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Integrative Rheumatology and Orthopedics Center (IROC)
HSS is focused on clinical care and research in musculoskeletal diseases and serves large patient populations through close collaboration among rheumatologists and orthopedists. For patients with rheumatic diseases like inflammatory arthritis, recommendations for orthopedic surgery must be carefully considered and planned.
The Integrative Rheumatology and Orthopedics Center (IROC) seeks to improve the lives of patients with rheumatic diseases undergoing orthopedic surgery while providing a platform for translational collaborations through:
- Patient-centric research in medical and surgical care
- New scientific knowledge to optimize timely patient access and appropriate therapy selection
- Safer and more efficient protocols to achieve optimal clinical outcome
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A Bridge to Better Orthopedic Outcomes
Our Center has the potential to understand the circumstances that predict beneficial outcomes of orthopedic surgery procedures, as well as identify factors that may influence poor outcomes and adverse events. These findings can then be applied more broadly to patients with rheumatic diseases who are undergoing orthopedic surgical procedures. Our unique collaborations have created a foundation for translational research, enabling us to provide biospecimens for our translational collaborative work. Our multidisciplinary approach, including rheumatologists, orthopedists, and basic scientists, is essential to defining medical, surgical, and biologic characteristics that contribute to optimal outcomes.
The greatest innovation of the Center will derive from the cross-fertilization of ideas leading to novel projects that occurs when orthopedists, rheumatologists, and basic scientists collaborate on clinical questions. The Center will create and support the intellectual environment that leads to innovative projects through ongoing dialogue and discussion.
We are actively enrolling patients with osteoarthritis, rheumatoid arthritis, lupus, or psoriatic arthritis for the following studies:
- Perioperative Flare in Rheumatoid Arthritis: Characterization of Clinical and Biological Features
- Clinical and Molecular Characteristics for Subtyping Osteoarthritis
- Accelerating Medicines Partnership: Autoimmune and Immune-Mediated Disease – Rheumatoid Arthritis (AMP-AIM for RA)
- Identifying Molecular Changes that Contribute to Arthritis Bone Erosion
- Clinical, Histopathologic and Immunologic Characteristics and Outcomes of Patients with Psoriatic Arthritis Undergoing Arthroplasty
- Synovial Fibroblasts in Hand Arthritis
For more information or if interested in learning more about enrolling, please email rheumresearch@hss.edu or call 917.260.4514.
Physicians
Surgeons
Pathologists
Scientists
Research Assistants
- Hadeel Abdul-Rehman
- Stephen Batter
- Solana Cushing
- Xiaoshun L
Research Studies
The close working relationship among rheumatologists, translational scientists, orthopedists, and pathologists at HSS has facilitated the development of unique clinical and translational research opportunities. By establishing this research center we have:
- Been key collaborators in several NIH-funded multi-institutional international consortiums, such as Aceelerating Medicines Partnership (AMP) and
Restoring Joint Health and Function to Reduce Pain (RE-JOIN) - Been pioneers in establishing the guidelines for perioperative medicine
- Examined the healthcare access of patients in terms of health equity
- Conducted research projects to better understand healthcare disparities in different populations and to move towards health equity
- Worked to better understand orthopedic outcomes by developing measurement tools
Our Goals
- Implement research studies with the goal of increasing access of appropriate patients to orthopedic surgical procedures
- Achieve excellent surgical outcomes while avoiding medical complications, even in those patients with complex rheumatologic diseases
- Ensure that patients achieve their individual goals and optimal satisfaction.
- These multidisciplinary efforts will also facilitate translational research that might inform new understanding of disease mechanisms.
Contact Us
For more information or if interested in learning more about enrolling, please email rheumresearch@hss.edu or call 917.260.4514.
Current Enrolling Research Projects
- Perioperative Flare in Rheumatoid Arthritis: Characterization of Clinical and Biological Features
Investigator: Susan Goodman, MD
The purpose of this study is to understand the cells, genes, and molecular pathways involved in the synovial tissue (or “synovium”), synovial fluid, and blood of patients with rheumatoid arthritis (RA) undergoing total joint replacement surgery. We use these samples to understand the biological mechanisms underlying various symptoms, including joint swelling, stiffness, disease flaring, and fatigue.
Main Enrollment Criteria:- Diagnosis of Rheumatoid Arthritis and no other rheumatic/autoimmune conditions
- Undergoing a total joint replacement or synovectomy
- Clinical and Molecular Characteristics for Subtyping Osteoarthritis
Investigator: Bella Mehta, MD
The purpose of this study is to better understand distinct knee osteoarthritis (OA) subtypes by using clinical and genetic information, with the ultimate goal of advancing knee OA (KOA) therapy. We will confirm the genetically defined subtypes with tissue collected during surgery. This approach has the potential to define KOA subtypes that would be therapeutically actionable in disease modification.
Main Enrollment Criteria:- Diagnosis of Osteoarthritis and no other rheumatic/autoimmune conditions
- Undergoing first primary total knee arthroplasty
- Accelerating Medicines Partnership: Autoimmune and Immune-Mediated Disease – Rheumatoid Arthritis (AMP-AIM for RA)
Investigator: Laura Donlin, PhD and Susan Goodman, MD
This study seeks to advance precision medicine in RA treatment by developing methods to predict which biologic medication will work best for each individual patient. To do this, we employ a minimally invasive ultrasound-guided synovial biopsy technique to collect tissue samples from the joint lining (synovium). By gaining deeper insights into the various mechanisms of RA, this research aims to optimize personalized treatment strategies, ensuring that each patient receives the therapy best suited to their specific disease profile.
Main Enrollment Criteria:- Diagnosis of Rheumatoid Arthritis
- Swollen/active knee or wrist
- Interested in undergoing a synovial biopsy of the knee or wrist
- Identifying Molecular Changes that Contribute to Arthritis Bone Erosion
Investigator: Kyung-Hyun Park-Min, PhD and Susan Goodman, MD
We want to better understand the genetic and molecular factors contributing to joint damage in rheumatoid arthritis (RA). Certain genes in patients’ joint fluid may contribute to the worsening of bone erosion in RA. We hope to compare the expression of these genes between patients with erosive RA versus non-erosive RA to learn more about how we can further advance RA therapies.
Main Enrollment Criteria:- Diagnosis of Osteoarthritis and no other rheumatic/autoimmune conditions
- Undergoing first primary total knee arthroplasty
- Clinical, Histopathologic and Immunologic Characteristics and Outcomes of Patients with Psoriatic Arthritis Undergoing Arthroplasty
Investigator: Susan Goodman, MD
Patients with psoriatic arthritis (PsA) frequently undergo total hip and knee replacements, yet complications such as infection are higher for them than for patients with osteoarthritis. The specific factors that increase their risk are not understood, as studies have primarily been performed using large databases that do not contain patient-specific information, such as use of immune suppression or extent of active skin rash, which might increase risk. In this study, we will enroll patients with PsA prior to joint replacement and collect both clinical and biologic information about disease features so we can determine which are linked to worse outcomes or complications, with the goal of improving their outcomes.
Main Enrollment Criteria:- Diagnosis of Psoriatic Arthritis and fulfillment of CASPAR criteria
- Undergoing a knee or hip arthroplasty
- Synovial Fibroblasts in Hand Arthritis
Investigator: Melanie Smith, MD
Synovial biology in the small hand joints is poorly understood. While small joints can have a similar inflammatory infiltrate compared to large joints, there is evidence that resident fibroblasts may be different. In addition, EOA is particularly poorly understood and there are no effective therapeutics. Again, resident synovial fibroblasts are likely to play a key role in pathology. We hope to understand synovial biology in the small hand joints better
Main Enrollment Criteria:- Patients undergoing a hand joint replacement or a hand joint fusion
Other Enrolling Research Projects
- The Established Rheumatoid Arthritis Cohort
- Do SLE Patients have more Early Adverse Events within 6 Months of THR and TKR?
Educational Resources
Publications
Mannstadt, I., Goodman, S., Rajan, M., Young, S., Wang, F., Navarro-Millan, I., Mehta, B. 2024. A Novel Approach for Mixed-Methods Research Using Large Language Models: A Report Using Patients’ Perspectives on Barriers to Arthroplasty. American College of Rheumatology 6(6):375-379.
Goodman SM, Mannstadt I, Gibbons JAB, Rajan M, Bass A, Russell L, Mehta B, Figgie M, Parks ML, Venkatachalam S, Nowell WB, Brantner C, Lui G, Card A, Leung P, Tischler H, Young SR, Navarro-Millán I. Healthcare disparities: patients' perspectives on barriers to joint replacement. BMC Musculoskelet Disord. 2023 Dec 18;24(1):976. doi: 10.1186/s12891-023-07096-0. PubMed PMID: 38110904; PubMed Central PMCID: PMC10726517.
Hannon CP, Goodman SM, Austin MS, Yates A Jr, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Rheumatol. 2023 Nov;75(11):1877-1888. doi: 10.1002/art.42630. Epub 2023 Sep 25. PMID: 37746897.
Zhang F, Jonsson AH, Nathan A, Millard N, Curtis M, Xiao Q, Gutierrez-Arcelus M, Apruzzese W, Watts GFM, Weisenfeld D, Nayar S, Rangel-Moreno J, Meednu N, Marks KE, Mantel I, Kang JB, Rumker L, Mears J, Slowikowski K, Weinand K, Orange DE, Geraldino-Pardilla L, Deane KD, Tabechian D, Ceponis A, Firestein GS, Maybury M, Sahbudin I, Ben-Artzi A, Mandelin AM 2nd, Nerviani A, Lewis MJ, Rivellese F, Pitzalis C, Hughes LB, Horowitz D, DiCarlo E, Gravallese EM, Boyce BF, Moreland LW, Goodman SM, Perlman H, Holers VM, Liao KP, Filer A, Bykerk VP, Wei K, Rao DA, Donlin LT, Anolik JH, Brenner MB, Raychaudhuri S. Deconstruction of rheumatoid arthritis synovium defines inflammatory subtypes. Nature. 2023 Nov;623(7987):616-624. doi: 10.1038/s41586-023-06708-y. Epub 2023 Nov 8. PubMed PMID: 37938773; PubMed Central PMCID: PMC10651487.
Mirza SZ, Zhang Y, Do HT, Mehta B, Goodman SM, Bass AR. Black Patients are More Likely to Undergo Early Revision Total Knee Arthroplasty in a Matched Cohort Regardless of Surgeon Experience. J Arthroplasty. 2023 Jun 7:S0883-5403(23)00610-1. doi: 10.1016/j.arth.2023.05.067. Epub ahead of print. PMID: 37295621.
Smith MH, Gao VR, Periyakoil PK, Kochen A, DiCarlo EF, Goodman SM, Norman TM, Donlin LT, Leslie CS, Rudensky AY. Drivers of heterogeneity in synovial fibroblasts in rheumatoid arthritis. Nat Immunol. 2023 Jun 5. doi: 10.1038/s41590-023-01527-9. Epub ahead of print. PMID: 37277655.
England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Chan KK, Constien D, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips LR, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol. 2023 May 25. doi: 10.1002/art.42507. Epub ahead of print. PMID: 37227071.
Sculco P, Kapadia M, Moezinia CJ, Mannstadt I, Miller AO, Donlin L, Henry M, Russell L, Figgie M, Nocon A, Pannellini T, Goodman SM. Clinical and Histological Features of Prosthetic Joint Infections May Differ in Patients With Inflammatory Arthritis and Osteoarthritis. HSS J. 2023 May;19(2):146-153. doi: 10.1177/15563316231153395. Epub 2023 Feb 13. PMID: 37065104; PMCID: PMC10090847.
Frezza, D., DiCarlo, E., Hale, C., Ramirez, D., Mehta, B., Slater, D., Habib, S., Frank, M.O., Spolaore, E., Smith, M.H., Donlin, L., Goodman, S., Thompson, J.R., Orange, D.E., 2023. Computer Vision Analysis of Rheumatoid Arthritis Synovium Reveals Lymphocytic Inflammation is Associated With Immunoglobin Skewing in Blood. Arthritis & Rheumatology 75(12):2137-2147.
Mehta B, Goodman SM, DiCarlo E, Jannat-Khah D, Gibbons JAB, Otero M, Donlin L, Pannellini T, Robinson WH, Sculco P, Figgie M, Rodriguez J, Kirschmann JM, Thompson J, Slater D, Frezza D, Xu Z, Wang F, Orange DE. Machine learning identification of thresholds to discriminate osteoarthritis and rheumatoid arthritis synovial inflammation. Arthritis Res Ther. 2023 Mar 2;25(1):31. doi: 10.1186/s13075-023-03008-8. PMID: 36864474; PMCID: PMC9979511.
Burke, O.C., Gibbons, J.A., Do, H., Lai, E., Bradford, L., Bass, A., Amen, T., Russell, L., Mehta, B., Parks, M., Figgie, M., Goodman, S., 2023. Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study. Arthroplasty Today 23:101212.
Mehta, B., Jannat-Khah, D., Glaser, K.K., Luo, Y., Sammaritano, L.R., Branch, D.W., Goodman, S., Lockshin, M., Wang, F., Ibrahim, S., Salmon, J.E., 2022. Fetal and maternal morbidity in pregnant patients with Lupus: a 10-year US nationwide analysis. RMD Open 9(1):e002752.
Goodman SM, Bykerk VP, DiCarlo E, Cummings RW, Donlin LT, Orange DE, Hoang A, Mirza S, McNamara M, Andersen K, Bartlett SJ, Szymonifka J, Figgie MP. Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty: Rates, Characteristics, and Risk Factors. J Rheumatol. 2018 Mar 15. pii: jrheum.170366. doi: 10.3899/jrheum.170366. [Epub ahead of print] PubMed PMID: 29545451.
Mizoguchi F, Slowikowski K, Wei K, Marshall JL, Rao DA, Chang SK, Nguyen HN, Noss EH, Turner JD, Earp BE, Blazar PE, Wright J, Simmons BP, Donlin LT, Kalliolias GD, Goodman SM, Bykerk VP, Ivashkiv LB, Lederer JA, Hacohen N, Nigrovic PA, Filer A, Buckley CD, Raychaudhuri S, Brenner MB. Functionally distinct disease-associated fibroblast subsets in rheumatoid arthritis. Nat Commun. 2018 Feb 23;9(1):789. doi: 10.1038/s41467-018-02892-y. PubMed PMID: 29476097; PubMed Central PMCID: PMC5824882.
Stephenson W, Donlin LT, Butler A, Rozo C, Bracken B, Rashidfarrokhi A, Goodman SM, Ivashkiv LB, Bykerk VP, Orange DE, Darnell RB, Swerdlow HP, Satija R. Single-cell RNA-seq of rheumatoid arthritis synovial tissue using low-cost microfluidic instrumentation. Nat Commun. 2018 Feb 23;9(1):791. doi: 10.1038/s41467-017-02659-x. PubMed PMID: 29476078; PubMed Central PMCID: PMC5824814.
Orange DE, Agius P, DiCarlo EF, Robine N, Geiger H, Szymonifka J, McNamara M, Cummings R, Andersen KM, Mirza S, Figgie M, Ivashkiv LB, Pernis AB, Jiang CS, Frank MO, Darnell RB, Lingampali N, Robinson WH, Gravallese E; Accelerating Medicines Partnership in Rheumatoid Arthritis and Lupus Network, Bykerk VP, Goodman SM, Donlin LT. Identification of Three Rheumatoid Arthritis Disease Subtypes by Machine Learning Integration of Synovial Histologic Features and RNA Sequencing Data. Arthritis Rheumatol. 2018 Feb 22. doi: 10.1002/art.40428. [Epub ahead of print] PubMed PMID: 29468833.
Mehta BY, Bass AR, Goto R, Russell LA, Parks ML, Figgie MP, Goodman SM. Disparities in Outcomes for Blacks versus Whites Undergoing Total Hip Arthroplasty: A Systematic Literature Review. J Rheumatol. 2018 Feb 1. pii: jrheum.170855. doi: 10.3899/jrheum.170855. [Epub ahead of print] PubMed PMID: 29419468.
Goodman SM. Do Recent Trends in RA Surgery Reflect Success in Disease Management? J Rheumatol. 2018 Feb;45(2):147-149. doi: 10.3899/jrheum.171056. PubMed PMID: 29419445.
Goodman SM, Mandl LA, Parks ML, Zhang M, McHugh KR, Lee YY, Nguyen JT, Russell LA, Bogardus MH, Figgie MP, Bass AR. Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty. Clin Orthop Relat Res. 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8. Epub 2016 Jun 8. PubMed PMID: 27278675; PubMed Central PMCID: PMC4965380.
In the News
For Professionals
The IROC works with HSS eAcademy to provide continuing education to rheumatologists nationally and internationally:
- Access to HSS Rheumatology Grand Rounds lecture series
- Adult Reconstruction & Joint Replacement (ARJR) Indications Conference
Trainee education
The IROC is involved in educating Research Assistants at HSS, medical students from Weill Cornell Medical College, residents from NewYork-Presbyterian Hospital, and fellows from HSS. Learn more about the HSS Adult Rheumatology Fellowship.
