Michael M Ward

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

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Publications (175)952.36 Total impact

  • Maria G Tektonidou · Abhijit Dasgupta · Michael M Ward
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    ABSTRACT: Objective: End-stage renal disease (ESRD) is a major consequence of lupus nephritis, but how this risk has changed over time is unknown. We conducted this systematic review to examine changes in ESRD among adults with lupus nephritis from 1970 to 2015, and to estimate risks of ESRD for contemporary patients. Methods: We searched PubMed, Embase, and the Cochrane Database for cohort studies and clinical trials on ESRD in adults with lupus nephritis. We analyzed studies from developed and developing countries separately. The outcome was probability of ESRD at 5, 10, and 15 years of lupus nephritis. Results: We included 187 articles that reported on 18,309 patients. In developed countries, the 5-year risk of ESRD decreased from 16% (95% credible interval (CI) 14%, 17%) in the early 1970's to 11% (95% CI 10%, 12%) in the mid-1990's and then plateaued. ESRD risks at 10 years and 15 years showed steeper declines but also plateaued in 1993-1997, with a notable increase in risk in the late 2000's. The decrease in risk between 1970's and mid-1990's coincided with increased use of cyclophosphamide. The 15-year ESRD risk was higher in developing than in developed countries. Patients with class IV lupus nephritis had the greatest risk of ESRD, with 15-year risk of 44% during the 2000's. Conclusions: Risks of ESRD in lupus nephritis improved between the 1970's and the mid-1990's, and then plateaued, with a slight increase in risk in the late 2000's. This pattern suggests limitations in the effectiveness of, or access to, current treatments. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Arthritis and Rheumatology
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    ABSTRACT: Objective Syndesmophytes in ankylosing spondylitis (AS) can occur anywhere along the vertebral rim, but little is known about how and where they develop, and particularly if they first form in certain locations along the rim. This information might provide clues to their aetiology. We examined the spatial distribution of syndesmophytes in the thoracolumbar spine in patients with AS using CT. Methods We performed lumbar spine CT scans in 50 patients and used a validated computer algorithm to measure syndesmophyte heights in six intervertebral disc spaces. We measured heights every five radial degrees around the rim of each superior and inferior vertebral endplate. Results Syndesmophytes were observed in 208 of 296 intervertebral disc spaces. Both ascending and descending syndesmophytes were non-randomly distributed along the vertebral rim (p<0.0001 for deviation from uniform distribution). Syndesmophytes occurred most often at the posterolateral vertebral rim, and least commonly at the posterior rim and anterior rim. In disc spaces with only small isolated syndesmophytes, these were also most likely to occur at the posterolateral rim. Syndesmophyte distribution varied with the vertebral level. Localisation at the posterolateral rim was most pronounced at T10-T11, T12-T12 and T12-L1, while L2-L3 and L3-L4 exhibited little localisation. Conclusions Syndesmophytes are not randomly distributed around the vertebral rim, as might be expected if they develop solely in response to inflammation. Rather, they preferentially occur, and likely develop first, at the posterolateral rim. Studying factors that can lead to this pattern may help elucidate how syndesmophytes develop.
    No preview · Article · Jan 2016 · Annals of the Rheumatic Diseases
  • Runsheng Wang · Sherine E Gabriel · Michael M Ward
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    ABSTRACT: Objective: The long-term outcome of patients with non-radiographic axial spondyloarthritis (nr-axSpA) is unclear, particularly whether few or most progress to ankylosing spondylitis (AS). Our objective was to examine the progression to AS in a population-based inception cohort of patients with nr-axSpA. Methods: The Rochester Epidemiology Project (REP) is a longstanding population-based study of health in the residents of Olmsted County, Minnesota. We searched the REP from 1985 to 2010 using diagnostic and procedural codes for back pain, HLA-B27 and pelvis magnetic resonance imaging, and performed detailed chart review to identify subjects who fulfilled the Assessment of Spondyloarthritis International Society classification criteria for axSpA but did not have AS. We followed these subjects from disease onset to March 15(th) , 2015, and used survival analysis to measure time to progression to AS. Results: After screening 2151 patients, we identified 83 subjects with new-onset nr-axSpA. Over a mean follow-up of 10.6 years, 16 subjects progressed to AS. The probabilities of remaining as nr-axSpA at 5, 10, and 15 years were 93.6%, 82.7%, and 73.6%, respectively. Subjects in the imaging arm (n=18) progressed more frequently and rapidly than those in the clinical arm (n=65) (28% versus 17%; hazard ratio 3.50, 95% CI 1.15-10.6, p=0.02). Conclusions: A minority (26%) of patients with nr-axSpA progressed to AS when followed for up to 15 years. This suggests that the classification criteria for nr-axSpA identifies many patients unlikely to progress to AS, or that nr-axSpA is a prolonged prodromal state, requiring longer follow-up to evolve to AS. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Arthritis and Rheumatology
  • Michael M Ward · Atul Deodhar · John D Reveille · Liron Caplan

    No preview · Article · Dec 2015 · Arthritis and Rheumatology
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    Michael M Ward · Abhijit Dasgupta · Runsheng Wang

    Preview · Article · Nov 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Objective: Medications for rheumatoid arthritis (RA) may affect survival. However, studies often include limited follow-up and do not account for selection bias in treatment allocation. Using a large longitudinal database, we examined the association between prednisone use and mortality in RA, and whether this risk was modified with concomitant disease-modifying antirheumatic drug (DMARD) use, after controlling for propensity for treatment with prednisone and individual DMARDs. Methods: In a prospective study of 5,626 patients with RA followed for up to 25 years, we determined the risk of death associated with prednisone use alone and combined treatment of prednisone with methotrexate or sulfasalazine. We used the random forest method to generate propensity scores for prednisone use and each DMARD at study entry and during follow-up. Mortality risks were estimated using multivariate Cox models that included propensity scores. Results: During follow-up (median 4.97 years), 666 patients (11.8%) died. In a multivariate, propensity-adjusted model, prednisone use was associated with an increased risk of death (HR 2.83 [95% CI 1.03, 7.76]). However, there was a significant interaction between prednisone use and methotrexate use (p=0.03), so that risk was attenuated when patients were treated with both medications (HR 0.99 [95% CI 0.18, 5.36]). However, combination treatment also weakened the protective association of methotrexate with mortality. Results were similar for sulfasalazine. Conclusion: Prednisone use was associated with a significantly increased risk of mortality in patients with RA. This association was mitigated by concomitant DMARD use, but combined treatment also negated the previously reported beneficial association of methotrexate with survival in RA. This article is protected by copyright. All rights reserved.
    No preview · Article · Sep 2015
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    ABSTRACT: Objective: To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods: A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results: In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion: These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.
    Full-text · Article · Sep 2015 · Arthritis and Rheumatology
  • Runsheng Wang · Abhijit Dasgupta · Michael M Ward
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    ABSTRACT: To compare the efficacy of 20 non-steroidal anti-inflammatory drugs (NSAIDs) in the short-term treatment of ankylosing spondylitis (AS). We performed a systematic literature review of randomised controlled trials of NSAIDs in patients with active AS. We included trials that reported efficacy at 2-12 weeks. Efficacy outcomes were the change in pain score and change in the duration of morning stiffness. We also examined the number of adverse events. We used Bayesian network meta-analysis to compare effects directly and indirectly between drugs. We included 26 trials (66 treatment arms) of 20 NSAIDs with 3410 participants in the network meta-analysis. Fifty-eight per cent of trials had fewer than 50 participants. All 20 NSAIDs reduced pain more than placebo (standardised mean difference ranging from -0.65 to -2.2), with 15 NSAIDs significantly better than placebo. Etoricoxib was superior to celecoxib, ketoprofen and tenoxicam in pain reduction, but no other interdrug comparisons were significant. There were no significant differences among NSAIDs in decreases in the duration of morning stiffness or the likelihood of adverse events. Adverse events were uncommon in these short-term studies. In 16 trials that used NSAIDs at full doses, etoricoxib was superior to all but two other NSAIDs in pain reduction. Etoricoxib was more effective in reducing pain in AS than some other NSAIDs, but there was otherwise insufficient evidence to conclude that any particular NSAID was more effective in the treatment of AS. Comparisons were limited by small studies. 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
  • 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.
    No preview · Article · May 2015 · Current opinion in rheumatology
  • 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.
    No preview · Article · Feb 2015 · Journal of Clinical Epidemiology
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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.
    No preview · Article · Feb 2015
  • Sovira Tan · Jianhua Yao · John A Flynn · Lawrence Yao · Michael M Ward
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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.
    No preview · Article · Jan 2015 · The Journal of Rheumatology
  • 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.
    No preview · Chapter · Jan 2015
  • 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) health survey in clinical trials of rheumatoid arthritis (RA), estimates of minimum 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 (SRMs). 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 scales 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. Conclusion: 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.
    No preview · Article · Dec 2014
  • Sovira Tan · Jianhua Yao · John A Flynn · Lawrence Yao · Michael M Ward
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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 mm(3). 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.
    No preview · Article · Nov 2014 · Rheumatology (Oxford, England)
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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.
    Preview · Article · Oct 2014 · Arthritis and Rheumatology
  • 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.
    No preview · Article · Oct 2014
  • 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.
    No preview · Article · Aug 2014 · Rheumatic Disease Clinics of North America
  • 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.
    No preview · Article · Jun 2014 · Journal of clinical epidemiology
  • 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.
    No preview · Article · May 2014 · Clinical Rheumatology

Publication Stats

6k Citations
952.36 Total Impact Points


  • 2003-2016
    • National Institute of Arthritis and Musculoskeletal and Skin Diseases
      베서스다, Maryland, United States
  • 2003-2015
    • National Institutes of Health
      • • Intramural Research Program (IRP)
      • • National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
      • • Center for Clinical Research
      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
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 2011
    • National Technical University of Athens
      Athínai, Attica, Greece
  • 2007
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, California, United States
  • 1996-2003
    • Stanford Medicine
      • Division of Immunology and Rheumatology
      Stanford, California, United States
  • 1999-2002
    • VA Palo Alto Health Care System
      Palo Alto, California, United States
  • 1993-2002
    • Stanford University
      • Department of Medicine
      Stanford, California, United States
    • San Jose State University
      • Department of Economics
      San José, California, United States
  • 1995
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 1989-1992
    • Duke University Medical Center
      • • Division of Rheumatology and Immunology
      • • Department of Medicine
      Durham, North Carolina, United States