News Release

ACP releases comprehensive framework to address disparities and discrimination in health care

Embargoed News from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. ACP Releases Comprehensive Framework to Address Disparities and Discrimination in Health Care
Abstract: https://www.acpjournals.org/doi/10.7326/M20-7219
URL goes live when the embargo lifts

More needs to be done to understand and address disparities and discrimination in health and health care that negatively impact racial, ethnic, religious, and cultural communities and persons in the United States, says the American College of Physicians (ACP). In a new policy paper published in Annals of Internal Medicine, ACP lays out a framework that confronts the various, interconnected, and compounding aspects of U.S. society that contribute to poorer health outcomes for persons based on their race, ethnicity, religion, and/or cultural identities. ACP further proposes specific policy recommendations to address the issue in education and the health care workforce, for specific populations, and in criminal justice practices in a related series of three position papers. Those papers will be available at http://www.acponline.org.

ACP's policy framework includes recommendations that U.S. policymakers commit to understanding and addressing disparities in health and health care to enhance the quality and effectiveness of health care for all; and that policymakers comprehensively address the interconnected contributors to health and health care disparities including the role of racism, discrimination, lack of coverage and access to care, poverty, and other social drivers of health. The framework then lays out a series of 15 additional recommendations to reduce health disparities. Those recommendations discuss specific contributors to disparities and steps that could be taken to help improve them.

Media contacts:
For an embargoed PDF, please contact Angela Collom at acollom@acponline.org.
To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

2. Sturdy supportive shoes better than flat flexible shoes for managing knee pain
Abstract: https://www.acpjournals.org/doi/10.7326/M20-6321
URL goes live when the embargo lifts

A randomized controlled trial found that sturdy supportive shoes improve knee pain on walking and knee-related quality of life compared with flat flexible shoes. This evidence supports recommendations that previously had been based on expert opinion in the absence of data. Findings are published in Annals of Internal Medicine.

Knee osteoarthritis is a common problem that causes pain and can limit a person's activities. People with knee osteoarthritis are often advised to wear stable supportive shoes. However, some experts believe that flat flexible shoes that allow more of a "barefoot" experience may provide more benefit.

Researchers from The University of Melbourne randomly assigned 164 patients with knee osteoarthritis to wear either sturdy supportive shoes or flat flexible shoes for at least 6 hours per day for 6 months to compare pain and the ability to participate in activities, such as walking. The participants were equally divided into the two groups and the researchers used standard surveys to measure patients' pain, activity levels, and quality of life at the beginning and end of the study. At 6 months, the researchers found no evidence that flat flexible shoes were better than sturdy supportive shoes. Patients in the stable sturdy shoe group reported greater improvements in pain when walking and knee-related quality of life compared to the flat flexible shoe group. According to the researchers, these findings provide hard data to support clinical guidelines that recommend sturdy supportive shoes for patients with knee osteoarthritis.

Media contacts:
For an embargoed PDF, please contact Angela Collom at acollom@acponline.org.
The corresponding author, Rana Hinman, can be reached directly at ranash@unimelb.edu.au.

3. Janus kinase inhibitors may provide powerful and safe new treatment options for severe TAFRO
Abstract: https://www.acpjournals.org/doi/10.7326/L20-1051
URL goes live when the embargo lifts

Janus kinase (JAK1/2) inhibitors may provide powerful and safe new options for treatment of severe thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and Organomegaly (TAFRO) syndrome, a rare inflammatory disorder of unknown cause. A case report describing the first use of a JAK1/2 inhibitor to treat severe TAFRO syndrome is published in Annals of Internal Medicine.

In patients with severe TAFRO syndrome, the recommended first-line therapy is anti-interleukin(IL)-6/IL-6-R therapy with high-dose corticosteroids. Cyclosporin and anticalcineurin are recommended by the Japanese TAFRO research group, and multiagent chemotherapy should be considered in patients with severe disease. With low response rates to treatment, recent research has begun to look at the unique pathway of the disease. JAK inhibitors are approved in myelofibrosis, rheumatoid arthritis, and being evaluated in many autoimmune diseases with promising results, and patients with TAFRO can also have autoimmune features.

Researchers from Jean Monnet University Saint-Etienne treated a patient with symptoms of severe TAFRO. Despite attempts at treatment with recommended therapies, the patient's symptoms persisted. In line with recent mechanistic studies, the patient was treated with the Janus kinase inhibitor ruxolitinib and showed significant improvement. According to the researchers, the patient has had no flares or adverse events for more than a year and is still receiving treatment. These findings suggest that Janus kinase inhibitors deserve further research as a potentially effective and safe treatment for severe TAFRO.

Media contacts:
For an embargoed PDF, please contact Angela Collom at acollom@acponline.org.
To reach the corresponding author, Martin Killian, please email him directly at Martin.Killian@chu-st-etienne.fr.

Also in this issue:

Polymyalgia Rheumatica and Giant Cell Arteritis
Robert M. Centor, MD
Annals On Call Podcast
Abstract: https://www.acpjournals.org/doi/10.7326/A20-0004

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