Publications by authors named "Philip Robinson"

423 Publications

Musculoskeletal ultrasound imaging standards in the UK: British Society of Skeletal Radiologists (BSSR) position statement.

Br J Radiol 2021 Apr 1:20210198. Epub 2021 Apr 1.

Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.

There has been some concern expressed by UK regulator, the Professional Standards Authority regarding the risks arising from Independent sonographer practices. The Professional Standards Authority presented evidence demonstrating that there are instances of harm occurring because of errors made by non-radiologists performing musculoskeletal ultrasound (MSKUS), particularly MSKUS-guided interventions. This document summarises British Society of Skeletal Radiologists position for Musculoskeletal use of ultrasound in UK, representing the agreed consensus of experts from the British Society of Skeletal Radiologists Ultrasound committee. The purpose of this position statement is to review the current practices affecting the delivery of MSKUS. Recommendations are given for education and training, audit and clinical governance, reporting, and medicolegal issues.
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http://dx.doi.org/10.1259/bjr.20210198DOI Listing
April 2021

Value of a patient-reported-outcome measure of carcinoid syndrome symptoms.

Eur J Endocrinol 2021 May;184(5):711-722

Service d'Oncologie Médicale et Hépatogastroentérologie, Hospices Civil de Lyon, Lyon, France.

Objective: Literature on patient-reported outcomes (PRO) of carcinoid syndrome symptoms (CSS) is scarce. We used a patient-reported outcome measure (PROM) to evaluate CSS, the domains of daily life impacted by CSS, the main symptoms that affect daily life, its change according to clinical, biological and morphological evolution, and the risk factors for a poor PRO-CSS score.

Methods: Patients completed the PRO-CSS, EORTC-QLQ30, and GI-NET21 questionnaires at the time of their clinical, laboratory, and morphological assessments in a multicentre French cohort study from February 2019 to May 2020.

Results: In total, 147 patients with metastatic ileal (n =126), lung (n =20), or unknown primitive neuroendocrine tumour but high 5-hydroxyindole-3-acetic acid level (n =1) were included; 42 (32%) received an above-label dose of somatostatin analogues. Fifty-one (35%) patients had a poor PRO-CSS score. Travelling and food restriction were the two main domains affected. Diarrhoea (mean: 2.3/5 on Likert scale), imperiousness (mean of 2.5/5), fatigue (2.2/5), abdominal pain (1.7/5), and flushing episodes (1.5/5) were the main symptoms affecting daily life. The PRO-CSS score was not correlated to the clinical assessment performed by physicians at the baseline and during the follow-up. Patients with a poor PRO-CSS score had a higher tumour burden.

Conclusions: PROM-CSS may help physicians make an objective assessment of CSS and its impact in daily practice; this tool could become a key evaluation criterion in clinical trials focusing on CSS.
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http://dx.doi.org/10.1530/EJE-20-1138DOI Listing
May 2021

Changing COVID-19 outcomes in patients with rheumatic disease-are we really getting better at this?

Lancet Rheumatol 2021 Feb 28;3(2):e88-e90. Epub 2021 Jan 28.

University of Queensland Faculty of Medicine, Herston, Australia.

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http://dx.doi.org/10.1016/S2665-9913(21)00008-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906652PMC
February 2021

Perceptual implications of different Ambisonics-based methods for binaural reverberation.

J Acoust Soc Am 2021 Feb;149(2):895

Dyson School of Design Engineering, Imperial College London, London SW7 2DB, United Kingdom.

Reverberation is essential for the realistic auralisation of enclosed spaces. However, it can be computationally expensive to render with high fidelity and, in practice, simplified models are typically used to lower costs while preserving perceived quality. Ambisonics-based methods may be employed to this purpose as they allow us to render a reverberant sound field more efficiently by limiting its spatial resolution. The present study explores the perceptual impact of two simplifications of Ambisonics-based binaural reverberation that aim to improve efficiency. First, a "hybrid Ambisonics" approach is proposed in which the direct sound path is generated by convolution with a spatially dense head related impulse response set, separately from reverberation. Second, the reverberant virtual loudspeaker method (RVL) is presented as a computationally efficient approach to dynamically render binaural reverberation for multiple sources with the potential limitation of inaccurately simulating listener's head rotations. Numerical and perceptual evaluations suggest that the perceived quality of hybrid Ambisonics auralisations of two measured rooms ceased to improve beyond the third order, which is a lower threshold than what was found by previous studies in which the direct sound path was not processed separately. Additionally, RVL is shown to produce auralisations with comparable perceived quality to Ambisonics renderings.
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http://dx.doi.org/10.1121/10.0003437DOI Listing
February 2021

Addressing the challenges of the SARS-CoV-2 pandemic in patients affected by autoimmune and rheumatic disease.

Best Pract Res Clin Rheumatol 2021 03 17;35(1):101664. Epub 2021 Feb 17.

Washington University School of Medicine, St. Louis, Missouri, USA.

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http://dx.doi.org/10.1016/j.berh.2021.101664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888248PMC
March 2021

Prevalence and Longevity of SARS-CoV-2 Antibodies Among Health Care Workers.

Open Forum Infect Dis 2021 Feb 17;8(2):ofab015. Epub 2021 Jan 17.

Hoag Center for Research and Education, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA.

Background: Understanding severe acute respiratory syndrome coronavirus 2 antibody prevalence in a spectrum of health care workers (HCWs) may provide benchmarks of susceptibility, help us understand risk stratification, and support enactment of better health policies and procedures.

Methods: Blood serum was sampled at enrollment and 8-week follow-up from HCWs (n = 3458) and from community first responders (n = 226) for immunoglobulin G (IgG) analyses. Demographics, job duties, location, and coronavirus disease 2019-related information were collected.

Results: The observed IgG antibody prevalence was 0.93% and 2.58% at enrollment (May/June) and 8-week follow-up (July/August), respectively, for HCWs, and 5.31% and 4.35% for first responders. For HCWs, significant differences ( < .05) between negative and positive at initial assessment were found for age, race, fever, and loss of smell, and at 8-week follow-up for age, race, and all symptoms. Antibody positivity persisted at least 8 weeks in all positive HCWs.

Conclusions: We found considerably lower antibody prevalence among HCWs compared with other published studies. While rigorous safety process measures instituted in our workplace and heightened awareness at and outside of the workplace among our HCWs may have contributed to our findings, the significant discrepancy from our community prevalence warrants further studies on other contributing factors.
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http://dx.doi.org/10.1093/ofid/ofab015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880269PMC
February 2021

Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective.

Lancet Rheumatol 2021 Jan 8;3(1):e71-e82. Epub 2020 Dec 8.

Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA.

Giant cell arteritis, a common primary systemic vasculitis affecting older people, presents acutely as a medical emergency and requires rapid specialist assessment and treatment to prevent irreversible vision loss. Disruption of the health-care system caused by the COVID-19 pandemic exposed weak points in clinical pathways for diagnosis and treatment of giant cell arteritis, but has also permitted innovative solutions. The essential roles played by all professionals, including general practitioners and surgeons, in treating these patients have become evident. Patients must also be involved in the reshaping of clinical services. As an international group of authors involved in the care of patients with giant cell arteritis, we reflect in this Viewpoint on rapid service adaptations during the first peak of COVID-19, evaluate challenges, and consider implications for the future.
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http://dx.doi.org/10.1016/S2665-9913(20)30386-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834492PMC
January 2021

Accumulating evidence suggests anti-TNF therapy needs to be given trial priority in COVID-19 treatment.

Lancet Rheumatol 2020 Nov 5;2(11):e653-e655. Epub 2020 Sep 5.

Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK.

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http://dx.doi.org/10.1016/S2665-9913(20)30309-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832144PMC
November 2020

Divergent effects of acute versus chronic glucocorticoids in COVID-19.

Lancet Rheumatol 2021 Mar 18;3(3):e168-e170. Epub 2021 Jan 18.

Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1016/S2665-9913(21)00005-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833899PMC
March 2021

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Ann Rheum Dis 2021 Jan 27. Epub 2021 Jan 27.

National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK

Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases.

Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
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http://dx.doi.org/10.1136/annrheumdis-2020-219498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843211PMC
January 2021

Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes.

Best Pract Res Clin Rheumatol 2021 03 23;35(1):101657. Epub 2020 Dec 23.

University of Queensland School of Clinical Medicine, HERSTON, QLD, Australia; Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, HERSTON, QLD, Australia.

There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.
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http://dx.doi.org/10.1016/j.berh.2020.101657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756169PMC
March 2021

Gout models of care: The next step is to facilitate implementation.

Int J Rheum Dis 2020 Sep;23(9):1115-1116

University of Queensland Faculty of Medicine, Brisbane, Qld, Australia.

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http://dx.doi.org/10.1111/1756-185X.13900DOI Listing
September 2020

The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 3: imaging techniques.

Eur Radiol 2021 Jan 7. Epub 2021 Jan 7.

Department of Radiology, Hospital de la Ribera, Valencia, Spain.

Objectives: Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided.

Methods: The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved.

Results: Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements.

Conclusion: The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications.

Key Points: • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
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http://dx.doi.org/10.1007/s00330-020-07501-5DOI Listing
January 2021

The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting.

Eur Radiol 2021 Jan 7. Epub 2021 Jan 7.

Department of Radiology, Hospital de la Ribera, Valencia, Spain.

Objectives: Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building.

Methods: The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0-10). This is the second part of a three-part consensus series and focuses on 'General issues' and 'Parameters and reporting'.

Results: Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to 'General issues' (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and 'Parameters and reporting' (16 addressing femoral/acetabular parameters) were produced.

Conclusions: The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the 'gold standard' imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning.

Key Points: • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the 'gold standard' modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg's angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head-neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.
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http://dx.doi.org/10.1007/s00330-020-07432-1DOI Listing
January 2021

Global research collaboration in a pandemic-challenges and opportunities: the COVID-19 Global Rheumatology Alliance.

Curr Opin Rheumatol 2021 03;33(2):111-116

Centre for Rheumatology & Department of Neuromuscular Diseases, University College London.

Purpose Of Review: This review discusses the coronavirus disease-2019 (COVID-19) Global Rheumatology Alliance (GRA), the reason for its formation, the challenges with running the registry, and future opportunities for global collaborative research in rheumatology.

Recent Findings: The GRA has been successful in collecting and publishing a large volume of case data on patients with rheumatic disease with COVID-19. In addition, the GRA has published reviews, opinion pieces, and patient-directed summaries of research to further assist in disseminating timely and accurate information about COVID-19 in rheumatic diseases. There have been numerous challenges in the journey but they have been addressed through a collaborative problem-solving approach.

Summary: The initial objectives of the GRA to describe the outcomes in patients with rheumatic disease who developed COVID-19 have been achieved. There has been extensive use of the data in the clinic and also to try and understand the mechanisms of disease and opportunities for drug repurposing. There remain numerous important areas for research which the GRA will continue to pursue as the pandemic evolves.
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http://dx.doi.org/10.1097/BOR.0000000000000783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924930PMC
March 2021

Axial spondyloarthritis: concept, construct, classification and implications for therapy.

Nat Rev Rheumatol 2021 02 23;17(2):109-118. Epub 2020 Dec 23.

Department of Medicine, University of Otago, Wellington, New Zealand.

The axial spondyloarthritis (axSpA) disease concept has undergone substantial change from when the entity ankylosing spondylitis was defined by the modified New York criteria in 1984. Developments in imaging, therapy and genetics have all contributed to changing the concept of axSpA from one of erosions in the sacroiliac joints to a spectrum of disease with and without changes evident on plain radiographs. Changes to the previously held concept and construct of the disease have also necessitated new classification criteria. The use of MRI, primarily of the sacroiliac joints, has substantially altered the diagnosis and differential diagnosis of axSpA. Many in the axSpA community believe that the current classification criteria lack specificity, and the CLASSIC study is underway to examine this area. Although much about the evolving axSpA disease concept is universally agreed, there remains disagreement about operationalizing aspects of it, such as the requirement for the objective demonstration of axial inflammation for the classification of axSpA. New imaging technologies, biomarkers and genetics data will probably necessitate ongoing revision of axSpA classification criteria. Advances in our knowledge of the biology of axSpA will settle some differences in opinion as to how the disease concept is applied to the classification and diagnosis of patients.
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http://dx.doi.org/10.1038/s41584-020-00552-4DOI Listing
February 2021

The prevalence of gout and hyperuricaemia in Australia: An updated systematic review.

Semin Arthritis Rheum 2021 Feb 18;51(1):121-128. Epub 2020 Dec 18.

Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

Background: Gout continues to increase in prevalence in developed countries with Oceanic countries particularly affected. Both gout and hyperuricaemia are associated with the metabolic syndrome and its sequelae. Recently, the Australian Institute for Health and Welfare (AIHW) reported a prevalence rate of 0.8% which appeared incongruous with other published research. Thus, an updated systematic review was undertaken to review the literature on the prevalence of gout and hyperuricaemia in Australia from data published after 2011.

Methods: A comprehensive, systematic search was conducted in MEDLINE, Embase and Web of Science in addition to relevant websites to identify research reporting the prevalence of gout and/or hyperuricaemia in Australia from May 2011 until June 2020. Crude gout and hyperuricaemia prevalence data was obtained and presented alongside case ascertainment, time-period, age range and stratified by gender if available.

Results: 118 full text articles were screened. 12 articles were included for analysis of gout prevalence. 4 articles were identified for the hyperuricaemia analysis. Wide variation in prevalence figures exist largely due study design and sample age range. Studies using a case definition of self-reported diagnosis of gout reported prevalence rates between 4.5% and 6.8%. The remaining studies used either electronic coding data from general practitioners or wastewater estimation of allopurinol consumption and documented adult prevalence rates between 1.5% and 2.9%. Prevalence increases with age, male sex and over time in keeping with global data. Hyperuricaemia prevalence ranged between 10.5% and 16.6% in Caucasian or an Australian representative population. AIHW estimates applied a chronic condition status, defined as current and lasted or expected to last more than six months, to cases of gout in the Australian National Health Survey. This likely results in an under-estimation in reported Australian gout prevalence rates.

Conclusions: Gout is highly prevalent in Australia compared to global comparisons and continues to increase over time. Hyperuricaemia prevalence is also high although contemporary data is limited.
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http://dx.doi.org/10.1016/j.semarthrit.2020.12.001DOI Listing
February 2021

A systematic review of the infectious complications of colchicine and the use of colchicine to treat infections.

Semin Arthritis Rheum 2021 02 17;51(1):101-112. Epub 2020 Dec 17.

University of Queensland School of Clinical Medicine, Queensland, Australia. Electronic address:

Objective: Colchicine has been used historically as an anti-inflammatory agent for a wide range of diseases. Little is known regarding the relationship between colchicine use and infectious disease outcomes. The objective of this study was to systematically examine infectious adverse events associated with colchicine usage and the clinical use of colchicine for infectious diseases.

Methods: A systematic review was conducted in accordance with PRISMA methodology. PubMed, EMBASE, Scopus and Cochrane Library databases were searched (up to 12 October, 2020) for interventional and observational studies that included colchicine usage associated with infectious adverse events or infectious disease outcomes.

Results: A total of 9,237 studies were initially identified and after exclusions, 36 articles comprising 21 interventional studies and 15 observational studies were included in this systematic review. There were 19 studies that reported infectious adverse events and 17 studies that examined the efficacy of colchicine in treating infectious disease. Only two out of six studies reported a significant benefit using colchicine in the management of viral liver disease. There was some evidence colchicine is beneficial in managing COVID-19 by reducing time to deterioration, length of stay in hospital and mortality. Colchicine had some benefit in managing malaria, condyloma accuminata and verruca vulgaris, viral myocarditis and erythema nodosum leprosum based on case-series or small, pilot clinical studies. Two of the clinical trials and five of the observational studies reported significant associations between infections adverse events and colchicine usage. Risk of pneumonia was found in three studies and post-operative infections were reported in two studies. Risks of urinary tract infections, H. pylori and C.difficile were only reported by one study each.

Conclusion: There is a current lack of clinical evidence that colchicine has a role in treating or managing infectious diseases. Preliminary studies have demonstrated a possible role in the management of COVID-19 but results from more clinical trials are needed. There is inconclusive evidence that suggests colchicine is associated with increased risk of infections, particularly pneumonia.
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http://dx.doi.org/10.1016/j.semarthrit.2020.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832726PMC
February 2021

Non-neoplastic Soft Tissue Tumors and Tumor-like Lesions.

Semin Musculoskelet Radiol 2020 Dec 11;24(6):645-666. Epub 2020 Dec 11.

Department of Radiology, University Hospitals of Leicester, Leicester, Leicestershire, United Kingdom.

Clinicians are commonly faced with patients presenting with a solitary palpable soft tissue mass. Most soft tissue lesions are benign, and not every mass is due to a neoplastic process. Many pathologies can mimic a malignant tumor. Despite appropriate clinicoradiologic assessment, these lesions can be mistaken for a soft tissue sarcoma and can lead to multiple investigations or an intervention, inconveniencing patients and leading to an increased health care cost. With the relevant clinical history, clinical examination, and specific imaging characteristics, the diagnosis can be narrowed. We present a pictorial review of soft tissue sarcoma mimics with guidance on appropriate differential diagnoses.
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http://dx.doi.org/10.1055/s-0040-1713606DOI Listing
December 2020

The Potential for Repurposing Anti-TNF as a Therapy for the Treatment of COVID-19.

Med (N Y) 2020 Dec 3;1(1):90-102. Epub 2020 Dec 3.

Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK.

Coronavirus disease 2019 (COVID-19) currently has few effective treatments. Given the uncertainty surrounding the effectiveness and uptake of a vaccine, it is important that the search for treatments continue. An exaggerated inflammatory state is likely responsible for much of the morbidity and mortality in COVID-19. Elevated levels of tumor necrosis factor (TNF), a key pro-inflammatory cytokine, have been shown to be associated with increased COVID-19 mortality. In patients with rheumatoid arthritis, TNF blockade reduces not only biologically active TNF but other pro-inflammatory cytokines important in COVID-19 hyperinflammation. Observational data from patients already on anti-TNF therapy show a reduced rate of COVID-19 poor outcomes and death compared with other immune-suppressing therapies. Anti-TNF has a long history of safe use, including in special at-risk populations, and is widely available. The case to adequately assess anti-TNF as a treatment for COVID-19 is compelling.
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http://dx.doi.org/10.1016/j.medj.2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713589PMC
December 2020

SARS-CoV-2 antibody prevalence in health care workers: Preliminary report of a single center study.

PLoS One 2020 12;15(11):e0240006. Epub 2020 Nov 12.

Hoag Center for Research and Education, Hoag Memorial Hospital Presbyterian, Newport Beach, California, United States of America.

Serological surveys have been conducted to establish prevalence for COVID-19 antibodies in various cohorts and communities, reporting a wide range of outcomes. The prevalence of such antibodies among healthcare workers, presumed at higher risk for infection, has been increasingly investigated, more studies are needed to better understand the risks and infection transmission in different healthcare settings. The present study reports on initial sero-surveillance conducted on healthcare workers at a regional hospital system in Orange County, California, during May and June, 2020. Study subjects were recruited from the entire hospital employee workforce and the independent medical staff. Data were collected for job duties and locations, COVID-19 symptoms, a PCR test history, travel record since January 2020, and existence of household contacts with COVID-19. A blood sample was collected from each subject for serum analysis for IgG antibodies to SARS-CoV-2. Of 2,992 tested individuals, a total 2,924 with complete data were included in the analysis. Observed prevalence of 1.06% (31 antibody positive cases), adjusted prevalence of 1.13% for test sensitivity and specificity were identified. Significant group differences between positive vs. negative were observed for age (z = 2.65, p = .008), race (p = .037), presence of fever (p < .001), and loss of smell (p < .001), but not for occupations (p = .710). Possible explanation for this low prevalence includes a relatively low local geographic community prevalence (~4.4%) at the time of testing, the hospital's timely procurement of personal protective equipment, rigorous employee education, patient triage, and treatment protocol development and implementation. In addition, cross-reactive adaptive T cell mediated immunity, as recently described, may possibly play a greater role in healthcare workers than in the general population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240006PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660494PMC
November 2020

Coronavirus disease 2019: investigational therapies in the prevention and treatment of hyperinflammation.

Expert Rev Clin Immunol 2020 12 25;16(12):1185-1204. Epub 2020 Nov 25.

Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine , Baltimore, MD, USA.

: The mortality of coronavirus disease 2019 (COVID-19) is frequently driven by an injurious immune response characterized by the development of acute respiratory distress syndrome (ARDS), endotheliitis, coagulopathy, and multi-organ failure. This spectrum of hyperinflammation in COVID-19 is commonly referred to as cytokine storm syndrome (CSS). : Medline and Google Scholar were searched up until 15th of August 2020 for relevant literature. Evidence supports a role of dysregulated immune responses in the immunopathogenesis of severe COVID-19. CSS associated with SARS-CoV-2 shows similarities to the exuberant cytokine production in some patients with viral infection (e.g.SARS-CoV-1) and may be confused with other syndromes of hyperinflammation like the cytokine release syndrome (CRS) in CAR-T cell therapy. Interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha have emerged as predictors of COVID-19 severity and in-hospital mortality. : Despite similarities, COVID-19-CSS appears to be distinct from HLH, MAS, and CRS, and the application of HLH diagnostic scores and criteria to COVID-19 is not supported by emerging data. While immunosuppressive therapy with glucocorticoids has shown a mortality benefit, cytokine inhibitors may hold promise as 'rescue therapies' in severe COVID-19. Given the arguably limited benefit in advanced disease, strategies to prevent the development of COVID-19-CSS are needed.
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http://dx.doi.org/10.1080/1744666X.2021.1847084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879704PMC
December 2020

Association of Race and Ethnicity With COVID-19 Outcomes in Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance Physician Registry.

Arthritis Rheumatol 2021 03 2;73(3):374-380. Epub 2021 Feb 2.

University of California, San Francisco.

Objective: Racial/ethnic minorities experience more severe outcomes of coronavirus disease 2019 (COVID-19) in the general US population. This study was undertaken to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status, and mortality in people with rheumatic disease.

Methods: US patients with rheumatic disease and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance physician registry between March 24, 2020 and August 26, 2020 were included. Race/ethnicity was defined as White, African American, Latinx, Asian, or other/mixed race. Outcome measures included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, rheumatic disease diagnosis, comorbidities, medication use prior to infection, and rheumatic disease activity.

Results: A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, African American patients (OR 2.74 [95% CI 1.90-3.95]), Latinx patients (OR 1.71 [95% CI 1.18-2.49]), and Asian patients (OR 2.69 [95% CI 1.16-6.24]) had higher odds of hospitalization compared to White patients. Latinx patients also had 3-fold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75-6.05]). No differences in mortality based on race/ethnicity were found, though power to detect associations may have been limited.

Conclusion: Similar to findings in the general US population, racial/ethnic minorities with rheumatic disease and COVID-19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID-19 in people with rheumatic diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic.
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http://dx.doi.org/10.1002/art.41567DOI Listing
March 2021

Blind estimation of the direct-to-reverberant ratio using a beta distribution fit to binaural coherence.

J Acoust Soc Am 2020 10;148(4):EL359

Facebook Reality Labs Research, Redmond, Washington 98052,

Knowledge of the direct-to-reverberant ratio (DRR) can be useful in various acoustic and audio applications. While the DRR can be computed easily from a room impulse response (RIR), blind estimation using sources of opportunity is necessary when such RIRs are not available. This paper describes a method for blind estimation of the DRR which involves fitting a beta distribution to the magnitude-squared coherence between two binaural audio signals, aggregated over time and frequency. Validation experiments utilizing speech convolved with binaural RIRs yield DRR estimates that are within the just-noticeable difference for DRRs in the range -15 to +18 dB.
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http://dx.doi.org/10.1121/10.0002144DOI Listing
October 2020

Potential of Augmented Reality Platforms to Improve Individual Hearing Aids and to Support More Ecologically Valid Research.

Ear Hear 2020 Nov/Dec;41 Suppl 1:140S-146S

Facebook Reality Labs Research, Redmond, Washington, USA.

An augmented reality (AR) platform combines several technologies in a system that can render individual "digital objects" that can be manipulated for a given purpose. In the audio domain, these may, for example, be generated by speaker separation, noise suppression, and signal enhancement. Access to the "digital objects" could be used to augment auditory objects that the user wants to hear better. Such AR platforms in conjunction with traditional hearing aids may contribute to closing the gap for people with hearing loss through multimodal sensor integration, leveraging extensive current artificial intelligence research, and machine-learning frameworks. This could take the form of an attention-driven signal enhancement and noise suppression platform, together with context awareness, which would improve the interpersonal communication experience in complex real-life situations. In that sense, an AR platform could serve as a frontend to current and future hearing solutions. The AR device would enhance the signals to be attended, but the hearing amplification would still be handled by hearing aids. In this article, suggestions are made about why AR platforms may offer ideal affordances to compensate for hearing loss, and how research-focused AR platforms could help toward better understanding of the role of hearing in everyday life.
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http://dx.doi.org/10.1097/AUD.0000000000000961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676615PMC
October 2020

Management of autoimmune disease during the COVID-19 pandemic.

Aust Prescr 2020 Oct 18;43(5):146-147. Epub 2020 Aug 18.

Faculty of Medicine, University of Queensland, Herston, Queensland.

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http://dx.doi.org/10.18773/austprescr.2020.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572196PMC
October 2020

Giant Cell Arteritis and COVID-19: Similarities and Discriminators. A Systematic Literature Review.

J Rheumatol 2020 Oct 15. Epub 2020 Oct 15.

PM is a clinical training fellow within the Medical Research Council- GlaxoSmithKline (MRC-GSK) Experimental Medicine Initiative to Explore New Therapies network and receives project funding unrelated to this work. PM also receives cofunding from the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre. MP is supported in part by Grant Number T32 AR007611-13 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). SES received funding from the Vasculitis Clinical Research Consortium (VCRC)/Vasculitis Foundation Fellowship. The VCRC is part of the Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Science (NCATS). The VCRC is funded through collaboration between NCATS, and NIAMS (U54 AR057319). SLM receives infrastructure support from the MRC TARGET Partnership Grant (MR/N011775/1/MRC_/Medical Research Council/United Kingdom) and from the NIHR Leeds Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. P. Mehta, Rheumatology Fellow, MD, Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, Department of Rheumatology, University College London Hospital (UCLH) NHS Trust, London, UK; S.E. Sattui, Rheumatology Fellow, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA; K. van der Geest, Rheumatology Fellow, PhD, E. Brouwer, Internist Rheumatologist, Associate Professor, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; R. Conway, Consultant Rheumatologist, PhD, Department of Rheumatology, St. James's Hospital, Dublin, Ireland; M.S. Putman, Clinical Instructor of Medicine, MD, Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA; P. Robinson, Associate Professor, PhD, University of Queensland Faculty of Medicine, Brisbane, Australia; S.L. Mackie, Associate Clinical Professor and Honorary Consultant Rheumatologist, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. P. Mehta, S.E. Sattui, and K. van der Geest made equal contributions to this work. KSMvdG received a speaker fee from Roche (2019) paid to the UMCG. EB received consultancy and speaker fees from Roche (2017 and 2018) paid to the UMCG. PR reports no competing interests related to this work, outside of this work he reports personal consulting and/or speaking fees from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer and UCB and travel assistance from Roche. SLM received consultancy fees from Roche (2015) and was supported by Roche to attend EULAR 2019. She has acted as investigator on clinical trials in GCA for Sanofi, Roche and GSK. Consultancy fees from Roche (2016, 2018) and Sanofi (2017) were paid to her institution. She is Patron of the UK charity Polymyalgia Rheumatica & Giant Cell Arteritis UK. RC, PM, MSP, SES have no conflicts of interest declared. Address correspondence to Dr. S.L. Mackie, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Harrogate Road, Leeds LS7 4SA, UK. Email: Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication September 29, 2020.

Objective: To identify shared and distinct features of giant cell arteritis (GCA) and coronavirus disease 2019 (COVID-19) to reduce diagnostic errors that could cause delays in correct treatment.

Methods: Two systematic literature reviews determined the frequency of clinical features of GCA and COVID-19 in published reports. Frequencies in each disease were summarized using medians and ranges.

Results: Headache was common in GCA but was also observed in COVID-19 (GCA 66%, COVID-19 10%). Jaw claudication or visual loss (43% and 26% in GCA, respectively) generally were not reported in COVID-19. Both diseases featured fatigue (GCA 38%, COVID-19 43%) and elevated inflammatory markers (C-reactive protein [CRP] elevated in 100% of GCA, 66% of COVID-19), but platelet count was elevated in 47% of GCA but only 4% of COVID-19 cases. Cough and fever were commonly reported in COVID-19 and less frequently in GCA (cough, 63% for COVID-19 vs 12% for GCA; fever, 83% for COVID-19 vs 27% for GCA). Gastrointestinal upset was occasionally reported in COVID-19 (8%), rarely in GCA (4%). Lymphopenia was more common in COVID-19 than GCA (53% in COVID-19, 2% in GCA). Alteration of smell and taste have been described in GCA but their frequency is unclear.

Conclusion: Overlapping features of GCA and COVID-19 include headache, fever, elevated CRP and cough. Jaw claudication, visual loss, platelet count and lymphocyte count may be more discriminatory. Physicians should be aware of the possibility of diagnostic confusion. We have designed a simple checklist to aid evidence-based evaluation of patients with suspected GCA.
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http://dx.doi.org/10.3899/jrheum.200766DOI Listing
October 2020

Giant cell tumour of soft tissue-a rare presentation of a common pathology.

BJR Case Rep 2020 Sep 27;6(3):20200012. Epub 2020 May 27.

Plastic Surgeon St.James's University Hospital, Leeds, LS9 7TF, UK.

We present the case of a giant cell tumour of soft tissue (GCT-ST) presenting as a slow-growing paraspinal mass. Imaging investigations revealed a well-circumscribed subcutaneous lesion containing fluid-fluid levels and an internal solid nodule. The imaging findings resulted in only a tentative differential which included haematoma or complex epidermoid cyst but failed to provide a definitive diagnosis. The patient underwent an image-guided biopsy from which a histopathological diagnosis of a GCT-ST was made. GCT-ST is a primary soft tissue neoplasm that is clinically and histologically similar to giant cell tumour of bone. Given its rare occurrence, there is very little published literature on the characteristic imaging findings of GCT-ST to help with its diagnosis which is usually only made histologically. The aim of this case report is to highlight our specific imaging findings and add to the limited pre-existing imaging data on GCT-ST.
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http://dx.doi.org/10.1259/bjrcr.20200012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465752PMC
September 2020