Ernest R Vina

Interests

Research

Osteoarthritis, Systemic lupus erythematosus, Racial/ethnic disparities, Decision-making, Health services research, Rheumatology

Courses

No activities entered.

Scholarly Contributions

Chapters

• Vina, E. R., & Kwoh, C. K. (2016). Osteoarthritis. In Hazzard's Geriatric Medicine and Gerontology. McGraw Hill.

Journals/Publications

• Hurst, C., Soto, M., Vina, E. R., & Rodgers, K. E. (2023).

  Renin-Angiotensin System-Modifying Antihypertensive Drugs Can Reduce the Risk of Cardiovascular Complications in Lupus: A Retrospective Cohort Study

  . Am J Med, 136(3), 284-293. doi:10.1016/j.amjmed.2022.11.016
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  Patients with systemic lupus erythematosus have a higher incidence of cardiovascular disease than the general population. Antihypertensive drugs that modify the renin-angiotensin system (RAS) are used to protect renal function in lupus nephritis and may also have extrarenal effects that lower cardiovascular disease risk due to their anti-inflammatory properties. In this study, we compared the effects of RAS vs non-RAS antihypertensive drugs on cardiovascular disease incidence in patients with lupus.Using a medical insurance claims dataset, 220,168 patients with lupus were identified, of which 31,647 patients (4018 patients prescribed RAS drugs, 27,629 patients prescribed non-RAS drugs) were eligible for the study. Patients had a mean age of 46.1 years, were 93.0% female, and healthy (96.9% Charlson Comorbidity Index score 0-4). Patients in the 2 drug groups were propensity score matched using demographic data, risk factors, and comorbidities.Use of RAS vs non-RAS drugs lowered the relative risk (RR) of diagnosis of cardiovascular disease (RR 0.80; 95% confidence interval [CI], 0.74-0.87), which was more pronounced after propensity score matching (RR 0.62; 95% CI, 0.57-0.68). The decreased risk in cardiovascular disease occurred regardless of lupus nephritis status (with lupus nephritis: RR 0.51; 95% CI, 0.39-0.65; without lupus nephritis: RR 0.65; 95% CI, 0.59-0.72). RAS-modifying therapies significantly increased cardiovascular disease-free survival probability over a 5-year period (86.0% vs 78.3% probability).RAS-modifying drugs reduced the risk of cardiovascular disease in patients with systemic lupus erythematosus in this dataset. These findings have the potential to impact clinical decision-making with regards to hypertension management in patients with lupus.
• Vina, E. R., Patel, P., Grest, C. V., Kwoh, C. K., Jakiela, J. T., Bye, T., & White, D. K. (2023).

  Does Physical Activity Confound Race Differences in Osteoarthritis‐Related Functional Limitation?

  . Arthritis Care & Research. doi:10.1002/acr.25209
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  This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)-related functional limitation.OA Initiative study participants with or at increased risk of knee OA who wore an accelerometer were included. Race was self-reported. Average time spent in moderate to vigorous physical activity (minutes per day) based on ActiGraph uniaxial accelerometer data was assessed. Functional limitation was based on the following: (1) inability to achieve a community walking speed (1.2 m/s) standard, (2) slow walking speed (
• Vina, E. R., Redford, A. H., & Kwoh, C. K. (2022).

  RACIAL AND ETHNIC DIFFERENCES IN THE MEDICAL MANAGEMENT OF OSTEOARTHRITIS: A SYSTEMATIC REVIEW

  . Osteoarthritis & Cartilage, 30, S387-S388. doi:10.1016/j.joca.2022.02.523
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  Purpose: Racial/ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to differences in the utilization or prescription of pharmacologic treatments. The objectives of this systematic review were to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA and to determine the extent of the persistence of racial/ethnic differences in OA treatment use after adjustment for sociodemographic and clinical factors.
• Vina, E. R., Tsoukas, P. H., Abdollahi, S., Mody, N., Roth, S., Redford, A. H., & Kwoh, C. K. (2022).

  Racial and ethnic differences in the pharmacologic management of osteoarthritis: rapid systematic review

  . Ther Adv Musculoskelet Dis., 14, 1-17. doi:10.1177/1759720x221105011
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  Background: Racial and ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments. Objectives: The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA. Data sources and methods: A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations. Conclusion: This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.
• Kwoh, C. K., Vina, E. R., Hannon, M. J., Quinones, C., Hausmann, L. R., Ibrahim, S. A., & Dagnino, J. (2021).

  The Role of Knowledge and Attitudes About Nonsteroidal Anti‐inflammatory Drugs in Determining Treatment Use

  . ACR Open Rheumatology, 3(3), 154-163. doi:10.1002/acr2.11235
• Kwoh, C. K., Youk, A. O., Vina, E. R., Mcclendon, J., Kwoh, C. K., Ibrahim, S. A., Hausmann, L. R., & Essien, U. R. (2021). Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination.. Arthritis care & research, 73(1), 11-17. doi:10.1002/acr.24481
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  Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain..We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of
• Vina, E. R., & Quinones, C. (2021). Understanding the Role and Challenges of Patient Preferences in Disparities in Rheumatologic Disease Care. Rheumatic diseases clinics of North America, 47(1), 83-96.
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  Evidence suggests patient preferences, including values and perspectives, have affected clinical outcomes, such as compliance, patient well-being, and satisfaction with care. A literature review was conducted with the purpose of exploring the tools used to elicit patients' treatment preferences and their roles in clinical outcomes. This review revealed racial differences in treatment preferences among patients with rheumatic and musculoskeletal diseases. The use of decision aids is a proactive intervention with potential for reducing race disparities and improving clinical outcomes. The utilization of patient preferences and values can improve outcomes by complementing the shared decision-making approach between patients and rheumatologists.
• Vina, E. R., Hannon, M. J., Quinones, C., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., & Kwoh, C. K. (2021). The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR open rheumatology, 3(3), 154-163.
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  The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA).
• Vina, E. R., Quinones, C., Hausmann, L. R., Ibrahim, S. A., & Kwoh, C. K. (2021). Association of Patients' Familiarity and Perceptions of Efficacy and Risks With the Use of Opioid Medications in the Management of Osteoarthritis. The Journal of rheumatology.
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  While opioids are known to cause unintended adverse effects, they are being utilized by a number of patients with osteoarthritis (OA). The aim of this study was to evaluate the association of patient familiarity and perceptions regarding efficacy and risks with opioid medication use for OA.
• Vina, E. R., Youk, A. O., Quinones, C., Kwoh, C. K., Ibrahim, S. A., & Hausmann, L. R. (2021).

  Use of Complementary and Alternative Therapy for Knee Osteoarthritis: Race and Gender Variations

  . ACR Open Rheumatology, 3(9), 660-667. doi:10.1002/acr2.11307
• Vina, E. R., Youk, A. O., Quinones, C., Kwoh, C. K., Ibrahim, S. A., & Hausmann, L. R. (2021). Use of Complementary and Alternative Therapy for Knee Osteoarthritis: Race and Gender Variations. ACR open rheumatology, 3(9), 660-667.
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  To evaluate race and gender variations in complementary and alternative medicine (CAM) use for knee osteoarthritis (OA) (unadjusted and adjusted for demographic and clinical factors).
• Weaver, J. S., Vina, E. R., Munk, P. L., Klauser, A., Elifritz, J., & Taljanovic, M. S. (2021).

  Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

  . J Clin Med, 11(1), 166. doi:10.3390/jcm11010166
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  Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.
• Kwoh, C. K., Vina, E. R., Masood, H. S., Kwoh, C. K., Ibrahim, S. A., Hausmann, L. R., Hannon, M. J., Dagnino, J., & Arellano, A. (2020). Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity.. The American journal of medicine, 133(6), 733-740. doi:10.1016/j.amjmed.2019.11.016
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  Our objective was to determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral nonsteroidal anti-inflammatory drugs (NSAIDs) and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors..Knee and hip osteoarthritis study participants were identified. Surveys were administered to collect sociodemographics, clinical information, and oral treatment methods for arthritis. Multivariable logistic regression models were created using a fully conditional method..Hispanics (n = 130), compared to non-Hispanic whites (n = 204), were less likely to have a high school education (26.9% vs 63.2%, P
• Kwoh, C. K., Youk, A. O., Weiner, D. K., Vina, E. R., Tighe, C. A., Kwoh, C. K., Ibrahim, S. A., Hausmann, L. R., Gallagher, R. M., & Bramoweth, A. D. (2020). Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity.. Pain medicine (Malden, Mass.), 21(3), 501-510. doi:10.1093/pm/pnz187
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  Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA..We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity..The sample included 517 patients (Mage = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b = 3.08, P
• McClendon, J., Essien, U. R., Youk, A., Ibrahim, S. A., Vina, E., Kwoh, C. K., & Hausmann, L. R. (2020). Cumulative Disadvantage and Disparities in Depression and Pain among Veterans with Osteoarthritis: The Role of Perceived Discrimination. Arthritis care & research. doi:10.1002/acr.24481
  More info

  Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), we sought to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain.
• Tighe, C. A., Youk, A., Ibrahim, S. A., Weiner, D. K., Vina, E. R., Kwoh, C. K., Gallagher, R. M., Bramoweth, A. D., & Hausmann, L. R. (2020). Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity. Pain medicine (Malden, Mass.), 21(3), 501-510. doi:10.1093/pm/pnz187
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  Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA.
• Vina, E. R., Hannon, M. J., Masood, H. S., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., Arellano, A., & Kwoh, C. K. (2020). Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity. The American journal of medicine, 133(6), 733-740. doi:10.1016/j.amjmed.2019.11.016
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  Our objective was to determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral nonsteroidal anti-inflammatory drugs (NSAIDs) and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors.
• Vina, E. R., Ran, D., Ashbeck, E. L., & Kwoh, C. K. (2020). Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women. Clinical orthopaedics and related research, 478(7), 1453. doi:10.1097/CORR.0000000000001001
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  When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender.
• Kwoh, C. K., Vina, E. R., Kwoh, C. K., Hannon, M. J., & Dagnino, J. (2019). THU0624 UNDERSTANDING ETHNIC DIFFERENCES IN THE UTILIZATION OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS FOR OSTEOARTHRITIS. Annals of the Rheumatic Diseases, 78, 605-605. doi:10.1136/annrheumdis-2019-eular.4401
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  Background: The prevalence of arthritis-attributable activity limitation, work limitation and severe pain are significantly higher among Hispanics than among non-Hispanic Whites (NHWs) in the US. While Hispanics are less likely to report regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), reasons for this decreased NSAID use are unknown. It is also unclear whether there are ethnic differences in the use of both over-the-counter (OTC) and prescription NSAIDs. Objectives: To determine: 1) if there are ethnic differences in the use of OTC and prescription oral NSAIDs for knee/hip osteoarthritis (OA); 2) if there are differences in familiarity with and perceptions of efficacy and risk of NSAIDs between Hispanics and NHWs; and 3) if patient attitudes/beliefs about NSAIDs mediate observed ethnic differences in the use of NSAIDS for OA. Methods: Participants ≥50 years of age with chronic frequent pain due to knee/hip OA completed structured interviews. Data on sociodemographic characteristics, clinical information, actual use of oral NSAIDs for OA treatment (last 6 months), and familiarity with NSAIDs (3 items, yes/no response) were collected. Perceptions of efficacy (4 items) and risk (3 items) of NSAIDs were evaluated using five-category ordinal response scale questions. Responses were averaged, with higher values indicating higher perception of efficacy/risk. Fisher’s exact or Wilcoxon-Mann-Whitney tests were conducted to determine if knowledge and perceptions about NSAIDs differed by ethnicity. Multivariable logistic regression models were built to determine if ethnic differences in NSAID use were mediated by knowledge and perceptions about the medication. Results: Among knee/hip OA patients, Hispanics (n=130), in comparison to NHWs (n=204), were younger (mean age 61.8 vs. 65.7) and less likely to have an annual income of ≥$40K (21.6% vs. 56.5%). Hispanics, compared to NHWs, had lower odds of using an OTC NSAID (OR 0.57, 95% CI 0.36-0.90) but greater odds of using a prescription NSAID (OR 1.66, 95% CI 1.04-2.64) for OA. Hispanics, compared to NHWs, were also less likely to ever hear about OTC and prescription oral NSAID to treat OA or have a good understanding of either oral NSAID type as a treatment for OA (Table 1). Mean [SD] perceived efficacy of OTC and prescription oral NSAIDs were slightly lower among Hispanics than NHWs (2.91 [0.98] vs. 3.12 [0.88], p=0.0565; 3.03 [1.02] vs. 3.34 [0.87], p=0.0047; respectively). Mean [SD] perceived risk of prescription NSAIDs was lower among Hispanics than NHWs (2.44 [1.03] vs. 2.82 [1.01], p=0.0012). After adjustment for all familiarity with OTC NSAIDs questions, and perceived efficacy and risk of OTC oral NSAIDs scores, the association between OTC NSAID use and ethnicity was attenuated and no longer significant (OR 1.01, 95%CI 0.54-1.89). After adjustment for familiarity with and perceptions of efficacy and risk of prescription NSAIDs, the association between prescription NSAID use and ethnicity remained significant (OR 2.62, 95%CI 1.51-4.54). Conclusion: Among patients with knee or hip OA, Hispanics were less likely than NHWs to utilize an OTC oral NSAID as treatment for arthritis. They were also less familiar with the use of NSAIDs for OA treatment and less likely to believe in their efficacy. Patient familiarity and perceptions of OTC oral NSAIDs may mediate ethnic differences in the use of NSAIDs for knee/hip OA. Disclosure of Interests: Ernest Vina Grant/research support from: Astrazeneca, Consultant for: Astrazeneca, Michael Hannon Employee of: Pinney Associates, Jazmin Dagnino: None declared, C. Kent Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis
• Vina, E. R., Di, R., Ashbeck, E. L., & Kwoh, C. K. (2019).

  Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women

  . Clin Orthop Relat Res. doi:10.1097/corr.0000000000001001
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  When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender.(1) Does the association between widespread pain and no clinically important improvement in osteoarthritis-related pain and disability 2 years after TKA differ between men and women? (2) Does the use of pain medications 2 years after TKA differ between those with widespread pain and those without widespread pain before surgery?Osteoarthritis Initiative (https://nda.nih.gov/oai/) study participants were followed annually from March 2005 until October 2015. Participants who underwent TKA up to the 7-year follow-up visit with pain/disability assessment at the protocol-planned visit before TKA and at the second planned annual visit after surgery were included in the analysis. Among 4796 study participants, 391 had a confirmed TKA, including 315 with pain/disability assessment at the protocol-planned visit before TKA. Overall, 95% of participants (298) had the required follow-up assessment; 5% (17) did not have follow-up data. Widespread pain was defined based on the modified American College of Rheumatology criteria. Symptoms were assessed using the WOMAC pain (range 0 to 20; higher score, more pain) and disability (range 0 to 68; higher score, more disability) scores, and the Knee Injury and Osteoarthritis Outcome Score for pain (range 0 to 100; higher score, less pain). Improvements in pain and disability were classified based on improvement from established clinically important differences (decrease in WOMAC pain ≥ 1.5; decrease in WOMAC disability ≥ 6.0; increase in Knee Injury and Osteoarthritis Outcome Score for pain ≥ 9). At baseline, more women presented with widespread pain than men (45% [84 of 184] versus 32% [36 of 114]). Probability and the relative risk (RR) of no clinically important improvement were estimated using a logistic regression analysis in which participants with widespread pain and those without were compared. The analyses were done for men and women separately, then adjusted for depression and baseline outcome scores.Among women, preoperative widespread pain was associated with an increased risk of no clinically important improvement 2 years after TKA, based on WOMAC pain scores (13.5% versus 4.6%; RR 2.93 [95% CI 1.18 to 7.30]; p = 0.02) and the Knee Injury and Osteoarthritis Outcome Score for pain (16.5% versus 4.9%; RR 3.39 [95% CI 1.34 to 8.59]; p = 0.02). Given the lower and upper limits of the confidence intervals, our data are compatible with a broad range of disparate associations between widespread pain and lack of clinically important improvement in WOMAC pain scores (RR 0.77 [95% CI 0.22 to 2.70]; p = 0.68) and the Knee Injury and Osteoarthritis Outcome Score for pain (RR 1.37 [95% CI 0.47 to 4.00]; p = 0.57) among men, as well as clinically important improvement in WOMAC disability scores among men (RR 0.72 [95% CI 0.20 to 2.55]; p = 0.61) and women (RR 1.98 [95% CI 0.92 to 4.26]; p = 0.08). Participants presenting with widespread pain before TKA were more likely than those without widespread pain to use medication for symptoms of knee osteoarthritis most days for at least 1 month 2 years after TKA (51% [61 of 120] versus 32% [57 of 178]; mean difference, 18.8 [95% CI 7.3 to 30.1]; p < 0.01).Widespread pain before TKA was associated with an increased risk of no clinically important improvement in knee pain 2 years postoperatively among women. Because of the small number of men with widespread pain in the sample, the results for men were inconclusive. In clinical practice, screening TKA candidates for widespread pain may be useful, and expectations of surgical outcomes may need to be tempered if patients have a concurrent diagnosis of widespread pain. Future studies should include more men with widespread pain and investigate if treatment of widespread pain before or concurrent with TKA surgery may improve surgical outcomes.Level III, therapeutic study.
• Vina, E. R., Hannon, M. J., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., Arellano, A., & Kwoh, C. K. (2019). Modifiable Determinants of Exercise Use in a Diverse Ethnic Population With Osteoarthritis. Arthritis care & research, 71(11), 1495-1503.
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  To determine the extent of ethnic differences in the use of exercise for therapy and identify relevant modifiable determinants of exercise use among patients with knee/hip osteoarthritis (OA).
• Vina, E. R., Hausmann, L. R., Obrosky, D. S., Youk, A., Ibrahim, S. A., Weiner, D. K., Gallagher, R. M., & Kwoh, C. K. (2019). Social & psychological factors associated with oral analgesic use in knee osteoarthritis management. Osteoarthritis and cartilage, 27(7), 1018-1025.
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  Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA.
• Abbate, L. M., Jeffreys, A. S., Coffman, C. J., Schwartz, T. A., Arbeeva, L., Callahan, L. F., Negbenebor, N. A., Kohrt, W. M., Schwartz, R. S., Vina, E., & Allen, K. D. (2018). Demographic and Clinical Factors Associated with Non-Surgical Osteoarthritis Treatment Use Among Patients in Outpatient Clinics. Arthritis care & research, 70(8), 1141-1149. doi:10.1002/acr.23466
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  To identify patient demographic and clinical characteristics associated with osteoarthritis (OA) treatment use.
• Hausmann, L. R., Ibrahim, S. A., Kwoh, C. K., Youk, A., Obrosky, D. S., Weiner, D. K., Vina, E., Gallagher, R. M., Mauro, G. T., & Parks, A. (2018). Rationale and design of the Staying Positive with Arthritis (SPA) Study: A randomized controlled trial testing the impact of a positive psychology intervention on racial disparities in pain. Contemporary clinical trials, 64, 243-253. doi:10.1016/j.cct.2017.09.001
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  Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
• Hausmann, L. R., Youk, A., Kwoh, C. K., Gallagher, R. M., Weiner, D. K., Vina, E. R., Obrosky, D. S., Mauro, G. T., McInnes, S., & Ibrahim, S. A. (2018). Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis: A Randomized Clinical Trial. JAMA network open, 1(5), e182533.
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  Positive psychological interventions for improving health have received increasing attention recently. Evidence on the impact of such interventions on pain, and racial disparities in pain, is limited.
• Kabadi, S., Yeaw, J., Bacani, A. K., Tafesse, E., Bos, K., Karkare, S., DeKoven, M., & Vina, E. R. (2018).

  Healthcare resource utilization and costs associated with long-term corticosteroid exposure in patients with systemic lupus erythematosus

  . Lupus, 27(11), 1799-1809. doi:10.1177/0961203318790675
• Kabadi, S., Yeaw, J., Bacani, A. K., Tafesse, E., Bos, K., Karkare, S., DeKoven, M., & Vina, E. R. (2018). Healthcare resource utilization and costs associated with long-term corticosteroid exposure in patients with systemic lupus erythematosus. Lupus, 27(11), 1799-1809.
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  Objective To evaluate the association between exposure to oral corticosteroids and future healthcare resource utilization and costs for patients with systemic lupus erythematosus. Methods Adults diagnosed with systemic lupus erythematosus (index date) between 1 January 2008 and 30 June 2013 and naive to oral corticosteroids with continuous health plan enrollment for ≥6 months pre- and ≥5 years post-index were identified from a large health plan claims database. Per-patient monthly average daily dose of oral corticosteroids (prednisone or its equivalent) was calculated for the first 2 years post-index to categorize patients into four steroid exposure cohorts: low (≤5 mg/day), medium (6-20 mg/day), high (>20 mg/day) and no steroids. Differences in healthcare resource utilization and total healthcare costs during the third year post-index across corticosteroid exposure cohorts were modeled with adjustment for baseline characteristics. Results The study included 18,618 systemic lupus erythematosus patients (163 high dose, 1127 medium dose, 6717 low dose and 10,611 no steroids). Compared to low-dose corticosteroid users, high-dose corticosteroid users were more likely to have emergency room visits (39.3% vs. 29.7%; p = 0.0085) and to be hospitalized (21.5% vs. 12.3%; p = 0.0005). After adjustment for baseline characteristics, they also had significantly greater average annual total healthcare costs (US$60,366 vs. US$18,777; p 
• Kwoh, C. K., Vina, E. R., Ratzlaff, C., Ran, D., Kwoh, C. K., & Ashbeck, E. L. (2018). Race, sex, and risk factors in radiographic worsening of knee osteoarthritis.. Seminars in arthritis and rheumatism, 47(4), 464-471. doi:10.1016/j.semarthrit.2017.08.008
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  Characterize radiographic worsening in knee osteoarthritis (KOA) by race and sex over 4 years and evaluate the role of established risk factors in observed race/sex differences..Whites (WHs) (694 males and 929 females) and African-Americans (AAs) (92 males and 167 females) at risk for radiographic KOA were eligible. Cox shared frailty models were used to estimate race and sex group differences in radiographic worsening, defined by Kellgren-Lawrence (K-L) and OARSI joint space narrowing (JSN). Mixed effect models for repeated measures were used to estimate race- and sex-specific mean medial and lateral fixed joint space width (fJSW) over 4 years of follow-up, as well as annual loss of fJSW..Risk of OARSI medial JSN grade worsening was higher among AA males than WH females [HR = 2.28, (95% CI: 1.14-4.57)], though adjustment for KOA risk factors attenuated the association. Compared to WH females, WH males had lower risk of K-L grade worsening [adjusted HR = 0.75 (95% CI: 0.58-0.96)]. Mean baseline medial fJSW (mm) was 6.49 in WH and AA males, 5.42 in WH females, and 5.41 in AA females. Annual change in mean medial fJSW was greater in AA males (-0.19mm/year) than in other subgroups (-0.09 WH males, -0.07 WH females, -0.10 AA females, p < 0.0001). Compared to WHs, AAs had less lateral fJSW at baseline and throughout follow-up..Compared to WHs and AA females, AA males experienced higher risk of medial joint space loss. Controlling for established risk factors attenuated associations between race/sex and disease worsening, suggesting that risk factors such as obesity, history of knee injury, and bony finger joint enlargements largely explain race/sex variations in rates of KOA development and progression.
• Vina, E. R., & Kwoh, C. K. (2018). Epidemiology of osteoarthritis: literature update. Current opinion in rheumatology, 30(2), 160-167. doi:10.1097/BOR.0000000000000479
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  The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors.
• Vina, E. R., Kwoh, C. K., Hausmann, L. R., Youk, A., Gallagher, R. M., Weiner, D. K., Obrosky, D. S., Mauro, G. T., McInnes, S., & Ibrahim, S. A. (2018).

  Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis: A Randomized Clinical Trial

  . JAMA Network Open, 1(5), e182533. doi:10.1001/jamanetworkopen.2018.2533
• Vina, E. R., Ran, D., Ashbeck, E. L., & Kwoh, C. K. (2018). Natural history of pain and disability among African-Americans and Whites with or at risk for knee osteoarthritis: A longitudinal study. Osteoarthritis and cartilage, 26(4), 471-479.
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  Compare knee pain and disability between African Americans (AAs) and Whites (WHs), with or at risk of knee osteoarthritis (KOA), over 9 years, and evaluate racial disparities in KOA-related symptoms across socioeconomic and clinical characteristics.
• Vina, E. R., Ran, D., Ashbeck, E. L., Ratzlaff, C., & Kwoh, C. K. (2018). Race, sex, and risk factors in radiographic worsening of knee osteoarthritis. Seminars in arthritis and rheumatism, 47(4), 464-471. doi:10.1016/j.semarthrit.2017.08.008
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  Characterize radiographic worsening in knee osteoarthritis (KOA) by race and sex over 4 years and evaluate the role of established risk factors in observed race/sex differences.
• Vina, E. R., Ran, D., Kwoh, C. K., & Hannon, M. J. (2018). THU0649 Understanding ethnic differences in the utilisation of exercise for osteoarthritis. Annals of the Rheumatic Diseases, 77, 519-520. doi:10.1136/annrheumdis-2018-eular.3571
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  Background According to a US survey, the prevalence of arthritis-attributable activity limitation, work limitation and severe pain are all significantly higher among Hispanics than among non-Hispanics (NHs). Ethnic differences in osteoarthritis (OA) patients’ experience of pain may be related to marked disparities in the use of OA treatments. According to EULAR OA guidelines, exercise should be an integral part of the management of knee and hip OA. Whether or not exercise is underutilised and why it may be underutilised by Hispanics to treat OA is unclear. Objectives The objective of this study was to determine if there are ethnic differences in the history and current use of exercise as therapy for patients with knee or hip OA. The secondary objective was to compare Hispanic and NH patients with lower extremity OA with respect to their familiarity and perceptions of the efficacy and risk of exercise as treatment for OA. Methods Research participants≥50 years of age with chronic and frequent pain due to knee or hip OA were recruited from a university medical centre. Structured interviews were conducted to determine patient sociodemographic characteristics, clinical information, self-reported actual use/prescription receipt of exercise for OA treatment (currently, last 5 years), and familiarity with exercise (3 items, yes/no response). Perceptions of the benefits (4 items) and risks (3 items) of exercise, and willingness to exercise to treat OA were also evaluated; each question in these measures has a five-category ordinal response scale. Fisher’s exact or Wilcoxon-Mann-Whitney tests were conducted to determine if knowledge and perceptions about exercise were associated with ethnicity (Hispanic vs NH). Results In our cohort of patients with knee or hip OA, Hispanics (n=119), in comparison to NHs (n=201), were younger (mean age 61.5 vs. 65.3) and less likely to have an annual income of ≥$50,000 (13.5% vs. 39.1%). A lower proportion of Hispanics than NHs reported using exercise to treat OA at present (51% vs. 66%, p=0.0165) and in the last five years (68% vs. 84%, p=0.0010) or receiving a prescription for exercise in the last five years (45% vs. 67%, p Hispanics, compared to NHs, were also less likely to report ever hearing about exercise to treat OA (71.43% vs. 91.83%, p Conclusions Among patients with knee or hip OA, Hispanics were less likely than NHs to utilise exercise as treatment for arthritis. They were also less familiar with its use for OA treatment, less likely to believe in its efficacy, and less willing to use it as treatment for OA. Improving patient knowledge and attitudes about exercise may increase utilisation of this OA treatment and help reduce ethnic differences in OA outcomes. Disclosure of Interest E. Vina: None declared, D. Ran: None declared, M. Hannon: None declared, C. Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis
• Vina, E. R., Schwartz, T. A., Schwartz, R. S., Negbenebor, N. A., Kohrt, W. M., Jeffreys, A. S., Coffman, C. J., Callahan, L. F., Arbeeva, L., Allen, K. D., & Abbate, L. M. (2018). Demographic and Clinical Factors Associated With Nonsurgical Osteoarthritis Treatment Among Patients in Outpatient Clinics.. Arthritis care & research, 70(8), 1141-1149. doi:10.1002/acr.23466
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  To identify patient demographic and clinical characteristics associated with osteoarthritis (OA) treatment use..This was a secondary data analysis of 3 clinical trials among patients with hip or knee OA conducted in Duke Primary Care practices, the Durham Veterans Affairs (VA) Health Care System, and the University of North Carolina-Chapel Hill (UNC). At baseline, participants reported sociodemographic characteristics, OA-related pain and function, and OA treatment use, including oral analgesics, topical creams, joint injections, and physical therapy. Separate, multivariable logistic models (adjusted for clustering of clinics and providers for the Duke and VA cohorts) were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between participant characteristics and each type of OA treatment..Oral analgesic use was reported by 70-82% of participants across the 3 cohorts. Physical therapy, knee injections, and topical creams were used by 39-52%, 55-60%, and 25-39% of Duke, VA, and UNC participants, respectively. In multivariable models, worse pain, stiffness, and function, per 5-unit increase, were associated with greater odds of using any oral analgesic for the cohorts from Duke (OR 1.18 [95% CI 1.08-1.28]) and UNC (OR 1.14 [95% CI 1.05-1.24]), but not for the VA cohort (OR 1.04 [95% CI 0.95-1.14]). For all 3 cohorts, nonwhites had higher odds of using topical creams compared to whites..Results suggest potential underutilization of therapies other than oral analgesics. Patient characteristics may affect OA treatment use, and understanding the relationship between these factors and OA treatment preferences may improve adherence to OA treatment guidelines.
• Youk, A. O., Weiner, D. K., Vina, E. R., Obrosky, D. S., Kwoh, C. K., Ibrahim, S. A., & Hausmann, L. R. (2018). OP0216 Examining modifiable psychological & social health factors associated with use of osteoarthritis oral analgesic treatment. Annals of the Rheumatic Diseases, 77, 157-157. doi:10.1136/annrheumdis-2018-eular.3813
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  Background EULAR recommends the use of non-opioid oral medicines (acetaminophen, NSAIDs, or COX-2 inhibitors) for the management of knee osteoarthritis (OA). Opioids are also recommended when these other therapies fail. There are known demographic and clinical differences in OA treatment use. Patients’ social and psychological health may also influence use of medications, yet their association with the utilisation of opioid or non-opioid oral OA treatments is unknown. Objectives Determine which modifiable social and psychological health factors are associated with use of oral opioid and non-opioid medications for OA. Methods Baseline data from a randomised controlled trial that examined the effects of a positive psychological intervention on pain in veterans with knee OA were used. For our study, patients were categorised based on self-reported use of the following oral medications for OA at baseline: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used χ2 or analysis of variance to compare sociodemographic, clinical, social, and psychological health variables by baseline OA treatment use. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study), health literacy (‘How confident are you filling out medical forms by yourself’), and depressive symptoms (Patient Health Questionnaire-8). All models were adjusted for age, sex, race, income, OA symptom severity (WOMAC), self-reported Charlson comorbidity index, and body mass index. Results In this sample, 30.6% (n=110) reported taking opioid analgesics for OA, 54.2% (n=195) reported non-opioid use, and 15.3% (n=55) reported no oral analgesic use. Compared to the other groups, those taking opioids were younger (mean age 62.5 vs 64.3 vs 67.1, respectively, p=0.002) and had higher mean WOMAC scores (54.5 vs 45.7 vs 42.7, p The table 1 shows the associations between the social and psychological health measures with oral analgesic use, adjusted for sociodemographic and clinical factors. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95% CI: 1.08 to 8.07) when adjusted for sociodemographic and clinical factors. Depression level was not significantly associated with non-opioid oral medication use, compared to no oral analgesic medication use, in a similarly adjusted model. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. Conclusions Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid (vs. non-opioid) analgesics for OA. Social support and health literacy were not significantly associated with oral analgesic use for OA when sociodemographic and clinical factors were accounted for. Disclosure of Interest E. Vina: None declared, L. Hausmann: None declared, D. Obrosky: None declared, A. Youk: None declared, D. Weiner: None declared, S. Ibrahim: None declared, C. Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis
• Vina, E. R., Kallan, M. J., Collier, A., Nelson, C. L., & Ibrahim, S. A. (2017).

  Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set

  . Geriatric Orthopaedic Surgery & Rehabilitation, 8(4), 192-201. doi:10.1177/2151458517726409
• Vina, E. R., Kallan, M. J., Collier, A., Nelson, C. L., & Ibrahim, S. A. (2017). Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set. Geriatric orthopaedic surgery & rehabilitation, 8(4), 192-201.
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  Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission.
• Vina, E. R., Nelson, C. L., Kallan, M. J., Ibrahim, S. A., & Collier, A. (2017). THU0707 Race & rehabilitation destination after total hip replacement. Annals of the Rheumatic Diseases, 76, 474-475. doi:10.1136/annrheumdis-2017-eular.2168
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  Background There are marked racial/ethnic disparities in the utilization of hip joint replacement in the US. Differences in post-surgical rehabilitation care may influence this disparity. There is relatively little research on racial variations in post-hip joint replacement surgery care processes. Objectives The main objective of this analysis was to examine racial differences in where patients go for post-acute care rehabilitation after elective hip replacement surgery. We also assessed whether or not where patients go for post-surgery rehabilitation care impacts quality of care markers such as 90-day hospital readmission. Methods A retrospective, large regional dataset analysis using the Pennsylvania Health Care Cost Containment Council database was performed. Patients who underwent elective hip replacement surgery and discharged from Pennsylvania hospitals between fiscal years 2008–2012 were selected. Post-surgery rehabilitation destinations options included: home with self-care, home with home health (HH) care; skilled nursing facility (SNF) and in-patient rehab facility (IRF). We used multinomial logistic regression models to estimate unadjusted and adjusted relative risk ratios (aRRRs) of being discharged home with HH care, to a SNF or to an IRF (vs. home with self-care) after surgery, comparing African-American (AA) to white patients. Multivariable models adjusted for patient-level and facility-level variables associated (p Results Among all patients analyzed, 4,391 self-identified as AA and 63,625 self-identified as white. Among those The Figure summarizes the unadjusted (UN) and adjusted (ADJ) RRRs of referral to an IRF, SNF and HH care (vs. home self-care) in AAs (vs. whites) by age group. Among patients Conclusions Compared to whites, AA patients who underwent hip replacement were more likely to be discharged to an IRF or SNF. Furthermore, discharge to either IRF or SNF was associated with higher risk of hospital readmission. Disclosure of Interest None declared
• Kwoh, C. K., Ashbeck, E. L., Ran, D., Vina, E. R., & Kaur, M. (2016).

  Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters: Pain and Arthroplasty Preference

  . Arthritis Care & Research, 69(1), 95-103. doi:10.1002/acr.23084
• Kwoh, C. K., Vina, E. R., Kwoh, C. K., & Hannon, M. J. (2016). Improvement following total knee replacement surgery: Exploring preoperative symptoms and change in preoperative symptoms.. Seminars in arthritis and rheumatism, 45(5), 547-55. doi:10.1016/j.semarthrit.2015.10.002
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  To determine whether changes in preoperative osteoarthritis (OA) symptoms are associated with improvement after total knee replacement (TKR) and to identify predictors of clinically significant improvement..Data on Osteoarthritis Initiative participants who were annually assessed and underwent TKR were included. T0 was the assessment prior to TKR while T-1 was the assessment prior to that. T+2 was the second assessment after TKR. We compiled data on the Western Ontario and McMaster Universities OA Index (WOMAC), OA-related symptoms, and radiographic severity. We defined clinically significant improvement as improvement in WOMAC total score ≥ to the minimal important difference (MID) (0.5 SD of mean change) between T0 and T+2 and also considered other definitions of improvement. Logistic regression models were performed to evaluate the relationship between improvement and preoperative measures..Improved (n = 211) compared to unimproved (n = 58) patients had greater worsening of their WOMAC pain (p = 0.002) and disability (p < 0.001) from T-1 to T0. Preoperative measures as predictors of improvement included higher WOMAC disability (OR = 1.08, p < 0.001), presence of chronic OA symptoms in the surgical knee (OR = 5.77, p = 0.033), absence of OA-related symptoms in the contralateral knee (OR = 9.25, p < 0.001), exposure to frequent knee bending (OR = 3.46, p = 0.040), and having a Kellgren-Lawrence x-ray grade of ≥2 in the contralateral knee (OR = 4.71, p = 0.010)..More than 75% of participants had improvement after TKR. Improved patients were more likely to have escalation of OA pain and disability prior to surgery than unimproved patients. Other preoperative measures predicted improvement after TKR.
• Kwoh, C. K., Vina, E. R., Richardson, D., Medvedeva, E., Kwoh, C. K., Ibrahim, S. A., & Collier, A. (2016). Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial.. Clinical orthopaedics and related research, 474(8), 1755-64. doi:10.1007/s11999-016-4834-z
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  A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA..We asked: (1) Does a patient-centered intervention consisting of a decision aid for knee OA and motivational interviewing improve the proportion of referrals of blacks with knee OA to orthopaedic surgery? (2) Does the intervention increase patients' willingness to undergo TKA?.Adults who self-identified as black who were at least 50 years old with moderate to severe knee OA were enrolled from urban primary care clinics in a two-group randomized, controlled trial. A total of 1253 patients were screened for eligibility, and 760 were excluded for not meeting inclusion criteria, declining to participate, or other reasons. Four hundred ninety-three patients were randomized and completed the intervention; three had missing referral data at followup. The mean age of the patients was 61 years, and 51% were women. The majority had an annual household income less than USD 15,000. Participants in the treatment group were shown a decision-aid video and had a brief session with a trained counselor in motivational interviewing. Participants in the control group received an educational booklet about OA that did not mention joint replacement. The two groups had comparable demographic and socioeconomic characteristics. The primary outcome was referral to orthopaedic surgery 12 months after treatment exposure. Receipt of referral was defined as the receipt of a recommendation or prescription from a primary care provider for orthopaedic evaluation. The secondary outcome was change in patient willingness to undergo TKA based on patient self-report..The odds of receiving a referral to orthopaedic surgery did not differ between the two study groups (36%, 90 of 253 of the control group; 32%, 76 of 240 of the treatment group; odds ratio [OR], 0.81; 95% CI, 0.56-1.18; p = 0.277). At 2 weeks followup, there was no difference between the treatment and the control groups in terms of increased willingness to consider TKA relative to baseline (34%, 67 of 200 patients in the treatment group; 33%, 68 of 208 patients in the control group; OR, 1.06; p = 0.779). At 12 months followup, the percent increase in willingness to undergo TKA still did not differ between patients in the treatment and control groups (29%, 49 of 174 in the treatment group; 27%, 51 of 191 in the control group; OR, 1.10; p = 0.679)..A combination decision aid and motivational interviewing strategy was no better than an educational pamphlet in improving patients' preferences toward joint replacement surgery for knee OA. The type of intervention treatment also did not affect access to surgical evaluation. Other tools that target patient knowledge, beliefs, and attitudes regarding surgical treatments for OA may be further developed and tested in the future..Level I, therapeutic study.
• Kwoh, C. K., Zhou, J. J., Vina, E. R., Ran, D., Kwoh, C. K., Ibrahim, S. A., Hannon, M. J., & Ashbeck, E. L. (2016). Patient preferences for total knee replacement surgery: Relationship to clinical outcomes and stability of patient preferences over 2 years.. Seminars in arthritis and rheumatism, 46(1), 27-33. doi:10.1016/j.semarthrit.2016.03.012
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  Evaluate the relationship between patient preferences for total knee replacement (TKR) with receipt of TKR, and assess participant characteristics that may influence change in willingness to undergo TKR..Structured interviews of knee osteoarthritis (OA) patients were conducted. Logistic regression models were conducted to assess the association between baseline willingness and eventual receipt of TKR, adjusted for sociodemographic and clinical variables. Mixed models for repeated measures were used to estimate the effects of sex, race, social support, Δ WOMAC, and orthopedic consult on change in willingness..A total of 589 participants were willing, and 215 participants were unwilling to undergo TKR. Willing participants, compared to others, were more often White (69.4% vs. 48.4%), with more than a high school education (60.8% vs. 47.0%) and employed (39.1% vs. 26.5%). At follow-up, the odds of having TKR were twice as high among those who were willing to have the procedure at baseline, but this was no longer significant when adjusted for demographic variables (adjusted OR = 1.82, 95% CI: 0.89-3.69). Willingness to undergo TKR declined over 2 years. Among those who were willing to undergo TKR at baseline but did not obtain one, only 66.5% were still willing at the 2-year follow-up. This decline was less among those who had a greater increase (>median) in WOMAC disability (adjusted Δ = -0.34, 95% CI: -0.47 to -0.20) than those who had minimal change in their WOMAC disability (p = 0.08). The decline in willingness was also less among those who had seen an orthopedic surgeon (adjusted Δ = -0.32, 95% CI: -0.46 to -0.17) than those who did not (p = 0.05)..Preference for TKR was consistent with TKR surgery utilization, but not after controlling for patient demographic characteristics. Willingness to undergo TKR declined over time, but this decrease was mitigated by worsening OA-related disability and by consultation with an orthopedic surgeon.
• Vina, E. R., Hannon, M. J., & Kwoh, C. K. (2016). Improvement following total knee replacement surgery: Exploring preoperative symptoms and change in preoperative symptoms. Seminars in arthritis and rheumatism, 45(5), 547-55. doi:10.1016/j.semarthrit.2015.10.002
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  To determine whether changes in preoperative osteoarthritis (OA) symptoms are associated with improvement after total knee replacement (TKR) and to identify predictors of clinically significant improvement.
• Vina, E. R., Ran, D., Ashbeck, E. L., Ibrahim, S. A., Hannon, M. J., Zhou, J. J., & Kwoh, C. K. (2016). Patient preferences for total knee replacement surgery: Relationship to clinical outcomes and stability of patient preferences over 2 years. Seminars in arthritis and rheumatism, 46(1), 27-33. doi:10.1016/j.semarthrit.2016.03.012
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  Evaluate the relationship between patient preferences for total knee replacement (TKR) with receipt of TKR, and assess participant characteristics that may influence change in willingness to undergo TKR.
• Vina, E. R., Ran, D., Kwoh, C. K., & Ashbeck, E. (2016). AB0754 Racial Differences in Knee Osteoarthritis Pain, Symptoms and Disability Reporting. Annals of the Rheumatic Diseases, 75(Suppl 2), 1163-1163. doi:10.1136/annrheumdis-2016-eular.3239
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  Background Manifestations and severity of knee osteoarthritis (KOA) vary across racial groups. Characterizing this variability allows identification of vulnerable groups and customizing interventions accordingly. Pain and functional limitations tend to be greater among African-Americans (AAs) than Whites (WHs) with KOA. Differential progression in KOA symptoms by race has not been well-described. Objectives To compare progression over 9 years in reported pain, disability and other symptoms of AAs and WHs with or at high-risk of KOA Methods Data from baseline to 108 months were gathered from the Osteoarthritis Initiative (OAI). The study rationale and inclusion criteria for OAI (people ages 45–79 with symptoms of and/or radiographic KOA, or with risk factors for developing KOA) have been described (http://oai.epi-ucsf.org/datarelease/). All AA and WH subjects were included in the study. Knee pain, disability and other OA symptom trajectories were based on: 1) WOMAC pain subscale score [range: 0–20], 2) Knee pain severity in the past 30 days based on a numerical rating scale (NRS) [range: 0–10], 3) WOMAC disability subscale score [range: 0–68], and 4) Knee Injury and Osteoarthritis Outcome (KOOS) other symptoms score [range: 0–100]. Higher scores indicate greater OA-related pain/disability in all measures, except for KOOS symptoms score. Mixed effect models for repeated measures were used to test for racial differences in mean values and mean change during follow-up. All models were adjusted for age, sex, body mass index [BMI], and education. Results A total of 3790 WH and 874 AA OI participants were included, and the majority (58.4%) were female. Mean (SD) age at baseline was 61.2 (9.2) years, and mean (SD) BMI was 28.7 (4.9) kg/m 2 . Baseline WOMAC pain subscale score was higher in AAs (mean 3.90 [95% CI: 3.72 to 4.08]) in comparison to WHs (mean 2.09 [95% CI: 2.00 to 2.18]) (p≤0.0001). After the second administration of the questionnaires 1-year post-baseline, there was a significantly greater decline in mean WOMAC pain score among AAs compared to WHs (-0.64 [95% CI: -0.79 to -0.50] vs. -0.15 [95% CI: -0.22 to -0.08]; p Trajectories of mean pain severity measured with a NRS, WOMAC disability, and KOOS symptom score had similar patterns, with a significantly greater decline among AAs from baseline to the first year of follow-up, followed by relatively stable group means. Change in mean scores over the first year of follow-up for AAs, in comparison to WHs, were as follows: pain severity (-0.70 [95% CI: -0.83 to -0.56] vs. -0.14 [95% CI: -0.20 to -0.08]; p Conclusions The results suggest that AAs report a precipitous drop in KOA-related symptoms between first administration at baseline and second administration 1 year later. Self-reported measures of symptoms are accepted as primary endpoints in randomized controlled trials (RCTs) and commonly used in observational studies. The implications for RCTs that rely on changes in these measures to demonstrate drug efficacy include obscured treatment effects among AAs, as well as biased selection for trial eligibility. Disclosure of Interest None declared
• Vina, E. R., Ran, D., Kwoh, C. K., & Ashbeck, E. (2016). SAT0445 Race and Sex Differences in Radiographic Progression of Knee Osteoarthritis. Annals of the Rheumatic Diseases, 75(Suppl 2), 832-833. doi:10.1136/annrheumdis-2016-eular.2996
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  Background Knee osteoarthritis (KOA) is more common in African-Americans (AAs) than Whites (WHs) in the United States. The prevalence and severity of osteophytes, bone sclerosis and joint space narrowing (JSN) are also greater among AAs than among WHs. Radiographic KOA features between the two races may also vary according to sex. Objectives To determine if the pattern of radiographic progression in KOA varies by race and sex Methods Knees of AAs and WHs with minimal or no radiographic KOA (Kellgren-Lawrence [K-L] grades 0 or 1) at baseline in the Osteoarthritis Initiative (OAI) were selected for analysis. Serial fixed-flexion knee x-rays through the 96 month visit were scored for K-L grade and tibiofemoral JSN based on Osteoarthritis Research Society International grade. A subset, enriched for those that developed radiographic KOA, were assessed for joint space width (JSW) using digital imaging software. Mixed models for repeated measures were used to estimate race- and sex-specific mean JSW and 95% confidence interval at fixed locations in the medial (x=0.250mm) and lateral (x=0.725mm) compartments, as well as average annual loss in fixed JSW (fJSW). Generalized estimating equation logistic regression models were used to estimate the effect of race and sex on: summary radiographic grade progression (defined by any increase in K-L grade ≥1), and JSN progression (defined by any increase in OARSI grade ≥1) in the medial and lateral compartments. Models were adjusted for time to progression, baseline age, body mass index (BMI), family history of joint replacement, bony enlargements in the distal interphalangeal joints, frequent knee-bending, and history of knee injury or surgery. Results 3,776 knees were studied from 695 WH men, 932 WH women, 93 AA men, and 168 AA women, with mean age of 59 years and BMI of 28 kg/m 2 . Mean baseline medial fJSW was as follows: 6.53 in WH men, 5.43 in WH women, 6.51 in AA men, and 5.48 in AA women. Figure 1 displays the race and sex-specific mean medial fJSW during the study period, after adjustment, with 95% CIs. Annual medial fJSW loss (mm/year) over 8 years was significantly greater in AA men (-0.13) than in all other subgroups (-0.07 WH men, -0.06 WH women, -0.07 AA women, p In the adjusted models, odds of radiographic K-L grade progression were significantly higher in AA men (adjusted odds ratio [aOR] 2.18, 95%CI [1.22–3.91], p=0.009) and in WH men (aOR 1.53, 95% CI [1.18–1.98], p=0.002), in comparison to WH women. The odds did not significantly differ between AA and WH women (p=0.476). In fully adjusted models, the odds of having OARSI grade progression in medial JSN was slightly higher in AA women in comparison to WH women (aOR 1.38, 95% CI [0.91–3.46]), p=0.090), though this was not significant. Compared to WH women, WH men had greater odds of lateral JSN progression (aOR 2.25, 95% CI [1.29–3.92], p=0.004). There was no significant difference in lateral JSN progression among AA women (p=0.542) and AA men (p=0.509), in comparison to WH women. Conclusions Compared to WHs and AA women, AA men were more likely to have radiographic knee OA progression over time. Loss of JSW and progression of JSN in specific compartments may vary based on race and sex. Further research to characterize and identify causes of differential KOA progression by race and sex is warranted. Disclosure of Interest None declared
• Vina, E. R., Richardson, D., Medvedeva, E., Kent Kwoh, C., Collier, A., & Ibrahim, S. A. (2016). Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial. Clinical orthopaedics and related research, 474(8), 1755-64. doi:10.1007/s11999-016-4834-z
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  A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA.
• Kwoh, C. K., Vina, E. R., Cloonan, Y. K., Hannon, M. J., Boudreau, R. M., & Ibrahim, S. A. (2015). Determinants of patient preferences for total knee replacement: African-Americans and whites. Arthritis research & therapy, 17, 348.
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  Patient preferences contribute to marked racial disparities in the utilization of total knee replacement (TKR). The objectives of this study were to identify the determinants of knee osteoarthritis (OA) patients' preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR.
• Vina, E. R., Hausmann, L. R., Utset, T. O., Masi, C. M., Liang, K. P., & Kwoh, C. K. (2015). Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study. Lupus science & medicine, 2(1), e000110.
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  Racial disparities in the clinical outcomes of systemic lupus erythematosus (SLE) exist. Perceived racial discrimination may contribute to disparities in health.
• Vina, E. R., Ran, D., Ashbeck, E. L., Kaur, M., & Kwoh, C. K. (2017). Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters. Arthritis care & research, 69(1), 95-103.
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  To determine if severity of osteoarthritis-related knee pain is associated with a willingness to undergo total knee replacement (TKR) and whether this association is confounded or modified by components of socioeconomic status and health care coverage.
• Vina, E. R., Utset, T. O., Hannon, M. J., Masi, C. M., Roberts, N., & Kwoh, C. K. (2015). Racial differences in treatment preferences among lupus patients: a two-site study. Clinical and experimental rheumatology, 32(5), 680-8.
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  To identify the demographic, clinical and psychosocial characteristics associated with racial differences in willingness to receive cyclophosphamide (CYC) or participate in a research clinical trial (RCT) among patients with systemic lupus erythematosus (SLE).
• Vina, E. R., Utset, T. O., Roberts, N., N, R., Masi, C. M., Kwoh, C. K., Hannon, M. J., & Ck, K. (2014). Racial differences in treatment preferences among lupus patients: a two-site study.. Clinical and experimental rheumatology, 32(5), 680-8.
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  To identify the demographic, clinical and psychosocial characteristics associated with racial differences in willingness to receive cyclophosphamide (CYC) or participate in a research clinical trial (RCT) among patients with systemic lupus erythematosus (SLE)..Data from 163 African-American (AA) and 180 white (WH) SLE patients were evaluated. Structured interviews and chart reviews were conducted to determine treatment preferences in hypothetical situations and identify variables that may affect preferences. Logistic regression models were performed to evaluate the relationship between patient preferences and race, adjusted for patient characteristics..Among patients who had never received CYC (n=293), 62.9% AAs compared to 87.6% WHs were willing to receive the medication (p
• Vina, E. R. (2013).

  RACIAL DIFFERENCES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS' TREATMENT PREFERENCES: A TWO-SITE STUDY

  . Arthritis & Rheumatism.
• Vina, E. R., Cloonan, Y. K., Ibrahim, S. A., Hannon, M. J., Boudreau, R. M., & Kwoh, C. K. (2013).

  Race, Sex, and Total Knee Replacement Consideration: Role of Social Support

  . Arthritis Care Res (Hoboken). doi:10.1002/acr.21925
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  Objective To determine whether there are racial differences in social support among patients with knee osteoarthritis (OA) and whether the impact of social support on patient preferences for total knee replacement (TKR) varies by race and sex. Methods A total of 514 white and 285 African American patients with knee OA were surveyed. Logistic regression models were performed to determine if the relationship between willingness to undergo TKR and the interaction of patient race and sex was mediated by social support. Results Compared to whites with knee OA, African American patients were less likely to be married ( P < 0.001), reported less close friends/relatives ( P < 0.001), and had lower Medical Outcomes Study Social Support Scale (MOS‐SSS) scores ( P < 0.001). African American patients were also less willing to undergo TKR (62% versus 80%; P < 0.001) than whites. The odds of willingness to undergo TKR were less in white females compared to white males when adjusted for recruitment site, age, income, and the Western Ontario and McMaster Universities Osteoarthritis Index score (odds ratio [OR] 0.57, 95% confidence interval [95% CI] 0.34–0.96). This difference was no longer significant when further adjusted for marital status, number of close friends/relatives, and MOS‐SSS score, but the effect size remained unchanged (OR 0.60, 95% CI 0.35–1.02). The odds of willingness to undergo TKR remained much less in African American females (OR 0.35, 95% CI 0.19–0.64) and African American males (OR 0.28, 95% CI 0.14–0.54) compared to white males when controlled for sociodemographic, clinical, and social support measures. Conclusion African American patients reported less structural and functional social support than whites. Social support is an important determinant of preference for TKR surgery only among whites.
• Vina, E. R., Cloonan, Y. K., Ibrahim, S. A., Hannon, M. J., Boudreau, R. M., & Kwoh, C. K. (2013). Race, sex, and total knee replacement consideration: role of social support. Arthritis care & research, 65(7), 1103-11.
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  To determine whether there are racial differences in social support among patients with knee osteoarthritis (OA) and whether the impact of social support on patient preferences for total knee replacement (TKR) varies by race and sex.
• Vina, E. R., Green, S. L., Trivedi, T., Kwoh, C. K., & Utset, T. O. (2013).

  Correlates of Sleep Abnormalities in Systemic Lupus

  . J Clin Rheumatol. doi:10.1097/rhu.0b013e31827cd20d
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  Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease that is associated with poor health-related quality-of-life outcomes. Objectives The objectives of this study were to identify correlates of the domains of the Medical Outcomes Study (MOS) Sleep Scale in SLE and to determine the factors most associated with overall sleep quality. Methods Sleep in 118 SLE patients was assessed using the self-administered MOS Sleep Scale. Bivariate correlations were determined between each of 6 MOS Sleep subscale scores and each sociodemographic, clinical, or psychological predictor variable. Serial hierarchical multiple regression analyses were computed to identify the variables associated with the individual sleep domains and the overall Sleep Problems Index. Results The MOS Sleep Scale scores of patients with SLE were poorer than the US general population. Depression moderately correlated with 5 (all P < 0.01) and anxiety with 4 subscale scores (all P < 0.05). The SLE Disease Activity Index did not significantly correlate with any of the subscale scores. Results of a multivariate regression model showed that sleep adequacy and sleep disturbance were independently associated with depression (β = −0.84; 95% confidence interval [CI], −1.37 to −0.32; and β = 0.80; 95% CI, 0.15–1.45; respectively). Daytime somnolence was significantly associated with daily prednisone dosage (β = 0.54; 95% CI, 0.29–0.80) and anxiety trait (β = 0.81; 95% CI, 0.41–1.21). Snoring independently correlated with anxiety (β = 1.64; 95% CI, 0.80–2.29). When demographic, clinical, and psychological variables were simultaneously regressed on the Sleep Problems Index, pain trended toward association with overall sleep problems (β = 0.17; 95% CI, −0.02 to 0.36). Conclusions Patients with SLE have greater sleep problems relative to the general population. Psychosocial factors, particularly depression and anxiety, are important determinants that are significantly associated with sleep abnormalities in SLE.
• Vina, E. R., Green, S. L., Trivedi, T., Kwoh, C. K., & Utset, T. O. (2013). Correlates of sleep abnormalities in systemic lupus: a cross-sectional survey in an urban, academic center. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 19(1), 7-13.
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  Systemic lupus erythematosus (SLE) is a complex autoimmune disease that is associated with poor health-related quality-of-life outcomes.
• Vina, E. R., Kwoh, C. K., Ibrahim, S. A., Hannon, M. J., Cloonan, Y. K., & Boudreau, R. M. (2013). AB1319 Examination of determinants of patient preferences for total knee replacement (TKR) among men and women. Annals of the Rheumatic Diseases, 71(Suppl 3), 713-713. doi:10.1136/annrheumdis-2012-eular.1315
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  Background Elective TKR is an effective treatment option for end-stage knee osteoarthritis (OA) that is rapidly growing. Although women have as much or greater prevalence of knee OA than men, men undergo TKR more often than women. Patient preference is emerging as an important consideration in TKR gender disparities. However, few studies have examined the determinants of patients’ preference in a racially diverse sample of men and women. Objectives We sought to identify whether determinants of patients’ preference for TKR differ by gender. Methods Our sample consisted of 509 women (59% white) and 290 men (73% white) with chronic, frequent knee pain and radiographic evidence of knee OA. We used logistic regression models, stratified by gender, to identify clinical and socio-cultural determinants of patients’ preference for TKR. Clinical and socio-cultural factors were entered simultaneously into the stratified models. Stepwise selection methods were used to select socio-cultural items to be included in the final models, using a criterion of p
• McBurney, C. A., & Vina, E. R. (2012).

  Racial and Ethnic Disparities in Rheumatoid Arthritis

  . Curr Rheumatol Rev. doi:10.1007/s11926-012-0276-0
• McBurney, C. A., & Vina, E. R. (2012). Racial and ethnic disparities in rheumatoid arthritis. Current rheumatology reports, 14(5), 463-71.
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  Racial and ethnic health disparities are a national health issue. They are well described in other chronic diseases, but in rheumatoid arthritis (RA), research into their causes, outcomes, and elimination is in its early stages. Health disparities occur in a complex milieu, with system-level, provider-level, and individual-level factors playing roles. Dissecting the overlapping aspects of race/ethnicity, socioeconomic variables, and how their individual components combine to explain the magnitude of disparities in RA can be challenging. Recent research has focused on the extent to which treatment preferences, adherence, trust in physicians, patient-physician communication, health literacy, and depression have contributed to observed disparities in RA. Practicing evidence-based medicine, improving patient-physician communication skills, reducing language and literacy barriers, improving adherence to therapies, raising awareness of racial/ethnic disparities, and recognizing comorbidities such as depression are steps clinicians may take to help eliminate racial/ethnic disparities in RA.
• Vina, E. R. (2012).

  RACE AND TOTAL JOINT REPLACEMENT (TJR) CONSIDERATION: THE ROLE OF SOCIAL SUPPORT

  . Arthritis & Rheumatism.
• Vina, E. R., Masi, C. M., Green, S. L., & Utset, T. O. (2012). A study of racial/ethnic differences in treatment preferences among lupus patients. Rheumatology (Oxford, England), 51(9), 1697-706.
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  To determine whether there are racial/ethnic differences in the willingness of SLE patients to receive CYC or participate in clinical trials, and whether demographic, psychosocial and clinical characteristics contribute to these differences.
• Vina, E. R., Rhew, D. C., Weingarten, S. R., Weingarten, J. B., & Chang, J. T. (2009). Relationship between organizational factors and performance among pay-for-performance hospitals. Journal of general internal medicine, 24(7), 833-40.
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  The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.
• Vina, E. R., Rhew, D. C., Weingarten, S., Weingarten, J. B., & Chang, J. T. (2009).

  Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

  . J Gen Intern Med.. doi:10.1007/s11606-009-0997-6
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  The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture.More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05).Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.
• Vina, E. R., Dang, S., Trinh, N., & Arkfeld, D. G. (2005). Rheumatology quiz, systemic lupus erythematosus and coining. Resident and Staff Physician, 51(5), 16, 20.
• Vina, E. R., Fang, A. J., Wallace, D. J., & Weisman, M. H. (2005).

  Chronic Inflammatory Demyelinating Polyneuropathy in Patients with Systemic Lupus Erythematosus: Prognosis and Outcome

  . Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2005.08.008
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  To identify clinical characteristics, laboratory features, approaches to management, and predictors of outcome of chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with systemic lupus erythematosus (SLE). An analysis of 6 adults with the concurrent diagnosis of CIDP and SLE seen at a SLE Clinic from 1994 to 2004 with a review of 13 patients with SLE and CIDP reported in the medical literature from 1950 through 2004. Among our 6 patients with SLE and CIDP, 3 (50%) achieved a substantial clinical response to intravenous immunoglobulin (IVIg) and the remainder had a minimal response. The improved patients were more likely to have received treatment earlier (within 1 year of CIDP onset) and to respond faster (
• Vina, E. R., Fang, A. J., Wallace, D. J., & Weisman, M. H. (2005). Chronic inflammatory demyelinating polyneuropathy in patients with systemic lupus erythematosus: prognosis and outcome. Seminars in arthritis and rheumatism, 35(3), 175-84.
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  To identify clinical characteristics, laboratory features, approaches to management, and predictors of outcome of chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with systemic lupus erythematosus (SLE).
• Yamamoto, T., Kakar, N. R., Vina, E. R., Johnson, P. E., & Bing, R. J. (2001). Effect of cyclooxygenase-2 inhibitor (celecoxib) on the infarcted heart in situ. Pharmacology, 63(1), 28-33.
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  Several attempts have been made to replace aspirin with compounds without gastric toxicity; a cyclooxygenase-2 (COX-2) inhibitor, celecoxib, and a nitric oxide-aspirin, NCX-4016, have been developed for this purpose. This paper compares effects of celecoxib, NCX-4016 and aspirin on production of prostacyclin (PGI2) and thromboxane A2 (TXA2) and activation of the inducible form of nitric oxide synthase (iNOS) in infarcted heart in situ. Aspirin was most effective in reducing myocardial PGI2 synthesis and formation of TXA2. Myocardial effects of celecoxib resemble those of NCX-4016, although the two compounds have different modes of action.
• Yamamoto, T., Kakar, N., Vina, E. R., Johnson, P. E., & Bing, R. J. (2001).

  Effect of Cyclooxygenase-2 Inhibitor (Celecoxib) on the Infarcted Heart in situ

  . Pharmacology. doi:10.1159/000056109
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  Several attempts have been made to replace aspirin with compounds without gastric toxicity; a cyclooxygenase-2 (COX-2) inhibitor, celecoxib, and a nitric oxide-aspirin, NCX-4016, have been developed for this purpose. This paper compares effects of celecoxib, NCX-4016 and aspirin on production of prostacyclin (PGI2) and thromboxane A2 (TXA2) and activation of the inducible form of nitric oxide synthase (iNOS) in infarcted heart in situ. Aspirin was most effective in reducing myocardial PGI2 synthesis and formation of TXA2. Myocardial effects of celecoxib resemble those of NCX-4016, although the two compounds have different modes of action.
• Yamamoto, T., Kakar, N. R., Vina, E. R., Johnson, P. E., & Bing, R. J. (2000). The effect of aspirin and two nitric oxide donors on the infarcted heart in situ. Life sciences, 67(7), 839-46.
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  Nitric oxide (NO) donors are heterogeneous substances which release NO, a biologically active compound. NO released by nitric oxide donors has important effects on the circulation by causing vasodilation, diminishing myocardial contractile force, inhibiting platelet aggregation, and counteracting the effects of thromboxane A2. In the infarcted heart, activation of the inducible form of nitric oxide synthase (iNOS) and the formation of prostacyclin and thromboxane A2 by cyclooxygenase (COX) were increased. Myocardial infarction also resulted in increased myocardial NO production. Aspirin (acetylsalicylic acid. ASA) at low concentration (35 mg/kg/day) fails to change iNOS production, in contrast to higher dose (150 mg/kg/day) which, as previously shown, inhibits iNOS activity. ASA at all doses also suppresses myocardial prostanoid formation because of inhibition of COX. Recently, two NO donors have been synthesized: NCX 4016 and Diethylenetriamine/NO (DETA/NO). NCX 4016 combines an NO-releasing moiety with a carboxylic residue via an esteric bond. We describe here that NCX 4016 (65 mg/kg/day) increased prostacyclin and thromboxane A2 production in the infarcted heart muscle, overcoming the inhibitory effects of ASA. As a result of nitric oxide release, oxidation products of NO (NO2- and NO3-; NOx) in arterial blood rose following administration of NCX 4016. On oral administration, NCX 4016 did not change systemic arterial pressure. The effects of a single NO donor, DETA/NO (1.0 mg/kg/day) on the infarcted heart were also investigated On intravenous administration, the compound increased NO concentration in arterial blood slightly but to a lesser degree than NCX 4016. Like NCX 4016, it raised myocardial production of prostacyclin and thromboxane A2 in the infarcted heart. However, it caused a severe fall in blood pressure. These findings demonstrate that newly-synthesized NO donors release nitric oxide in situ and increase myocardial production of prostanoids. NCX 4016 has therapeutic potential because it can be orally administered, lacks hypotensive effects, increases blood levels of nitric oxide and myocardial prostacyclin production.

Presentations

• Kaur, M., Zhou, L., Ashbeck, E., Vina, E. R., Roemer, F., Guermazi, A., Hunter, D. J., & Kwoh, C. K. (2018, October). Evaluating MRI-Detected Knee Inflammation Prior to Total Knee Replacement As a Predictive Biomarker of Clinically Important Pain Reduction Two Years Later. American College of Rheumatology Annual Meeting. Chicago, IL.
• Vina, E. R., Hausmann, L., Obrsosky, D. S., Youk, A., Weiner, D., Ibrahim, S. A., & Kwoh, C. K. (2018, June). Examining Modifiable Psychological & Social Health Factors Associated with Use of Osteoarthritis Oral Analgesic Treatment.. European League Against Rheumatism Annual Meeting. Amsterdam, Netherlands.
• Vina, E. R. (2017, October). Gender and Race Disparities in Osteoarthritis. Department of Medicine Research Seminar Series. Tucson, AZ.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2017, November). Widespread Pain Prior to Total Knee Replacement (TKR) Is Associated with Increased Risk of No Clinical Improvement in Pain Among Women. American College of Rheumatology Annual Meeting. San Diego, CA.
• Vina, E. R., Hannon, M., & Kwoh, C. K. (2014, November). Improvement following total knee replacement (TKR) surgery: exploring preoperative symptoms and change in preoperative symptoms. American College of Rheumatology Annual Meeting. Boston, MA.
• Vina, E. R., Rhew, D., Weingarten, S., Weingarten, J., & Chang, J. (2008, June). The relationship between organizational factors and high performance among hospitals participating in the CMS, Premier Hospital Quality Incentive Demonstration Project. 25th Annual Academy Health Research Meeting. Washington, DC.

Poster Presentations

• Vina, E. R., Dagnino, J., & Kwoh, C. K. (2019, November). Attitudes and Beliefs About Opioid Medications: Determining Treatment Use in Osteoarthritis. American College of Rheumatology Annual Meeting. Atlanta, GA.
• Vina, E. R., Hannon, M. J., Dagnino, J., & Kwoh, C. K. (2019, June). Understanding ethnic differences in the utilization of nonsteroidal anti-inflammatory drugs for osteoarthritis. European League Against Rheumatism Annual Meeting. Madrid, Spain.
• Masood, H., Hannon, M. J., Kwoh, C. K., Dagnino, J., & Vina, E. R. (2018, October). Examining Ethnic Differences in Osteoarthritis (OA) Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs. American College of Rheumatology Annual Meeting. Chicago, IL.
• Masood, H., Hannon, M., Dagnino, J., Kwoh, C. K., & Vina, E. R. (2019, January). Examining Ethnic Differences in Osteoarthritis (OA) Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). University of Arizona Principal Investigator Poster Session. Tucson, AZ.
• Tighe, C., Ibrahim, S. A., Youk, A., Vina, E. R., Parks, A., Weiner, D., Kwoh, C. K., & Hausmann, L. (2018, June). Examining pain catastrophizing and self-efficacy as cross-sectional mediators of sleep disturbance and pain in a sample of Veterans with arthritis. Annual Meeting of the Associated Professional Sleep Societies, LLC. Baltimore, MD.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2018, January). Widespread Pain Prior to Total Knee Replacement (TKR) Is Associated with Increased Risk of No Clinical Improvement in Pain Among Women. University of Arizona Principal Investigator Poster Session. Tucson, AZ.
• Vina, E. R., Ran, D., Hannon, M. J., & Kwoh, C. K. (2018, June). Understanding ethnic differences in the utilization of exercise for osteoarthritis. American College of Rheumatology Research Workshop. San Francisco, CA.
• Vina, E. R., Ran, D., Hannon, M. J., & Kwoh, C. K. (2018, June). Understanding ethnic differences in the utilization of exercise for osteoarthritis. European League Against Rheumatism Annual Meeting. Amsterdam, Netherlands.
• Vina, E. R. (2017, November). Widespread Pain Prior to Total Knee Replacement (TKR) Is Associated with Increased Risk of No Clinical Improvement in Pain Among Women. University of Arizona College of Medicine Junior Investigator Poster Forum. Tucson, AZ.
• Vina, E. R., Kallan, M. J., Collier, A., Nelson, C. L., & Ibrahim, S. A. (2017, June). Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set. European League Against Rheumatism Annual Meeting. Madrid, Spain.
• Vina, E. R., Ashbeck, E. L., Ran, D., & Kwoh, C. K. (2016, June). Race and sex differences in radiographic progression of knee osteoarthritis. European League Against Rheumatism Annual Meeting. London, England.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2016, November). Racial Differences in Self-Reported Pain and Disability: A Longitudinal Study of Knee Osteoarthritis. American College of Rheumatology Annual Meeting. Washington, DC.
• Vina, E. R., Ran, D., Ashbeck, E., Kaur, M., & Kwoh, C. K. (2016, November). Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters. American College of Rheumatology Annual Meeting. Washington, DC.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2017, January). Racial Differences in Self-Reported Pain and Disability: A Longitudinal Study of Knee Osteoarthritis. Department of Medicine Principal Investigator Poster Session. Tucson, Arizona.
• Vina, E. R., Ran, D., Ashbeck, E., Ibrahim, S., Hannon, M., Zhou, J., & Kwoh, C. K. (2015, November). Patient preferences for total knee replacement surgery: two year follow-up.. American College of Rheumatology Annual Meeting. San Francisco, CA.
• Vina, E. R., Utset, T., Hannon, M., Masi, C., & Kwoh, C. K. (2013, October). Racial differences in lupus patients’ treatment preferences: a two-site study. American College of Rheumatology Annual Meeting. San Diego, CA.
• Vina, E. R., Cloonan, Y., Ibrahim, S., Hannon, M., Boudreau, R., & Kwoh, C. K. (2012, November). Race, gender and total knee replacement consideration: the role of social support. American College of Rheumatology Annual Meeting. Washington, DC.
• Vina, E. R., Cloonan, Y., Ibrahim, S., Hannon, M., Boudreau, R., & Kwoh, C. K. (2012, October). Race and total joint replacement consideration: the role of social support. Society for Medical Decision-Making Annual Meeting. Phoenix, AZ.
• Vina, E. R., Masi, C., Green, S., & Utset, T. (2012, July). Racial differences in treatment preferences among lupus patients in an urban academic center. Health Services Research & Development Service/Quality Enhancement Research Initiative Meeting. National Harbor, MD.
• Vina, E. R., Masi, C., Green, S., & Utset, T. (2011, November). Racial disparities in treatment preferences among lupus patients in an urban academic center. American College of Rheumatology Annual Meeting. Chicago, IL.
• Vina, E. R., Green, S., & Utset, T. (2010, June). The medical outcomes study (MOS) sleep scale in lupus patients. 9th International Congress on Systemic Lupus Erythematosus. Vancouver, Canada.
• Vina, E. R., Masi, C., Green, S., & Utset, T. (2010, November). Racial disparities in treatment preferences among lupus patients. American College of Rheumatology Annual Meeting. Atlanta, GA.