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Hospital For Special Surgery Physician-Scientists Share Advances In Rheumatology Research

November 7, 2011

Most women with lupus can safely carry out pregnancy

Hospital for Special Surgery physician-scientists who focus on arthritis, lupus, vasculitis and related conditions are traveling from New York City to Chicago this week to share their recent findings at the 75th Annual Scientific Meeting of the American College of Rheumatology (ACR).

Special Surgery investigators will present advances that should influence the future of clinical care. Of the meeting’s highlights, results from the nine-year National Institutes of Health (NIH) funded study led by Jane Salmon, M.D., senior author, rheumatologist and Collette Kean Research Professor at Hospital for Special Surgery, found a favorable prognosis for pregnancy outcomes in women with lupus. The study’s results will be presented on Monday, Nov. 7 and at an ACR press conference on Tuesday, Nov. 8, at 8:30am CT.

“We have demonstrated that with diligent care and counseling, successful pregnancy can be a reality for women faced with lupus,” says Dr. Salmon. “Historically, doctors have cautioned against becoming pregnant, but with the medical insights we have learned from our research, these women have reason for new hope.”

Additional significant topics presented by HSS experts include socioeconomic factors that influence patients’ appointment compliance at a specialized lupus clinic, one-year results following a cardiovascular prevention program in lupus and antiphospholipid syndrome patients, expectations for rheumatoid arthritis patients following total knee replacement, use of anti-TNF medications before patients undergo total knee replacement, and the link between mental health and inflammatory flares in Wegener’s granulomatosis disease.

“The goal for the physicians at Hospital for Special Surgery’s Division of Rheumatology is to better understand disease so that we can better care for patients,” explained Physician-in-Chief Mary K. Crow, M.D. “We hope to take the knowledge we gain at the laboratory bench and apply what we learn to patients who need the most innovative care.”

At the meeting, the ACR will also honor three Hospital for Special Surgery faculty members with prestigious awards: Dr. Laura Robbins, DSW, CSW, MSW, senior vice president of education and academic affairs and scientist at Hospital for Special Surgery, will receive the ACR’s Lifetime Achievement Award. Dr. Theresa Lu, MD, PhD, pediatric rheumatologist at Hospital for Special Surgery, will receive the Henry Kunkel Young Investigator Award, and Physician-in-Chief Emeritus Stephen A. Paget, M.D. will receive the Distinguished Clinician Scholar Award.

The Lifetime Achievement Award being given to Laura Robbins is the highest honor that the Association of Rheumatology Health Professionals (ARHP) bestows, and is presented to an investigator whose career has demonstrated a sustained and lasting contribution to the field of rheumatology. The Henry Kunkel Young Investigator Award is granted to a young physician scientist, age 45 or younger, who has made outstanding and promising independent contributions to basic and clinical research in the field of rheumatology. The Distinguished Clinician Scholar Award is awarded to a rheumatologist who has made outstanding contributions in clinical medicine, clinical scholarship, or education.

“It is remarkable that three Hospital for Special Surgery experts in rheumatologic disease have been honored with ACR Awards,” said Dr. Crow, who is also a past president of the ACR. “Each of these Special Surgery experts has significantly contributed to the field of rheumatology.”

Dr. Robbins, the first ARHP President, focuses on qualitative research as a way to understand the role of culture and ethnicity in rheumatologic patients’ health care experience. Dr. Lu is studying the contribution of blood vessels to the altered immune system function that is responsible for autoimmune diseases, including lupus and scleroderma. Dr. Paget served as the hospital’s physician-in-chief and chair of the Division of Rheumatology from 1995 to 2010, and today continues to advance delivery of outstanding care to patients and superior education of rheumatology trainees through the hospital’s new Rheumatology Education Academy.

Highlights of presentations by Hospital for Special Surgery physician-scientists include:

Most Women with Lupus Can Have Successful Pregnancy Outcomes (1707)

Monday, November 7, 2011: 4:30 PM, W 183 A

ACR Press Conference: Tuesday, November 8 at 8:30AM, Location W 175C

Investigators of the NIH-funded PROMISSE Study (Predictors of pRegnancy Outcome: BioMarkers In antiphospholipid antibody Syndrome and Systemic Lupus Erythematosus) evaluated 333 pregnant women with lupus and found that 80 percent of patients had a favorable pregnancy outcome. The findings provide reassurance for patients with stable lupus, who are contemplating pregnancy, and suggest factors that merit caution for the minority of high-risk lupus patients. “Patients enrolled in this study had inactive lupus at the time of conception and during their first trimester, which we believe explains why a large majority of these women had successful and uncomplicated pregnancies,” explained Jane Salmon, M.D. “Now that our treatments are more effective and we have a better understanding of the disease, we can identify a window when pregnancy is safe and outcomes are good for mother and fetus. Our findings should change the way patients and physicians view pregnancy in women with lupus.”

Life Challenges Prevent Those with Lupus from Keeping Doctors’ Appointments (867)

Sunday, November 6, 2011: 4:30 PM; Room W 194 A

Healthcare providers at the Mary Kirkland Center for Lupus Care observed that many patients failed to keep doctors’ appointments, which can lead to less-favorable outcomes in these lupus patients’ care. Researchers at the Center examined this patient population, largely homogenous with low socioeconomic status, and found that most of these individuals did not attend their appointments because of either tardy or unreliable transportation, such as ambulettes, or because of insufficient childcare. “Healthcare appointment compliance is critical for a lupus patient’s care, because timely communication with their physician keeps both parties up-to-date on prescription and care instructions,” explains senior author. Doruk Erkan, M.D. “By not following up with scheduled appointments, patients may stay on a course of medication that should be changed, which could quickly become dangerous.”

Rheumatoid Arthritis Patients Have Low Expectations After Knee Replacement Surgery (1694)

Monday, November 7, 2011: 5:45 PM; Room W 196 B

Compared with osteoarthritis (OA) patients, individuals with rheumatoid arthritis (RA) who undergo total knee replacement surgery have lower expectations about their postsurgical outcomes. These lower expectations could cause some patients to slack on their postsurgical rehabilitation, leading to worse outcomes. The researchers compared 62 RA patients with 124 OA patients to make their conclusions. “If rheumatoid arthritis patients are healthy enough to have surgery, they should really expect good outcomes. It would be a real shame if these patients could have significantly improved function, but don’t because they expect to be able to do less in their postsurgery therapy,” said Lisa Mandl, M.D., co-author of the study and rheumatologist at Hospital for Special Surgery. “What we can do as doctors is ensure that we educate our patients properly,” said Susan Goodman, M.D., HSS rheumatologist who led the study.

One-Year Results of Cardiovascular Intervention Program in Lupus and Antiphospholipid Antibody (aPL) Positive Patients (1666)

Monday, November 7, 2011: 2:45 PM; Room W 476

Results from the first year of a three-year cardiovascular disease prevention counseling program in lupus patients show that the program’s patients are motivated to better control their cardiovascular health by maintaining healthy diet and exercise regimes. However, while there was a significant improvement in diet and exercise habits, the findings do not show a significant improvement in clinical parameters such as high blood pressure, body-mass index, or cholesterol profile at one-year follow-up. “We’re encouraged that these patients are working hard to improve their cardiovascular health, and it is possible that they will have improved results after the study has reached the end of its third year,” said senior author Doruk Erkan, M.D. “These results demonstrate just how difficult it is for lupus patients to improve their cardiovascular disease risk factors that would be relatively easier to achieve in most other individuals.”

Tweaking Withdrawal of Rheumatoid Arthritis Medications Before Surgery May Reduce Disease Flares (2224)

Tuesday, November 8, 2011: 9:00 AM-6:00 PM; Room: Poster Hall

To minimize infections, doctors stop giving anti-TNF medications before surgery. These medications are powerful immunosuppressants and effectively control disease activity in RA patients. However, it is not known how long anti-TNFs should be held prior to surgery to ensure the best outcomes in patients. Stopping them too early may put these patients at risk for RA flares, which may complicate recovery. This study found no increased risk of infections in RA patients taking anti-TNF medications compared with those not on these medications, and a trend toward more postoperative flares in the anti-TNF patients. Different anti-TNFs were held seemingly arbitrarily, with no correlation to half-life. Rheumatologist Lisa Mandl, M.D., senior author of the study, said more evidence-based studies are needed to determine optimal timing of pre-operative use of these medications.

Stress Triggers Disease Flares in Patients with Vasculitis (2371)

Tuesday, November 8, 2011: 9:00 AM-6:00 PM; Room: Poster Hall

Stress can contribute to disease flares in those with Wegener’s granulomatosis — a form of vasculitis that causes inflammation that destroys blood vessels. This is the first study to show that mental health is a risk factor for patients with vasculitis. “When this disease flares, people are really sick. It affects the lungs, sinuses, kidneys and nerves, and can cause fever and rashes,” said Robert Spiera, M.D., lead author of the study and director of the Vasculitis and Scleroderma Program at Hospital for Special Surgery. Dr. Spiera suggests that doctors be attentive to the psychological health of these patients along with their medical care.

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