Michael M Ward

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 베서스다, Maryland, United States

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Publications (145)822.87 Total impact

  • Sovira Tan, Runsheng Wang, Michael M Ward
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    ABSTRACT: Syndesmophytes are characteristic components of the spine disorder of ankylosing spondylitis. Understanding their growth may reveal insights to pathogenesis and potential treatment. We review recent studies on rates of development of syndesmophytes, patient characteristics associated with more rapid syndesmophyte growth, local vertebral abnormalities that precede syndesmophytes, systemic biomarkers of syndesmophytes, and studies of medications. New syndesmophytes develop in one-third of patients over 2 years. Consistent clinical predictors are male sex, elevated serum C-reactive protein levels, and preexisting syndesmophytes. Concomitant vertebral inflammation and fat dysplasia on MRI predict future syndesmophytes at the same vertebral location, but most syndesmophytes do not have recognized antecedents. Associations with serum levels of Wingless pathway proteins are inconsistent, as are the results of observational studies of tumor necrosis factor-alpha inhibitors. Although there is better understanding of the frequency of syndesmophyte development, the pathogenesis of syndesmophytes remains unclear.
    Current opinion in rheumatology 05/2015; 27(4). DOI:10.1097/BOR.0000000000000179 · 5.07 Impact Factor
  • Michael M. Ward, Lori C. Guthrie, Maria Alba
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    ABSTRACT: Estimates of minimal clinically important differences in health measures may be affected by the anchor used. We examined if domain-specific transition questions had higher construct validity than global health transition questions as anchors for measures in a given domain. In a prospective study of 249 patients with rheumatoid arthritis, we examined changes in pain, physical function, joint swelling, stiffness, fatigue, and depression with treatment. We related these changes to a domain-specific transition question, global arthritis transition question, and the Short Form-36 (SF-36) health transition item. Changes in all six clinical measures were more highly correlated with the domain-specific transition questions than with the global arthritis question and SF-36 transition question. Discrimination between patients who improved or not was also better using domain-specific questions. Estimates of minimal clinically important improvement (MCII) differed with the anchor when these were based on mean changes. MCII estimates from receiver operating characteristic curve analysis were not influenced by the choice of anchor when anchors had high agreement. Domain-specific transition questions had higher construct validity as anchors for determining clinically important differences in health measures focused on a single domain than either global disease or general health transition questions. Published by Elsevier Inc.
    Journal of Clinical Epidemiology 02/2015; 68(6). DOI:10.1016/j.jclinepi.2015.01.028 · 5.48 Impact Factor
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    ABSTRACT: Objective. To compare rates of hospitalizations for serious infections, trends in rates from 1996 to 2011, and in-hospital mortality between patients with systemic lupus erythematosus (SLE) and those without SLE in a national sample. Methods. We analyzed hospitalizations for pneumonia, bacteremia/sepsis, urinary tract infections, skin infections, and opportunistic infections among adults in the Nationwide Inpatient Sample. We compared rates of hospitalizations yearly among patients with SLE and the general population. We also computed odds ratios for in-hospital mortality. Results. In 1996, the estimated number of hospitalizations for pneumonia in patients with SLE was 4382, followed by sepsis (2305), skin infections (1422), urinary tract infections (643), and opportunistic infections (370). Rates were much higher in SLE than those without SLE, with age-adjusted relative risks ranging from 5.7 (95% confidence interval (CI) 5.5, 6.0) for pneumonia to 9.8 (95% CI 9.1, 10.7) for urinary tract infection in 1996. Risks increased over time, so that by 2011, all relative risks exceeded 12.0. Overall risk of in-hospital mortality was higher in SLE only for opportunistic infections (adjusted odds ratio 1.52; 95% CI 1.12, 2.07). However, in pneumonia and sepsis, mortality risks were higher in SLE among those that required mechanical ventilation. Conclusion. Hospitalization rates for serious infections in SLE increased substantially between 1996 and 2011, reaching over 12 times higher than in patients without SLE in 2011. Reasons for this acceleration are unclear. In-hospital mortality was higher among patients with SLE and opportunistic infections, and those with pneumonia or sepsis who required mechanical ventilation. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    02/2015; DOI:10.1002/acr.22575
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    ABSTRACT: Using the 3-D imaging capability of computed tomography (CT), we developed an algorithm quantitating syndesmophyte height along the entire vertebral rim. We investigated its reliability and sensitivity to change, performed a 2-year longitudinal study, and compared it to CT measures of syndesmophyte volume. We performed thoracolumbar spine CT scans on 33 patients at baseline, Year 1, and Year 2, and computed syndesmophyte height in 4 intervertebral disc spaces (IDS). Height was computed every 5° (72 angular sectors) along the vertebral rim. These 72 measures were summed to form the circumferential height per IDS, and results from 4 IDS were summed to provide results per patient. To assess reliability, we compared results between 2 scans performed on the same day in 9 patients. Validity was assessed by associations with spinal flexibility. Coefficient of variation for circumferential syndesmophyte height was 0.893% per patient, indicating excellent reliability. Based on the Bland-Altman analysis, an increase in circumferential height of more than 3.44% per patient represented a change greater than measurement error. At years 1 and 2, mean (SD) circumferential syndesmophyte height increases were 10.2% (11.7%) and 16.1% (14.0%), respectively. Sensitivity to change was 0.72 and 0.87 at years 1 and 2, respectively. Circumferential syndesmophyte height correlated with the Schober test (r = -0.56, p = 0.0003) and lateral thoracolumbar flexion (r = -0.73, p < 0.0001). CT-based circumferential syndesmophyte height had excellent reliability and good sensitivity to change. It was more highly correlated with spine flexibility than syndesmophyte volume. The algorithm shows promise for longitudinal studies of syndesmophyte growth.
    The Journal of Rheumatology 01/2015; 42(3). DOI:10.3899/jrheum.140965 · 3.17 Impact Factor
  • Runsheng Wang, Michael M. Ward
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    ABSTRACT: Arthritis is the common term used to describe pathological changes of joints and adjoining parts of the bone. Several types of arthritis commonly affect the spine. Osteoarthritis, a non-inflammatory type of arthritis, most often affects the cervical spine and the lumbar spine. Neck pain, limited neck and head motion, low back pain, and limited flexibility of the low back can result from progressive joint damage. Degeneration of the intervertebral disk may accompany cervical and lumbar osteoarthritis, and can cause either nerve root or spinal cord compression. Ankylosing spondylitis is the most common inflammatory arthritis that principally affects the spine rather than other joints, and is characterized by slow development of bony fusion among the adjacent vertebrae. Rheumatoid arthritis, the most common type of inflammatory arthritis, affects mostly the limb joints but can also affect the cervical spine, causing neck pain and headache. Cervical spine arthritis also often occurs in children with juvenile idiopathic arthritis. Radiography is an essential diagnostic tool in the evaluation of patients with spinal arthritis, but provides limited information on the posterior spinal structures. Magnetic resonance imaging can be useful for defining abnormalities in the posterior spinal joints, the nerve roots, and the spinal cord.
    Spinal Imaging and Image Analysis, 01/2015: pages 31-66;
  • Michael M. Ward, Lori C. Guthrie, Maria I. Alba
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    ABSTRACT: Objective: Despite wide use of the Short-Form 36 (SF-36) in clinical trials of rheumatoid arthritis (RA), estimates of minimal clinically important improvement (MCII) for its scales are not well-established. We estimated MCIIs for SF-36 scales in patients with active RA.Methods: In this prospective longitudinal study, we studied 243 patients who had active RA, and who completed the SF-36 before and after treatment escalation. We first assessed responsiveness with standardized response means (SRM). For scales with adequate responsiveness (SRM ≥ 0.50), we used patient judgments of improvement in arthritis status as anchors for estimating MCIIs. We used receiver operating characteristic curve analysis to identify the MCIIs as the change associated with a specificity of 0.80 for improvement.Results: Patients had substantial improvement in RA activity with treatment. However, among SF-36 scales, only the physical functioning and bodily pain scale and the physical component summary had adequate responsiveness. Using 0.80 specificity for improvement as the criterion, the MCIIs were 7.1 for the physical functioning scale, 4.9 for the bodily pain scale, and 7.2 for the physical component summary.Conclusions: Low responsiveness precluded estimation of valid MCIIs for many SF-36 scales in patients with RA, particularly the scales assessing mental health. Although the SF-36 has been included in many clinical trials to broaden the assessment of health status, low responsiveness limits the interpretation of changes in its mental health-related scales. © 2014 American College of Rheumatology.
    12/2014; 66(12). DOI:10.1002/acr.22392
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    ABSTRACT: Objective. Syndesmophytes in AS typically grow slowly, but it is not known whether growth is uniform among syndesmophytes in the same intervertebral disc space (IDS) or among different IDSs in the same patient or if growth is heterogeneous. We examined the dynamics of syndesmophyte growth over 24 months using CT, with the main aim of determining if syndesmophytes in the same IDS or the same patient grow at similar rates. Methods. We performed lumbar spine CT scans on 33 patients and measured syndesmophytes in four IDSs using a validated computer algorithm. Scans were done at baseline and 12 and 24 months. We compared absolute and percentage changes in volume from baseline to 12 months and to 24 months among syndesmophytes in the same IDS and among four IDSs of each patient. We also examined whether growth among all IDSs differed between study years. Results. Among 60 IDSs with at least two syndesmophytes at baseline (range 2-6), there was substantial heterogeneity in both absolute (P < 0.0001) and percentage (P = 0.0002) volume increases among syndesmophytes in the same IDS. Several IDSs had both syndesmophytes with no growth and syndesmophytes that increased by >100 mm3. Similarly there was significant heterogeneity in syndesmophyte growth among IDSs of individual patients. Increases in total syndesmophyte volume for each patient also tended to differ between study years (P = 0.07). Conclusion. Syndesmophytes in AS do not all grow continuously. Rates of growth over 24 months commonly differ between syndesmophytes in the same IDS and between different IDSs in the same patient, suggesting that local factors regulate syndesmophyte growth.
    Rheumatology (Oxford, England) 11/2014; 54(6). DOI:10.1093/rheumatology/keu423 · 4.44 Impact Factor
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    ABSTRACT: Objective Systemic lupus erythematosus (SLE) has one of the highest hospital readmission rates among chronic conditions. This study was undertaken to identify patient-level, hospital-level, and geographic predictors of 30-day hospital readmissions associated with SLE. Methods Using hospital discharge databases from 5 geographically dispersed states, we studied all-cause readmission of SLE patients between 2008 and 2009. We evaluated each hospitalization as a possible index event leading up to a readmission, our primary outcome. We accounted for clustering of hospitalizations within patients and within hospitals and adjusted for hospital case mix. Using multilevel mixed-effects logistic regression, we examined factors associated with 30-day readmission and calculated risk-standardized hospital-level and state-level readmission rates. ResultsWe examined 55,936 hospitalizations among 31,903 patients with SLE. Of these hospitalizations, 9,244 (16.5%) resulted in readmission within 30 days. In adjusted analyses, age was inversely related to risk of readmission. African American and Hispanic patients were more likely to be readmitted than white patients, as were those with Medicare or Medicaid insurance (versus private insurance). Several clinical characteristics of lupus, including nephritis, serositis, and thrombocytopenia, were associated with readmission. Readmission rates varied significantly between hospitals after accounting for patient-level clustering and hospital case mix. We also found geographic variation, with risk-adjusted readmission rates lower in New York and higher in Florida as compared to California. Conclusion We found that approximate to 1 in 6 hospitalized patients with SLE were readmitted within 30 days of discharge, with higher rates among historically underserved populations. Significant geographic and hospital-level variation in risk-adjusted readmission rates suggests potential for quality improvement.
    10/2014; 66(10). DOI:10.1002/art.38768
  • Michael M. Ward, Lori C. Guthrie, Maria I. Alba
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    ABSTRACT: Objective The patient global assessment (PGA) is intended to provide an integrated summary of all symptoms of arthritis, but it is not clear which disease features most impact patients' assessments of changes in their overall status. We investigated what aspects of rheumatoid arthritis (RA) activity correlated best with prospectively measured changes in the PGA and with patients’ retrospective judgments of improvement.Methods We studied 250 patients with active RA in a prospective longitudinal study. Disease activity measures were collected before and after treatment escalation. Prospectively measured changes in PGA and patients' judgments of improvement or worsening at the followup visit were tested for correlations with changes in patient-reported measures of symptoms and functioning, joint counts, and laboratory tests.ResultsPatients improved during the study, with the mean ± SD PGA decreasing from 55.6 ± 25.2 to 37.6 ± 24.0. At the followup visit, 167 patients (66.8%) reported improvement in overall arthritis status. Changes in pain severity, stiffness severity, and fatigue were the only significant correlates of changes in PGA. In contrast, changes in the Health Assessment Questionnaire, tender joint count or Disease Activity Score in 28 joints (DAS28), and stiffness severity were associated with retrospective judgments of improvement.Conclusion Prospectively measured changes in PGA in RA were related solely to other patient-reported measures, but patients’ retrospective judgments of improvement were related to functional limitations, tender joint count, and DAS28. Patients' subjective judgments of improvement reflect aspects of RA different from the PGA and may be a simple complementary measure of treatment efficacy.
    10/2014; 67(6). DOI:10.1002/acr.22509
  • Michael M. Ward
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    ABSTRACT: Recent clinical trials have provided evidence for the efficacy of low-dose intravenous cyclophosphamide and mycophenolate mofetil as induction treatment for patients with proliferative lupus nephritis in comparative trials with standard-dose intravenous cyclophosphamide. Trials of maintenance treatments have had more variable results, but suggest that the efficacy of mycophenolate mofetil may be similar to that of quarterly standard-dose intravenous cyclophosphamide and somewhat more efficacious than azathioprine. Differential responses to mycophenolate mofetil based on ethnicity suggest that it may be more effective in black and Hispanic patients. Rituximab was not efficacious as an adjunct to induction treatment with mycophenolate mofetil.
    Rheumatic Disease Clinics of North America 08/2014; 40(3). DOI:10.1016/j.rdc.2014.05.001 · 1.74 Impact Factor
  • Michael M. Ward, Lori C. Guthrie, Maria Alba
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    ABSTRACT: Objective Estimates of minimal clinically important improvements (MCIIs) are larger among patients with higher values at baseline, suggesting that these patients require larger changes to appreciate improvements. We examined if baseline dependency of MCIIs was associated with specific patients across three measures, or was owing to floor and ceiling effects. Study Design and Setting We prospectively examined 250 outpatients with active rheumatoid arthritis (RA). We used an anchor-based approach to estimate MCIIs for three measures of RA activity (patient global assessment, swollen joint count, and walking time). We examined if the same patients constituted the baseline subgroups with high MCIIs across measures. Results The MCIIs were greater for those with higher baseline values of all three measures. At the ceiling, there was little opportunity to improve, and judgments were unrelated to measured changes. At midrange, improvements were balanced by worsenings, including some judged as improvements. At the floor, improvements were not similarly balanced. Patients in subgroups with high MCII for patient global assessment were not also predominantly in subgroups with high MCII for the swollen joint count or walking time, and vice versa. Conclusion Variation in MCII by baseline values is because of floor and ceiling effects rather than expectations of particular patients.
    Journal of clinical epidemiology 06/2014; 67(6). DOI:10.1016/j.jclinepi.2013.10.025 · 5.48 Impact Factor
  • Michael M Ward
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    ABSTRACT: The American College of Rheumatology, the Spondyloarthritis Research and Treatment Network, and the Spondylitis Association of America have begun collaborating on a project to develop treatment guidelines for axial spondyloarthritis. The project will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, which is based on systematic literature reviews and quantitative evidence summaries, to develop treatment recommendations for the use of pharmacological interventions, rehabilitation, surgery, preventive care, and disease monitoring in patients with ankylosing spondylitis and axial spondyloarthritis.
    Clinical Rheumatology 05/2014; DOI:10.1007/s10067-014-2660-9 · 1.77 Impact Factor
  • Michael M Ward, Lori C Guthrie, Maria I Alba
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    ABSTRACT: Thresholds of minimal clinically important improvement (MCII) are needed to plan and interpret clinical trials. We estimated MCIIs for the rheumatoid arthritis (RA) activity measures of patient global assessment, pain score, Health Assessment Questionnaire Disability Index (HAQ), Disease Activity Score-28 (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). In this prospective longitudinal study, we studied 250 patients who had active RA. Disease activity measures were collected before and either 1 month (for patients treated with prednisone) or 4 months (for patients treated with disease modifying medications or biologics) after treatment escalation. Patient judgments of improvement in arthritis status were related to prospectively assessed changes in the measures. MCIIs were changes that had a specificity of 0.80 for improvement based on receiver operating characteristic curve analysis. We used bootstrapping to provide estimates with predictive validity. At baseline, the mean (±SD) DAS28-ESR (erythrocyte sedimentation rate) was 6.16±1.2 and mean SDAI was 38.6±14.8. Improvement in overall arthritis status was reported by 167 patients (66.8%). Patients were consistent in their ratings of improvement versus no change or worsening, with receiver operating characteristic curve areas ≥0.74. MCIIs with a specificity for improvement of 0.80 were: patient global assessment -18, pain score -20, HAQ -0.375, DAS28-ESR -1.2, DAS28-CRP (C-reactive protein) -1.0, SDAI -13, and CDAI -12. MCIIs for individual core set measures were larger than previous estimates. Reporting the proportion of patients who meet these MCII thresholds can improve the interpretation of clinical trials in RA.
    Annals of the rheumatic diseases 05/2014; DOI:10.1136/annrheumdis-2013-205079 · 9.27 Impact Factor
  • Michael M. Ward, Lori C. Guthrie, Maria I. Alba
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    ABSTRACT: Objective To examine the association of the American College of Rheumatology (ACR) response criteria (20% improvement [ACR20], ACR50, and ACR70) and the European League Against Rheumatism (EULAR) response criteria with patient-reported improvement in rheumatoid arthritis (RA) activity.Methods Two hundred fifty patients with active RA were studied prospectively, before and after escalation of antirheumatic treatment. Patients were asked to report if they subjectively judged that they had experienced important improvement with treatment, and the proportion of patients who reported improvement was compared with the proportion who met the ACR20, ACR50, ACR70, and EULAR response criteria.ResultsImprovement in overall arthritis status was reported by 167 patients (66.8%), while 107 patients (42.8%) had an ACR20 response, 52 (20.8%) had an ACR50 response, 24 (9.6%) had an ACR70 response, and 136 (54.4%) had a EULAR moderate/good response. ACR20 response had a sensitivity of 0.57 and a specificity of 0.85 for clinically important improvement as judged by patients. Sensitivities of the ACR50, ACR70, and EULAR moderate/good responses were 0.30, 0.14, and 0.68, respectively, while their specificities were 0.97, 0.99, and 0.73, respectively. The ACR hybrid score with the highest sensitivity and specificity for important improvement was 19.99.Conclusion Among patients with active RA, ACR20 responses are highly specific measures of improvement as judged by patients, but exclude a substantial proportion of patients who consider themselves improved. Response criteria are associated with, but not equivalent to, patient-perceived improvement.
    05/2014; 66(9). DOI:10.1002/art.38705
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    ABSTRACT: We investigated the quality of care and factors associated with variations in care among a national cohort of Medicaid enrollees with incident lupus nephritis. Using Medicaid Analytic eXtract (MAX) files from 47 U.S. states and D.C. for 2000-2006, we identified a cohort of individuals with incident lupus nephritis. We assessed performance on three measures of health care quality: receipt of immunosuppressive, renal-protective anti-hypertensive, and anti-malarial medications. We examined performance on these measures over one year, and applied multivariable logistic regression models to understand whether sociodemographic, geographic or health care access factors were associated with higher performance on quality measures. We identified 1711 Medicaid enrollees with incident lupus nephritis. Performance on quality measures was low at 90 days (21.9% for immunosuppressive therapy, 44.0% for renal protection and 36.4% for anti-malarials), but increased by one year (33.7%, 56.4%, and 45.8%, respectively). Younger individuals, Blacks and Hispanics were more likely to receive immunosuppressive therapy and hydroxychloroquine. Younger individuals were less likely to receive renal-protective anti-hypertensive medications. We found significant geographic variation in performance, with patients in the Northeast receiving higher quality of care compared to other regions. Poor access to health care, as assessed by having a greater number of treat-and-release emergency departments visits compared to ambulatory encounters, was associated with lower receipt of recommended treatment. These nationwide data suggest low overall quality of care and potential delays in care for Medicaid enrollees with incident lupus nephritis. Significant regional differences also suggest room for quality improvement. © 2013 American College of Rheumatology.
    04/2014; 66(4). DOI:10.1002/acr.22182
  • Source
    Grant H Louie, Michael M Ward
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    ABSTRACT: Purpose of review One of the major goals of treatment of ankylosing spondylitis is to prevent or slow the development of spinal new bone formation. Recent observational studies are compared with the results from clinical trials for the effects of tumor necrosis factor-alpha inhibitors (TNFi) and NSAIDs on radiographic measures of spinal damage. Recent findings Data from clinical trials indicate that treatment up to 2 years with TNFi was not associated with a difference in rates of progression of spinal damage, compared with historical controls. These studies were based on open-label extensions, and analyzed as cohort studies. Recent observational studies have suggested that TNFi may reduce radiographic progression. The different conclusions may be related to the longer treatment and observation period of these observational studies, which may have permitted detection of changes in this slowly evolving process. There is emerging evidence from a clinical trial and retrospective studies that continuous NSAID use may slow radiographic progression. Summary Lack of evidence that TNFi slows radiographic progression in ankylosing spondylitis in data from clinical trials may be because of the design of these studies, and possibly not a true null treatment effect.
    Current Opinion in Rheumatology 03/2014; 26(2):145-150. DOI:10.1097/BOR.0000000000000025 · 5.07 Impact Factor
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    Grant H Louie, Michael M Ward
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    ABSTRACT: One of the major goals of treatment of ankylosing spondylitis is to prevent or slow the development of spinal new bone formation. Recent observational studies are compared with the results from clinical trials for the effects of tumor necrosis factor-alpha inhibitors (TNFi) and NSAIDs on radiographic measures of spinal damage. Data from clinical trials indicate that treatment up to 2 years with TNFi was not associated with a difference in rates of progression of spinal damage, compared with historical controls. These studies were based on open-label extensions, and analyzed as cohort studies. Recent observational studies have suggested that TNFi may reduce radiographic progression. The different conclusions may be related to the longer treatment and observation period of these observational studies, which may have permitted detection of changes in this slowly evolving process. There is emerging evidence from a clinical trial and retrospective studies that continuous NSAID use may slow radiographic progression. Lack of evidence that TNFi slows radiographic progression in ankylosing spondylitis in data from clinical trials may be because of the design of these studies, and possibly not a true null treatment effect.
    Current opinion in rheumatology 01/2014; · 5.07 Impact Factor
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    ABSTRACT: Accurate measurement of syndesmophyte development and growth in ankylosing spondylitis (AS) is needed for studies of biomarkers and of treatments to slow spinal fusion. We tested the longitudinal validity and sensitivity to change of quantitative measurement of syndesmophytes using CT. We performed lumbar spine CT scans on 33 patients with AS at baseline, 1 year and 2 years. Volumes and heights of syndesmophytes were computed in four intervertebral disk spaces. We compared the computed changes to a physician's ratings of change based on CT scan inspection. Sensitivity to change of the computed measures was compared with that of the modified Stoke AS Spinal Score (radiography) and a scoring method based on MRI. At years 1 and 2, respectively 24 (73%) and 26 (79%) patients had syndesmophyte volume increases by CT. At years 1 and 2, the mean (SD) computed volume increases per patient were, respectively 87 (186) and 201 (366) mm(3). Computed volume changes were strongly associated with the physician's visual ratings of change (p<0.0002 and p<0.0001 for changes at years 1 and 2, respectively). The sensitivity to change over 1 year was higher for the CT volume measure (1.84) and the CT height measure (1.22) than either the MRI measure (0.50) or radiography (0.29). CT-based syndesmophytes measurements had very good longitudinal validity and better sensitivity to change than radiography or MRI. This method shows promise for longitudinal clinical studies of syndesmophyte development and growth.
    Annals of the rheumatic diseases 12/2013; 74(2). DOI:10.1136/annrheumdis-2013-203946 · 9.27 Impact Factor
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    ABSTRACT: Abstract Purpose . Time perspective, a psychological construct denoting subjective orientation to either present or future concerns, has been inconsistently associated with healthy behaviors in adults. We hypothesized that associations would be stronger in young adults, who are first developing independent attitudes, than in older adults. Design . Cross-sectional survey. Setting . The study was conducted in three cities in the Mid-Atlantic region. Subjects . Subjects were 790 patrons of barber and beauty shops. Measures . Measures used were the Zimbardo Time Perspective Inventory future, present-fatalistic, and present-hedonistic subscales and current smoking, days per week of recreational exercise, and height and weight, by self-report. Analysis . We tested if associations between time perspective and exercise, obesity, and current smoking differed by age group (18-24 years, 25-34 years, and 35 years and older) using analysis of variance and logistic regression. Results . Higher future time perspective scores, indicating greater focus on future events, was associated with more frequent exercise, whereas higher present-fatalistic time perspective scores, indicating more hopelessness, was associated with less frequent exercise in 18- to 24-year-olds, but not in older individuals. Lower future time perspective scores, and higher present-hedonistic time perspective scores, indicating interest in pleasure-seeking, were also associated with obesity only in 18- to 24-year-olds. Current smoking was not related to time perspective in any age group. Conclusion . Time perspective has age-specific associations with exercise and obesity, suggesting stages when time perspective may influence health behavior decision making.
    American journal of health promotion: AJHP 11/2013; 29(1). DOI:10.4278/ajhp.130122-QUAN-39 · 2.37 Impact Factor
  • Robert A Colbert, Michael M Ward
    The Lancet 09/2013; 382(9906). DOI:10.1016/S0140-6736(13)61913-3 · 45.22 Impact Factor

Publication Stats

4k Citations
822.87 Total Impact Points

Institutions

  • 2004–2015
    • National Institute of Arthritis and Musculoskeletal and Skin Diseases
      베서스다, Maryland, United States
  • 2013
    • University of Texas Medical School
      • Department of Internal Medicine
      Houston, Texas, United States
  • 2012
    • Northern Inyo Hospital
      BIH, California, United States
  • 2005–2012
    • National Institutes of Health
      • National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
      Maryland, United States
  • 2011
    • National Technical University of Athens
      Athínai, Attica, Greece
  • 2007
    • University of Pittsburgh
      • Division of Rheumatology and Clinical Immunology
      Pittsburgh, PA, United States
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, California, United States
  • 2006
    • U.S. Department of Health and Human Services
      Washington, Washington, D.C., United States
  • 2000–2003
    • Stanford Medicine
      • Division of Immunology and Rheumatology
      Stanford, California, United States
  • 1998–2003
    • VA Palo Alto Health Care System
      Palo Alto, California, United States
  • 1998–1999
    • Stanford University
      • Department of Medicine
      Palo Alto, California, United States