Sogol Amjadi

University of Nevada, Las Vegas, Las Vegas, Nevada, United States

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Publications (10)37.24 Total impact

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    ABSTRACT: Objective: To evaluate the effect of sustained ACR/EULAR Boolean remission on residual joint inflammation assessed by magnetic resonance imaging (MRI) and to secondarily evaluate other clinical definitions of remission, within an early seropositive rheumatoid arthritis (RA) cohort.Methods: A subcohort of 118 RA patients were enrolled from patients who completed the two-year double-blind randomized Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) trial. Patients received a single contrast enhanced 1.5 Tesla MRI of their most involved wrist. Two readers scored MRI for synovitis, osteitis, tenosynovitis, and erosions. Clinical assessments were performed every three months during the trial and at time of MRI.Results: The subcohort was 92% seropositive with mean age 51 years, duration 4.1 months, and DAS28-ESR 5.8 at TEAR entry. Total MRI Inflammatory Scores (tenosynovitis+synovitis+osteitis) were lower among patients in clinical remission. Lower MRI scores were correlated with longer duration of CDAI remission (rho=0.22, p=0.03). At the time of MRI, 89 patients had no wrist pain/tenderness/swelling; however, all 118 patients had MRI evidence of residual joint inflammation after two years. No statistically significant differences in damage or MRI inflammatory scores were observed across treatment groups.Conclusion: This is the first detailed appraisal describing the relationship between clinical remission cut-points and MRI inflammatory scores within a RA RCT. The most stringent remission criteria (2011 ACR/EULAR and CDAI) best differentiate the total MRI inflammatory scores. These results document that 2-years of triple therapy or TNF+methotrexate treatment in early RA does not eliminate MRI evidence of joint inflammation. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2014
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    ABSTRACT: Recent data suggest that atherosclerotic disease is increased in patients with idiopathic inflammatory myositis (IIM) and that dyslipidemia is a significant risk factor for cardiovascular events. Lipid-lowering agents may be associated with myopathic side effects. The current work evaluates the use of lipid-lowering therapy in patients with IIM treated by IIM specialists belonging to the International Myositis Assessment and Clinical Studies (IMACS) Group. The IMACS Group is a multidisciplinary coalition of experts with significant interest and experience in IIM. IMACS members were asked to complete an 18-item online survey detailing their clinical practice on monitoring and treating hypercholesterolemia in IIM patients. Specific questions regarding the types of lipid-lowering therapies used in IIM patients and any side effects associated with treatment were asked. Sixty-three IMACS members representing 23 countries and a minimum of 1,641 IIM patients participated in the online survey. Seventy-six percent of these specialists treating adult IIM patients use lipid-lowering therapies in their patients. HMG co-enzymeA reductase inhibitors (statins) were the most commonly used agents (93 %). Thirty-six cases of worsening myositis associated with statin use were reported in over 300 patients using lipid-lowering therapies. Seven of eight responders who reported worsening in myositis with lipid-lowering therapies reported cases in which the myositis improved after holding therapy. This survey suggests that statins are commonly used by physicians specializing in the treatment of patients with IIM and that some myositis patients worsen with statin use and may improve on dechallenge. More research regarding the safety of lipid-lowering agents in patients with IIM is warranted.
    No preview · Article · Apr 2012 · Clinical Rheumatology
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    ABSTRACT: Reverse cholesterol transport (RCT) is a major antiatherogenic function of high density lipoprotein (HDL). In the current work, the authors evaluated whether the RCT capacity of HDL from rheumatoid arthritis (RA) patients is impaired when compared to healthy controls. HDL was isolated from 40 patients with RA and 40 age and sex matched healthy controls. Assays of cholesterol efflux, HDL's antioxidant function and paraoxanase-1 (PON-1) activity were performed as described previously. Plasma myeloperoxidase (MPO) activity was assessed by a commercially available assay. Mean cholesterol efflux capacity of HDL was not significantly different between RA patients (40.2% ± 11.1%) and controls (39.5% ± 8.9%); p=0.75. However, HDL from RA patients with high disease activity measured by a disease activity score using 28 joint count (DAS28>5.1), had significantly decreased ability to promote cholesterol efflux compared to HDL from patients with very low disease activity/clinical remission (DAS28<2.6). Significant correlations were noted between cholesterol efflux and the DAS28 (r=-0.39, p=0.01) and erythrocyte sedimentation rate, (r=-0.41, p=0.0009). Higher plasma MPO activity was associated with worse HDL function (r=0.41/p=0.009 (antioxidant capacity); r=0.35, p=0.03 (efflux)). HDL's ability to promote cholesterol efflux was modestly but significantly correlated with its antioxidant function (r=-0.34, p=0.03). The cholesterol efflux capacity of HDL is impaired in RA patients with high disease activity and is correlated with systemic inflammation and HDL's antioxidant capacity. Attenuation of HDL function, independent of HDL cholesterol levels, may suggest a mechanism by which active RA contributes to increased cardiovascular (CV) risk.
    Preview · Article · Jan 2012 · Annals of the rheumatic diseases
  • Sogol S. Amjadi · Veena K. Ranganath · Daniel E. Furst
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    ABSTRACT: The aging process is complex and there is a high degree of variability in the rate at which an individual ages. Presently, the aging process and its effects in the body are not fully understood. In general, there are some differences in pharmacokinetic and pharmacodynamics effects of medications when comparing younger and older patients. Some of the most important changes that occur with aging are within the liver and kidneys. Although liver function tests such as serum bilirubin, cholesterol, and alkaline phosphatase are not significantly different between older and younger adults, decreased hepatic blood flow, liver mass, and enzymatic activity are seen in many older adults. However, these changes are not necessarily clinically significant and do not take place in all elderly patients. Renal dysfunction requires that some drugs such as methotrexate are dose-adjusted in the elderly patients. Pharmacodynamic changes in older patients may result in an altered sensitivity to drugs as well, resulting in increased adverse events or decreased/increased clinical response. Overall, there are not many clinically important pharmacodynamic changes when examining disease-modifying antirheumatic drugs (DMARDs) or biologic agents used in rheumatoid arthritis. Currently, the available data suggests that conventional DMARDs and biologic agents are similarly effective in the old and the young. Hence, older RA patients should not be excluded from the usual use of these agents to obtain optimal control of disease. While most studies suggest effective and safe outcomes associated with the use of DMARDs/biologics in the elderly, it is important to keep in mind the possibility of an increased incidence or severity of drug toxicity, particularly among the frail elderly who are an especially vulnerable group of patients. Frail older patients may have poor cardiac, renal, and/or liver function, and a decreased immune function (hence a higher risk for infections). Consequently, their treatment should be approached cautiously, keeping in mind the pharmacokinetic and pharmacodynamic changes that may occur with aging. This chapter briefly reviews the data regarding the use of conventional DMARDs and biologic agents in rheumatoid arthritis patients with an emphasis on their use in older patients where data is available. KeywordsRheumatoid arthritis-Elderly-Disease-modifying antirheumatic drugs-Biologic agents
    No preview · Chapter · Dec 2010
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    ABSTRACT: To assess gender differences in disease characteristics and treatment responses over time in a disease-modifying antirheumatic drug (DMARD)-naive seropositive early rheumatoid arthritis (RA) cohort. Patients with polyarticular disease who were DMARD-naive and had seropositive early RA (< 14 months) were recruited by the Western Consortium of Practicing Rheumatologists. Each patient was examined at study entry, after 6 and 12 months, and yearly thereafter. Clinical and demographic data were collected. We investigated gender differences in baseline disease characteristics and treatment using chi-squared, Mann-Whitney U, and t tests. We used generalized estimating equations (GEE) models for repeated measures to examine whether the rate of change of specific disease outcomes during the first 2 years after DMARD initiation was significantly influenced by gender. At baseline, men (n = 67) and women (n = 225) had similar disease activity and radiographic damage; men, however, had significantly worse erosion, while women had worse joint space narrowing. Despite similar treatment, women had worse disease progression over the 2-year followup, as assessed by trends in Disease Activity Score 28/erythrocyte sedimentation rate (DAS28-ESR4), physician global scores, and tender joint counts. In the GEE model, gender was significantly associated with the rate of change of DAS28-ESR4 scores (p = 0.009), although not independently associated with disease activity. Self-reported measures (Health Assessment Questionnaire-Disability Index, patient global scores, fatigue, pain) were worse among women at baseline and throughout the study period. Men were more likely to achieve remission. At baseline, men and women had similar disease activity and joint damage. Responses to treatment over time were better among men in this prebiologic era; women had worse progression despite similar treatment.
    Full-text · Article · Oct 2010 · The Journal of Rheumatology
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    ABSTRACT: Differences in clinical characteristics of older and younger rheumatoid arthritis (RA) patients have led some researchers to believe that RA in older patients is a distinct clinical entity and requires specialized therapeutic management. Whether or not there are any differences in clinical features and prognosis between older and younger RA patients, there is general consensus that RA should be treated aggressively early in the course of the disease to achieve the best clinical outcome. For this reason, all patients, irrespective of age, are treated with commonly used disease-modifying antirheumatic drugs/biologic agents. Although the data are limited, published safety and efficacy papers on older RA patients suggest that most disease-modifying antirheumatic drugs/biologic agents have similar efficacy and safety outcomes to younger RA patients. However, due to multiple comorbidities, older RA patients may be at a higher risk for adverse drug reactions.
    No preview · Article · Oct 2010 · Aging Health
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    ABSTRACT: To characterize the antiinflammatory function of high-density lipoprotein (HDL) in patients with rheumatoid arthritis (RA) and to identify specific differences in HDL-associated proteins and enzymes that distinguish proinflammatory HDL from normal, antiinflammatory HDL. We studied 132 RA patients. The antiinflammatory function of HDL was assessed by a cell-free assay, and proinflammatory HDL was defined by an HDL inflammatory index > or =1. Plasma and HDL-associated protein levels of apolipoprotein A-I (Apo A-I), haptoglobin, hemopexin, hemoglobin, and myeloperoxidase (MPO) were measured by direct and sandwich enzyme-linked immunosorbent assays, respectively. Lecithin:cholesterol acyltransferase (LCAT) activity was measured by a commercially available assay. Age, disease activity, the presence of erosive disease, non-Caucasian race, and smoking were significantly associated with proinflammatory HDL on multivariate analysis. Patients with proinflammatory HDL had higher measures of systemic inflammation, and a significant correlation was observed between RA disease activity (using the Disease Activity Score in 28 joints) and the HDL inflammatory index (r = 0.54, P < 0.0001). Compared with patients with antiinflammatory HDL, patients with proinflammatory HDL had significantly higher levels of haptoglobin, hemoglobin, Apo A-I, and MPO associated with HDL (P < 0.05 for all comparisons except MPO, which was P = 0.05). LCAT activity was lowest in patients with proinflammatory HDL, but was also significantly reduced in RA patients with antiinflammatory HDL as compared with healthy controls (P = 0.001). Proinflammatory HDL in this RA patient cohort was associated with active disease and an altered protein cargo as compared with antiinflammatory HDL in RA patients and in healthy controls. The antiinflammatory function of HDL was inversely correlated with systemic inflammation in RA patients and may warrant further investigation as a mechanism by which active RA increases cardiovascular morbidity and mortality.
    Full-text · Article · Oct 2009 · Arthritis & Rheumatology
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    ABSTRACT: To assess the course of the modified Rodnan skin thickness score (MRSS) in 3 large, multicenter, double-blind, randomized controlled trials (RCTs) of patients with diffuse cutaneous systemic sclerosis (dcSSc) with different baseline disease durations, as defined from the date of onset of the first dcSSc symptom (excluding Raynaud's phenomenon) or from the date of onset of the first dcSSc-related symptom (including Raynaud's phenomenon). Data from 3 RCTs examining high-dose versus low-dose D-penicillamine (D-Pen Trial), recombinant human relaxin versus placebo (Relaxin Trial), and oral bovine type I collagen versus placebo (Collagen Trial) treatment in patients with dcSSc were pooled and analyzed. Patients were divided into 5 groups according to their disease duration at baseline. The linear mixed model for correlated data was used to model the 2 predictors of MRSS: time in study (expressed in months after baseline) and baseline disease duration (expressed in months, calculated from the date of onset of the first symptom characteristic of dcSSc with and without Raynaud's phenomenon). At study entry, the mean MRSS value was 21.0 in the D-Pen Trial cohort, 27.3 in the Relaxin Trial cohort, and 26.1 in the Collagen Trial cohort. Time in study was a significant predictor of improvement in MRSS regardless of the disease duration at baseline (P<0.0001). Patients with a disease duration of >or=24 months showed a greater rate of decline as compared with patients with a disease duration of <24 months (P<0.05). Similar results were obtained when disease duration was reclassified by including the time of the first Raynaud's phenomenon symptom in the definition. Our study confirms recent findings that in patients entered into these 3 RCTs, skin thickening did not follow the same trend in natural history as that seen in the dcSSc populations entered into early, open longitudinal studies previously reported. These findings have important implications for study design, in which "prevention of worsening" is the main objective.
    Full-text · Article · Aug 2009 · Arthritis & Rheumatology
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    ABSTRACT: New methodologies allow the scores for the Health Assessment Questionnaire-Disability Index (HAQ-DI) to be translated into preferences/utility scores. We evaluated the construct validity of the HAQ-DI-derived Short Form-6D (SF-6D) score and assessed its responsiveness to change over 6- and 12-month followup periods in patients with early aggressive rheumatoid arthritis (RA). Patients (n=277) participating in an RA observational study completed self-reported measures of symptoms and the HAQ-DI at baseline and at 6 and 12 months. Total Sharp scores, C-reactive protein, and erythrocyte sedimentation rate were assessed along with clinical data. Construct validity was assessed by examining the association between SF-6D score and patient-reported and clinical measures using Spearman correlation coefficients. The responsiveness of SF-6D to change was assessed using patient and physician assessments of the disease as clinical anchors. The magnitude of responsiveness was calculated using SF-6D effect size (ES). Mean SF-6D scores were 0.690, 0.720, and 0.723 at baseline and 6 and 12-month followup, respectively. Baseline patient-reported measures had moderate to high correlations with baseline SF-6D (r=0.43 to 0.52); whereas clinical measures had negligible to low correlations with SF-6D (r=0.001 to 0.32). ES was moderate for the groups that were deemed to have improved (ES 0.63-0.75) but negligible to small for those that did not (ES 0.13-0.46). Our data support the validity and responsiveness of the HAQ-DI derived SF-6D score in an early RA cohort. These results support the use of the HAQ-DI derived SF-6D in RA cohorts and clinical trials lacking preference-based measures.
    Full-text · Article · May 2009 · The Journal of Rheumatology
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    ABSTRACT: A "window of therapeutic opportunity" has been hypothesized to be present in early rheumatoid arthritis (RA). To determine the date of this window, we must know the symptom-onset date of the RA. Patients participating in an observational study of early aggressive rheumatoid factor (RF) positive RA were evaluated to assess the accuracy of their recall of symptom-onset date by comparing the onset date they reported at the first visit with that reported on subsequent 6-monthly questionnaires. One hundred eighty-six patients with early RA (at entry: median disease duration 5.8 mo, mean RF 413.8 +/- 630.7 IU/ml, 20.6 +/- 10.9 swollen and 23.7 +/- 13.4 tender joints) completed a self-reported mailed questionnaire every 6 months for up to 5 years. As a part of each questionnaire, patients were asked to recall their RA symptom-onset date. These dates were then compared to the dates reported on the initial questionnaire. Thirteen months after symptom onset (i.e., about 6 mo after study entry) 61% of patients recalled the symptom-onset date (within 1 mo) that they had reported at baseline; the proportion decreased to 39% at 31 months and 25% after 70 months. During this period, the proportion overestimating RA duration remained about 20%, but the proportion underestimating it increased from 23% at 13 months to 39% at 31 months, and to 50% after 56 months. Patients with longer disease duration, less disease activity, and higher pain levels tended to be less accurate. Accuracy of recall of RA symptom-onset date by patients tends to decline over a period of 5 years. This should be taken into consideration when enrolling patients, when interpreting the findings of early RA clinical trials, and when attempting to ascertain the presence of a window of therapeutic opportunity.
    No preview · Article · Oct 2004 · The Journal of Rheumatology

Publication Stats

198 Citations
37.24 Total Impact Points


  • 2014
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
  • 2004-2012
    • University of California, Los Angeles
      • • Division of Rheumatology
      • • Department of Medicine
      Los Ángeles, California, United States