Category Archives: Research

Meet Olivia Kwan: One of Our Newest Foundation Sponsored Fellows!

Right now, access to care is not always guaranteed for arthritis patients, and the problem is even worse for children living with juvenile arthritis. A child with arthritis currently travels an average of 57 miles to be seen by a pediatric rheumatologist. The Arthritis Foundation has been working to help close the gap on the nation’s rheumatologist shortage through ourfellowship initiative. In 2018 we announced五个奖学金颁奖典礼;印第安纳大学健康中心的莱利儿童医院获得了其中一笔资助,该医院最近宣布他们的奖学金已授予奥利维亚·关博士。

Continue readingMeet Olivia Kwan: One of Our Newest Foundation Sponsored Fellows!

Meet Dr. Laura Cannon: One of Our Newest Foundation Sponsored Fellows

Because access to care is not always guaranteed, we’ve been working to help close the gap on the nation’s rheumatologist shortage through ourfellowship initiative. As one of the five new 2020 fellowship grant awardees, Duke University announced their fellowship has been awarded to Dr. Laura Cannon.

Continue readingMeet Dr. Laura Cannon: One of Our Newest Foundation Sponsored Fellows

OA Patient Guidelines

Arthritis Today’s Snapshots from the ACR Meeting: Part 2

The editors ofArthritis Todaymagazine were on the scene, collecting news and information to share with readers from the American College of Rheumatology’s (ACR) Annual Meeting, November 9-13, in Atlanta. Here are a few of the many interesting and enlightening research topics they learned about.

Genes Play a Role in Disease Changes in Pregnancy
What do women with rheumatoid arthritis (RA) expect when they are expecting? The rule of thumb has long been that RA goes quiet during pregnancy but flares after delivery. But that’s not true for everyone, and researchers in Copenhagen, Denmark, and Oakland, California, are trying to figure out why. In two small studies, they looked at gene expression profiles of women with RA who had similar disease activity pre-pregnancy, and then again during the third trimester and at three months post-partum. They compared these gene profiles to those of healthy women. Researchers found a pre-pregnancy genetic signature that predicted improvement or worsening during pregnancy. They also found differences between the RA and healthy groups in gene expression during the post-partum period.–MARCY O’KOON

Patient Partner Perspective:Shannan O’Hara-Levi attended a couple sessions related torheumatic conditions and pregnancy. As a patient of child-bearing age, she is concerned about having enough resources and information about family planning with RA but also how any reproductive health legislation impacts rheumatology patients.

“Rheumatology patients and their rheumatologists need to strengthen their conversations about their reproductive health.”–Shannan O’Hara

Rheumatology patients who plan their pregnancies have better outcomes according to some of the research she heard at ACR, so Shannan wants other patients with RA like her to understand how vital it is to communicate and discuss any family planning with their doctors. She says this states the case for even more support for patient engagement in the decision-making of health care for arthritis.

Is Remission That Important Anyway?

A presentation by members of EULAR (the European League Against Rheumatism), deconstructed remission – that is, the absence of disease activity in inflammatory types of arthritis (such as RA). Titled “The Road to Remission is Long and Bumpy but Worth It in the End,” the presenters first examined how remission is measured. (Doctors use 17 different combinations of function scales, blood markers and joint exam results.) Another presenter looked at the benefits of remission, including better function, less disability and joint damage and longer overall survival – but noted that there is a trade-off between the aggressive treatment needed to achieve remission (more medication, more doctor visits and tests) and the benefits of achieving it. A third presenter examined whether certain medications are better for achieving remission, or if it’s the overall strategy that counts. (Hint: it’s the strategy.) And the last presenter took a look in the crystal ball to see if doctors will be able to predict remission using molecular changes, similar to methods used for certain types of cancer. The answer? Yes, but not yet.–ANDREA KANE

Machine Learning Used to Predict Flares
医生无法预测哪些类风湿性关节炎患者能够成功地减少或停止使用生物制剂。一组研究人员开始研究机器是否能做得更好。他们设计了一种计算机算法,使用真实世界的患者临床数据并分析变量,如生物剂量百分比变化、疾病活动、疾病持续时间和炎症标志物水平。他们发现,一台机器可以在逐渐减弱后学习预测耀斑,并且随着更多患者的临床数据的添加,它的性能有所提高。我们的目标是有朝一日为医生提供一种可靠的工具,指导他们减少用药。– MARCY O’KOON

Why Sky-High Biologic Prices?
Public spending in the U.S. on biologics almost doubled between 2012 and 2016 due mostly to drug price hikes over those years – not to more people getting access to them, one study found. Natalie McCormick, PhD, a post-doctoral fellow at Harvard Medical School and Mass General Hospital, and her team analyzed data from Medicare (Parts B and D) and Medicaid. In one analysis, for example, they determined that price increases for 11 biologics accounted for 56% ($1.7 billion) of the increased spending (after adjusting for inflation) in Medicare Part D, compared to 37% ($1.1 billion) for an increase in new users. Adalimumab (Humira) and etanercept (Enbrel), two of the oldest and most widely prescribed biologics, had the biggest increases in price.––ANDREA KANE

Tapering Biologics When They’re Hard to Get
In the United States, people who take biologics and reach remission are often eager to taper off the medication, but in New Zealand, the decision is difficult, even though it’s recommended by EULAR. In her abstract session, “Rheumatoid Arthritis Patients’ Perspectives on Tapering of Biologics,” Lisa Stamp, PhD, of the University of Otago in Christchurch, explained that fewer biologics are available to people with inflammatory arthritis in New Zealand, where a government agency decides which drugs are subsidized. Patients must try and fail numerous other medications (from methotrexate to gold shots) for many months before qualifying for a subsidized biologic. “These people have been through a lot to get to a biologic,” Stamp said. As a result, they were anxious that if they tapered off it, they wouldn’t be able to get it again if their disease worsened. However, not having to get injections or infusions “makes you feel like you’re well.” Participants wanted to make the decision to taper with their rheumatologist, but better tools are needed to help patients make the decision and feel assured that their needs would be addressed.–JILL TYRER

Inflammatory Arthritis Infection Risks After Joint Replacement
Despite the good safety record of nearly 1 million total hip and knee replacement surgeries performed annually in the U.S., they are not without risk, including infections. A study presented by Susan Goodman, MD, director of the Integrative Rheumatology and Orthopedics Center of Excellence and the medical chief of the Combined Arthritis Program at the Hospital for Special Surgery, showed that rheumatoid arthritis (RA) patients are at a higher risk of developing a prosthetic joint infection compared to those with OA. In addition, the length of time after surgery that patients stayed at risk was longer for those with RA than OA. Dr. Goodman cited several reasons, including the use of medications such as immunosuppressants, having active RA, having disabilities, the implants themselves, tobacco use and revisions of previous implants.– BRYAN D. VARGO

Patient Partner Perspective:Laura Genoves attended this session, which brought up some major concerns for patients with RA like her.

“Hearing that RA patients have an increased risk of infection after joint replacement surgery made me feel wary.”– Laura Genoves

Laura was glad to learn that researchers are trying to better determine what factors contribute to this increased risk of infection. People with RA must be aware of what can potentially happen post-surgery. All surgeries come with risks associated, but it’s a whole other level of risks to consider for people with RA, so Laura feels like this is definitely something patients should know and discuss with their rheumatologists.

OA Patient Guidelines

Arthritis Today’s Snapshots from the ACR Meeting: Part 1

The editors ofArthritis Todaymagazine were on the scene, collecting news and information to share with readers from the American College of Rheumatology’s (ACR) Annual Meeting, November 9-13, in Atlanta. Here are a few of the many interesting and enlightening research topics they learned about.

Anti-inflammatory Diet Improves Disease
Strawberries, apples, brussel sprouts on a table长期以来,人们一直不确定饮食是否会影响炎性关节炎的疾病活动度。两项研究提供了一些证据来证明这一点。在一项研究中,17名活动性类风湿关节炎(RA)患者(定义为至少三个疼痛和三个肿胀的关节)遵循了两周的抗炎饮食。在测量氧脂素、参与炎症、疼痛和其他细胞功能的分子之前、期间和之后的血液测试。这种饮食添加了姜黄、抗氧化剂、益生元和益生菌。它消除了促炎成分,如乳糖(在日记中发现的)、面筋和红肉,并提高了omega-3和omega-6脂肪酸的比例。研究发现,这些受试者有良好的饮食坚持。14天后,一系列疾病指标显著降低,测试显示与血液中羟脂素水平的变化有关。作者的结论是,饮食有可能补充药物治疗和改善风湿性关节炎患者的生活质量。–MARCY O’KOON

Depression and Resilience
Inflammation has been shown to have a role in depression, but does that make depression an inflammatory disorder? No, emphasized Andrew Miller, MD, a researcher in Emory School of Medicine’s psychiatry department. Depression may be associated with the inflammation that’s at the heart of inflammatory diseases like rheumatic and psoriatic arthritis and lupus, but it’s not associated in otherwise healthy people with depression. (Biologics that have been used to target inflammation in depression have had no effect.)

在同一会议上,“风湿病中精神病学共病的机制和中介”,Afton Hassett,密歇根大学慢性疲劳和疼痛研究中心的心理学家和研究员,探索了韧性在关节炎和疼痛患者中的作用。风湿病患者往往比“健康”的人更消极,但积极的情绪——这是恢复力的关键——与更少的疼痛、更少的药物需求、更早出院和其他积极的结果有关。好消息是韧性是可以习得的。哈塞特描述了一些练习,包括以下三点:1)选择未来的一个时间点,比如从现在起1年或5年之后,想象自己是最好的自己,充分发挥自己的潜力,然后详细写下来。2)每天写下三件让你感激的事;随着时间的推移,你会意识到更小的事情值得欣赏。3)这周挑一天为别人做五件好事,为自己做一件好事。– JILL TYRER

Patient Partner Perspective: Stacy Courtnayattended this session on pain, depression and anxiety and said it really resonated with her.

“The more connections you have with people living in a similar situation as you, the better mental and emotional health you will have. Support groups are the key to managing your overall well-being.” – Stacy Courtnay

Stacy says “we need the support of each other” and being involved in the Arthritis Foundation has really helped her to make these connections since it is a big part of the mission. The Live Yes! Arthritis Network has played a huge role in helping her to get connected with people who understand her struggles.

The Problem of Sleeplessness
对于关节炎患者来说,疼痛会影响睡眠并不奇怪;研究表明,更显著的相关性是失眠加剧疼痛。密歇根大学的Anna Kratz博士和英国阿伯丁大学的Daniel Whibley博士在一个名为“不再数羊:循证睡眠管理”的会议上讨论了睡眠不足对关节炎患者的影响和治疗方法。(惠布利说,事实上,数羊入睡要比放松想象多花20分钟。)他讨论了昼夜节律在不同人的睡眠模式中的作用(“早起鸟”vs.“夜猫子”),以及夜间睡眠的结构(夜间醒来几次是正常的)。他还说,患有风湿病的人通常“睡眠效率”较差——他们醒着躺着的时间比其他人睡着的时间更长。睡眠不足会导致精神障碍以及疼痛和疲劳,有睡眠问题的人应该筛查其原因,比如阻塞性睡眠呼吸暂停或慢性失眠——这两种情况在关节炎患者中很常见——或阿片类药物或其他药物的副作用。

Good sleep hygiene (getting regular exercise; keeping a dark, quiet bedroom; keeping a regular sleeping schedule; shutting off blue-light electronics, etc.) helps many people, but people with rheumatic disease may need more help. The American Academy of Sleep Medicine discourages the use of sleep medications and recommends cognitive behavioral therapy for insomnia (CBTi) as a first-line treatment. In the U.S., however, it’s hard to find people qualified to practice CBTi. (Whibley and Kratz suggested rheumatology practices have someone trained in CBTi.) “The most important thing is to be regular in your sleep-waking patterns, and that includes weekends,” Whibley said. If you don’t sleep well, seek help. “Don’t assume that poor sleep in part of the condition.”–JILL TYRER

Patient Partner Perspective: Cheryl Crowattended this session on sleep, which shestated was a very informative and engaging session. She was surprised by some of the information she learned when it comes to sleep and the rheumatic disease population. Cheryl said having a patient on this sleep panel sharing her story was powerful to witness as a patient herself.

“与普通人相比,在患风湿病的人群中,失眠和阻塞性睡眠呼吸暂停更常见,37-50%的人有某种障碍。我完全不知道。让我想去做评估。” – Cheryl Crow


Standard PRO Measures Miss Younger Patients
Patient-reported outcome measures (PROMs) are routinely used by doctors as well as in research, but Erika Mosor, a researcher at the Medical University of Vienna, Austria, found that the standard measures may not get a true view of younger patients. In her session, “When You Read This, You Really Feel Old: Perspectives of Young People with Inflammatory Arthritis on Patient Reported Outcome Measures from a European Qualitative Study,” she reported that patients aged 18 to 35 said the PROMs of daily functioning and other issues “seem like they’re for old people.” They don’t address technology, childcare, social life, sex, loss of friends and other issues relevant to younger patients. Because their concerns are overlooked, results may be skewed so these patients appear to be doing better than they are; some patients said they considered marking worse scores just to get their concerns recognized. PROMs should be more tailored to patients so they can be used more effectively in shared decision-making, Mosor said.– JILL TYRER

Meet Sabina Ratner: One of Our Newest Foundation Sponsored Fellows!

Because access to care is not always guaranteed, we’ve been working to help close the gap on the nation’s rheumatologist shortage through ourfellowship initiative. This year we announcedfour new fellowship awards. One of those grants was offered to SUNY Downstate Medical Center, which recently announced their fellowship has been awarded to Dr. Sabina Ratner.

Dr. Ratner will be a welcome addition to this program. She began her undergraduate training at Brooklyn College, followed by graduate training as a physician’s assistant (PA) at SUNY Downstate in NY. She earned her medical degree from American University of Antigua College of Medicine in Antigua and Barbuda.

Dr. Ratner explains how she became interested in rheumatology:


I worked as a PA at NY Methodist Hospital for seven years before my accident. During my employment, I covered a variety of services, and I discovered that there were many facets to medicine that were fascinating, stimulating and rewarding. My experiences helped sharpen my clinical acumen and appreciation and understanding of medicine. Initially, I worked with the department of surgery, which included general surgery and orthopedics. My duties included patient care in the clinic and floors, emergency room admissions, pre- and post-operative care and counseling patients. As a PA, I was inspired by the passion and wisdom of the people I worked with. My colleagues recognized my aptitude for medicine and strongly encouraged me to get my medical degree.



There are many reasons why I want to join the field of rheumatology. I find it to be a very diverse field that is rapidly evolving and allows for the treatment of a broad range of conditions. Also, it is a specialty that can be challenging because a qualified physician must be able to treat different disease processes, solving medical mysteries. It is exciting and gratifying to help improve the quality of lives of others. I want to train and learn from the dedicated experts, which will give me the opportunity to broaden my understanding and knowledge about the disease progression and treatment with new agents that prevent further destruction in the body.


Thanks to the generosity of our donors, Dr. Ratner will be able to follow her dreams and become a valuable addition to the number of new rheumatologists through this fellowship program.

OA Patient Guidelines

Working to Develop OA Patient-Centric Guidelines


关节炎基金会科学战略高级副总裁盖伊·埃金(Guy Eakin)说:“传统上,随着指南的制定,患者的声音会被唤起,但并不总是存在。”“通过我们的合作,我们能够将ACR风湿病专业知识与Live Yes!患者社区开创了一个过程,确保治疗患者的指导方针反映了将接受他们的患者的独特观点。”

The new guidelines were presented as part of the 2019 ACR/Association of Rheumatology Professionals (ARP) Annual Meeting held in Atlanta on November to discuss the process of how the guidelines were developed and the results.

“We are proud to have been involved in this work and to facilitate the important contributions of the patient partners,” said Cindy McDaniel, Arthritis Foundation’s Senior Vice President of Consumer Affairs. “Their lived experiences truly helped to guide this project.”

The draft guidelines include the followingStrong Recommendations, for which there is strong evidence for benefits, clearly outweighing harms foralmost allOA patients:

  • Educational, behavioral, and psychosocial approaches:
    • Weight loss,especially for those with hip and knee OA.
    • Self-efficacy, self-managementprograms to help build skills like fitness and exercise goal‑setting, problem-solving, and positive thinking.
  • Mind-body and physical approaches:
    • Exercise: aerobic, strengthening, neuromuscular, and aquatic exercise are all recommended.
    • Tai-chi, especially for those with hip and knee OA.
    • Medical devices and aids:Use of canes (for hip and knee OA), orthotic devices, and wrist braces.
  • Pharmacological approaches
    • Topical non-steroidal anti-inflammatory drugs (NSAIDs, especially for knees)
    • Oral NSAIDs
    • Intra-articular steroid injections (knee, hip)
    • Imaging guidance for injections (hip)

The draft guidelines include the followingConditional Recommendations, for which there is less evidence that benefits may outweigh harms, fora majorityof OA patients:

  • Educational, behavioral, and psychosocial approaches:
    • Cognitive behavioral therapy.
  • Mind-body and physical approaches:
    • Yoga,especially for those with knee OA.
    • Balance training,especially for those with hip and knee OA.
    • Medical devices and aids:Use thermal interventions, radio‑frequency ablation (knee), medical tape, orthotic devices, acupuncture, and knee braces.
  • Pharmacological approaches
    • Topical NSAIDs (hand)
    • Topical capsaicin (knee)
    • Intra-articular steroid injections (hand)
    • Intra-articular steroid injection over other injectables
    • Chondroitin sulfate (hand)
    • Acetaminophen
    • Duloxetine (knee)
    • Tramadol

Learn more byreading the paper containing完整的建议清单和支持证据。


The meeting was attended by close to 16,000 rheumatologists and other rheumatology healthcare professionals, researchers, fellows in training and exhibitors from more than 100 countries gathered to learn about the latest scientific advances, clinical issues, and engage in professional development.

加入Live Yes!Arthritis Network FOR FREE.我们的社区在这里帮助你。

Arthritis Foundation Patient Partners

Daily Dose – Arthritis Foundation Patient Partners Perspective

The Patient Voice in Action
November 13, 2019

Today during #ACR19, our Patient Partners were able to see why having the opportunity to provide patient input can make a difference. Here’s the daily dose of what they learned as the meeting wraps up today & why it matters for people with arthritis.

Patient Engagement in New OA Guidelines
New draftguidelines for the treatment of osteoarthritis(OA) were released and discussed during a presentation today. I appreciated the ACR partnering with the Arthritis Foundation to provide patient input in this process. Although I was not one of the patients on the task force, I was glad to be attending this session in person where they officially released this new information. It provided me the opportunity as a patient to provide feedback and ask a question about the guidelines since I live with osteoarthritis.

“It’s important as patients that we are able to provide input on these types of guidelines, since we’re the ones living with the daily pain.”– Raquel Masco

The new guidelines provide an update on what the latest research supports as far as treatment for OA. I had the opportunity to ask why massage is listed as a treatment the research is “conditionally against” for hip and knee OA, especially because I love a good massage. Basically, it can be an effective treatment for some people, but not everyone and this is all based on what quality research is available to support it. Unfortunately, there’s not a lot of good research when it comes to massage for hip and knee OA. It doesn’t mean I won’t still go or that people shouldn’t if it helps you. A lot of the things the guidelines are conditionally against seem to be a big point of discussion for why more research is needed.

That’s why it’s so important for us as patients to raise our voices, raise awareness and raise funding to support more research for arthritis.
By: Raquel Masco

Arthritis Foundation Patient Partners shared their stories in the exhibit booth at the ACR annual meeting. (Pictured from left: Raquel Masco, Kevin Purcell, Shannan O’Hara-Levi and Ife Okwumabua)

Managing the Difficult-To-Treat RA Cases
During a session titled –How do I manage this Patient? Difficult-To-Treat RA Cases,a panel of rheumatologists discussed crowd-sourced questions regarding multi-level patient needs within the rheumatology practice. As a patient listening in to this discussion, I was interested to hear the vast difference between the rheumatology panel and how they would treat a specific patient.



“As a patient, my takeaway from this session was the importance of being an informed patient.” – Shannan O’Hara-Levi

在专家组中,有人提到风湿病学家通常需要遵循一些特定的模型,然而,有人指出,患者之间存在差异,模型并不总是相符的。在我看来,这似乎是显而易见的,然而,由于保险问题,立法和成本驱动的干预,这是一个主要的患者和医生的担忧。Price of treatment, especially in newly diagnosed patients and those with specific insurance regulations, is a driving factor to treatment.

Having the opportunity to be here to see these medical professionals’ debate and learn from each other is an amazing experience. Research is constantly changing, and the field of rheumatology is constantly expanding and growing. My recommendation to other patients like me is to ask questions. If something doesn’t feel right to you, then speak up to your rheumatologist.
By Shannan O’Hara-Levi

我们将回顾关节炎基金会病人伙伴在美国风湿病学会年会上的所有重点,所以请继续关注。Check out the other ACR Daily Dose blogs to read more from the patient perspectives.

Arthritis Foundation Patient Partners

Daily Dose – Arthritis Foundation Patient Partners Perspective

Patient Voices that Take ACR from Theory to Reality
November 12, 2019

Today during #ACR19, our Patient Partners were able to connect with rheumatologists and researchers about the ways that their stories can inform their work. Here’s the daily dose of what they learned & why it matters for people with arthritis.

Perspectives on Patient Engagement in Research

Patients and their caregivers are the experts in their experience – and that expertise is valuable to providers and researchers as they investigate new therapies. Today, we got to hear from excellent speakers about the value of sharing our patient perspectives – and the many ways that we can be empowered to tell our stories.

True patient engagement is providing patients an opportunity to help you BUILD the box, not just check it.” – Corinne Pinter


The more that we are able to share our stories, the more we are able to help others understand why patient engagement is so important.

“I’ve seen my story make a difference for researchers through the relationship that the Arthritis Foundation has with thePARTNERSlike CARRA & PR-COIN.” – Kate Kuhns

By: Corinne Pinter and Kate Kuhns

Track Your Wonder Drug with a Wearable Device
Exercise: the Wonder Drug

There’s a lot of research to support physical activity as being one of the most beneficial treatments for people with all types of arthritis. I learned the research shows the most benefits for those who exercised longer than 3 months. It helps to reduce inflammation, pain, stiffness and fatigue in many patients. For people with osteoarthritis like me, if you’re overweight, losing the extra weight is so important. Another motivating reason to exercise is the 40-60% increased risk for cardiovascular diseases when you have a rheumatic condition. These are the reasons we’re at a higher risk for cardiovascular issues:

  • Inactivity
  • Being overweight
  • Systemic inflammation
  • Age, pain, sleep (not enough sleep, poor quality sleep)
  • Lack of physical activity support


“I started doing HIIT training myself about a year ago. That along with proper diet helped me to lose weight and maintain weight loss to the point where I can have a more active lifestyle.” – Nick Steen

Wearable Technologies Can Help Increase Physical Activity
Another session I attended also discussed the importance of physical activity when you have a form of arthritis. Having wearable technology helps to hold ourselves accountable to maintaining physical activity levels. One of the researchers reported that the wearable devices (like Fitbit or pedometers) helped to increase the number of steps that people took and increase their activity levels. It’s a good way to actually change behaviors when it comes to exercise.
By Nick Steen

A Public Approach to Arthritis Pain
By Stacy Courtnay

There’s growing attention to chronic pain in public health and this is good for people living with arthritis and rheumatic conditions. This session really spoke to my passion in raising awareness about how hard it can be to live with rheumatoid arthritis. We need to speak up and educate others on arthritis and how debilitating it is. The more awareness we can bring, the more funding we can get and this can bring us closer to a cure.

“This is so important to me and our mission at the Arthritis Foundation. Do not suffer in silence! Share your story.” – Stacy Courtnay

Stay tuned for more highlights from the Arthritis Foundation Patient Partners as they wrap up their time at the American College of Rheumatology annual meeting. Check out them out on Twitter, Facebook and Instagram as they share information throughout the day while they represent your patient voice.