Dr. Tuhina Neogi is new Chief of Rheumatology
We are delighted to announce that Tuhina Neogi, M.D., Ph.D., Professor, Department of Medicine has accepted our offer to become Chief of the Rheumatology Section effective January 1, 2019. Dr. Neogi received her M.D. from the University of Toronto and Ph.D. from the Boston University School of Public Health. She leads an internationally known research team focused on knee osteoarthritis and gout, pain mechanisms in osteoarthritis, and methodologic issues in rheumatic diseases. She has served on a number of national and international committees and organizations, including guideline writing and FDA committees. Her work has been continuously supported by both NIH and national foundations. She is a past recipient of the prestigious Henry Kunkel Young Investigator Award from the American College of Rheumatology and the Robert Dawson Evans Research Mentoring Award from the Department of Medicine. She is also leading the CTSI’s Research Career Support Program. Dr. Neogi is an exceptional investigator, clinician, mentor, and role model. We are thrilled that she has so enthusiastically embraced this critically important leadership opportunity for our department and look forward to working with her.
As part of our strategy to enhance further the clinical and academic programs in Rheumatology, the Sections of Rheumatology and Clinical Epidemiology will be administratively and programmatically re-unified starting January 1, 2019. I would like to express my gratitude to Drs. Robert Simms (Chief, Rheumatology Section) and David Felson (Chief, Clinical Epidemiology Section) for their thoughtful and generous support of the consolidation of the two sections. Their selfless approach to building rheumatology through the consolidation under Dr. Neogi’s leadership has been both remarkable and admirable. Dr. Simms will be appointed an Evans Scholar and will be further building the Scleroderma Program. Dr. Felson will be assuming a more prominent leadership position within the Clinical and Translational Science Institute and continue to expand his very prominent research program. We are very grateful to Drs. Simms and Felson for their many years of service to the department and look forward to working with them in their new roles.
Posted on Monday, January 7th, 2019
Department of Medicine
Boston University Medical Center
715 Albany Street, Evans 113
Boston, MA 02118
A recent article
Carlesso LC, Segal NA, Frey-Law L, Zhang Y, Lu N, Nevitt M, Lewis CE, Neogi T. Pain susceptibility phenotypes in those free of knee pain with or at risk of knee osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Rheumatol. 2018 Oct 11. doi: 10.1002/art.40752. [Epub ahead of print] PMID:30307131.
was featured in the online publication
Click here to view
A recent paper, published in October in JAMA Internal Medicine, detailed research in a large observational study exploring the risk of CKD among patients prescribed allopurinol for gout. The research was cited in Internal Medicine News and in the Highlights section of JAMA Network.
Vargas-Santos AB, Peloquin CE, Zhang Y, Neogi T. Association of chronic kidney disease with allopurinol use in gout treatment [published online October 8, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.4463Google Scholar
A paper on persistent pain and OA published in Arthritis & Rheumatology in October was referenced in ScienceDaily and EurekAlert
Carlesso LC, Segal NA, Frey-Law L, Zhang Y, Lu N, Nevitt M, Lewis CE, Neogi T. Pain susceptibility phenotypes in those free of knee pain with or at risk of knee osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Rheumatol. 2018. Epub 2018/10/12. doi: 10.1002/art.40752. PubMed PMID: 30307131.
About The Curbsiders
The Curbsiders is an Internal Medicine Podcast featuring three board-certified Internists as they interview (“curbside”) the experts to provide listeners with clinical pearls and practice-changing knowledge. Join Dr. Matthew Watto, Dr. Stuart Brigham, and Dr. Paul Williams as they serve up some triple-distilled knowledge (and maybe a little humor) for your continuing medical education. No boring lectures here, just the stuff you wish they’d taught in medical school and residency. For more information, visit www.thecurbsiders.com.
The Curbsiders are board-certified Internists practicing in San Antonio, TX. The opinions expressed on this show are those of The Curbsiders and do not necessarily represent the views and opinions of their places of employment. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician.
Diclofenac May Boost MI Risk in Patients with Spondyloarthritis
May 7, 2018 • By Marilynn Larkin
Print-Friendly Version / Save PDF
NEW YORK (Reuters Health)—Risk of myocardial infarction (MI) is increased in patients with spondyloarthritis (SpA) who use the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, but not in those who take naproxen, researchers say.
You Might Also Like
Maureen Dubreuil, MD, MSc, of Boston University School of Medicine, and colleagues analyzed 20 years of medical records from the U.K.’s Health Improvement Network for adults ages 18–89 with incident ankylosing spondylitis (AS) or psoriatic arthritis (PsA), two forms of SpA. Controls had incident osteoarthritis (OA).
Within each cohort, the team then matched each MI case to four controls without MI.
NSAID use was categorized as a) current (prescription within 180 days prior to index date); b) recent (181-365 days); or c) remote (>365 days).
The daily dosage of diclofenac was 100 mg or more in 92% of individuals with OA, 95% of those with AS and 92% of those with PsA. The most common daily dosage of naproxen was 1,000 mg (55%); the dose was 1,000 mg or more in 56% of patients with OA, 63% of those with AS and 72% of those with PsA.
Among those whose most recent prescription was an NSAID other than diclofenac or naproxen, the most common drugs were ibuprofen (55%), celecoxib (11%), meloxicam (10%), rofecoxib (7%), etoricoxib (5%), indomethacin (3%) and etodolac (3%). All other NSAIDs accounted for 2% or less of prescriptions.
Within the SpA cohort of 8,140 and the OA cohort of 244,339, there were 115 and 6,287 cases of MI, respectively.
As reported online April 19 in Annals of Rheumatic Diseases, current diclofenac use was associated with an adjusted OR of 3.32 for MI in SpA patients. The risk was also increased in those with OA (aOR, 1.26).1
A similar pattern was seen with current use of other NSAIDs (aOR, 1.17), but not with current naproxen use (aOR 0.98).
Because current diclofenac was associated with increased MI risk, the authors also assessed whether recent use (18–365 days from prescription date) conferred risk. The unadjusted OR for recent use in SpA was 1.45, and in OA, 0.94. By contrast, recent naproxen was not associated with an increased or decreased risk in either SpA or OA.
Overall, the authors state, “Current use of diclofenac in SpA was associated with a twofold to threefold risk of MI relative to remote use of any NSAID.”
“[Although] this finding warrants some concern,” Dr. Dubreuil tells Reuters Health, “similar studies should be conducted in other data sets and other populations to help determine if a change in clinical practice is warranted.”
“If confirmed,” she says by email, “it is possible that subsequent treatment guidelines would recommend for or against a specific NSAID as first-line treatment in spondyloarthritis.”
Daniel Solomon, MD, MPH, chief, Section of Clinical Sciences, Divisions of Rheumatology and Pharmacoepidemiology at Brigham and Women’s Hospital in Boston comments to Reuters Health by email, “We know that all NSAIDs confer cardiovascular [CV] risk. However, most patients with normal CV risk who use these agents intermittently will not experience harm. Chronic use of NSAIDs in patients with certain risk factors is associated with substantial potential for CV and other adverse events.”
“The best data we have on these issues comes from large randomized controlled trials, such as PRECISION which tested different NSAIDs across patients with osteoarthritis (OA) or rheumatoid arthritis (RA),” says Dr. Solomon, who was a coauthor on PRECISION.2
“No important differences were found in relative risks across different NSAIDs by disease,” he notes. “In other words, patients with OA and RA experienced the same relative risks by NSAID. However, the CV risk was higher in RA so absolute risks were higher for the RA patients.”
The authors of the current study “specifically examined patients with spondyloarthritis and with OA and found that use of current diclofenac conferred an increased relative risk for CV events compared to past use among both patient groups, but the relative risk was increased for SpA compared with OA,” he says.
“This is interesting and there are biologic reasons why this is plausible,” he says, “but by no means are these results practice-changing. NSAID observational studies are very tricky because of confounding by indication as well as over the counter NSAID use. These results should generate new hypotheses that might be tested in prospective cohorts.”
Patients should not be told to steer clear of diclofenac, he adds. “All NSAIDs, including celecoxib, confer CV, gastrointestinal and renal risk. Patients should not use these agents chronically if they have known CV or renal disease.”
- Dubreuil M, Louie-Gao Q, Peloquin CE, et al. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis. 2018 Apr 19. pii: annrheumdis-2018-213089. [Epub ahead of print]
- Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascular safety of celecoxib, naproxen or ibuprofen for arthritis. N Engl J Med. 2016 Dec 29;375(26):2519-29. Epub 2016 Nov 13.
Tuhina Neogi has been appointed as Program Chair for the 2019 Osteoarthritis Research Society International (OARSI) Congress, to take place in Toronto, Ontario, Canada May 2 – 5, 2019
Tuhina Neogi has been named as a co-PI for the American College of Rheumatology (ACR) Gout Treatment Guidelines Update.
Please join us in congratulating Tuhina on her participation in this important contribution to the treatment of gout!
for being selected as a recipient of the 2018 SAA/Bruckel Early Career Investigator in #AxSpA Award #spotspondy
June 18, 2018
(Boston)–Maureen Dubreuil, MD, MSc, assistant professor of Clinical Epidemiology Research & Training at Boston University School of Medicine (BUSM), is one of two recipients of the 2018 Spondylitis Association of America (SAA) Bruckel Early Career Investigator in Axial Spondyloarthritis Award.
Spondyloarthritis is a type of arthritis that attacks the spine and, in some people, the joints of the arms and legs. Dubreuil’s research focuses on comorbidities and pharmacoepidemiology of spondyloarthritis. She is currently studying patient preferences and the cost-effectiveness of treatment modalities for this disease. The $20,000 award will help this ongoing research.
The award was created to recognize outstanding “contributions to the care and understanding of patients with spondyloarthritis.” It was named in honor of the SAA’s co-founder Jane Bruckel and is given annually to the early career investigator who shows the most promise to contribute to the understanding or therapy of axial spondyloarthritis.
One theme of Dubreuil’s work is heart disease in spondyloarthritis. She led a study that examined the risk of heart attacks with non-steroidal anti-inflammatory drugs (NSAIDs) in spondyloarthritis patients, using a large database from the United Kingdom. The study found that specific NSAIDs may increase risk of heart attacks to a greater degree in people with spondyloarthritis than those with osteoarthritis. She is studying this same topic in other populations, including a large database in the United States. Dubreuil also collaborated on a study of the effects of statin (cholesterol medication) use in ankylosing spondylitis, finding that statins appear to have a more protective effect in people with ankylosing spondylitis than in the general population.
“A second theme of my work is understanding patients’ preferences for treatments in spondyloarthritis,” she explained. In 2016 she began work on a National Institutes of Health-funded project to assess factors that influence spondyloarthritis patients’ preferences for medications. “In the coming year, I will begin work on a cost-effectiveness study, comparing different approaches to spondyloarthritis treatment, such as starting with an NSAID versus starting with a biologic medication.”
Dubreuil is a member of the Spondyloarthritis Research and Treatment Network (SPARTAN), and of the Assessment of Spondyloarthritis International Society (ASAS), and serves on the Early Career Investigator Subcommittee of the American College of Rheumatology. In 2013, she was awarded the Arthritis Foundation Clinical to Research Transition Award and 2016, she began work on a K23-funded project to study patient preferences, and the cost-effectiveness of treatment modalities for spondyloarthritis, to inform both clinical care and policy decisions.
March 28, 2018
Wednesday, December 20, 2017
The symposium was organized by Dr. Tuhina Neogi and sponsored by Pfizer and Lilly. This was a very informative event featuring international experts in OA.
Wednesday, December 13, 2017
The CTSI was delighted to host the Natural Language Processing Symposium. A distinguished panel of speakers gathered for a symposium on Natural Language Processing and Machine Learning at BU to learn how we may incorporate these methods into future studies in EMR database.
This symposium was sponsored by:
Wing Tat Lee Endowment- Supports collaborations between BUSM faculty and faculty at a mainland Chinese university (with preference for Hong Kong). The cooperative programs may include training faculty from either institution; holding seminars, workshops and symposia; and carrying out research projects of common interest.
ACR Public Release: 3-Nov-2017
American College of Rheumatology announces 2017 award recipients
Leading rheumatology researchers and thought leaders honored for accomplishments and service
American College of Rheumatology
ATLANTA – The American College of Rheumatology (ACR) announced the 2017 recipients of its Master of the ACR designation, Awards of Distinction, and Distinguished Fellow Award honors during the opening lecture of the 2017 ACR/ARHP Annual Meeting in San Diego. These recognitions are given annually to members who exhibit outstanding contributions to the field of rheumatology.
Master of the ACR Designation
Recognition as a Master is one of the highest honors that the College bestows on its distinguished members. The designation of Master is conferred on ACR members, age 65 or older, who have made outstanding contributions to the field of rheumatology through scholarly achievement and/or service to their patients, students, and the rheumatology profession. These honorees have devoted their long careers to furthering rheumatology research and improving clinical standards in the treatment of rheumatic diseases.
Among the 2017 recipients of the Masters of the ACR designation is:
- David Felson, MD, MPH, Boston University School of Medicine, Clinical Research Training Unit, Boston, MA
About the ACR/ARHP Annual Meeting
The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR17 hashtag.
About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit http://www.rheumatology.org.
Dec 6, 2014
Interview originally appeared on December 5, 2014 | ACR 2014, Arthritis, Osteoarthritis, Rheumatologic Pain
Watch the video here
By Tuhina Neogi MD
For some patients with knee osteoarthritis, pain signals are centralized and become more intense, rather than waning with time. Is this caused by continuing injury to the damaged knee, or is inflammation more prominent?
In this video, researcher Tuhina Neogi of Boston University School of Medicine describes research presented at the 2014 annual meeting of the American College of Rheumatology that addressed this question by assessing specific signs of inflammation (synovitis and effusion on MRI) and noninflammatory tissue injury (bone marrow lesions) with relation to the development of central sensitization of pain.
An Associate Professor at Boston University School of Medicine, Dr. Neogi studies the epidemiology of rheumatic disease.
You’ve been looking at the causes of sensitization of knee osteoarthritis pain. How do you define sensitization?
Can you tell us about the study that you presented at the ACR?
We’ve heard a lot lately about the fact that rheumatologists are able to address inflammation but they’re not so able to address pain. Do you think your findings have any practical implications with regard to what rheumatologists are or are not able to do?
If your listeners want to look for the next paper that carries this research forward, what might its title be? What should they be looking for?
We and others have demonstrated that sensitization is associated with increased pain severity … and change in pain over time. But what we didn’t know is what causes sensitization in knee OA.
Inflammation likely contributes to sensitization in knee osteoarthritis, whereas bone marrow lesions do not appear to do so. Therefore, bone marrow lesions likely contribute to pain through other mechanisms.
We need to do some more studies to see if intervening early on these parameters of inflammation has an effect.
I think overall the take-home message for clinicians is that pain is a multifactorial symptom and we need to move more towards mechanism-based pain management that’s not a one-size-fits-all for everyone. … We cannot just say “This is the first step. This is the second step.” It has to become more personalized.
Neogi T, Nevitt MC, Scholz J, et al. Effect of Synovitis, Effusion and Bone Marrow Lesions on Development of Sensitization in Knee OA: The Multicenter Osteoarthritis Study ACR Abstract #2783, 2014 66:S1306. Abstract Supplement, 2014 ACR/ARHP Annual Meeting
Arthritis Foundation News Blog – April 13, 2017
If you have osteoporosis you’ve probably heard of, and may have been treated with, a class of drugs that are used to prevent and treat bone loss: bisphosphonates. Dr. Tuhina Neogi and her research team are using new methods to look at how the long-term effects of using these drugs may be related to the progression of knee osteoarthritis (OA).
Dr. Neogi’s 2-year Arthritis Foundation-funded project, “Bisphosphonate Effects in Knee Osteoarthritis,” is looking at the relationship of bisphosphonate treatment and the structural changes in the knee associated with OA progression. To do this, Dr. Neogi and her team are looking at how knee joint space width, three-dimensional (3D) bone shape, and bone marrow lesions change in OA patients over time.
Dr. Neogi is interested in this research for several reasons. First, the long-term effects of bisphosphonates on knee OA is controversial due to conflicting study results and concerns about changing bone properties over time. “Bisphosphonates are used to maintain and improve bone density by improving or rebuilding (remodeling) bone in patients with osteoporosis. It helps to reduce the risk of fractures. However, remodeling bone in patients with OA may not be the same as remodeling bone in patients with osteoporosis. Changing the bones by making them stiffer may not be good for OA. On the other hand, bisphosphonates may have beneficial effects on chondrocytes (cells in the cartilage). Thus, the benefits versus the risks are not clear.”
Dr. Neogi is also interested in looking at the data in new ways to reduce the confusion found in earlier studies with conflicting or inconclusive results. Earlier studies used only x-rays to evaluate structural changes in OA. She and her team are also using magnetic resonance imaging (MRI), focusing on bone marrow lesions that can cause pain in OA, and 3-D bone shape, which can provide a more global assessment of what is going on in the joint. “Structural changes associated with OA are traditionally assessed as joint-space width on x-rays, which lack sensitivity to change. It takes a long time for joint width changes to be detected by x-rays. MRI can provide insights into how OA is changing over much shorter periods of time, and is therefore likely a better way to assess a drug’s effects on OA.”
The team is also using data from a large United Kingdom (UK) medical database to determine if taking bisphosphates can slow the progression of knee OA and make a difference in if, or when, a knee replacement may be needed. “About 97% of knee replacements are performed because of OA and is therefore a good indicator of people who have progressed to “end-stage” knee OA,” Dr. Neogi explained. Dr. Neogi and her team began this project by analyzing the data from a UK database that included information from about 13 million patients. She explained it was important to use the UK data because patients there have universal healthcare, so no one would be excluded because they could not afford or have access to medical treatment. The team chose two sets of patient groups to compare. One group included newly diagnosed OA patients who were new users of bisphosphonates. The second group included newly diagnosed OA patients who were similar to the first set (like age, sex, weight, etc.), except they were not users of bisphosphonates. After comparing the long-term data, the team found that significantly fewer patients in the bisphosphonate treatment group went on to have knee replacement surgery than the non-users.
The team is now analyzing the data from the MRI studies using data from a nationwide research study sponsored by the National Institutes of Health that is looking at knee osteoarthritis. While the analyses are not finished, they are seeing results that are similar to the UK database results. Subjects who were taking bisphosphonate treatment had less severe structural progression.
The different approaches to looking at OA outcomes are showing results pointing in the same direction. While bisphosphonate treatment may not work for everyone and additional work needs to be done on these projects, Dr. Neogi feels that her team’s research results may support some promising long-term effects of bisphosphonates and this drug class could potentially be a therapeutic option for millions of Americans with knee OA.
Dr. Neogi is a Professor of Medicine at Boston University School of Medicine and a Professor of Epidemiology at the Boston University School of Public Health.
May 12, 2017
The 2017 Carol Nachman Prize for Rheumatology was awarded to David T. Felson, MD, MPH, Professor of Medicine and Epidemiology at BUSM and BUSPH.
David T. Felson (SPH’84), Professor of Epidemiology at the School of Public Health and of Medicine at the School of Medicine, has been awarded the 2017 Carol Nachman Prize for Rheumatology.
The prize is the most prestigious international award for research in rheumatology. Felson received the award on May 12 in Wiesbaden, Germany.
Dr. Felson’s research interests include understanding how to prevent and treat osteoarthritis (OA)—also known as degenerative joint disease, or “wear and tear” arthritis. He is studying whether treatments for rheumatic diseases are effective and, particularly in osteoarthritis, identifying risk factors for disease, testing treatments, and characterizing MRI features of normal knees and knees with pain. He also studies outcome measurement (tests that objectively determine a patients’ baseline function at the beginning of treatment) in rheumatic disease, and has focused in this work on rheumatoid arthritis trials.
Felson led a series of major studies to identify prevalence, impact, and risk factors for knee OA. In the Framingham Osteoarthritis Study, his group first documented that obesity increased the risk of OA and that weight loss could lessen that risk. The first to introduce magnetic resonance imaging in large-scale studies, his group discovered that meniscal tears and other structural pathology were present in most middle-aged and older persons regardless of knee pain. He inaugurated the study of structural correlates of joint pain, identifying for the first time that in OA, synovitis and bone marrow lesions cause pain; these structural findings have now emerged as targets of treatment. Recent work from his group suggests that chronic alterations in the nervous system that enhance pain sensitivity affect most patients with OA pain.
Working with the FDA and rheumatology organizations, he also led the effort to standardize clinical trial outcome measurement in rheumatoid arthritis, creating the first core set of outcomes and coming up with the American College of Rheumatology definition of improvement (ACR20). This outcome standardization made it possible for the first time to gauge the relative efficacy of new drugs such as TNF inhibitors.
The recipient of numerous awards, Felson was the first non-basic scientist recipient of the Kunkel Young Investigator Award from the American College of Rheumatology, and from this same organization, he received its inaugural Clinical Research Award.
Felson graduated from Harvard College and received his MD from Johns Hopkins University. After a residency in internal medicine at Case Western Reserve, he trained in rheumatology at Boston University and received his MPH in epidemiology from SPH. He joined the BU faculty in 1984, became a professor in 1994, and was appointed chair of clinical epidemiology in 2001. He is Director of Training and Education for the BU Clinical Translational Science Institute and Director of Clinical Epidemiology at Boston Medical Center.
4/27/ – 4/30/2017
Members of the unit participated with invited lectures, oral presentations, and posters.
David Felson – Invited Lecture: Metabolic OA: Does it exist?
Tuhina Neogi – Invited Lecture: Current perspectives on pain in OA
Tuhina Neogi – Invited Lecture: Effect of bisphosphonate use on trajectories of MRI-based three-dimensional bone shape of the knee over four years
Devyani Misra – Oral Presentation #822: Obesity-related systemic inflammation and knee synovitis
Kathy Bacon – Poster #642: The non-linear relationship of quadriceps strength to functional limitations in people with knee OA: The MOST Study
Reza Jafarzadeh – Poster #528: Assessing mediating effect of bone marrow lesions and synovitis following extreme weight loss on knee pain reduction
Deepak Kumar – Poster #149: Degeneration of patellofemoral and tibiofemoral compartments following ACL reconstruction and associated gait mechanics: A longitudinal 2-year study
Deepak Kumar – Poster #185: Knee loading is lower during mindful walking compared to regular walking: A preliminary study
Deepak Kumar – Poster #266: Effects of weight loss on patellofemoral loading in overweight and obese adults with patellofemoral OA: Secondary analysis from the IDEA randomized trial
Deepak Kumar – Poster #594: Vastus medialis intramuscular fat is associated with increase in MRI degeneration of the knee over 3 years
Jing-Sheng Li – Poster #468: Racial differences in MRI-based 3D bone shape of the femur vs the tibia at the knee: Data from the Osteoarthritis Initiative
Erin Macri – Poster #285: Defining abnormal cut-points for patellofemoral alignment and trochlear morphology and their relation to patellofemoral OA: The Framingham OA Study
Tuhina Neogi – Poster #30: Relation of pain sensitization to development of constant, persistent pain in knee OA: The MOST Study
Shanshan Sheehy – Poster #301: Can adipokines elucidate the sex disparity in osteoarthritis?