According to results presented at the annual 

American College of Gastroenterology (ACG) 2020 conference

 tended to have higher hospitalization costs, a longer length of stay, and increased disease severity. However, there was no noticeable increased risk in mortality for these patients.

Although prior small-scale studies have shown an increased risk of hepatic decompensation and hospitalization among those with cirrhosis, there has been limited data that addresses the impact of influenza among patients with other types of chronic liver diseases.

To address this shortcoming, Sheena Mago, DO, of University of Connecticut Health Center, and colleagues conducted a retrospective cohort study using data from the 2010-2014 Nationwide Inpatient Sample.

Using ICD-9 codes, they identified adults ≥18 years hospitalized with influenza. Patients with chronic liver diseases were further stratified according to specific diagnosis, which included alcoholic cirrhosis, non-alcoholic cirrhosis, alcoholic fatty liver, non-alcoholic fatty liver disease, biliary cirrhosis, and autoimmune hepatitis.

All diagnosis categories were compared with one another as well as with those with no history of chronic liver disease.

Thus, the investigators found that a total of 30,268 patients were admitted to the hospital for influenza. Of the total, 1.7% of patients were diagnosed with chronic liver disease.

The majority of chronic liver disease patients had non-alcoholic fatty liver disease (n = 236), followed by non-alcoholic cirrhosis (n = 171).

Mago and team showed that patients with chronic liver disease had increased risk of disease severity (OR, 2.66; 95% CI, 2.26-3.13; 

These patients also trended towards a longer length of hospital stay (OR, 1.07; 95% CI, 1.01-1.15; 

 = .031) as well as a higher hospitalization cost (OR, 1.24; 95% CI, 1.15-1.33; 

The investigators also noted that alcoholic fatty liver (OR, 39.26; 95% CI, 1.78-428.46, 

 = .003) and alcoholic cirrhosis (OR, 4.54; 95% CI, 1.23-13.49; 

 = .011) were both associated with increased odds of mortality.

However, despite the findings, there was no overall increased risk in mortality chronic liver disease (OR, 1.38; 95% CI, 0.68-2.51; 

According to the team, limitations of the study included analysis of only hospitalized patients, reliance on ICD coding, and a lack of vaccination data.

They nonetheless stressed the importance of their findings.

“The increased risk of disease severity, hospital charges, and length of stay amongst even a small subset of chronic liver disease patients highlights the importance of yearly influenza vaccinations in this population,” they wrote.

Impact of Influenza in Patients with Chronic Liver Disease: A National Inpatient Analysis

Articles

American College of Gastroenterology

New research shows patients with chronic liver disease admitted for influenza had an increased risk of disease severity but not a higher odds of mortality. 

Chronic Liver Disease Plus Influenza Linked to Increased Inpatient Burden

While tofacitinib, a Janus kinase inhibitor, is currently approved to treat moderate to severe ulcerative colitis (UC), there has been limited prospective real-world data on the treatment in 

A team, led by Millie D. Long, MD, MPH, FACG, Associate Professor of Medicine at the University of North Carolina, used an electronic system to evaluate patient reported outcomes in real-time to measure the clinical response during the induction phase of tofacitinib in ulcerative colitis patients.

American College of Gastroenterology (2020) conference

, the investigators examined 65 patients initiating tofacitinib from 13 academic and community gastroenterology practices. The research team obtained demographic information, disease, and medication for each patient.

In addition, the patients completed surveys on days 1-14, as well as week 6, 10, and 14.

The investigators sought outcome data of the simple clinical colitis activity index (SCCAI), and patient reported outcome measure information system (PROMIS) measures of depression, anxiety, and social satisfaction. A score larger than 4 with a decrease greater than 1.5 points was considered a response.

The investigators calibrated PROMIS measures using a T score (mean of the US population equal to 50, standard deviation (SD) of 10), where a higher PROMIS score equates to more of the measure (higher scores worse for depression, anxiety, and better for social satisfaction).

Overall, 62 (95%) patients completed the electronic PRO data through week 6. The mean age of the patient population was 38.4 (SD, 14.9), while 61.5% of the patients were male. The mean disease duration was 9.6 years and 58.5% of the patients were on concomitant steroids at baseline.

The mean disease activity at baseline was active (SCCAI of 5.6 (SD 3.2)), with reductions in mean disease activity to SCCAI 3.1 on day 14, 2.7 on week 14. When the first in-person clinical visit occurred in week 2-6, only 18.2% remained on steroids. Of the patients initiating tofacitinib without concomitant corticosteroid use (n = 27), early reductions in SCCAI was found (mean SCCAI 5.4 at baseline, reduced to SCCAI 3.8 by day 4).

Improvements in all PROMIS measures were seen through week 14 and a total of 54.2% met the criteria for response at day 14, while 52.2% met this criteria at week 6.

“Real time electronic PRO data capture provided the ability to assess cessation of steroids and time to response to tofacitinib via important PRO outcomes,” the authors wrote. “Tofacitinib was associated with a rapid response in this ongoing prospective multi-center real-world cohort, independent of steroid use. Continued enrollment and long-term data, planned through week 30, will enhance our understanding of UC.”

Time to Improvement in Patient-Reported Outcomes With Tofacitinib in Ulcerative Colitis: Initial Results From a Real World Prospective Multicenter Study (TOUR)

More than half of the patient population achieved a defined response at both day 14 and week 6.

New Study Looks at Response Rate of Tofacitinib in Ulcerative Colitis

While many treatments may wane in effectiveness in patients with 

 (EoE), initial data shows dupilumab (Dupixent) could be beneficial at least up to 2 years for patients.

, researchers found the treatment significantly improved dysphagia and histological and endoscopic measures of EoE in patients.

In a double-blind, placebo-controlled, phase 2 study, the investigators examined 41 adult patients with active EoE. Each participant received either 12 weeks of subcutaneous dupilumab 300 mg weekly or placebo.

The study drug modulated 1302 genes, with very similar transcriptomes in all 3 analyzed esophageal regions. Dupilumab also significantly normalized the expression of genes associated with type 2 inflammation, including genes associated with type 2 inflammatory cell responses, proinflammatory cytokine production, and mucins.

In addition, dupilumab normalized genes associated with eosinophils and mast cells by downregulating genes linked to eosinophil recruitment and genes encoding eosinophil and mast cell surface proteins, which are all dysregulated in the EoE transcriptome.

, Evan Dellon, MD, MPH, professor of Medicine and Epidemiology, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, explained how dupilumab could be a top of the line treat for patients with EoE.

Videos

Research shows dupilumab remains effective in EoE for up to 2 years.

Evan S. Dellon, MD, MPH: Dupilumab Shows Promise Treating Eosinophilic Esophagitis

A new post-hoc analysis of the VARSITY trial found vedolizumab to be more effective than adalimumab in achieving and maintaining early disease control in patients with moderately to severely active 

 integrin antibody was especially pronounced in those without any prior exposure to anti-TNF agents.

These findings were presented at the annual 

The VARSITY trial, a phase 3b, randomized, double-blind, double-dummy, multicenter, active-controlled active-controlled study, initially demonstrated that vedolizumab led to higher rates of clinical remission and endoscopic improvement than adalimumab.

However, the investigators believed that assessing disease control, defined as a combination of clinical, endoscopic, and histologic remission endpoints, would provide more clinically meaningful measures.

Thus, Edward Loftus, Jr., MD, of Mayo Clinic College of Medicine, Minnesota, and colleagues evaluated the trajectory of changes in disease control between the 2 biologics from week 14 to week 52. They assessed evolution in disease control over this time using the proportion of patients who maintained, improved, or lost treatment benefit.

They also analyzed data according to whether or not patients in either arm were anti-TNF naïve or experienced.

Included in their analysis was a total of 769 patients with ulcerative colitis, all of whom were randomized 1:1 to receive intravenous vedolizumab or subcutaneous adalimumab. A majority of the patients in either arm were male (56.0% adalimumab vs 60.8% vedolizumab), were not using a corticosteroid at baseline (63.7% vs 63.9%), and were anti-TNF naïve (79.0% vs 79.2%).

In the adalimumab group, the median ulcerative colitis duration was 4.5 years. For those who received vedolizumab, the median disease duration was 4.8 years.

Thus, the results showed that at week 14 and at week 52, clinical remission, endoscopic and histologic improvement, as well as overall disease control, were achieved with greater frequency with vedolizumab than with adalimumab.

Furthermore, more patients who received vedolizumab maintained each efficacy outcome and overall disease control between 14-52 versus those who received adalimumab.

These differences between the arms were even more pronounced between the anti-TNF-naïve subgroups.

For example, 18.7% and 16.8% of anti-TNF-naïve vedolizumab users gained and maintained disease control outcomes, respectively—compared with 11.2% and 10.0% of anti-TNF-naïve adalimumab users, respectively. 

As for anti-TNF-experienced vedolizumab users, 13.8% and 9.2% gained and maintained disease control outcomes, respectively. In the anti-TNF-experienced adalimumab subgroup, 7.4% achieved disease control outcome and 4.4% maintained it.

The investigators noted that at week 52, the overall rate of disease control was higher with vedolizumab (47.3% anti-TNF-naïve; 39.0% anti-TNF experienced) than with adalizumab (32.7% anti-TNF-naïve; 24.2% anti-TNF-experienced).

“These data suggest that vedolizumab is superior to adalimumab during both induction treatment evaluated at Week 14 and maintenance treatment evaluated at Week 52,” they wrote. “Most of the observed treatment differences in anti-TNF naïve patients at Week 52 were established with early response to treatment between Week 0 and Week 14.”

Disease Control and Changes in Individual Treatment Outcomes From Week 14 to Week 52 With Vedolizumab or Adalimumab in Ulcerative Colitis: A VARSITY Trial Post Hoc Analysis

A new study presented at ACG shows vedolizumab to be superior to adalimumab in maintaining early disease control in patients with moderate-to-severe ulcerative colitis.

Vedolizumab Associated with Ulcerative Colitis Control and Maintenance 

While it is known that patients who suffer from 

, researchers do not know exactly how cycle threshold could be used to predict the likelihood of this occurrence.

A team, led by Varun Moktan, MD, Mayo Clinic, investigated cycle threshold as a surrogate for bacterial and toxin burden in CDI to accurate predict the development of post-infection irritable bowel syndrome (PI-IBS) in data presented at the annual 

American College of Gastroenterology (ACG) 2020 Conference

Post-infection irritable bowel syndrome is characterized by the symptoms of IBS following a viral, bacterial or parasitic gastroenteritis. This condition occurs in up to 25% of patients following a CDI. The polymerase chain reaction (PCR) cycle threshold is an embedded result within a two-step C. diff testing algorithm that quantifies the bacterial burden, where the amount of nucleic acid in the sample is inversely proportional to the cycle threshold.

Having a higher load of bacterium, the assay is positive at a lower value, while previous research shows cycle threshold to be a marker for clinical severity and outcomes in CDI.

In the retrospective study, the investigators examined hospitalized patients with an initial indeterminate C. diff toxin test requiring second stage confirmatory laboratory-developed PCR test. The team collected patient demographics, such as age, sex, race, ethnicity, and body mass index (BMI). Patients diagnosed with IBS following the C. diff infection were identified by ICD10 code and collected PCR cycle threshold data from a microbiology lab.

The authors used a two-sample t test to compare the continuous variables between the non-IBS and IBS arms of the study and compared categorical variables between the 2 groups using a Chi-squared test.

A total of 62 patients in the study underwent PCR testing between May 2014 and October 2019, with a mean age of 64 ± 16 years and 23 (35%) patients subsequently diagnosed with IBS. The mean cycle threshold in the IBS patients compared to the non-IBS group 0.8±2.5 and 29.5±3.6 (

= 0.12) and BMI was 26.0±-5.5 versus 29.7±7.5 (

Overall, 26% of the IBS patients were male and 95% were Caucasian (n = 22). The investigators found a significant association between sex, lower BMI, and the development of IBS (

“In this retrospective cohort of patients diagnosed with CDI, PCR cycle thresholds did not vary significantly among patients who did and did not develop IBS,” the authors wrote. “Lower BMI and female sex were associated with the development of IBS. Further studies with larger cohorts are needed to determine if Ct is predictive for the development of IBS following CDI and the viability of two-step PCR testing in this scenario.”

The Utility of Clostridioides difficile PCR Cycle Threshold in Patients With Post-Infection Irritable Bowel Syndrome

In data presented at ACG, investigators found a link between sex, lower BMI, and the development of irritable bowel syndrome in patients following a c. diff infection.

New Data Looks at Link Between C. Diff Infections and Irritable Bowel Syndrome

Ustekinumab could be a new treatment in reducing rectal bleeding, while normalizing stool frequency in patients suffering from 

A team, led by Maria T. Abreu , MD, University of Miami Miller School of Medicine, evaluated the effect of ustekinumab maintenance therapy on stool frequency and rectal bleeding through 92 weeks in patients who were treated in the long-term extension of the UNIFI trial in data presented virtually during the annual 

In the UNIFI randomized-withdrawal study, researchers evaluated the safety and efficacy of subcutaneous ustekinumab in patients with moderately to severely active ulcerative colitis, who had responded to intravenous ustekinumab induction. The patients who completed the 44 week maintenance study had the option of entering the long-term extension through a total of 220 weeks.

The individuals in the placebo arm of the maintenance study were discontinued from the long-term extension.

During this period, each eligible patient received dose adjustment placebo to q8w or q12w to q8w or q8w to q8w [sham dose adjustment) starting at week 56 based on investigator assessment of the patient’s ulcerative colitis disease activity.

Dose adjustment was considered part of the treatment experience and was not considered a treatment failure in the study.

The researchers also recorded the number of stools and rectal bleeding symptoms for 7 days prior to each visit. Overall, the researchers evaluated the proportion of patients with Mayo stool frequency subscores of 0 (normal number of stools) or 1 (1-2 stools more than normal) or rectal bleeding subscores of 0 (no rectal bleeding found) and summarized the absolute stool number.

Included in the final analysis of the long-term study were 141 patients who received ustekinumab 90 mg q12w and 143 participants who received ustekinumab 90 mg q8w. The absolute stool numbers in the ustekinumab q12w and q8w groups at induction baseline were 6.6 and 6.5 stools per day, respectively. These numbers ultimately decreased to 2.8 and 2.7, respectively, by maintenance baseline.

Reductions achieved at maintenance baseline were maintained at week 92 at 2.7 and 2.2 stools per day, respectively. At induction baseline, only 12.8% and 18.2% of patients, respectively, had Mayo stool frequency subscores of 0 or 1.

At maintenance baseline, 80.9% and 80.4% in the 2 treatment dosing groups had Mayo stool frequency subscores of 0 or 1. These percentages were maintained through week 92 as well at 79.4% and 86.7%, respectively. At induction baseline, there was no blood seen in the stool of 9.2% and 7.0% of the patients, respectively.

By maintenance baseline, 9.2% and 7.0% had no blood found in their stool and these percentages were maintained through week 92 (86.5% and 88.8%), respectively.

“Among patients who were treated in the long-term extension, reductions in stool frequency and rectal bleeding that had been achieved after IV ustekinumab induction were maintained through 2 years of ustekinumab SC maintenance,” the authors wrote. “These data support the durability of response to ustekinumab in ulcerative colitis.”

Effect of Ustekinumab Maintenance Therapy on Stool Frequency and Rectal Bleeding Through 2 Years in the UNIFI Phase 3 Study in Ulcerative Colitis

In a poster presented during ACG, investigators show data from a long-term extension of the UNIFI trial.

Ustekinumab Reduces Rectal Bleeding in Ulcerative Colitis Patients

 the American College of Gastroenterology (ACG) 2020 conference

, there was no apparent effect or influence of opioid dependence on total pancreatectomy with islet autotransplantation (TPIAT) outcomes.

 receiving the surgical procedure have shown dependence on chronic opioid therapy.

A team led by Aws Alameri, MD, at the University of Texas Health Center at San Antonio, collected data from the National Inpatient Sample (NIS), the largest all-payer inpatient database in the United Stated. The data represented patients between 2008-2014 who were >18 years, admitted for chronic pancreatitis, and who underwent TPIAT.

The team measured mortality, length of stay, and cost of hospitalization among patients that were opioid dependent and those who were not.

Thus, they assessed a total of 990 patients. Of the population, the team identified 67 patients who had a diagnosis of opioid abuse of dependence.

The overall median age was 42, with median ages in the opioid dependance group and non-dependence groups being 48 and 42, respectively.

Women constituted a majority of patients that underwent TPIAT in both groups—76.9% in the opioid cohort and 64.0% in the non-dependence cohort.

“Surprisingly the majority of opioid dependence patients that underwent TPIAT were on the western part of the US [85.2%] and none were in the Midwest or Northeast,” they wrote.

They also noted that there were 2 deaths among those not dependent on opioid therapy, and none among those with dependence. However, it was noted these findings were not statistically significant.

Additionally, the length of hospital stay was higher among patients without opioid abuse (median, 12 days) in comparison to those with opioid abuse (11 days). It was also reported that the cost of hospitalization was higher in the former group ($68,938) than the latter ($60,412). And yet, both of these findings were also considered statistically significant.

Overall, the investigators concluded that opioid dependence does not seem to play a role in outcomes in patients undergoing TPIAT.

“This is promising and may be an impetus to consider performing the surgery in patients with chronic pancreatitis and opioid dependence,” they wrote.

They acknowledged that their retrospective study is limited in that it could not provide insight into long term outcomes for these kinds of patients.

remains a critical concern for physicians and healthcare providers treating patients with acute and chronic pain. During the 

 pandemic, opioid abuse and related deaths have seen significant increases.

In terms of implications and next steps for this study, Alameri and colleagues noted that it would be necessary to undertake prospective studies in order to make the appropriate surgical/treatment choices for such patients who must deal with the pain of chronic pancreatitis.

Opioid Dependence and Outcomes in Total Pancreatectomy with Islet Autotransplantation in Patients With Chronic Pancreatitis

Patients with chronic pancreatitis can exhibit dependence on chronic opioid therapy prior to receiving total pancreatectomy with islet autotransplantation.

Study Shows Opioid Dependence Has No Impact on TPIAT Outcomes

 underscore a need to mitigate unnecessary isolation and antibiotic use among patients suspected of 

These unnecessary isolation protocols can have significant financial and emotional burdens, with them being especially pronounced in minority populations.

Michelle Thomas, MD, and colleagues at Harlem Hospital Center, New York, conducted a retrospective study to determine factors that could predict CDI among African Americans, the majority population at Harlem Hospital.

They assessed a total of 251 suspected patients, of which 48% were females. The median age of this population was 61. 

Of the total, only 22% were confirmed positive for CDI.

Furthermore, the average length of hospital stay for the whole population varied from 1-80, with the average length of antibiotic use being 14 days. For those with confirmed CDI, the average hospital stay was 33 days—versus 34 for those without CDI.

Thomas and colleagues noted that there was no significant difference between the length of antibiotic use between the CDI and non-CDI populations.

They did note that older patients, most notably those ≥6

 years, presented with a higher rate of infection (

<.05). Further, they found the blacks had increased incidences of CDI when compared with Hispanics.

®, Thomas discussed these findings, noting the disparities in age and ethnicity.

“That was not much of a surprise, because the studies show that older adults are more at risk,” she said.

“But we’re not quite sure in terms of the ethnic disparity that we saw. We wonder if it’s based off the GI micriobiome—in terms of difference in ethnicities being exposed to 

She also shed light on her experiences dealing with patients who are isolated due to suspected CDI and the emotional distress it may cause for them.

Isolation as a result of suspected C. Diff can take a significant financial toll on the healthcare system, thus it is necessary to determine appropriate factors that can predict CDI.

Mitigating Unnecessary Isolation Due to Suspected C. Diff Infection

 encompasses a group of autoimmune diseases that has proven difficult to manage due its systemic nature. These conditions may involve muscles, skin, and even the lungs. Today, there still remain challenges in diagnosing and managing them.

Chester Oddis, MD, of the University of Pittsburgh Department of Medicine, is an expert in idiopathic inflammatory myopathies who presented at the Congress of Clinical Rheumatology East 2020 about clinical characteristics and treatment aspects of myositis. 

 had the opportunity to speak with him about the current challenges in treating these types of conditions, promising new therapies for disease management, and how the COVID-19 pandemic has affected clinical practice in this area of rheumatology.

 Can you give a brief overview of myositis?

 These are autoimmune diseases that not only affect muscle, but they are systemic in their nature. For example, it's very common to have muscle involvements and skin involvement in many patients — as well as lung involvement, which is what I talked about a lot extensively during my presentation.

So, these diseases can be challenging, because there is a lot of systemic manifestations. And it can actually be joint involvement and other problems, just like what occurs in the other systemic diseases in rheumatology, including lupus.

It's an autoimmune attack that causes a lot of different things, like muscle weakness, inflammation in the joints, and significant skin rash. Unfortunately, it is the lung disease that oftentimes is a factor that really can adversely affect these patients with morbidity and mortality.

What is the importance of accurately diagnosing and classifying these types of diseases?

 In terms of diagnosis, I think it's important to make sure you're dealing with a particular autoimmune disease because there are going to be some mimics. Now, it's easy, in a way, whenever there is a rash. That's because the rash indicates this is dermatomyositis, for example. But if a patient just has muscle weakness — they don't have a rash, they don't have lung involvement, they don't have joint involvement — then, you've got to make sure that you're dealing with an autoimmune disease as opposed to one of the mimics of myositis. They might be anything from muscular dystrophy, to a drug/medication reaction, to other things that can affect muscle. 

So, it's almost easier when they have a rash that's characteristic of dermatomyositis.

 What are the challenges that come up in treating and managing myositis?

 Well, first you've got to diagnose it. And I think the challenge in diagnosing it is that you have to have the right collaborators. It's very easy, as I said, if they have a bad rash, and they're weak, and they have particular laboratory tests, such as autoantibody markers that are characteristic of the disease.

Now, the challenge in managing it is really significant, because a lot of these patients don't respond to conventional medications like steroids and methotrexate. Therefore, they require other disease modifying, or immunosuppressive, medications — especially when they get the involvement of lung, skin, joint, and muscle.

So, the challenge is to make the diagnosis in some instances, but also to get the right mix of treatment. These patients can have refractory muscle, skin, and other manifestations.

Are there any new, emerging therapies in this domain that are potentially promising?

 What we have now that we didn't have before is a multitude of potential biologic medications. We all know that the standard medication site, like steroids and methotrexate, work. But now we have had available many things, like rituximab, which depletes the B cells.

Also, there are a lot more trials that are available that are actually targeting specific cytokines in myositis. We're doing a trial, for example, looking at abatacept, which attacks the T cell in an effort to see if that improves the lung involvement and the muscle involvement in patients with myositis.

Another biologic therapy that is coming out is tofacitinib, or Xeljanz. It's an oral medication that is approved for rheumatoid arthritis. We've reported a small series of patients where the skin remarkably, and nicely, improved.

So, we're going to try anything that's going to work for other autoimmune diseases in this particular disease. You can go through the list of biologics. And it seems to me that the ones that help psoriasis skin rash might also help the rash of dermatomyositis.

 To shift gears a bit, we've seen how the COVID-19 pandemic has largely affected certain practices in healthcare and within various specialties. What would you say is the biggest challenge that this pandemic posed for you — whether it's on the side on the healthcare provider or the patient?

 In rheumatology, I don't think it has been a dramatic effect. Everybody was thinking in the beginning, "Oh boy, these patients are all on immunosuppressive medication. We're going to have to stop them." But we didn't do that, and it was not the recommendation of the American College of Rheumatology to do that.

So, many of our patients remained on the medications that they were taking (biologics, steroids, methotrexate, etc.) even if they were significantly immunosuppressive. That wasn't an anticipated problem as one would expect.

What was a challenge for us with the pandemic is seeing the patient face-to-face. If you're treating a disease where the muscle strength is something you want to follow, then you can't check it. I can't check your muscle strength looking at you [through the computer]. I can try to do it and say, "Okay, are you weaker, are you stronger, what's the change since the last visit?" But the challenge has been the sensitivity of detecting change clinically.

But we can see rash. We can rely on the patient telling us if the rash is better. So, the challenge has been a bit more on management and on diagnosis if it's a new patient. We like to see them face-to-face.

So, I wouldn't say that treatment has been as much of a problem as the diagnosis and management part of it.

 Do you have anything you want to add related to what we talked about or perhaps didn't discuss?

 What I would emphasize, which I did during my talk, is that many patients don't even have the muscle part of myositis. It's really the challenge of the things like I talked about earlier that really makes it difficult and interesting for us.

You've obviously heard of lupus, and the designation is systemic lupus. Well, all of our diseases are as equally systemic as lupus. And that's the challenge that I emphasized. Because I even presented cases during my lecture that really didn't have significant muscle problems.

So, it's the management of the many different manifestations. And it's also the appropriate diagnosis in terms of looking at autoantibodies that I emphasized. Those autoantibodies, those markers in the blood, are not only good for diagnosis, but they are also good for prognosis. By knowing what antibodies a patient has, you can also predict what types of problems they may get into later on. It always helps you to categorize and follow that patient.

Congress of Clinical Rheumatology East

An expert discusses the difficulties in diagnosing and managing myositis, as well as how the COVID-19 pandemic has affected clinical care.

Chester Oddis, MD: Myositis, Diagnosis and Management Challenges

 to continue caring for patients virtually. But the technology comes with many challenges.

The primary concern is a lack of a physical exam, Daniel Albert, MD, of Dartmouth-Hitchcock, said in a recent interview with 

. Rheumatologists often rely on a physical examination to get a better look at the whole patient.

“It’s a very difficult transition for providers to care for patients without a physical exam,” he said.

There are workarounds, however, but they require ingenuity. For example, patients often show Albert how they walk, how they use their upper extremities for activities, and physical exam maneuvers can be done similarly to how they would be done in person, but they have to use a visual rather than sensory input. Sometimes rheumatologists can elicit tender points on an individual if they are asked to put pressure on certain areas.

Other concerns exist, such as patients who are simply not suited for a virtual appointment, whether it be because they have a visual impairment or less cognitive ability than is required to conduct such an interview virtually. Sometimes diseases are just too complex and there are too many comorbidities, or the patient has too severe of a disease.

Lastly, it’s important for patients to buy into the idea of virtual encounters. If patients are uncomfortable, you have to give them the opportunity to be seen in the clinic.

Three key issues with using the technology over in-person visits.

Latest Conference Articles