Publications by authors named "Lockshin M"
Article Synopsis
- The 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria development used a four-phase methodology to identify high likelihood patients for research purposes.
- In the final phase, a multicriteria decision analysis (MCDA) helped rank the importance of candidate criteria based on evaluations from 192 real-world patients suspected of having APS.
- The consensus reached emphasized the need for separate clinical and laboratory scores for APS classification, aiming for greater specificity compared to existing systems that rely on a single score.
Objective: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR.
Methods: This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard.
Results: The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β-glycoprotein I antibodies).
The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria.
Arthritis Rheumatol
October 2023
Article Synopsis
- - The study aimed to create new and more specific classification criteria for antiphospholipid syndrome (APS) in collaboration with the American College of Rheumatology (ACR) and EULAR, using a detailed four-phase methodology.
- - The new criteria require at least one positive antiphospholipid antibody test and assign points across six clinical and two laboratory domains, classifying patients with a minimum of 3 points in both areas as having APS.
- - Compared to the older Sapporo criteria, the 2023 ACR/EULAR criteria showed a significant increase in specificity (99% vs. 86%) but slightly lower sensitivity (84% vs. 99%), demonstrating a more refined approach to diagnosing APS.
Objective: To evaluate and quantify the indicators of fetal and maternal morbidity in deliveries for patients with systemic lupus erythematosus (SLE) compared with deliveries in patients without SLE.
Methods: We used retrospective data from the National Inpatient Sample (NIS) to identify all delivery related hospital admissions of patients with and without SLE from 2008 to 2017 using ICD-9/10 codes. Fetal morbidity indicators included pre-term delivery and intrauterine growth restriction (IUGR).
Fertility is often a concern for women with SLE. In addition to known indirect factors that influence the ability of a woman with SLE to become pregnant, such as cytotoxic agents, other medications, advanced age and psychosocial effects of the disease, direct disease-related factors are believed to influence fertility. These include diminished ovarian reserve, menstrual irregularities (a function of disease activity) and the presence of antiphospholipid antibodies.
View Article and Find Full Text PDFArticle Synopsis
- COVID-19 is linked to high rates of thrombosis, with many patients showing prolonged aPTT and positivity for antiphospholipid antibodies (aPL), but the long-term effects of this positivity are still unclear.
- Research suggests there may be shared mechanisms between COVID-19 and antiphospholipid syndrome (APS), such as endothelial damage and thrombotic microangiopathy.
- The international APS-ACTION network established a working group to explore these connections and provide clinical guidelines for managing aPL-positive COVID-19 patients, emphasizing the need for further research.
Diagnostic uncertainty, commonly encountered in rheumatology and other fields of medicine, is an opportunity: Stakeholders who understand uncertainty's causes and quantitate its effects can reduce uncertainty and can use uncertainty to improve medical practice, science, and administration. To articulate, bring attention to, and offer recommendations for diagnostic uncertainty, the Barbara Volcker Center at the Hospital for Special Surgery sponsored, in April 2021, a virtual international workshop, "When a Diagnosis Has No Name." This paper summarizes the opinions of 72 stakeholders from the fields of medical research, industry, federal regulatory agencies, insurers, hospital management, medical philosophy, public media, health care law, clinical rheumatology, other specialty areas of medicine, and patients.
View Article and Find Full Text PDFMethods: We identified 20 adult patients with UCTD enrolled in the UCTD and Overlap Registry at our tertiary care level hospital. A licensed clinical social worker administered a 30-minute semistructured interview by telephone. The standardized questionnaire consisted of 14 open-ended questions on UCTD.
View Article and Find Full Text PDFObjective: The present study was undertaken to evaluate the pregnancy experiences of women receiving care in the division of rheumatology at a major academic center in New York City during the COVID-19 pandemic.
Methods: A web-based COVID-19 survey was emailed to 26,045 patients who were followed in the division of rheumatology at a single center in New York City. Women ages 18-50 years were asked about their pregnancy.
Article Synopsis
- An international initiative, supported by major rheumatology organizations, aims to create new classification criteria for identifying patients with antiphospholipid syndrome (APS) to enhance research.
- The study involved a two-phase process: Phase I collected a comprehensive list of criteria from literature and expert surveys, while Phase II systematically reduced the criteria and organized them into clinical and laboratory domains.
- Ultimately, a refined list of 27 candidate criteria was established across 6 domains, which will be tested in real-world cases to create a scoring system for APS classification.
Background: Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients.
View Article and Find Full Text PDFBackground: Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients.
View Article and Find Full Text PDFObjective: To provide reference data regarding the frequency and safety of elective termination of pregnancy in women with autoimmune rheumatic diseases followed up in 2 referral databases.
Methods: Two large databases, one from an autoimmune rheumatic disease referral clinical practice with a known interest in pregnancy (the Barbara Volcker Center for Women and Rheumatic Disease [BVC]), and one from an observational study of systemic lupus erythematosus- and antiphospholipid antibody-associated pregnancies (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus [PROMISSE]), were interrogated for histories of prior elective termination of pregnancy and complications related to incident pregnancy termination.
Results: Of women who had had prior pregnancies, 21.
Objective: To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD).
Methods: We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary.
Objective: To develop an evidence-based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD).
Methods: We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary.
Assisted reproductive technologies for women with rheumatic AID.
Best Pract Res Clin Obstet Gynaecol
April 2020
Assisted reproductive technology (ART) procedures are safe for women with rheumatic autoimmune diseases (rAID) when illness is inactive. Medications incompatible with pregnancy should be replaced with alternative pregnancy-compatible medications months before planned ART procedures to allow time to verify the substitute medication's efficacy and tolerability. Medications compatible with pregnancy should be continued, as should anticoagulation (warfarin changed to low-molecular-weight heparin) before pregnancy begins.
View Article and Find Full Text PDFObjective: iBook on Antiphospholipid Syndrome (APS) did not exist before our work, and hence the utility of an Apple iBook as a teaching method in APS for medical students has never been assessed. Our objective was to evaluate medical students' improvement of knowledge and satisfaction with an interactive APS iBook, in comparison with conventional teaching methods.
Methods: An iBook designer with the guidance of a medical team developed the APS iBook in both French and English.
Background: Although pregnancy in systemic lupus erythematosus (SLE) carries a high risk for mother and fetus, outcomes may be improving.
Objective: To assess nationwide trends and disparities in maternal and fetal complications among pregnant women with SLE.
Design: Retrospective cohort study.