Daniel H Solomon

Brigham and Women's Hospital, Boston, Massachusetts, United States

Are you Daniel H Solomon?

Claim your profile

Publications (455)3249.43 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To compare the risk of incident hypertension between initiators of TNF-α inhibitors and initiators of non-biologic disease modifying anti-rheumatic drugs (hereafter referred to as non-biologics) in rheumatoid arthritis patients taking methotrexate monotherapy. Methods: We conducted a cohort study using insurance claims data (2001-2012) from the US. We identified initiators of use of either TNF-α inhibitors or non-biologics. Subsequent exposure to these agents was measured monthly in a time-varying manner. The outcome of interest was incident hypertension, defined by a diagnosis and a prescription for an anti-hypertensive drug. Marginal structural models estimated hazard ratios adjusted for both baseline and time-varying confounders. To validate the primary analysis, we designed a verification analysis to evaluate a known association between leflunomide (a non-biologic disease modifying agent) and hypertension. Results: We identified 4,822 initiations of TNF-α inhibitor use and 2,400 of non-biologic use. Crude incidence rates of hypertension per 1,000 person-years of follow-up were 36 (95%CI 32-41) for the TNF-α inhibitor group and 42 (95%CI 34-51) for the non-biologics group. The crude hazard ratio of TNF-α inhibitors versus non-biologics for the risk of incident hypertension was 0.85 (95%CI 0.67-1.1). After adjusting for both baseline and time-varying covariates using marginal structural models, the HR was 0.95 (95%CI 0.74-1.2). In the verification analysis, the adjusted HR of incident hypertension was 2.3 (95%CI 1.7-3.0) in leflunomide initiators compared with methotrexate initiators. Conclusion: Treatment with TNF-α inhibitors was not associated with a reduced risk of incident hypertension compared with non-biologics in rheumatoid arthritis patients.
    No preview · Article · Jan 2016 · Epidemiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: This study examined the accuracy of claims-based algorithms to identify smoking against self-reported smoking data. Methods: Medicare patients enrolled in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study were identified. For each patient, self-reported smoking status was extracted from Women's Hospital Rheumatoid Arthritis Sequential Study and the date of this measurement was defined as the index-date. Two algorithms identified smoking in Medicare claims: (i) only using diagnoses and procedure codes and (ii) using anti-smoking prescriptions in addition to diagnoses and procedure codes. Both algorithms were implemented: first, only using 365-days pre-index claims and then using all available pre-index claims. Considering self-reported smoking status as the gold standard, we calculated specificity, sensitivity, positive predictive value, negative predictive value (NPV), and area under the curve (AUC). Results: A total of 128 patients were included in this study, of which 48% reported smoking. The algorithm only using diagnosis and procedure codes had the lowest sensitivity (9.8%, 95%CI 2.4%-17.3%), NPV (54.9%, 95%CI 46.1%-63.9%), and AUC (0.55, 95%CI 0.51-0.59) when applied in the period of 365 days pre-index. Incorporating pharmacy claims and using all available pre-index information improved the sensitivity (27.9%, 95%CI 16.6%-39.1%), NPV (60.4%, 95%CI 51.3%-69.5%), and AUC (0.64, 95%CI 0.58-0.70). The specificity and positive predictive value was 100% for all the algorithms tested. Conclusion: Claims-based algorithms can identify smokers with limited sensitivity but very high specificity. In the absence of other reliable means, use of a claims-based algorithm to identify smoking could be cautiously considered in observational studies. Copyright © 2016 John Wiley & Sons, Ltd.
    No preview · Article · Jan 2016 · Pharmacoepidemiology and Drug Safety
  • Margaret Seton · Marc Hansen · Daniel H. Solomon
    [Show abstract] [Hide abstract]
    ABSTRACT: Paget's disease of bone (PDB) is associated with a germline mutation in Sequestosome1/p62 (SQSTM1) found in ≤16 % of sporadic cases worldwide, and in 19-46 % of those studied with familial PDB. The P392L is the most prevalent mutation identified to date. This mutation by itself does not confer PDB or define the phenotype of PDB in a given person. Environmental determinants remain elusive, although increasing age of the individual, other gene polymorphisms in the context of SQSTM1 mutations, and measles virus have been implicated. Measles exposure has been unexamined in this context. The goal of this study is to compare the background history and phenotype of patients with PDB carrying the SQSTM1 P392L mutation to those patients without. Focusing on age, ancestry, P329L mutation, family history, measles exposure, distribution of PDB, and age of onset, we examined outcomes at 10 years. We postulated that aging may play a role in defining phenotype, and that this may become more visible in a well-characterized cohort. This is an observational study focused on a cohort of patients with PDB drawn from the New England Registry in whom environmental and family history has been catalogued, linked to radiographic data. Of the 217 persons who were enrolled in the Registry, 42 (19 %) responded to a letter inviting them to participate in testing for the presence of the measles antibody, and in genetic testing for the P392L mutation. The mean age of the cohort in 2001 was 70 years (range 55-79); 27 were men (64 %). The measles antibody was found in all cases tested. Nine patients had the P392L mutation (21 %), 2 with familial PDB. In these persons, early diagnosis of disease and spinal stenosis marked the male phenotype only. European ancestry was noted in the minority of those with P392L mutation. Most deaths recorded occurred in the ninth decade of life or later. Spinal stenosis emerges as a prominent phenotype in SQSTM1 P392L-positive men with aging. In these 42 patients with PDB from the New England Registry, most do not carry the SQSTM1 P392L mutation, and many do not have European ancestry. Exposure to measles was confirmed in the majority.
    No preview · Article · Dec 2015 · Calcified Tissue International
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: RA is associated with a 50-60% increase in risk of cardiovascular (CV) death. This study aimed to compare management of CV risk factors in RA and matched non-RA patients. Methods: A retrospective cohort study was conducted using UK clinical practice data. Patients presenting with an incident RA diagnosis were matched 1:4 to non-RA patients based on a propensity score for RA, entry year, CV risk category and treatment received at index date (date of RA diagnosis). Patients tested and treated for CV risk factors as well as those attaining CV risk factor management goals were evaluated in both groups. Results: Between 1987 and 2010, 24 859 RA patients were identified and matched to 87 304 non-RA patients. At index date, groups had similar baseline characteristics. Annual blood pressure, lipids and diabetes-related testing were similar in both groups, although CRP and ESR were higher in RA patients at diagnosis and decreased over time. RA patients prescribed antihypertensives increased from 38.2% at diagnosis to 45.7% at 5 years, from 14.0 to 20.6% for lipid-lowering treatments and from 5.1 to 6.4% for antidiabetics. Similar treatment percentages were observed in non-RA patients, although slightly lower for antihypertensives. Modest (2%) but significantly lower attainment of lipid and diabetes goals at 1 year was observed in RA patients. Conclusion: There were no differences between groups in the frequency of testing and treatment of CV risk factors. Higher CV risk in RA patients seems unlikely to be driven by differences in traditional CV risk factor management.
    Preview · Article · Dec 2015 · Rheumatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: FDA is considering an application for a biosimilar infliximab, which has been available in South Korea since November 2012. We aimed to examine the utilization patterns of both branded and biosimilar infliximab and other TNF in South Korea before and after the introduction of biosimilar infliximab. Methods: Using the claims data (4/2009-3/2014) of the Korean Health Insurance Review and Assessment Service database, which includes the entire South Korean population, we assessed the uptake of biosimilar infliximab. A segmented linear regression model examined utilization patterns of infliximab (the branded and biosimilar) and other TNF inhibitors (adalimumab and etanercept) before and after the introduction of biosimilar infliximab. Results: We identified 20,976 TNF inhibitor users, including 983 users of biosimilar infliximab. Among all the claims for any infliximab version, the proportion of biosimilar infliximab claims increased to 19% through March 2014. Before November 2012, each month there were 33 (95%CI 32-35) more infliximab claims, 44 (95%CI 40-48) more etanercept claims, and 50 (95%CI 47-53) more adalimumab claims. After November 2012, there were significant changes in the slopes with additional increases in the use of branded and biosimilar infliximab (9 claims/month, 95%CI 2-17) and decreases in etanercept (-52 claims/month, 95%CI -66 to -38) and adalimumab (-21 claims/month, 95%CI -35 to -6). Conclusion: After 15 months since its introduction in Korea, one-fifth of all infliximab claims were for the biosimilar. Introduction of biosimilar infliximab may affect the use of other TNF inhibitors and the magnitude of change will likely differ in other countries. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Arthritis and Rheumatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Clinical trials have shown that serotonin norepinephrine reuptake inhibitors, such as milnacipran, decrease pain in noninflammatory pain conditions such as fibromyalgia and osteoarthritis. We examined the effect of milnacipran on self-reported pain intensity and experimental pain sensitivity among patients with rheumatoid arthritis (RA) with widespread pain and stable RA disease activity. Methods: In this double-blind, crossover study, patients with RA with widespread pain, receiving a stable treatment regimen, were randomized (by a random number generator) to receive milnacipran 50 mg twice daily or placebo for 6 weeks, followed by a 3-week washout and crossed over to the other arm for the remaining 6 weeks. The primary outcome was change in average pain intensity, assessed by the Brief Pain Inventory short form. The sample size was calculated to detect a 30% improvement in pain with power = 0.80 and α = 0.05. Results: Of the 43 randomized subjects, 41 received the study drug, and 32 completed the 15-week study per protocol. On a 0-10 scale, average pain intensity decreased by 0.39 (95% CI -1.27 to 0.49, p = 0.37) more points during 6 weeks of milnacipran treatment compared with placebo. In the subgroup of subjects with swollen joint count ≤ 1, average pain intensity decreased by 1.14 more points during 6 weeks of milnacipran compared with placebo (95% CI -2.26 to -0.01, p = 0.04). Common adverse events included nausea (26.8%) and loss of appetite (9.7%). Conclusion: Compared with placebo, milnacipran did not improve overall, self-reported pain intensity among subjects with widespread pain receiving stable RA medications. Trial registration: ClinicalTrials.gov NCT01207453.
    No preview · Article · Dec 2015 · The Journal of Rheumatology
  • Daniel H Solomon · Chih-Chin Liu · I-Hsin Kuo · Agnes Zak · Seoyoung C Kim
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Nov 2015 · Annals of the rheumatic diseases
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Nov 2015 · Osteoarthritis and Cartilage
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Nov 2015 · The Journal of Rheumatology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2015
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: We examined the effect of blood pressure lowering drugs on BMD using data from the Study of Women’s Health Across the Nation. Thiazide users had a slower decline in BMD compared to nonusers, while decline among ACE inhibitor and beta blocker users were similar to rates in nonusers. Introduction Several blood pressure lowering drugs may affect bone mineral density (BMD), leading to altered fracture risk. We examined the effect of blood pressure lowering drugs on BMD using data from the Study of Women’s Health Across the Nation. Methods We conducted a propensity score matched cohort study. Women were initiators of ACE inhibitors (ACEi), beta-blockers (BB), or thiazide diuretics (THZD). Their annualized BMD changes during the 14 years of observation were compared with nonusers. Results Among the 2312 eligible women, we found 69 ACEi, 71 BB, and 74 THZD users who were matched by a propensity score with the same number of nonusers. THZD users had a slower annual percent decline in BMD compared to nonusers at the femoral neck (FN) (−0.28 % vs −0.88 %; p = 0.008) and the spine (−0.74 % vs −1.0 %; p = 0.34), albeit not statistically significant. Annual percent changes in BMD among ACEi and BB users were similar to rates in nonusers. In comparison with BB, THZD use was associated with a trend toward less annualized BMD loss at the spine (−0.35 % vs −0.60 %; p = 0.08) and a similar trend at the FN (−0.39 % vs −0.64 %; p = 0.08); in comparisons with ACEi, THZD was also associated with less loss at the FN (−0.48 % vs −0.82 %; p = 0.02), but not at the spine (−0.40 % vs −0.56 %; p = 0.23). Conclusions Neither ACEi nor BB was associated with improvements in BMD. THZD use was associated with less annualized loss of BMD compared with nonusers, as well as compared with ACEi and BB.
    No preview · Article · Oct 2015 · Osteoporosis International
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2015
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Sep 2015 · Rheumatology (Oxford, England)
  • Seoyoung C Kim · Jun Liu · Daniel H Solomon
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Aug 2015 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Aug 2015
  • D H Solomon · J Greenberg · J M Kremer · C J Etzel

    No preview · Article · Aug 2015 · Arthritis and Rheumatology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Aug 2015 · Clinical Rheumatology
  • Source
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Jul 2015 · Rheumatology (Oxford, England)
  • Daniel H Solomon · Michael E Weinblatt · Richard J Bucala

    No preview · Article · Jul 2015 · Arthritis and Rheumatology

Publication Stats

16k Citations
3,249.43 Total Impact Points


  • 2003-2016
    • Brigham and Women's Hospital
      • • Division of Pharmacoepidemiology and Pharmacoeconomics
      • • Department of Medicine
      • • Division of Rheumatology, Immunology, and Allergy
      Boston, Massachusetts, United States
  • 1997-2015
    • Harvard University
      Cambridge, Massachusetts, United States
    • Harvard Medical School
      • Department of Medicine
      Boston, 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
  • 2010
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2009-2010
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 2004-2008
    • Boston University
      Boston, Massachusetts, United States
  • 2006
    • University of Toronto
      • Institute of Health Policy, Management and Evaluation
      Toronto, Ontario, Canada