Kremers, Hilal Maradit

Abstract The accurate measurement of wrist range of motion (ROM) is crucial for assessing functional impairments and monitoring recovery in clinical and rehabilitation settings. Traditional methods, such as Goniometric measurement, while effective, require clinician involvement and provide limited dynamic data. Recent advancements in wearable and smartphone-based technologies offer promising alternatives, enabling remote self-monitoring and dynamic assessments. This paper presents a novel smartphone-based application for measuring wrist ROM, leveraging built-in accelerometers and gyroscopes to capture joint motion with high accuracy. The app provides real-time feedback through visualizations and haptic or auditory cues, enhancing usability and ensuring accurate measurements without clinician supervision. By focusing on accessibility, affordability, and ease of use, the proposed app aims to bridge the gap between clinical and home-based care, offering a scalable solution for remote rehabilitation and continuous care. This paper discusses the current state of ROM measurement technologies, the design of the app, and its potential to improve patient engagement and outcomes in both clinical and home settings.

Abstract In a previous study, we observed decreased 1,25-dihydroxyvitamin D levels, secondary hyperparathyroidism, and increased bone turnover markers in living kidney donors (LKDs) at 3 months and 36 months after kidney donation. In our recent survey-based study, we found no increased risk of fractures of all types but observed significantly more vertebral fractures in LKDs compared with matched controls. To elucidate the long-term effects of kidney donation on bone health, we recruited 139 LKDs and 139 age and sex matched controls from the survey-based participants for further mechanistic analyses. Specifically, we assessed whether LKDs had persistent abnormalities in calcium- and phosphorus-regulating hormones and related factors, in bone formation and resorption markers, and in density and microstructure of bone compared with controls. We measured serum markers, bone mineral density (BMD), bone microstructure and strength (via high-resolution peripheral quantitative computed tomography and micro-finite element analysis [HRpQCT]), and advanced glycation end-products in donors and controls. LKDs had decreased 1,25-dihydroxyvitamin D concentrations (donors mean 33.89 pg/mL vs. controls 38.79 pg/mL, percent difference = -12.6%; P < .001), increases in both parathyroid hormone (when corrected for ionized calcium; donors mean 52.98 pg/mL vs. controls 46.89 pg/mL,% difference 13%; P = .03) and ionized calcium levels (donors mean 5.13 mg/dL vs. controls 5.04 mg/dL; P < .001), and increases in several bone resorption and formation markers versus controls. LKDs and controls had similar measures of BMD; however, HRpQCT suggested that LKDs have a statistically insignificant tendency toward thinner cortical bone and lower failure loads as measured by micro-finite element analysis. Our findings suggest that changes in the hormonal mileu after kidney donation and the long-term cumulative effects of these changes on bone health persist for decades after kidney donation and may explain later-life increased rates of vertebral fractures.

Abstract Objectives To examine multimorbidity in psoriasis and its association with the development of psoriatic arthritis (PsA). Methods A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000–09) and prevalence (1 January 2010) cohorts of psoriasis were identified by manual chart review. A cohort of individuals without psoriasis (comparators) were identified (1:1 matched on age, sex and county). Morbidities were defined using two or more Clinical Classification Software codes ≥30 days apart within prior 5 years. PsA was defined using ClASsification of Psoriatic ARthritis (CASPAR) criteria. χ2 and rank-sum tests were used to compare morbidities, and age-, sex- and race-adjusted Cox models to examine the association of baseline morbidities in psoriasis with development of PsA. Results Among 817 incident psoriasis patients, the mean age was 45.2 years with 52.0% females, and 82.0% moderate/severe psoriasis. No multimorbidity differences were found between incident psoriasis patients and comparators. However, in the 1088 prevalent psoriasis patients, multimorbidity was significantly more common compared with 1086 comparators (odds ratio 1.35 and 1.48 for two or more and five or more morbidities, respectively). Over a median 13.3-year follow-up, 23 patients (cumulative incidence: 2.9% by 15 years) developed PsA. Multimorbidity (two or more morbidities) was associated with a 3-fold higher risk of developing PsA. Conclusion Multimorbidity was more common in the prevalent but not incident cohort of psoriasis compared with the general population, suggesting that patients with psoriasis may experience accelerated development of multimorbidity. Moreover, multimorbidity at psoriasis onset significantly increased the risk of developing PsA, highlighting the importance of monitoring multimorbid psoriasis patients for the development of PsA.

Importance Living kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone. Objective To compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so. Design, Setting, and Participants This survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023. Exposure Living kidney donation. Main Outcomes and Measures The rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs). Results At the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83). Conclusions and Relevance This survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D 3 may reduce the numbers of vertebral fractures and patient morbidity.

Abstract Background Periprosthetic joint infection (PJI) is often managed using a combination of medical and surgical treatments, including irrigation and debridement or joint resection, spacer placement, and then revision to reimplant the arthroplasty components. The timing between surgical stages may vary, and little information exists about the clinical and microbiological factors impacting these temporal relationships. Methods A single center cohort study was conducted. The cohort included all cases of PJI for which resection was performed at the University of Iowa Health Care (UIHCs) between January 1, 2009, and December 31, 2016. Using a 1-year follow-up period, we constructed Kaplan-Meier estimates of the time to revision after resection—overall and then stratified by joint location (knee vs. hip), organism identification (known vs unknown), and C-reactive protein level (CRP >10 mg/L vs. CRP ≤10 mg/L). We then used Cox proportional hazard modeling to identify factors associated with revision within 1 year. Results Among a total of 109 cases of prosthetic joint resections (n = 67 knee, n = 42 hip), 56.9% underwent revision surgery during the follow-up period (n = 46 knee, n= 16 hip). Most revisions occurred between 2.5 and 3.0 months after resection. Knee arthroplasties were significantly more likely to undergo revision during the study period (hazard ratio, HR = 2.53, 95% confidence interval, CI: 1.38, 4.94) compared to hip arthroplasties. Identification of one or more organism involved in the PJI was also associated with revision during the study window (HR = 3.56, 95% CI: 1.94, 6.47), whereas elevated CRP was associated with lower rates of revision during the study period (HR = 0.21, 95% CI: 0.09, 0.46 for CRP >10 mg/L compared to CRP ≤10 mg/L). Figure 1. Kaplan-Meier curves for revision within 1-year after resection for the (A) cohort overall and then stratified by (B) joint location (hip vs knee), (C) organism identification (known vs unknown), and (D) C-reactive protein level (CRP >10 mg/L vs. CRP ≤10 mg/L). Conclusion For patients with surgically managed PJIs, joint location, organism identification, and lower CRP level were all associated with revision procedures within 1-year after resection. These findings may reflect mechanical and microbiological factors influencing the decision to proceed with revision. The variable length between stages—and thus, the variable time during which a spacer is retained—may be important to measure in future observational and clinical studies examining PJI outcomes. Disclosures All Authors: No reported disclosures

The digitization of medical records and expanding electronic health records has created an era of “Big Data” with an abundance of available information ranging from clinical notes to imaging studies. In the field of rheumatology, medical imaging is used to guide both diagnosis and treatment of a wide variety of rheumatic conditions. Although there is an abundance of data to analyze, traditional methods of image analysis are human resource intensive. Fortunately, the growth of artificial intelligence (AI) may be a solution to handle large datasets. In particular, computer vision is a field within AI that analyzes images and extracts information. Computer vision has impressive capabilities and can be applied to rheumatologic conditions, necessitating a need to understand how computer vision works. In this article, we provide an overview of AI in rheumatology and conclude with a five step process to plan and conduct research in the field of computer vision. The five steps include (1) project definition, (2) data handling, (3) model development, (4) performance evaluation, and (5) deployment into clinical care.