (84%) and representativeness (85%) for physical functioning. The overall inter-rater- (n=62) and test-retest (n=39) reliability (ICC) of the three tests combined were 0.93 (0.88-0.96) and 0.94 (0.87-0.97), respectively. Eighty-two percent of the patients completed all tests and 94% finished less then 15 minutes (feasibility). CONCLUSION This study demonstrated a high validity and feasibility in an entirely different population, with both r- and nr-axSpA. The inter-rater- and test-retest reliability was excellent. The ASPI instructions are now available for Spanish-speaking patients.OBJECTIVE Numerous Patient-Reported Outcome Measures (PROMs) exist for the measurement of physical function for psoriatic arthritis (PsA), but only a few are validated comprehensively. The objective of this project was to prioritize PROMs for measuring physical function for potential incorporation into a standardized Outcome Measurement Set for PsA. METHODS A working group of 13 members including two patient research partners was formed. PROMs measuring physical function in PsA were identified through a systematic literature review and recommendations by the working group. The rationale for inclusion and exclusion from the original list of existing PROMs was thoroughly discussed and two rounds of Delphi exercises were conducted to achieve consensus. RESULTS Twelve PROMs were reviewed and discussed. Six PROMs were prioritized Health Assessment Questionnaire and four modifications (HAQ-Disability Index, HAQ-Spine, modified HAQ, Multidimensional HAQ), Medical Outcome Survey Short Form-36 (SF-36)- physical functioning domain and the PROMIS physical functioning module. CONCLUSION Through discussion and Delphi exercises, we achieved consensus to prioritize six physical function PROMs for PsA. These six PROMs will undergo further appraisal using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1.OBJECTIVE The aim of this study was to determine whether serum urate-associated genetic variants differ in their influence on gout risk in people taking a diuretic compared to those not taking a diuretic. METHODS This research was conducted using the UK Biobank Resource (n=359,876). Ten serum urate-associated single nucleotide polymorphisms (SNPs) were tested for their association with gout according to diuretic use. Gene-diuretic interactions for gout association were tested using a genetic risk score (GRS) and individual SNPs by logistic regression adjusting for relevant confounders. RESULTS After adjustment, use of a loop diuretic was positively associated with prevalent gout (OR 2.34 [2.08-2.63]), but thiazide diuretics were inversely associated with prevalent gout (OR 0.60 [0.55-0.66]). Compared with a lower GRS ( less then mean), a higher GRS (≥ mean) was positively associated with gout in those not on diuretics (OR 2.63 [2.49-2.79]), in those on loop diuretics (OR 2.04 [1.65-2.53]), in those on thiazide diuretics (OR 2.70 [2.26-3.23]), and in those on thiazide-like diuretics (OR 2.11 [1.37-3.25]). No non-additive gene-diuretic interactions were observed. CONCLUSION In people on diuretics, serum urate-associated genetic variants contribute strongly to gout risk, with a similar effect to that observed in those not taking a diuretic. These findings suggest that the contribution of genetic variants is not restricted to people with 'primary' gout and genetic variants can play an important role in gout susceptibility in the presence of other risk factors.