Cynthia S Crowson

Mayo Foundation for Medical Education and Research | MMS

Objective We aimed to characterize presentation and care pathways of patients with systemic lupus erythematosus (SLE), and delays in access to SLE‐specialized care. Methods We included patients with incident SLE from the Lupus Midwest Network registry. Time from the first medical encounter for SLE clinical manifestation to access to SLE‐specialize...

Objective We aimed to identify specific genetic-respiratory disease endotypes for rheumatoid arthritis (RA) risk. Methods This case–control study used the Mass General Brigham (MGB) and Mayo Clinic (MC) Biobanks for discovery and replication, respectively. We matched criteria-confirmed incident RA cases to four non-RA controls on age, sex and heal...

Objective polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis, but its relationship to the severity and outcome of PMR is unknown. Methods In a post-hoc analysis...

Objective The 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria score (≥20 points) has been associated with poor outcomes. We aimed to evaluate its utility as a predictor for mortality and hospitalisation and to derive and validate an omi...

Objective To investigate trends in depression and anxiety over three decades among individuals with rheumatoid arthritis (RA). Methods Patients with incident RA (age >18 years, meeting 1987 ACR criteria in 1985-2014) were identified using the Rochester Epidemiology Project. Individuals with RA were matched 1:1 with non-RA comparators on age, sex,...

Objective The aim of this study was to characterize the phenotype and genotype of patients with Yao syndrome (YAOS), with focus on comparing to prior cohorts, identifying novel features, and describing treatment observations. Methods A retrospective medical records review of patients with YAOS seen at Mayo Clinic was conducted to characterize clin...

Objectives To examine the clinicopathologic features of patients with polymyalgia rheumatica (PMR) who had thoracic aorta repair surgery. Findings were compared with those of a cohort of patients with giant cell arteritis (GCA) requiring thoracic aorta repair. Methods All patients evaluated at Mayo Clinic in Rochester, MN, with Current Procedural...

Objective Rheumatoid arthritis (RA) has been associated with an elevated dementia risk. The study aimed to examine how different diagnostic dementia definitions perform in those with RA compared to individuals without RA. Methods This study population included 2050 individuals (1025 with RA) from a retrospective population-based cohort in southern...

Background Relapse is common in patients with giant cell arteritis (GCA). A clinically relevant question for both patients and providers is whether the initial symptoms at GCA diagnosis will be present at time of relapse or whether other clinical features may manifest. Given most cohorts describe both baseline and relapse symptoms in aggregate, eva...

Background Previous studies have shown an increased mortality in persons with rheumatoid arthritis (RA) compared to the general population. Chronic systemic inflammation and excess comorbidity burden contribute to increased mortality in RA. Despite the advent of effective targeted therapies and improved comorbidity prevention and management strateg...

Background While it is well established that patients with rheumatoid arthritis (RA) have substantial morbidity and mortality, recent studies have shown that RA patients have increased mortality due to cancer. There are varying risks for the development of cancer in RA patients. RA patients are at an increased risk of developing lymphoma and lung c...

Background With population aging, the burden of stroke is rising globally, with disproportionally worse outcomes in women. Previous studies report about 1.6-fold increased risk of stroke in people with rheumatoid arthritis (RA) compared to the general population. Sex differences in the risk and outcomes of stroke in RA are not well understood. Obj...

Objective The recent EULAR SLE guidelines recommend the use of reduced GC regimens (0.3–0.5 mg/kg) in the treatment of LN. However, as they acknowledged, this is not evidence-based. Our objective was to evaluate the effect of different GC regimens with the standard of care therapy on renal response, infections, and mortality among patients with LN....

Objectives To determine whether antecedent sinusitis is associated with incident rheumatic disease. Methods This population-based case–control study included all individuals meeting classification criteria for rheumatic diseases between 1995 and 2014. We matched three controls to each case on age, sex and length of prior electronic health record h...

Objectives We aimed to cluster patients with rheumatoid arthritis (RA) based on comorbidities and then examine the association between these clusters and RA disease activity and mortality. Methods In this population-based study, residents of an eight-county region with prevalent RA on 1 January 2015 were identified. Patients were followed for vita...

Objective To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients. Methods The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-up through 31 December 2020, death or migration....

Objectives To examine multimorbidity in psoriasis and its association with the development of psoriatic arthritis (PsA). Methods A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000–09) and prevalence (1 January 2010) cohorts of psoriasis were identified by manual chart review. A coh...

Objective We aimed to evaluate the robustness of phase III randomised controlled trials (RCTs) for SLE and lupus nephritis (LN) using the fragility index (FI), the reverse FI (RFI) and the fragility quotient (FQ). Methods We searched for phase III RCTs that included patients with active SLE or LN. Data on primary endpoints, total participants and...

Objective The focus of this study was to assess changes in the cumulative incidence of extra‐articular manifestations of rheumatoid arthritis (ExRAs) and associated mortality risk. Methods This study evaluated trends in occurrence of ExRAs using a population‐based inception cohort that included all adult patients with incident rheumatoid arthritis...

Objectives To assess the prevalence and incidence of multimorbidity and the association with the SLICC/ACR damage index (SDI) among patients with systemic lupus erythematosus (SLE). Methods Using prevalent and incident population-based cohorts of patients with SLE and their matched comparators, we assessed 57 chronic conditions. Chronic conditions...

Objectives The objective is to examine utilisation of cardiovascular preventive services in patients with rheumatoid arthritis (RA), compared with a non-RA population, and to examine cardiovascular disease (CVD) screening rates among RA patients without diabetes mellitus (DM), hypertension or hyperlipidaemia to non-RA patients with one of these dia...

Objectives Active RA has been associated with an increased risk of both cardiovascular and peripheral vascular disease. We aimed to compare cerebrovascular changes in patients with and without RA, both with and without a neuropathologic diagnosis of neurodegenerative disease. Methods Patients with RA (n = 32) who died and underwent autopsy between...

Objectives: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is currently categorized under the small vessel vasculitides. There is limited knowledge about large vessel involvement in AAV (L-AAV), mainly described in case reports and small series. L-AAV can involve temporal arteries (TA-AAV), aorta (A-AAV), and periaortic so...

Objectives: Multimorbidity is burdensome for people with rheumatoid arthritis (RA). We investigated differences in multimorbidity and comorbidities by sex and age in the RA population. Methods: This cross-sectional analysis used national administrative claims (OptumLabs® Data Warehouse) from people with RA and non-RA comparators (matched on age,...

Objective To investigate the incidence of women with breast implants in 1964–2017Materials and Methods All women with breast implants in Olmsted County, MN between January 1, 1992 and December 31, 2017 were identified, and a comprehensive review of individual medical records was performed, adding to a previously identified cohort of women with brea...

Objective: We aimed to identify gene by respiratory tract disease interactions that increase RA risk. Methods: In this case-control study using the Mass General Brigham Biobank, we matched incident RA cases, confirmed by ACR/EULAR criteria, to four controls on age, sex, and electronic health record history. Genetic exposures included a validated...

Objectives: To investigate the clinicopathologic features of patients with giant cell arteritis (GCA) who had thoracic aorta aneurysm or dissection surgery. Methods: Patients who had thoracic aorta surgery between January 1, 2000, and December 31, 2021, at the Mayo Clinic, Rochester, Minnesota, were identified with current procedural terminology...

Introduction The longitudinal responses towards multiple doses of COVID-19 mRNA vaccines in patients with systemic autoimmune diseases remain incompletely understood. While observational studies suggested the safety of COVID-19 mRNA vaccines in rheumatic disease patients, laboratory evidence is lacking. Methods Here we evaluated seroreactivity, cl...

Objective The FRAX algorithm for risk prediction of major osteoporotic fractures and hip fractures accounts for several risk factors, including rheumatoid arthritis (RA), as individuals with RA have an excess burden of fractures. FRAX has not been validated in population-based RA cohorts in the US. We aimed to determine the accuracy of FRAX risk pr...

Objective To evaluate the safety and efficacy of tocilizumab (TCZ) in giant cell arteritis (GCA) in a large North American cohort. Methods Patients with GCA treated with TCZ between January 1, 2010, and May 15, 2020, were retrospectively identified. Kaplan-Meier methods were used to estimate time to TCZ discontinuation and time to first relapse af...

Background Screening for large artery manifestations in patients with Giant Cell Arteritis (GCA) has been adopted in clinical practice. However, the effect of recent use of imaging studies on incidence and mortality of large artery manifestations remains unclear. Objectives In this study, we aimed to investigate incidence trends and outcomes of la...

Background Systematic bias to greater severity of rheumatoid arthritis (RA) is often presumed to exist in patients referred for evaluation at academic centers. However, the magnitude of this potential bias has not been quantified to our knowledge. Objectives The objective was to test the hypothesis that patients in a referral population have great...

Background Patients with rheumatoid arthritis (RA) experience higher cardiovascular risk compared to individuals without inflammatory rheumatic disease. Observational studies indicate that methotrexate (MTX) may decrease cardiovascular risk in patients with RA. It is, however, unclear whether sex differentially impacts cardiovascular risk in MTX us...

Background Dementia is a major global mental health problem. The prevalence of dementia is increasing dramatically with increasing life longevity and population aging. Several studies found increased risk of dementia in patients with rheumatoid arthritis (RA) and reported a possibility of mitigating this risk with antirheumatic treatments. The unde...

Background Rheumatoid arthritis (RA) increases the burden of cardiovascular disease (CVD). Fasting blood glucose, fasting lipoprotein profiles, and blood pressure measurements are recommended at regular intervals to screen for classical CVD risk factors of diabetes mellitus (DM), hyperlipidemia (HLD), and hypertension (HTN), respectively. Objectiv...

Background Clinical guidelines recommend minimizing glucocorticoid use among patients with rheumatoid arthritis (RA) and many new therapeutic options in recent decades offer alternatives to glucocorticoids, but it is unknown whether glucocorticoid use has declined in patients with RA. Objectives To examine time trends in glucocorticoid use among p...

Background Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is currently categorized under the small vessel vasculitides and includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) [1]. There is limited knowledge about large vessel involvement i...

Background Comorbidities are common in patients with rheumatoid arthritis (RA), but there is little information regarding distinct comorbidity patterns in patients with RA and how these patterns impact disease activity and mortality. Objectives To examine clusters of patients with RA based on comorbidities, the association between these clusters a...

Background Clinically isolated aortitis (CIA) refers to inflammation of the aorta without signs of systemic vasculitis or infection [1]. The diagnosis of CIA generally relies on histopathologic evaluation of aortic tissue obtained during thoracic aortic aneurysm surgery making the diagnosis more challenging. Recent studies suggest that CIA might be...

Background Patients with rheumatoid arthritis (RA) are at increased risk for serious infections (SI) and have a higher prevalence of multimorbidity. The increased risk for SI has led to the creation of multiple infection risk models over the last decade for patients with RA. These models often include combinations of patient demographics, medicatio...

Background Despite a lower risk of ILD and ILD progression in anti-centromere antibody (ACA) positive systemic sclerosis (SSc) patients, ILD may still occur and progress. Little is known regarding risk factors for ILD in ACA+ SSc patients to help guide screening with high-resolution computed tomography (HRCT), and risk of ILD progression in ACA+ SS...

Background The most common extraarticular manifestation of rheumatoid arthritis (RA) is the rheumatoid nodule, which is reported to affect about 30% of patients with RA.[1] The development of rheumatoid nodules has been associated most strongly with high disease activity, seropositive status, and more rapid progression of joint destruction. Despite...

Background Systemic sclerosis (SSc) is a chronic inflammatory autoimmune disease characterized by vascular dysfunction and widespread internal organ fibrosis. Multimorbidity (MM), defined as the co-occurrence of two or more chronic conditions, can impact life expectancy, increase risk of hospitalizations, healthcare resource utilization and reduce...

Background/Purpose: Delays in access to specialized care and diagnosis of systemic lupus erythematosus (SLE) are associated with poor outcomes. Prior studies rely mostly on cross-sectional surveys and are probably subjected to recall bias. Moreover, Insufficient data from population-based SLE cohorts in the United States limits our understanding of...

Comparison of autoantibodies identified in at least 10% of incomplete lupus erythematosus ILE/ILE patients compared to SLE/SLE patients. 666 Background/Purpose: Smoking and use of estrogen-containing oral contraceptives (OCP) are SLE risk factors. Data on transitioning from cutaneous lupus erythematosus (CLE) to SLE and potential risk factors assoc...

Background/Purpose The presence of multiple chronic conditions (multimorbidity) is associated with disability and premature death. We determined the trajectory of multimorbidity in SLE compared to the general population. Methods An SLE cohort was assembled using OptumLabs Datawarehouse (OLDW) from 1/2006-9/2015. SLE cases were identified using > 3...

Objectives: To examine time trends in glucocorticoid (GC) use among patients diagnosed with rheumatoid arthritis (RA) during the biologic era. Methods: A population-based inception cohort of RA patients diagnosed during 1999 - 2018 was followed longitudinally through their medical records until death, migration or 12/31/2020. All patients fulfil...

Patients with rheumatoid arthritis (RA) can test either positive or negative for circulating anti-citrullinated protein antibodies (ACPA) and are thereby categorized as ACPA-positive (ACPA+) or ACPA-negative (ACPA−), respectively. In this study, we aimed to elucidate a broader range of serological autoantibodies that could further explain immunolog...

Objective. To evaluate seroreactivity and disease biomarkers after 2 or 3 doses of COVID-19 mRNA vaccines in a cohort of patients with rheumatic diseases. Methods. We collected biological samples longitudinally before and after 2-3 doses of COVID-19 mRNA vaccines from a cohort of patients with systemic lupus erythematosus (SLE), psoriatic arthritis...

Objective To assess trends in incidence of heart failure (HF) in patients with incident rheumatoid arthritis (RA) in 1980-2009 and to compare different HF definitions in RA. Methods The study population comprised Olmsted County, Minnesota residents with incident RA (age ≥ 18 years, 1987 ACR criteria met in 1980-2009). All subjects were followed un...

Objectives: Clinically isolated aortitis (CIA) refers to inflammation of the aorta without signs of systemic vasculitis or infection. Population-based data on the epidemiology of CIA in North America is lacking. We aimed to investigate the epidemiology of pathologically confirmed CIA. Methods: Residents of Olmsted County, Minnesota were screened...

Cardiovascular disease (CVD) risk is increased in most inflammatory rheumatic diseases (IRDs), reiterating the role of inflammation in the initiation and progression of atherosclerosis. An inverse association of CVD risk with body weight and lipid levels has been described in IRDs. Coronary artery calcium scores, plaque burden and characteristics,...

Background: To identify fine specificity anti-citrullinated protein antibodies (ACPA) associated with incident rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: This nested case-control study within the Brigham RA Sequential Study matched incident RA-ILD cases to RA-noILD controls on time of blood collection, age, sex,...

Objective There is a paucity of population‐based studies investigating the epidemiology of lupus nephritis (LN) in the US and long‐term secular trends of the disease and its outcomes. We aimed to examine the epidemiology of LN in a well‐defined 8‐county region in the US. Methods Patients with incident LN between 1976 and 2018 in Olmsted County, Mi...

Objective To assess the frequency of comorbidities and metabolic risk factors at and prior to GCA diagnosis. Methods Retrospective case-control study of patients with incident GCA between 1/1/2000 and 12/31/2019 in Olmsted County, MN. Two age- and sex-matched controls were identified, and each assigned an index date corresponding to an incidence d...

Objective There is little information about the epidemiology and factors associated with opioid therapy in systemic lupus erythematosus (SLE). We aimed to assess the prevalence of opioid therapy and explore factors associated with long-term opioid therapy (LTOT) in patients with SLE. Methods Patients with SLE were matched with non-SLE controls in...

We thank Wang and colleagues ¹ for their earnest interest in our recent paper, which evaluated the risk factors for dementia in an inception cohort of rheumatoid arthritis (RA). ² In their correspondence, ¹ the authors point out a possibility of confounding by several factors, including age, sex, education, calendar year of RA incidence, and race,...

Objective To characterize the epidemiological trends and mortality of cutaneous lupus erythematosus (CLE) between 1976 and 2018 in Olmsted County, Minnesota. Patients and Methods In this retrospective population-based cohort study, all incident and prevalent CLE cases among adult residents in Olmsted County, Minnesota, between January 1, 1976, and...

Objective To identify differences in multimorbidity and individual comorbidities among individuals with rheumatoid arthritis (RA), separated by race and ethnicity. Methods This case–control study within OptumLabs Data Warehouse from 2010 to 2019 matched RA cases (defined by 2 codes plus prescription of an RA drug) to non‐RA controls 1:1 on age, se...

Objectives Patients with rheumatoid arthritis (RA) can test either positive or negative for anti-citrullinated protein antibodies (ACPA), and are thereby ACPA-positive (ACPA+) or ACPA-negative (ACPA–), respectively. Through comprehensive profiling of autoantibodies in serum, we aimed to identify autoantibodies that are differentially abundant betwe...

The risk of progression to end-stage kidney disease (ESKD) in patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) and glomerulonephritis (AAV-GN) remains high. At 5 years of follow-up, 14% to 25% of patients will evolve to ESKD suggesting that kidney survival is not optimized in patients with AAV. The addition of...

Objective We aimed to determine the population‐based incidence, prevalence, and mortality of dermatomyositis (DM) using European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria. Methods This population‐based cohort study included incident DM from January 1, 1995 to December 31, 2019. We manually re...

Objective To describe the prevalence of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA), and to evaluate the proportion of patients with AF receiving guideline-recommended anticoagulation for prevention of stroke, based on data from a large international audit. Methods The cohort was derived from the international audit SUrvey...

Most rheumatic diseases have a stronger environmental than hereditary etiology. This article summarizes the key environmental risk factors for rheumatic diseases, the data sources that generated these findings, and the key pitfalls with existing research that every rheumatology clinician should know. Emerging research opportunities hold promise to...

Objective: The aim of this study was to determine inpatient health care utilization in an incident cohort of patients with systemic lupus erythematosus (SLE) compared with the general population. Methods: This was a population-based cohort study in the upper Midwest, United States. We included patients fulfilling the European League Against Rheuma...

Objective To identify clusters of comorbidities in patients with rheumatoid arthritis (RA) using 4 methods and to compare to patients without RA. Methods In this retrospective, population‐based study, residents of 8 Minnesota counties with prevalent RA as of January 1, 2015 were identified. Age‐, sex‐, and county‐matched non‐RA comparators were se...

Background Systemic lupus erythematosus (SLE) is a disease that can lead to damage of multiple organs and, along with certain treatments, increase the risk of developing cancer, cardiovascular disease, diabetes, osteoporosis, and infections. Preventive services are particularly important in patients with SLE to mitigate the aforementioned risks. We...

Extracellular sulfatase-2 (Sulf-2) influences receptor–ligand binding and subsequent signaling by chemokines and growth factors, yet Sulf-2 remains unexplored in inflammatory cytokine signaling in the context of rheumatoid arthritis (RA). In the present study, we characterized Sulf-2 expression in RA and investigated its potential role in TNF-α-ind...

Objective We aimed to determine the association of physical activity and dietary factors on RA risk. Methods This case-control study within the Mayo Clinic Biobank matched incident RA cases (two codes plus disease-modifying anti-rheumatic drug, PPV 95%) to controls 1:3 on age, sex, and recruitment year/location. A baseline questionnaire assessed a...

Objective To compare cardiovascular disease (CVD) rates in rheumatoid arthritis (RA) beneficiaries of the Social Security Disability Insurance (SSDI) with commercially insured RA patients. Method We created three cohorts of RA patients aged < 65 years for SSDI and three for Marketscan using claims data from 2006 to 2016. The cohort definitions wer...

Objective To identify the incidence, risk factors, and outcomes of rheumatoid arthritis–associated interstitial lung disease (RA‐ILD) and to assess time trends in the incidence and mortality in RA‐ILD. Methods We included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014. Subjects were followed until death, emigra...