Karla L. Miller

Glucosamine and Chondroitin Sulfate

Glucosamine and chondroitin sulfate, components of normal cartilage that are marketed as dietary supplements in the United States, have been evaluated for their potential role in the treatment of osteoarthritis. Due to claims of efficacy, increased prevalence of osteoarthritis, and a lack of other effective therapies, there has been substantial interest in using these dietary supplements as therapeutic agents for osteoarthritis. Though pharmacokinetic and bioavailability data are limited, use of these supplements has been evaluated for management of osteoarthritis symptoms and modification of disease progression. Relevant clinical trial efficacy and safety data are reviewed and summarized.

Comparing nebulized water versus saline after laryngeal desiccation challenge in Sjögren's Syndrome

This study examined the effects of a laryngeal desiccation challenge and two nebulized hydration treatments on phonation threshold pressure (PTP), vocal effort, and throat dryness in patients with chronic airway dryness.

Abatacept and serious respiratory infections in patients with previous lung disease.

Abatacept is a biologic agent used in the treatment of rheumatoid arthritis, for which underlying chronic obstructive lung disease is listed as a precaution to its use due to concern for increased risk of respiratory adverse events. We describe two cases of severe respiratory complications affecting rheumatoid arthritis patients undergoing treatment with abatacept who had been previously diagnosed with underlying lung disease.

The Quality of Life Burden Associated With Voice Disorders in Sjögren’s Syndrome

Objectives: This study examined quality of life burden of voice disorders in Sjögren’s syndrome (SS). Methods: Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders. Results: Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders (P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement. Conclusions: Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.

Nebulized isotonic saline improves voice production in Sjögren's syndrome

This study examined the effects of a topical vocal fold hydration treatment on voice production over time.

Voice disorders in Sjögren's syndrome: Prevalence and related risk factors

Sjögrens Syndrome (SS) is an autoimmune disease that causes sicca (dryness) symptoms by affecting secretions most notably of the lacrimal and salivary glands. Voice disorders have been documented in patients with SS, but the true prevalence and relationships among possible contributing factors remain unknown. This preliminary epidemiological investigation examined prevalence and risk factors for voice disorders in SS.

Voice, Speech, and Laryngeal Features of Primary Sjögren’s Syndrome

Objective: This study examined voice, speech, and laryngeal characteristics in primary Sjögren’s syndrome (pSS). Methods: Eleven patients (10 female, 1 male; mean [SD] age = 57 [14] years) from The University of Utah Division of Rheumatology provided connected speech and sustained vowel samples. Analyses included the Multi-Dimensional Voice Profile, the Analysis of Dysphonia in Speech and Voice, and dysphonia severity, speech clarity, and videolaryngostroboscopy ratings. Results: Shimmer, amplitude perturbation quotient, and average fundamental frequency differed significantly from normative values (P < .01). Cepstral Spectral Index of Dysphonia values indicated mild-to-moderate dysphonia in connected speech (mean [SD] = 20.26 [8.36]) and sustained vowels (mean [SD] = 16.91 [11.08]). Ratings of dysphonia severity and speech clarity using 10-cm visual analog scales suggested mild-to-moderate dysphonia in connected speech (mean [SD] = 2.11 [1.72]) and sustained vowels (mean [SD] = 3.13 [2.20]) and mildly reduced speech clarity (mean [SD] = 1.46 [1.36]). Videolaryngostroboscopic ratings indicated mild-to-moderate dryness and mild reductions in overall laryngeal function. Voice Handicap Index scores indicated mild-to-moderate voice symptoms (mean [SD] = 43 [23]). Conclusion: Individuals with pSS may experience dysphonia and articulatory imprecision, typically in the mild-to-moderate range. These findings have implications for diagnostic and referral practices in pSS.

The Bone Health Team: A Team-Based Approach to Improving Osteoporosis Care for Primary Care Patients:

Background: Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported. Objective: To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices. Design: Historical cohort study of a primary care–based intervention of a BHT from February 2013 to February 2015. Setting: Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System. Participants: Men aged 70 years and older and women aged 65 years and older. Intervention: Enrollment in the BHT. Measurements: Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication. Results: Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 (P < .001); chart diagnosis of osteopenia, HR = 37.00 (P < .001); chart diagnosis of osteoporosis, HR = 16.38 (P < .001); osteoporosis medication, HR = 17.03 (P < .001); and completion of DXA, HR = 139.9 (P < .001). Conclusions and Relevance: The implementation of a dedicated BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.

Epidemiology of Swallowing Disorders in Rheumatoid Arthritis: Prevalence, Risk Factors, and Quality of Life Burden

Objective: This investigation examined the prevalence, symptoms, risk factors, and quality-of-life burden of swallowing disorders in rheumatoid arthritis (RA), a chronic, progressive autoimmune inflammatory disease. Methods: One hundred individuals with RA (84 women, 16 men; mean age = 61.1 years, SD = 13.1) were interviewed regarding the presence, nature, and impact of swallowing symptoms and disorders. Associations between swallowing disorders, medical factors, RA disease severity, and quality of life were examined. Results: Forty-one percent of participants reported a current swallowing disorder that began gradually and was longstanding (most experiencing symptoms on a daily basis for at least 4 years). Symptoms compatible with solid food dysphagia contributed disproportionately to reporting a current swallowing disorder. Risk factors for dysphagia included a self-reported voice disorder, thyroid problems, esophageal reflux, and being physically inactive. Swallowing disorders increased with self-reported RA disease severity and contributed to a significantly greater burden on overall quality of life. Conclusion: Chronic, longstanding swallowing disorders are common in individuals with RA and appear to increase with disease severity. Those individuals with dysphagia reported greater reductions in quality of life as compared to those without, highlighting the need for improved awareness, exploration, and management of swallowing disorders in this population.

Bone Mineral Density in Navajo Men and Women and Comparison to Non-Hispanic Whites from NHANES (2005-2008).

Purpose. To describe bone mineral density (BMD) at the hip and spine and prevalence of low bone mass and osteoporosis in Navajo men and women across age, gender, and body mass index (BMI) compared with non-Hispanic (NH) Whites from NHANES (2005–2008). Methods. Cross-sectional dual energy x-ray absorptiometry measurements at the hip and spine in 1,097 participants from the Education and Research Towards Health study. Results. Bone mineral density was lower among younger Navajo than NH-Whites at lower BMI, and in overweight, younger men at lumbar spine and total hip. Spine BMD was lower in Navajo women, across BMI. Prevalence of low bone mass and osteoporosis in Navajo was higher than NH-Whites, particularly among women. Conclusions. Further research is needed to understand if lower BMD among younger Navajo signals a risk for future fracture, and fracture risk relative to BMD, given the challenges in health care access and fracture morbidity among minorities.