Robert F. Spiera, MD

Please do not hesitate to contact our office if you have questions regarding your insurance coverage. You may have coverage subject to the availability of 'out-of-network' benefits.

Appointments

Affiliations

Fellow, American College of Rheumatology
Fellow, American College of Physicians
Member, American Medical Association
Chairman, Scleroderma Foundation Tri State Chapter Medical Advisory Board
Member, Vasculitis Foundation Scientific Advisory Board
Member of Medical Advisory Board, Scleroderma Foundation (National)
Member, Subcommittee Research, Scleroderma Foundation Tri-State

Certification

Rheumatology
Internal Medicine

Awards

Castle Connolly Top Doctors in New York Metro Area, 2021
New York Magazine Top Doctors, 2021
Emmanuel Rudd, M.D. and Martin Gardy, M.D. Best Rheumatology Fellow Teacher Award, 2006
Founders Award Recipient for Clinical Investigation – Scleroderma Foundation, 2005
The Globus Award (Outstanding article in Mount Sinai Journal of Medicine) – Mount Sinai School of Medicine, 1998

Education

MD, Yale University School of Medicine, New Haven, CT, 1989

Residency

Internal Medicine, NY Hospital, New York, NY, 1989-1992

Fellowship

Rheumatology, Hospital for Special Surgery, NY, 1992-1995

State Licensure

Languages

English, Spoken by Office Staff: Spanish, French

Blog Posts

Selected Books/Chapters

• Spiera RF, Kagen LJ. Collagen vascular diseases: Polymyositis, dermatomyositis, and inclusion body myositis. In: Therapy of Systemic Rheumatic Disorders (eds, Furst D, van Riel P, Williams J), Marcell Decker, Inc,. New York, NY, 1998.
  
  
• Spiera RF. Systemic Sclerosis and related disorders. In: Manual of Rheumatology and outpatient orthopedic disorders. (eds, Paget S, Gibofsky A, Pellici P), Little Brown and Co., Boston, 2000.
  
  
• Spiera RF. Hyperlipoproteinemia and arthritis. In: Primer on the Rheumatic Diseases, 12th edition. (eds, Klippel J, Crawford L, Stone J, Weyand C), Atlanta: Arthritis Foundation, 2001.
  
  
• Spiera RF. Polymyalgia Rheumatica, Giant Cell Arteritis and Takayasu's Arteritis. In: Expert Guide to Rheumatology. (eds, Yee AMF, Paget SA), Am College of Physicians, Phil, PA, 2005.
  
  
• Spiera RF, Spiera, H. How Can I Be Sure It Is Really Sjögren's? The NewSjögren's Syndrome Handbook, 3rd edition. (ed Wallace DJ), Oxford University Press,Inc., New York, NY, 2005.
  
  
• Paget SP, Spiera RF. Polymyalgia Rheumatica and Temporal Arteritis . In: Cecil's Textbook of Medicine, 23d edition, (eds, Goldman L, Ausiello D), Saunders, an imprint of Elsevier Inc., 2007 (292), 2059-2062.
  
  
• Paget SP, Spiera RF. Polymyalgia Rheumatica In: Clinical Care in the Rheumatic Diseases, 3rd edition, (24), 153-157.
  
  
• Spiera RF, Paget SP, Polymyalgia Rheumatica and Temporal Arteritis . In: Cecil's Textbook of Medicine, 24th edition 2010
  
  
• Spiera RF, Spiera, H. "Why is Sjögren's so hard to diagnose?" The Sjögren's Syndrome Handbook, 4th edition. (ed Wallace DJ), Oxford University Press,Inc., New York, NY, 2010
  
  

Selected Journal Articles

• Spiera R, Davis M. Excitatory amino acid antagonists depress acoustic startle after infusion into the ventral nucleus of the lateral lemniscus or paralemniscal zone. Brain Res 445: 130 136, 1988.
• Spiera R. Excitatory amino acid transmitter involvement in transmission of the acoustic startle impulse. Yale J Biol Med 52(3): 318, 1989.
• Spiera RF, Gibofsky A, Spiera H. Silicone gel-filled implants and connective tissue disease: An overview. J Rheumatol 21: 239-245, 1994.
• Spiera RF, Gibofsky A, Spiera H. Immunological reactions to silicone implants: Risk and management. Clin Immunotherapeutics 1(6): 404-412, 1994.
• Spiera RF, Filippa D, Bains M, Paget SA. Esophageal involvement by Wegener’s granulomatosis. Arthritis Rheum 37: 1404-1407, 1994.
• Spiera RF, Gibofsky A, Spiera H. Breast implants and connective tissue diseases (letter). N Engl J Med 331(18) 1232, 1994.
• Spiera RF, Gibofsky A, Spiera H. Scleroderma in women with silicone breast implants. (Letter) Arthritis Rheum 38: 719, 1995.
• Spiera RF, Mysler E. DiCarlo E, O’Brien SJ. Diagnostic utility of small-bore arthroscopy and guided synovial tissue biopsy in an academic medical center. Arthritis Rheum 38: S232,1995.
• Oami S, Ornstein MH, Zang DY, Spiera RF, Phelps RG. Demonstration of hepatitis C in lesions of cutaneous vasculitis by PCR. Arthritis Rheum 38: S200, 1995.
• Spiera RF, Crow MK. Monoarticular arthritis: Differential diagnosis and evaluation. Journal of Musculoskeletal Med, 1996.
• Spiera H, Spiera RF. Silicone breast implants and connective tissue disease: An overview. The Mount Sinai Journal of Medicine, 64: 363-371, 1997.
• Spiera RF, Kagen LJ. Extra-muscular manifestations in idiopathic inflammatory myopathies. Current opinions in Rheumatology, 10: 556-561, 1998.
• Kupersmith MJ, Langer R, Mitnick H, Spiera RF, Spiera H, Richmond M, Paget SA. Visual performance in giant cell arteritis after one year of therapy. British Journal of Ophthalmology, 83:796-801, 1999.
• Spiera H, Spiera R. (2001, October 23). The Use of Corticosteroids in Rheumatoid Arthritis. http:/www.rheuma21st. com/cutting_main.html.
• Stone JH, Hoffman GS, Merkel PA Min YI, Uhlfelder MJL, Hellman DB. Specks US,Allen NB, Spiera RF, et al. A disease-specific activity index for Wegener’s Granulomatosis :Modification of the Birmingham Vasculitis Activity Score. Arthritis Rheumatism, 44:912-920, 2001.
• Spiera RF, Mitnick HJ, Kupersmith MJ, Richmond M, Spiera H, Peterson MGE, Paget SA. Prospective, double-blind, randomized, placebo controlled trial of methotrexate (combined with corticosteroids) in the treatment of giant cell arteritis (GCA). Clinical and Experimental Rheumatology, 19:495-501, 2001.
• Spiera RF, Paget, S, Spiera, H. Methotrexate in the treatment of GCA: Comment on the article by Jover and colleagues. [Letter] Annals of Internal Medicine 135:(No.11), 2001.
• Kupersmith MJ, Spiera RF, Langer R, Peterson M, Spiera H, Mitnick H, Paget S. Visual function and quality of life among patients with giant cell (temporal) arteritis. Journal of Neuro-Ophthalmology. 21(4):266-73, 2001.
• Spiera RF, Homel, P, Spiera, H. Long-Term Outcome in Lupus Nephritis. [Letter] Annals of Internal Medicine 137: (No.6), 2002.
• Spiera RF, Berman, RS, Werner, AJ, Spiera, H. Ticlopidine Induced Lupus: A report of four cases. Archives of Internal Medicine 162(19):2240-3, 2002.
• The WGET Research Group. Design of the Wegener’s Granulomatosis Etanercept Trial (WGET). Controlled Clin Trials 23:1-17, 2002.
• The WGET Research Group Limited Versus Severe Wegener’s Granulomatosis: Baseline data on patients in the Wegener’s Granulomatosis Etanercept Trial (WGET) Arthritis Rheumatism Vol. 48: (No. 8), 2299-2309, 2003.
• Hellman DB, Uhlfelder ML, Stone JH, Jenckes MW, Cid MC, Guillevin L, Moreland L, Dellaripa PF, Hoffman GS, Merkel PA, Spiera R, Brown l, Hernandez-Rodriguez J, Rubin HR. Domains of Health-Related Quality of Life Important to Patients with Giant Cell Arteritis. Arthritis & Rheumatism (Arthritis Care and Research) Vol 49: (No.6), 819-825, 2003.
• Spiera RF, Kupersmith M, Paget S, Spiera H. Vision Loss in Giant Cell Arteritis Patients Treated with Alternate-Day Corticosteroids: Comment on the Article by Hoffman et al. [Letter] Arthritis Rheumatism 48:(No. 4), 2003.
• Spiera RF, Spiera H. Differentiating Giant Cell Arteritis and Polymyalgia Rheumatica Journal of Musculoskeletal Medicine. 27-34 January, 2004.
• Spiera RF, Spiera H. Inflammatory Diseases in Older Adults: Polymyalgia Rehumatica. Geriatrics. 59 (November):39-40, 2004 .
• Spiera RF, Spiera H. Inflammatory Diseases in Older Adults, Part 2: Cranial Arteritis, Geriatrics. 59 (December): 25-29, 2004.
• Stone JH, Rajapakese VN, Hoffman GS, Specks U, Merkel PA, Spiera R, Davis RC, St. Clair EW, McCune J, Ross S, Hitt BA, Veenstra TD, Conrads TP Liotta LA, and Petricoin EF III. A Serum Proteomic Approach to Gauging the State of Remission In Wegener’s Granulomatosis. Arthritis Rheumatism. 52 (3):902-910, 2005.
• WGET Research Group. Etanercept plus standard therapy for Wegener’s granulomatosis. New England Journal of Medicine. 352(4):351-61, 2005.
• Merkel PA, Lo GH, Holbrook JT, Tibbs AK, Allen NB, Davis JC, Hoffman GS, McCune J, St Clair EW, Specks U, Spiera RF, Petri M, Stone JH. High Incidence of Venous Thrombotic Events Among Patients with Wegener’s Granulomatosis: The Wegener’s Clinical Occurrence of Thrombosis (WeCLOT) Study. Ann Intern Med 142: 620-626, 2005.
• Seo P, Min YI, Holbrook JT, Hoffman GS, Merkel PA, Spiera RF, Davis J, Ytterberg SR. Damage caused by Wegener’s granulomatosis and its treatment: Prospective data from the Wegener’s Granulomatosis Etanercept Trial. Arthritis and Rheumatism, 52(7): 2168-2178, Jun 28, 2005.
• Stone JH, Holbrook JT, Marriott MA, Tibbs A, Sejismundo LP, Min Y-I, Specks U, Merkel PA, Spiera RF, Davis JC, St. Clair EW, McCune J, Yetterberg SR, Allen NB and Hoffman GS for the WGET Research Group: Solid Malignancies In The Wegener’s Granulomatosis Etanercept Trial. 2005. Arthritis and Rheumatism.
• Samuels J, Spiera RF,. Newer Therapeutic Approaches to the Vasculitides: Biologic Agents. Rheumatic Disease Clinics of North America, 32 (2006) 187-200.
• Seo P, Min YI, Holbrook JT, Hoffman GS, Merkel PA, Spiera R, Davis JC, Ytterberg SR, St.Clair EW, Specks U, Stone JH. Clinical Outcomes and Relapse Rates in Limited versus Severe Wegener’s Granulomatosis. Arthritis and Rheumatism, 54(9): 1156, S487, September, 2006.
• Seo P, Merkel PA, Specks U, Hoffman GS, Langford CA, Spiera R, Kallenberg CG, Turkiewicz AM, St.Clair EW, Stone JH. Damage in ANCA-Associated Vasculitis: Preliminary Evidence for the ANCA-Associated Vasculitis Index of Damage (AVID). Arthritis and Rheumatism, 54(9): 1157, S487, September, 2006.
• Mahr AD, Neogi T, Xie H, Davis JC, Hoffman GS, McCune WJ, Specks U, Spiera RF, St.Clair EW, Stone JH, Merkel PA. Reevaluation of the Weighting System for the Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BVAS/WG). Arthritis and Rheumatism, 54(9): 1264, S526-7 September, 2006.
• Finkielman JD, Merkel PA, Schroeder D, Hoffman GS, Spiera R, St.Clair EW, Davis JC, McCune WJ, Tibbs AK, Ytterberg SR, Hummel AM, Viss MA, Peikert T, Stone JH, Specks U. Antineutrophil Cytoplasmic Antibodies Against Proteinase 3 Do Not Predict Disease Relapses in Wegener’s Granulomatosis. Arthritis and Rheumatism, 54(9): 2130, S835-6 September, 2006.
• Spiera RF, Spiera H. Therapy for Giant Cell Arteritis: Can we do better? Arthritis and Rheumatism, 54(10): 3071-3074 September, 2006.
• Sebastian JK, Mahr AD, Ahmed SS, Stone JH, Romay-Penabad Z, Davis JC, Hoffman GS, McCune WJ, St. Clair EW, Specks U, Spiera RF, Pierangei S, Merkel PA. Anti-Endothelial Cell Antibodies in Patients with Wegener’s Granulomatosis: Prevalence and Correlation with Disease Activity and Manifestations. The Journal of Rheumatology, 34(5):1027-31 May 2007. Epub 2007 Apr.15.
• Mahr AD, Jover JA, Spiera RF, Hernandez-Garcia C, Fernandez-Gutierrez B, LaValley MP, Merkel PA. Adjuctive Methotrexate for treatment of giant cell arteritis: An individual patient data meta-analysis. Arthritis and Rheumatism, 56(8):2789-2797 August 2007.
• Sebastian, JK, MD , Voetsch, B, MD, PhD, Stone, JH, MD, MPH, Romay-Penabad, Z, PhD, Lo, GH MD, MPH, Allen, NB, MD, Davis, Jr.,JC MD, MPH, Hoffman,GS, MD, MS, McCune,WJ, MD, St. Clair, EW, MD, Specks,U, MD, Spiera RF MD, Loscalzo,J, MD, PhD, Pierangeli,S, PhD, Merkel,PA, MD, MPH, for the Wegener’s Granulomatosis Etanercept Trial Research Group. The Frequency of Anticardiolipin Antibodies and Genetic Mutations Associated with Hypercoagulability Among Patients with Wegener’s Granulomatosis With and Without a History of a Thrombotic Event. Journal of Rheumatology,34 (12):2446-50 December 2007. Epub 2007 Oct 1.
• Postlethwaite AE, Wong WK, Clements P, Carbone LD, Chatterjee S, Fessler BJ, Kang AH, Korn J, Mayes M , Merkel PA, Molitor J, Moreland L, Rothfield N, Simms RW, Smith EA, Spiera R, Steen V, Warrington K, White B, Wigley F, Furst DE. Oral Collagen I (CI) in Diffuse Systemic Sclerosis (SSc): I. Oral CI does not improve in all patients but may improve skin in late disease”. Arthritis and Rheumatism. 2008
• Mahr AD, Neogi T, LaValley MP, Davis JC, Hoffman GS, McCune WJ, Specks U, Spiera RF, St.Clair EW, Stone JH, Merkel PA. Assessment of the Item Selection and Weighting in the Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BV AS/WG). Arthritis and Rheumatism (Arthritis Care and Research) 59 (6):884-891 May, 2008.
• Wung PK, Anderson T, Fontaine KR, Hoffman GS, Specks U, Merkel PA, Spiera R, Davis JC, St.Clair EW, McCune WJ, Stone JH. Effects of Glucocorticoids on weight change during the treatment of Wegener’s Granulomatosis. Arthritis and Rheumatism (Arthritis Care & Research) 59 (5):746-753 May, 2008.
• Postlethwaite AE, Wong WK, Clements P, Chatterjee S, Fessler BJ, Kang AH, Korn J, Mayes M , Merkel PA, Molitor J, Moreland L, Rothfield N, Simms RW, Smith EA, Spiera R, Steen V, Warrington K, White B, Wigley F, Furst. A multicenter, randomized, double-blind, placebo-controlled trial of oral type I collagen treatment in patients with diffuse cutaneous systemic sclerosis:I. Oral type I collagen does not improve skin in all patients, but may improve skin in late-phase disease. Arthritis and Rheumatism (Arthritis Care & Research) 58 (6):1810-1822 May 2008.
• Spiera RF, Gordon JK, Mehta M, Kirou KA, Lyman S, Kloiber SA, Crow MK. Phase IIa Trial of Imatnib Mesylate (Gleevec) in the Treatment of Diffuse Systemic Sclerosis – An Interim Analysis. Arthritis and Rheumatism, 58(9):1222, S623-4 October, 2008.
• MacDermott EJ, Barillas-Arias L, Taimeh ZA, Santiago AG, Mehta M, Duculan R, Spiera RF, Crow MK, Kirou KK. Activation of the Type I IFN Pathway in Systemic Sclerosis (SSc) is detected at the level of PBMC Gene Expression: Association with Higher Skin Scores, Inflammatory Markers and anti-Ro Antibodies. Arthritis and Rheumatism, 58 (9): 1139, S592-3 October, 2008 .
• Seo P, Silva F, Hoffman GS, Spiera RF, Davis JC, McCune WJ, St. Clair EW, Specks U, Stone JH, Merkel PA. Damage Caused by Wegener’s Granulomatosis: Data from a Multicenter Longitudinal Cohort. Arthritis and Rheumatism, 58 (9): 1868, S852 October, 2008.
• Seo P, Silva F, Hoffman GS, Spiera RF, Davis JC, McCune WJ, St. Clair EW, Specks U, Stone JH, Merkel PA. Morbidity and Mortality of Wegener’s Granulomatosis: Data from a Current Multicenter Longitudinal Cohort. Arthritis and Rheumatism, 58 (9): 1970, S852-3 October, 2008.
• Finkielman J, Merkel P, Schroeder D, Hoffman G, Spiera R, St.Clair W, Davis J, Mccune J, Lears A, Ytterberg S,, Hummel A, Viss M, Peikert T, Stone J, Specks U. Glycosylation of proteinase 3 (PR3) is not required for its reactivity with antineutrophil cytoplasmic antibodies (ANCA) in Wegener’s granulomatosis. Clinical and Experimental Rheumatology, On Line: Internet submissionclinexprheumatol.org
• Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, Kallenberg CGM, St. Clair EW, Turkiewicz A, Tchao NK, Webber L, Ding L, Sejismundo L, Mieras K, Weitzenkamp D, Ikle D, Seyfert-Margolis V, Mueller M, Brunetta P, Allen NB, Fervenza FC, Geetha D, Keogh KA, Kissin EY, Monach PA, Peikert T, Stegeman C, Ytterberg SR, and Specks U. Rituximab Versus Cyclophosphamide for the Induction of Remission In ANCA-Associated Vasculitis 2009, New England Journal of Medicine;363:221-32, 2010
• Silva F, Seo P, Schroeder DR, Stone JH, Merkel PA, Hoffman GS, Spiera R, Sebastian JK, Davis Jr JC, St. Clair WE, Allen NB, McCune JW, Ytterberg SR, Specks U. Solid Malignancies Among Patients with Wegener’s Granulomatosis Treated with Etanercept: Long-term Follow-up of Multicenter Longitudinal Cohort, “submitted, Arthritis & Rheumatism 2010”.
• Clowse M, Copland S, Hseih TC, Chow Sc, Hoffman G, Merkel P, Spiera R, Davis J, McCune J, Ytterberg S, Specks U, Stone J, WGET Research. Oral cyclophosphamide therapy diminishes ovarian reserve in women with Wegener’s Granulomatosis. submitted, Arthritis & Rheumatism 2010
• Spiera R, Gordon, J, Mersten J, Magro C, Mehta M, Wildman H, Kloiber S, Kirou K, Lyman S, Crow M. Imatinib Mesylate (Gleevec) in the Treatment of Diffuse Cutaneous Systemic Sclerosis. submitted, Arthritis & Rheumatism 2010
• Specks U, Seyfert-Margolis V, Merkel PA, Hoffman GS, Langford CA, Spiera R, Seo P, Kallenberg CGM, St. Clair EW, Ding L, Webber L, Mokhtarani M, Tchao NK, Ikle D, Brunetta P, Zhang D, Sejismundo L, Mueller M, and Stone JH for the RAVE-ITN Research Group. Design of the Rituximab in ANCA-Associated Vasculitis (RAVE) Trial: Testing a novel agent against an entrenched standard of care using a non-inferiority design . submitted, PLoS One.
• Gordon J, Spiera R, Targeting tyrosine kinases: a novel therapeutic strategy for Systemic Sclerosis, Current Opinions in Rheumatology “Submitted” 2010

For more publications, please see the PubMed listing.

Clinical Trials

• Abatacept (CTLA4-lg) for the Treatment of Relapsing, Non Severe, Granulomatosis with Polyangiitis (Wegener’s) (ABROGATE)
• Gleevec in the Treatment of Systemic Sclerosis - EXTENSION STUDY
• Scleroderma Registry and Repository (Old IRB #26069)
• Randomized, Double-Blind, Placebo-Controlled Trial of IL1-Trap, Rilonacept in Systemic Sclerosis-A Phase I/II Biomarker Trial (Old IRB #14115)
• VCRC Genetic Repository One Time DNA Protocol - 2016
• The Natural History and Outcome of Scleroderma Patients at High Risk or with Early Pulmonary Hypertension: a Multicenter Study Performed by from the Scleroderma Clinical Trials Consortium (PHAROS)
• Prospective Registry of Early Systemic Sclerosis (PRESS)- Phenotypic, Serologic, and Biomarker/Genetic Characteristics of Early Diffuse Cutaneous Scleroderma
• A Double Blind, Randomized, Placebo-Controlled Trial Evaluating Efficacy and Safety of Oral Nintedanib Treatment for at Least 52 Weeks in Patients with “Systemic Sclerosis associated Interstitial Lung Disease” (SSc-ILD)
• The LOTUSS Trial: An Open-Label, Randomized, Phase 2 Study of the Safety and Tolerability of Pirfenidone When Administered to Patients With Systemic Sclerosis−Related Interstitial Lung Disease (SSc-ILD) (LOTUSS)
• An International, Open Label, Randomized Controlled Trial Comparing Rituximab with Azathioprine as Maintenance Therapy in Relapsing ANCA-Associated Vasculitis
• ASCI: A Randomized, Double-blind, Placebo-controlled, Phase II Multicenter Trial of a Monoclonal Antibody to CD20 (Rituximab) for the Treatment of Systemic Sclerosis Associated Pulmonary Arterial Hypertension (SSc-PAH)
• A Phase III, Multicenter, Randomized, Double-Blind Placebo-Controlled Study to Assess the Efficacy and Safety of Tocilizumab in Subjects with Giant Cell Arteritis
• Phase 3, Multi-Center, Multinational, Randomized, Double-Blind, Study to Evaluate the Efficacy and Safety of Belimumab (HGS1006) in Combination with Azathioprine for the Maintenance of Remission in Wegener’s Granulomatosis and Microscopic Polyangiitis
• Prospective, Observational Safety Study Of Patients With Granulomatosis With Polyangiitis (Wegener’s) Or Microscopic Polyangiitis Treated With Rituximab
• VCRC Genetic Repository One Time DNA Protocol - 2013
• Prospective, Randomized, Placebo-Controlled, Double-Blind, Multicenter, Parallel group Study to Assess the Efficacy, Safety and Tolerability of Macitentan in Patients with Ischemic Digital Ulcers Associated with Systemic Sclerosis
• Phase IIa Trial of Tocilizumab in the Treatment of Polymyalgia Rheumatica
• Phase II/III, Multicenter, Randomized, Double-blind Placebo-Controlled Study to Assess the Efficacy and Safety of Tocilizumab vs. Placebo in Patients with Systemic Sclerosis
• Studies of Immune Deregulation in Patients with Rheumatoid Arthritis, Polymyalgia Rheumatica and Vasculitis
• Natural History and Outcome of Scleroderma Patients at High Risk or with Early Pulmonary Hypertension
• Belimumab for the Treatment of Diffuse Cutaneous Systemic Sclerosis
• Abatacept in Large Vessel Vasculitis
• Nilotinib in the Treatment of Systemic Sclerosis
• DISTOL 1: Digital Ischemic Lesions in Scleroderma Treated with Oral Treprostinil Diethanolamine: a Randomized, Double-blind, Placebo-controlled, Multicenter Study
• Scleroderma Cyclophosphamide or Transplantation (SCOT) Study
• The Myositis Registry and Repository - 2011
• Rituximab Therapy For The Induction Of Remission And Tolerance In ANCA-Associated Vasculitis
• Gleevec in the Treatment of Systemic Sclerosis

Patient Registries

• Dr. Spiera is a principal investigator for these patient registries.