Daniel H Solomon

Boston University, Boston, Massachusetts, United States

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Publications (435)3160.68 Total impact

  • Daniel H Solomon · Chih-Chin Liu · I-Hsin Kuo · Agnes Zak · Seoyoung C Kim ·
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    ABSTRACT: Background: Colchicine may have beneficial effects on cardiovascular (CV) disease, but there are sparse data on its CV effect among patients with gout. We examined the potential association between colchicine and CV risk and all-cause mortality in gout. Methods: The analyses used data from an electronic medical record (EMR) database linked with Medicare claims (2006-2011). To be eligible for the study cohort, subjects must have had a diagnosis of gout in the EMR and Medicare claims. New users of colchicine were identified and followed up from the first colchicine dispensing date. Non-users had no evidence of colchicine prescriptions during the study period and were matched to users on the start of follow-up, age and gender. Both groups were followed for the primary outcome, a composite of myocardial infarction, stroke or transient ischaemic attack. We calculated HRs in Cox regression, adjusting for potential confounders. Results: We matched 501 users with an equal number of non-users with a median follow-up of 16.5 months. During follow-up, 28 primary CV events were observed among users and 82 among non-users. Incidence rates per 1000 person-years were 35.6 for users and 81.8 for non-users. After full adjustment, colchicine use was associated with a 49% lower risk (HR 0.51, 95% CI 0.30 to 0.88) in the primary CV outcome as well as a 73% reduction in all-cause mortality (HR 0.27, 95% CI 017 to 0.43). Conclusions: Colchicine use was associated with a reduced risk of a CV event among patients with gout.
    Annals of the rheumatic diseases 11/2015; DOI:10.1136/annrheumdis-2015-207984 · 10.38 Impact Factor
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    ABSTRACT: Objective: To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes. Design: We used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care -- acetaminophen and corticosteroid injections -- failed to control pain. NSAID regimens were evaluated with and without proton pump inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where available. Estimates of treatment efficacy (pain reduction, occurring in ∼ 57% of patients on all regimens) and toxicity (major cardiac or gastrointestinal toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with tramadol) were derived from published literature. Annual costs came from Red Book Online®. Outcomes were discounted at 3%/year and included costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Key input parameters were varied in sensitivity analyses. Results: Adding ibuprofen to standard of care was cost saving, increasing QALYs by 0.07 while decreasing cost by $800. Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased costs by $300, resulting in an ICER of $54,800/QALY. Using prescription naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of prescription naproxen with prescription PPIs resulted in an ICER of $252,300/QALY. Regimens including tramadol or celecoxib cost more but added fewer QALYs and thus were dominated by several of the naproxen-containing regimens. Conclusions: In patients with multiple comorbidities, naproxen- and ibuprofen-containing regimens are more effective and cost-effective in managing OA pain than opioids, celecoxib or standard of care.
    Osteoarthritis and Cartilage 11/2015; DOI:10.1016/j.joca.2015.10.006 · 4.17 Impact Factor
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    ABSTRACT: Objective: We conducted a longitudinal observational study of biological disease-modifying antirheumatic drugs (bDMARD) to describe the proportions of patients with rheumatoid arthritis in remission who discontinued these agents, and to assess the potential predictors of the decision to discontinue. Methods: We used data from the US COnsortium of Rheumatology Researchers Of North America (CORRONA) and the Japanese National Database of Rheumatic Diseases by iR-net in Japan (NinJa) registries, and ran parallel analyses. Patients treated with bDMARD who experienced remission (defined by the Clinical Disease Activity Index ≤ 2.8) were included. The outcome of interest was the occurrence of bDMARD discontinuation while in remission. The predictors of discontinuation were assessed in the Cox regression models. Frailty models were also used to examine the effects of individual physicians in the discontinuation decision. Results: The numbers of eligible patients who were initially in remission were 6263 in the CORRONA and 744 in the NinJa. Among these patients, 10.0% of patients in CORRONA and 11.8% of patients in NinJa discontinued bDMARD while in remission over 5 years, whereas many of the remaining patients lost remission before discontinuing bDMARD. Shorter disease duration was associated with higher rates of discontinuation in both cohorts. In CORRONA, methotrexate use and lower disease activity were also associated with discontinuation. In frailty models, physician random effects were significant in both cohorts. Conclusion: Among patients who initially experienced remission while receiving bDMARD, around 10% remained in remission and then discontinued bDMARD in both registries. Several factors were associated with more frequent discontinuation while in remission. Physician preference likely is also an important correlate of bDMARD discontinuation, indicating the need for standardization of practice.
    The Journal of Rheumatology 11/2015; DOI:10.3899/jrheum.150240 · 3.19 Impact Factor
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    ABSTRACT: Objective: To evaluate rheumatoid arthritis (RA) and mortality risk among women followed prospectively in the Nurses' Health Study (NHS). Methods: We analyzed 119,209 women in the NHS that reported no connective tissue disease at enrollment in 1976. Comorbidity and lifestyle data were collected through biennial questionnaires. Incident RA cases were validated by medical record review. Cause of death was determined by death certificate and medical record review. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular disease (CVD), cancer, and respiratory mortality for women with RA compared to those without RA. Results: We validated 964 incident RA cases and identified 28,808 deaths during 36 years of prospective follow-up. Of 307 deaths among women with RA, 80 (26%) were from cancer, 70 (23%) were from CVD, and 44 (14%) were from respiratory causes. Women with RA had increased total mortality (hazard ratio [HR] 1.40, 95%CI 1.25-1.57) compared to those without RA, independent of mortality risk factors including smoking. RA was associated with significantly increased respiratory (HR 2.06, 95%CI 1.51-2.80) and cardiovascular mortality (HR 1.45, 95%CI 1.14-1.83), but not cancer mortality (HR 0.93, 95%CI 0.74-1.15). For women with seropositive RA, respiratory-related mortality was nearly three-fold higher than non-RA women (HR 2.67, 95%CI 1.89-3.77). Conclusion: Women with RA had significantly increased mortality compared to those without RA. Respiratory and cardiovascular mortality were both significantly elevated for women with RA. The nearly three-fold increased relative risk of respiratory mortality was observed only for those with seropositive RA. This article is protected by copyright. All rights reserved.
    10/2015; DOI:10.1002/acr.22752
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    ABSTRACT: Objective: Patient registries have contributed substantially to progress in clinical research in rheumatic diseases. However, not much is known about how to optimize the patient experience in such registries. We assessed patient views, motivations, and potential barriers towards participation in registry research to better understand how registries can be improved to maximize patient engagement. Methods: Focus groups were held with 23 patients (mean age=59 years, SD=13) from the Boston area and led by a bilingual moderator trained in focus group methodology using a semi-structured moderator guide. Three separate focus groups were conducted to thematic saturation: 1) patients with RA who had registry experience, 2) patients with any chronic illness and 3) Spanish-speaking patients with RA or OA. Patients in the latter 2 groups had no prior registry experience. Focus groups were audio-taped and transcribed. Four researchers independently analyzed transcripts using open data coding to identify themes. A normative group process was used to consolidate and refine themes. Results: Seven major themes were identified including: personalization/convenience of data collection; trust and confidentiality; camaraderie; learning about yourself and your disease; altruism; material motivators; and capturing mental health and other elements of the "lived" experience. We observed distinct differences in the discussion content of the Spanish-speaking patients compared to the English-speaking patients. Conclusion: This study identified patient attitudes towards registry research among those with and without prior experience in a registry. The results provide insight into strategies for registry design to maximize patient engagement, which can lead to more robust registry data. This article is protected by copyright. All rights reserved.
    10/2015; DOI:10.1002/acr.22767
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    ABSTRACT: Objective: To compare traditional cardiovascular (CV) risk factor management among patients with rheumatoid arthritis (RA) to that of matched non-RA controls within a large US managed care setting. Methods: Adult patients with RA and age- and sex- matched general population (general controls) or osteoarthritis (OA) controls were identified between 01/01/2007 and 12/31/2011. We compared healthcare utilization, measurement, treatment, and treatment target achievement of traditional CV risk factors among subgroups of CV comorbidity during one year of follow-up between RA and controls. Results: A total of 9,440 RA, 31,009 general controls, and 10,352 OA controls were included. The proportions with measurements (blood pressure (BP), low-density lipoprotein cholesterol (LDL), or hemoglobin A1C), treatment (anti-hypertensive, statin, or anti-diabetes), and treatment target achievement were slightly higher in patients with RA compared with general controls. Controlling for other factors, RA patients were more likely to have a measurement of BP (odds ratio [95% CI] = 16.77 [10.01-28.08]) or LDL (1.25 [1.13-1.39]), and to receive anti-hypertensives (1.84 [1.47-2.30]) or anti-diabetics (1.26 [1.01-1.56]) compared to general controls. RA was not associated with receiving a statin (1.01 [0.92-1.12]), however, a target LDL level was more likely to be achieved in RA compared to general controls (1.27 [1.17-1.37]) as well as target levels of BP and hemoglobin A1C. These results were consistent with results for OA controls except for a lower probability of receiving a statin in RA compared to OA. Conclusion: Traditional CV risk factors in patients with RA were not less aggressively managed compared to non-RA controls. This article is protected by copyright. All rights reserved.
    09/2015; DOI:10.1002/acr.22740
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    ABSTRACT: Objective: To examine in detail the outcomes of biologic DMARD (bDMARD) discontinuation while in remission occurring in daily clinical practice settings. We examined a multicentre longitudinal registry of RA patients. Methods: We utilized data from the NinJa multicenter registry in Japan. Patients who used bDMARDs and had one or more successive visits in remission (defined by the clinical disease activity index (CDAI) ≤2.8) before discontinuation were included. The outcome of failing bDMARD-free disease control was defined as a composite of the following: re-use of bDMARDs, intensification of non-biologic DMARDs or of oral glucocorticoids, or loss of CDAI remission. Results: Among 1037 patients who initially achieved remission on bDMARDs, 46 patients discontinued bDMARDs while remaining in remission. Of these 46 subjects, 41 (89.1%) were female, the median disease duration was 6.0 years and 31 (70.5%) had reported radiographical erosions. At the baseline, 27 (58.7%) used MTX and 19 (41.3%) used oral glucocorticoids. The bDMARD-free remission failure rate was estimated to be 67.4% at 1 year and 78.3% at 2 years. Loss of remission and reuse of bDMARDs were the more common reasons for failure. Lower CDAI within the remission range was associated with fewer failures. Conclusion: We found a high rate of failing bDMARD-free CDAI remission, indicating difficulty of maintaining disease control, even in patients who were in remission. Modification of non-biologic treatment was observed in some of the patients who remained in remission. Considering the cost of bDMARDs, such strategies for maintaining disease control after bDMARD discontinuation may be an important option.
    Rheumatology (Oxford, England) 09/2015; DOI:10.1093/rheumatology/kev329 · 4.48 Impact Factor
  • Seoyoung C Kim · Jun Liu · Daniel H Solomon ·
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    ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia associated with cardiovascular disease and mortality. Recent studies suggest an association between inflammation, hyperuricaemia and AF, but little is known whether gout is associated with AF risk. Using data from a US commercial insurance plan (2004-2013), we conducted a cohort study to evaluate the risk of incident AF in patients with gout versus osteoarthritis. Patients with gout or osteoarthritis were identified with ≥2 diagnoses and ≥1 dispensing for gout or osteoarthritis medications. Incident AF was defined as a new AF diagnosis and a new dispensing for anticoagulants or antiarrhythmics. The risk of incident AF in gout was also compared with the non-gout group. We identified 70 015 patients with gout and 210 045 with osteoarthritis, matched on age, sex and index date. The mean age was 57 years, and 81% were men. Over the mean 2-year follow-up, the incidence rate of AF per 1000 person-years was 7.19 in gout and 5.87 in osteoarthritis. The age, sex and index date-matched HR of AF was 1.23 (95% CI 1.14 to 1.32) in gout versus osteoarthritis. In a multivariable Cox regression, adjusting for age, sex, comorbidities, medications and healthcare usage, the HR of AF in gout was 1.13 (95% CI 1.04 to 1.23). When compared with non-gout, the multivariable HR of AF in gout was also increased (HR 1.21, 95% CI 1.11 to 1.33). In this large population-based cohort study, gout was associated with a modestly increased risk of incident AF compared with osteoarthritis and non-gout after adjusting for other risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Annals of the Rheumatic Diseases 08/2015; DOI:10.1136/annrheumdis-2015-208161 · 10.38 Impact Factor
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    ABSTRACT: Provide a contemporary estimate of osteoarthritis (OA) by comparing accuracy and prevalence of alternative definitions of OA. The Medical Expenditure Panel Survey (MEPS) household component (HC) records respondent-reported medical conditions as open-ended responses; professional coders translate these responses into ICD-9-CM codes for the medical conditions files. Using these codes and other data from the MEPS-HC medical conditions files, we constructed three case definitions of OA and assessed them against medical provider diagnoses of ICD-9-CM 715 [osteoarthrosis and allied disorders] in a MEPS subsample. The three definitions were: 1) strict = ICD-9-CM 715; 2) expanded = ICD-9-CM 715, 716 [other and unspecified arthropathies], OR 719 [other and unspecified disorders of joint]); and 3) probable = strict OR expanded + respondent-reported prior diagnosis of OA or other arthritis excluding rheumatoid arthritis (RA). Sensitivity and specificity of the three definitions were: strict - 34.6% and 97.5%; expanded - 73.8% and 90.5%; and probable - 62.9% and 93.5%. The strict definition for OA (ICD-9-CM 715) excludes many individuals with OA. The probable definition of OA has the optimal combination of sensitivity and specificity relative to the two other MEPS-based definitions and yields a national annual estimate of 30.8 million adults with OA (13.4% of US adult population) for 2008 - 2011. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    08/2015; DOI:10.1002/acr.22721
  • D H Solomon · J Greenberg · J M Kremer · C J Etzel ·

    Arthritis and Rheumatology 08/2015; DOI:10.1002/art.39413
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    ABSTRACT: Subcutaneous nodules are the most common conspicuous extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) is the leading cause of death in patients with RA. The objective of this study is to examine the possibility of a relationship between subcutaneous nodules and "first ever" cardiovascular disease event, i.e., myocardial infarction (MI), stroke, or cardiovascular death in a large registry-cohort of patients with RA. Patient information was collected from the CORRONA registry from October 2001 to September 2011. A total of 26,042 patients with RA were studied for the presence or absence of subcutaneous nodules. Cox proportional hazards regression models were constructed to estimate the hazard ratios (HR) for CVD events in relation to subcutaneous nodules at baseline. Three statistical models were used to examine the association between subcutaneous nodules and CVD: Model A adjusted for age and sex associated risk, model B adjusted for traditional CV risk factors, and model C adjusted for factors in models A and B plus underlying RA-specific measures. The definition of primary exposure was "subcutaneous nodules at baseline." A total of 3908 patients had subcutaneous nodules at baseline. Of the 566 total composite CVD events, 138 occurred in the group that had SCN at baseline. Incidence rate-ratio values (patients with subcutaneous nodules at baseline vs. no subcutaneous nodules at baseline) for composite CVD events, MI, stroke, and cardiovascular death were 1.55, 1.65, 1.37, and 1.68, respectively. Adjusted HR values (95 % CI) for composite CVD events based on "subcutaneous nodules-status at baseline" (primary exposure) were as follows: 1.35 (1.11-1.63) for model A, 1.25 (1.03-1.52) for model B, and 1.03 (0.831-1.277) for model C. Subcutaneous nodules were associated with increased CVD events in RA. This association persisted after adjusting for age, sex, and traditional CV risk factors.
    Clinical Rheumatology 08/2015; 34(10). DOI:10.1007/s10067-015-3032-9 · 1.77 Impact Factor
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    ABSTRACT: When treating RA patients, remission (REM) or at least low disease activity (LDA) is the ultimate therapeutic goal. The aim of this study was to assess the impact of multimorbidity on achieving REM or LDA. In a prospective RA cohort, we identified patients initiating any DMARD with follow-up data 1 year after. Treatment effects were measured using the clinical disease activity index (CDAI) and the modified health assessment questionnaire (MHAQ); multimorbidity status was assessed using a counted multimorbidity index (cMMI). The proportion of patients reaching REM or LDA 1 year after DMARD commencement with respect to the cMMI was evaluated. In regression models, we calculated the odds ratio of achieving REM or LDA, and predicted CDAI and MHAQ 1 year after DMARD commencement for various levels of cMMI, adjusting for age, sex, disease duration, serostatus, disease activity at DMARD commencement, number of previous DMARDs, and type of DMARD, steroid and NSAID use. A total of 815 patients started DMARDs; 414 were on the same DMARD after 1 year. The proportion of these patients achieving REM or LDA after 1 year was significantly lower in the patients with higher cMMI, following a linear trend (P < 0.01). After accounting for covariates, the odds ratio for REM associated with each additional morbidity in the cMMI was 0.72 (95% CI 0.55, 0.97) and 0.81 (95% CI 0.70, 0.94) for LDA. One year after DMARD initiation, CDAI (+0.16 per additional morbidity) and MHAQ scores (+0.15 per additional morbidity) were significantly worse (both P < 0.05). Increased multimorbidity negatively affects the therapeutic goal of REM and LDA. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Rheumatology (Oxford, England) 07/2015; DOI:10.1093/rheumatology/kev239 · 4.48 Impact Factor
  • Daniel H Solomon · Michael E Weinblatt · Richard J Bucala ·

    Arthritis and Rheumatology 07/2015; DOI:10.1002/art.39258
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    ABSTRACT: We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (IS) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). We utilized U.S. Medicaid data from 2000-2006 to identify adults 18-64 years with SLE who were new users of HCQ or IS. We defined the index date as receipt of HCQ or IS without use in the prior six months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days supply dispensed, for one-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR<80%) and acute care utilization adjusting for sociodemographics and comorbidities. We identified 9,600 HCQ new users and 3,829 IS new users with SLE. The mean MPR for HCQ was 47.8% (SD 30.3) and for IS, 42.7% (SD 30.7). 79% of HCQ users and 83% of IS users were nonadherent (MPR<80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% CI 1.43-1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25-1.50), comparing nonadherers to adherers. For IS users, the IRR of ED visits was 1.64 (95% CI 1.42-1.89) and of hospitalizations was 1.67 (95% CI 1.41-1.96) for nonadherers versus adherers. In this cohort, nonadherence to HCQ and IS was common and was associated with significantly higher subsequent acute care utilization. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    06/2015; DOI:10.1002/acr.22636
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    ABSTRACT: The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for patients with rheumatoid arthritis (RA) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only. We enrolled seven rheumatology practices in the US - four with NPs or PAs and three without. Disease activity of RA, categorized as remission, low, moderate, or high, using standardized measures were abstracted from medical records from the most recent two years. We performed a repeated measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist only, adjusting for disease duration, serologic status, RA treatments and disease activity measures. Records from 301 patients, including 1982 visits were reviewed. Patients had a mean age of 61 years and 77% were female. In the primary adjusted analysis, patients seen in practices with NPs or PAs were less likely to have higher disease activity (OR 0.32, 95% CI 0.17-0.60, p = 0.004) than those seen in practices with rheumatologists only. However, there were no differences in the change in disease activity. Patients seen in practices with NPs or PAs had lower RA disease activity over 2-years compared with those seen in rheumatologist only practices; no differences were observed in the change in disease activity between visits either within or between type of provider practice. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    06/2015; DOI:10.1002/acr.22643

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):138.1-138. DOI:10.1136/annrheumdis-2015-eular.1294 · 10.38 Impact Factor

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1289.3-1290. DOI:10.1136/annrheumdis-2015-eular.2262 · 10.38 Impact Factor
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    ABSTRACT: To describe the treatment profile of multimorbid patients with rheumatoid arthritis (RA) in contrast to patients with RA only. COMORA (Comorbidities in Rheumatoid Arthritis) is a cross-sectional, international study assessing morbidities, outcomes, and treatment of patients with RA. Patients were grouped according to their multimorbidity profile assessed by a counted multimorbidity index (cMMI). Treatment for RA was categorized as use of biologic disease-modifying antirheumatic drugs (bDMARD), in particular tumor necrosis factor inhibitors (TNFi), synthetic DMARD (sDMARD) use only, nonsteroidal antiinflammatory drug (NSAID) use, and corticosteroid use. Logistic regression models were performed to determine the OR of bDMARD, TNFi, sDMARD, NSAID, or corticosteroid use based on a patient's cMMI and global region after adjusting for age, disease activity, disease duration, educational level, and previous DMARD therapy. Out of 3920 patients, 32.7% received bDMARD; 59.9% sDMARD only, 51.1% used concomitant NSAID, and 54.8% used corticosteroid. Regional differences were observed with the most frequent use of bDMARD in the United States (46.5%) and lowest in North Africa (9%). After adjusting for confounders in logistic regression, the OR for bDMARD use was reduced for each additional morbidity (OR 0.89, 95% CI 0.83-0.96). Similar results were found for TNFi (OR 0.91, 95% CI 0.84-0.99), whereas the OR for use of sDMARD was increased (1.13, 95% CI 1.05-1.22). No significant change of OR was found for NSAID or corticosteroid use. In this study, the odds of bDMARD use decreases 11% for each additional chronic morbid condition after adjustment for regional differences, disease activity, and other covariates.
    The Journal of Rheumatology 06/2015; 42(7). DOI:10.3899/jrheum.141534 · 3.19 Impact Factor
  • D.H. Solomon · J Greenberg · J.R. Curtis · M Liu · M.E. Farkouh · P Tsao · J.M. Kremer · C.J. Etzel ·
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    ABSTRACT: Cardiovascular (CV) disease is the leading cause of mortality in rheumatoid arthritis (RA), but CV risk prediction scores derived in the general population do not accurately predict CV risk in RA patients. The goal of these analyses was to develop and internally validate an expanded CV risk prediction score for RA. Participants in CORRONA with RA and no known CVD were studied, with 2/3 used to derive the CV risk prediction score and 1/3 for internal validation. Traditional CV risk factors were included in the base Cox regression model, and RA-related variables were assessed in an expanded model predicting confirmed CV events. Fit and utility of the expanded model were evaluated. The study cohort included 23,605 subjects with 437 CV events followed for a median of 2.2 years. The RA variables significant in regression and included in the expanded model: disease activity (CDAI > 10 versus ≤ 10), disability (mHAQ-DI > 0.5 versus ≤ 0.5), daily prednisone use (any versus none), and disease duration (≥ 10 years versus less). The expanded model had good fit (Hosmer-Lemeshow goodness of fit p = 0.94) and a lower AIC than the base model. In the internal validation cohort, the c-statistic was significantly improved (0.7261 to 0.7609, p=0.0104). The net reclassification index for a 4-category risk tool was 40% (95% CI 37-44%). A newly developed expanded risk score for CV outcomes in RA performs well and improves the classification of risk compared with one that only includes traditional risk factors. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    Arthritis and Rheumatology 05/2015; 67(8). DOI:10.1002/art.39195
  • Heather O. Tory · Daniel H. Solomon · Sonali P. Desai ·
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    ABSTRACT: To report and analyze quality improvement (QI) efforts that are aimed at increasing adherence to preventive guidelines for glucocorticoid-induced osteoporosis (GIOP). We performed a PubMed literature search for full-length articles in English between 1966 and 2013, describing approaches for improving the quality of GIOP care. We reviewed articles using a structured approach and abstracted information on the patient population, study design, QI intervention, and primary outcome measures. A descriptive analysis was then performed. Literature search identified 661 articles; 38 were screened by abstract, 10 were identified for full review, and 7 were included. Two non-randomized, uncontrolled studies of system changes showed significant improvements in GIOP prevention: one increased concomitant prescriptions of glucocorticoids and calcium (37-49%, p < 0.0001) and vitamin D (38-53%, p < 0.0001) using a computerized order entry system; another used a dedicated clinical team to increase vitamin D levels from 19.5 to 29.4 (p = 0.001) and improve GIOP-related habits. Five articles described education-based interventions, including 3 randomized controlled trials (RCTs). Two non-significant RCTs focused on physicians, but one directed towards pharmacists and patients did increase calcium supplementation in the intervention vs. control arm (55.7% vs. 31.6%, p < 0.05). Two other non-randomized educational interventions did not show benefits. Comparison of articles was limited by the heterogeneity of the intervention methods and outcome measures used. None of the interventions produced robust changes, with overall adherence to GIOP guidelines remaining low. System-based interventions appeared more effective than education-based interventions, but a diverse array of factors likely needs to be addressed, requiring more randomized controlled trials and greater standardization of outcome measures. Copyright © 2014. Published by Elsevier Inc.
    Seminars in arthritis and rheumatism 04/2015; 44(5). DOI:10.1016/j.semarthrit.2014.09.011 · 3.93 Impact Factor

Publication Stats

14k Citations
3,160.68 Total Impact Points


  • 2004-2015
    • Boston University
      Boston, Massachusetts, United States
  • 2003-2015
    • Brigham and Women's Hospital
      • • Department of Medicine
      • • Division of Pharmacoepidemiology and Pharmacoeconomics
      • • Division of Rheumatology, Immunology, and Allergy
      Boston, Massachusetts, United States
  • 1997-2015
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 1997-2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009-2012
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
    • Blue Cross Blue Shield of Minnesota
      Eagan, Minnesota, United States
  • 2011
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Boston College, USA
      Boston, Massachusetts, United States
  • 2010-2011
    • Massachusetts General Hospital
      • Division of Cardiology
      Boston, Massachusetts, United States
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2009-2011
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2009-2010
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 2006
    • University of Toronto
      • Institute of Health Policy, Management and Evaluation
      Toronto, Ontario, Canada