ACR Journals on Air Podcast

Caring for older adults who suffer from rheumatic disease comes with it the need to manage multimorbidity, polypharmacy, and geriatric syndromes. Often, shifting priorities for those suffering with rheumatic musculoskeletal diseases (RMDs) is needed, sometimes leading to a prescribing cascade. The practice of ‘deprescribing’, an approach to optimize medication use to deliver a more ‘goal-concordant’ type of care was the focus of Dr. Una Makris and Dr. Jiha Lee’s latest research, Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More. When caring for older adults with RMDs, it very well may be that less is more.

Una Makris, MD, MSc - Una Makris, MD, MSc, is an Associate Professor of Internal Medicine in the Division of Rheumatic Diseases at UT Southwestern Medical Center and a clinical investigator at the VA North Texas Health Care System. As a clinically trained rheumatologist, with a research focus on aging, she is well positioned to investigate important questions that bridge the fields of rheumatology and geriatrics. Dr. Makris’ research (funded by VA HSR&D, NIA, RRF) focuses on developing innovative behavioral interventions for older adults with comorbid musculoskeletal pain and depression. As a health services researcher, her goal is to ultimately improve outcomes in this medically complex older population by developing safe, effective, and accessible interventions that shift the focus from pharmacological therapies to behavioral (physical activity) interventions.

 

Jiha Lee, MD, MS - Jiha Lee, MD, MS, is an Assistant Professor in the Division of Rheumatology in the Department of Internal Medicine at the University of Michigan (U-M) Ann Arbor. She completed her rheumatology fellowship and earned a Master of Health Sciences degree at Yale University. Dr. Lee’s long-term goal is to optimize safe and effective use of disease modifying antirheumatic drug use in older adults with RA. Since joining the faculty at U-M in 2017, she gained additional training in aging-related health services research as a Research Education Core scholar of the U-M Claude D. Pepper Older American Independence Center. Dr. Lee is funded by the National Institute of Aging (NIH/NIA) and is a GEMSSTAR awardee which is intended for specialty trained early career physician scientist to transition to aging research. Her research focuses on understanding suboptimal DMARD use in older adults with new diagnosis of late-onset RA, and for those who achieved disease remission, to evaluate de-escalation of biologics in older adults with RA. For the latter work, she was selected into the US Deprescribing Network Junior Intensive Program and has been collaborating with researchers across multiple disciplines.

Related Links:

• Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More

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In a study recently published in ACR Open Rheumatology, Geographic Variation in Disease Burden and Mismatch in Care of Patients With Rheumatoid Arthritis in the United States, first author Sharon Dowell, MD, set out to understand some of the factors associated with regional variation of rheumatoid arthritis (RA) in the United States. Dr. Dowell presents her study’s findings and conclusions. Tracy Johansson, MS, member of the RISE registry team, joins us to discuss how RISE attempts to close these gaps. Together, both of our guests help us to understand how geographic location contributes to a disproportionate level of care for those with RA and what we can do about it.

Sharon Dowell, MD - Sharon Dowell, MD, is a graduate of the University of the West Indies. She completed her internal medicine residency at the University of Connecticut and her Rheumatology Fellowship at the University of Maryland. She is now an Associate Professor of Medicine at Howard University in Washington, DC, fulfilling the tripartite mission of medical education, research, and clinical care.

 

Tracy Johansson, MS - Tracy Johansson, MS, has been a member of the ACR’s RISE registry team since March 2016. She was introduced to the field of rheumatology through her previous work with the Rheumatology Research Foundation. Tracy oversees management of the ACR’s suite of rheumatology quality measures and their implementation in RISE, engagement with current and future RISE practices, and the use of RISE data for research. Tracy is an avid sports fan and enjoys reading (more often, listening to) sci-fi/fantasy books.

Related Links:

• Geographic Variation in Disease Burden and Mismatch in Care of Patients With Rheumatoid Arthritis in the United States

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Pulmonary hypertension (PH), being a serious complication of systemic sclerosis (SSc), develops late in the course of SSc and carries with it a poor prognosis. With the median survival of about 3 years, new evidence suggests that early diagnosis and treatment can significantly improve survival. Joining us this week is Christopher P. Denton, PhD, FRCP, senior author of Dynamic Prediction of Pulmonary Hypertension in Systemic Sclerosis Using Landmark Analysis, published in Arthritis & Rheumatology. Dr. Denton’s latest study explores the prediction of short-term risk for PH using serial pulmonary function tests (PFTs).

Christopher P. Denton, PhD, FRCP - Joshua Baker, MD, MSCE, is an Associate Professor of Rheumatology and Epidemiology at the University of Pennsylvania and at the Corporal Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia. Primarily through the support of VA Awards, Dr. Baker has focused on identifying modifiable risk factors with the goal of improving clinical care of chronic forms of arthritis, particularly rheumatoid arthritis and osteoarthritis. Dr. Baker’s approach includes observational and interventional studies, focusing on skeletal muscle, health, obesity, cardiovascular disease, bone and joint health, and their associated long-term outcomes in patients with common forms of arthritis.

Related Links:

• Dynamic Prediction of Pulmonary Hypertension in Systemic Sclerosis Using Landmark Analysis

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In this episode, we are joined by Joshua Baker, MD, MSCE, first author of a paper recently published in Arthritis & Rheumatology, Associations Between Low Serum Urate, Body Composition, and Mortality. Dr. Baker, recognizing the controversy in whether low serum urate or uric acid (UA) level contribute to adverse outcomes, set out to evaluate the relation between low serum UA levels and sarcopenia, to assess whether sarcopenia confounds associations between these low levels and mortality.

Joshua Baker, MD, MSCE - Joshua Baker, MD, MSCE, is an Associate Professor of Rheumatology and Epidemiology at the University of Pennsylvania and at the Corporal Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia. Primarily through the support of VA Awards, Dr. Baker has focused on identifying modifiable risk factors with the goal of improving clinical care of chronic forms of arthritis, particularly rheumatoid arthritis and osteoarthritis. Dr. Baker’s approach includes observational and interventional studies, focusing on skeletal muscle, health, obesity, cardiovascular disease, bone and joint health, and their associated long-term outcomes in patients with common forms of arthritis.

Related Links:

• Associations Between Low Serum Urate, Body Composition, and Mortality

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When rheumatology concepts battle it out in a team bracket tournament, you get RheumMadness—A place for everyone who is crazy about rheumatology to connect, collaborate and compete, in an online learning experience, created by David Leverenz, MD. His body of work, RheumMadness: Creating an Online Community of Inquiry, featured in this episode, analyzes participant engagement and the presence of the online community of inquiry within its first year. Dr. Leverenz is an educator and rheumatologist at Duke University, and has a growing body of work in medical education. He recently completed a Clinician Scholar Educator Award from the Rheumatology Research Foundation to create Rheum Madness.

David Leverenz, MD - David Leverenz, MD, graduated from UT Southwestern Medical School in Dallas, TX. His residency training was at Vanderbilt University Medical Center in Nashville, TN, where he also served as a chief resident. He completed fellowship training in rheumatology at Duke University, where he is now on faculty as an assistant professor of medicine and the program director of the adult rheumatology fellowship program. Dr. Leverenz's academic interests are in medical education and quality improvement.

Related Links:

• RheumMadness: Creating an Online Community of Inquiry
• RheumMadness Website

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