Maureen Dubreuil, MD MSc

Funding rates for R01s decreased in 2025 for applicants from all career stages. grants.nih.gov/news-events/...

Scenes from CAThens @rheumcat.bsky.social

🐎I just learned of this interesting treatment possibility for #axSpA: HIPPOTHERAPY! A simulator mimics movement of a horse. This makes sense bc of the lumbar spine & hip mobility that riding requires. My relative with axSpA said "Should I start horsing around?!" www.tandfonline.com/doi/full/10....

It is an honor to continue serving on the board of SPARTAN alongside this esteemed group. We met last week to discuss the direction of #spondyloarthritis research and the future looks bright!💡 @spartanrheum.bsky.social @nigil-haroon.bsky.social @rheumcat.bsky.social

🧵 New study alert!
💊 Does early TNF inhibitor (TNFi) therapy reduce chronic opioid use in axial spondyloarthritis (axSpA)?
👉 We looked at real-world US data to find out.

📄 Arthritis Care & Research, 2025
🔗 acrjournals.onlinelibrary.wiley.com/doi/10.1002/...
@rheumcat.bsky.social

Trends in Opioid Prescriptions in Individuals with Axial Spondyloarthritis in the US and UK in the Last Two Decades: Analysis of Electronic Health Records and Insurance Claims Data - PubMed Opioid prescriptions rates remained stable over time in the UK, while they slightly decreased in the US as TNFi uptake increased. These trends may reflect a US nationwide change in guidance for opioid...

Our paper looking at annual prescription rates of opioids 💊 vs NSAIDs 💊and TNF inhibitors 💉for people with axial spondyloarthritis in the US & UK is now out @acr-journals.bsky.social

pubmed.ncbi.nlm.nih.gov/40977482/

@degirmenciberk2.bsky.social is preparing a visual abstract, so stay tuned

🗣️ How might implementation science be applied in your field? Are there evidence-based interventions that need broader uptake?

Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from s...

Proctor’s Conceptual model spans the intervention 💡, strategies 🧩, outcomes 🛠️ and efficacy/effectiveness 📊. pmc.ncbi.nlm.nih.gov/articles/PMC...

The updated Consolidated Framework for Implementation Research based on user feedback - Implementation Science Background Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework. Methods User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2. Results The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation. Conclusion The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances.

CFIR (consolidated framework for implementation research) is a determinant framework addresses the inner and outer settings, the implementation process, the innovation and the individuals’ roles and characteristics. implementationscience.biomedcentral.com/articles/10....

PARIHS is a determinant framework based on the concept that implementation is a function of: A. Evidence (research, clinical expertise, patient preferences), B. Context (setting, resources) and C. Facilitation through influence and relationships.

🖼️Frameworks exist in 3 forms: (1) Process: how to plan and execute a strategy, (2) Determinant: factors that impede or enable the implementation process and (3) Evaluative: selection of outcomes to study

IS uses conceptual frameworks to systematically understand why people do what they do (patients, clinicians, healthcare systems), how to operationalize an intervention, how to scale it and how to assess outcomes

✅ IS takes places following efficacy and effectiveness studies, within controlled settings and in practice.
3 types of hybrid IS studies: Type 1: primary aim is to determine effectiveness, Type 2: Codetermining effectiveness & feasibility, Type 3: focuses on implementation

💡Implementation science (IS) is the study of methods and strategies that facilitate uptake of evidence based interventions into routine practice.

We at BU Rheum had the pleasure of learning from Drs. Divya Shankar and Mari-Lynn Drainone to speak today on Implementation Science. sites.bu.edu/ciis/ @bu-bmc-rheum.bsky.social

We found that adults with axSpA or PsA had ⬇️ odds of hip/knee replacement with use ofTNFi, non-TNFi biologics or DMARDs as compared to NSAIDs. Odds w/ JAK inhib was also lower but not statistically significant. Use this info in shared decision-making!

Veterans I care for at VA Boston showed me so much love today with tasty treats! Incredible tomatoes, spaghetti & meatballs and homemade BBQ sauce! @vaboston.bsky.social

Uterus, on the other hand, gets mixed reviews.

This is critically important to our understanding of SpA!

blue.mackuba.eu/skythread/?a...

Neutrophil Extracellular Traps–Associated RNA Impedes CD4+ Treg Differentiation by TLR7–IRF7 Axis in Ankylosing Spondylitis Objective Our objective was to investigate the role of neutrophil extracellular traps (NETs) in the pathogenesis of inflammatory disorders in ankylosing spondylitis (AS). Methods Local and circula.....

🥅 NETs also important in SpA! Uveitis has high serum NETs (human & mouse studies). When neutrophil function is blocked using anti-Ly6G, IL-17 is 🔻 in ocular fluid. NETs provoke intraocular inflammation and also IL17-mediated systemic inflammation. acrjournals.onlinelibrary.wiley.com/doi/10.1002/...

Neutrophils are important in SpA! Card9 was found in axSpA GWAS (gain of function). It is involved a canonical NFKB pathway ➡️ inflammation via IL-1beta. Ruth Napier et al. found Card9 in neutrophils potentiates IL-17 production by CD4+ T cells doi.org/10.1136/ard-...

Macrophage migration inhibitory factor drives pathology in a mouse model of spondyloarthritis and is associated with human disease Macrophage migration inhibitory factor produced by neutrophils worsens spondyloarthritis by inducing a pathogenic TH17 phenotype in Tregs.

CD74 is on MHC I & is the receptor for macrophage migration inhibitory factor (MIF). Anti-CD74 are ⬆️ in SpA and MIF concentration is associated with rapid axSpA progression. MIF is made by mesenchymal stem cells under stress promotes Th17 differentiation. www.science.org/doi/10.1126/...

⛔ How might HLA-B27 *negative* axSpA develop? Mechanisms include anti-CD74, MIF, Card9 and NETs! acrjournals.onlinelibrary.wiley.com/cms/asset/11...

CD8+ T cells expressed marker for mucosal trafficking and differentiation including CD161 and integrins. Early activation of pathogenic T cells may occur in enteric organs, and then migrate to gut and eye. df6sxcketz7bb.cloudfront.net/manuscripts/...

Autoimmunity-associated T cell receptors recognize HLA-B*27-bound peptides - Nature A study shows that cross-reactivity of microbial antigens and self-antigens presented by HLA-B*27 may be important in the pathogenesis of diseases associated with HLA-B*27 and identifies the shared bi...

🦠 Blood and synovial fluid in axSpA contains T cell clones w/ specific TCR beta chains (e.g. TRBV9). TRBV9 cells were screened against a peptide library 📚 finding YEIH, a peptide conserved in bacteria (E. coli, salmonella, shigella, klebsiella, yersinia).
www.nature.com/articles/s41...

Peptide processing is altered in axSpA. Peptides are trimmed in the endoplasmic reticulum by enzymes ERAP 1 & 2. ERAP variants have been identified through GWAS in axSpA but some studies have shown that ERAP knock out is *protective* against axSpA. More research is needed.

🧬 Risk of axSpA differs based on HLA-B27 subtype. HLAB27 is the gene that codes for MHC Class I, which presents peptides to CD8+ T cells. ❄️HLAB27 MHCs are unique- they misfold as a homodimers 👯 which leads to a conserved cell stress response: the unfolded protein response (UPR) and inflammation.

The SPARTAN Review Course is on! Dr. Aki Nakamura presented on the pathogenesis of axial spondyloarthritis, highlighting new science around HLA-B27, arthritogenic peptides and mechanisms of disease independent of HLA-B27. deptmed.queensu.ca/index.php/pe...

💫As part of our T32 lecture series @bu-bmc-rheum.bsky.social welcomed Drs. Sarah Bagley (GIM) and Vanessa Xanthakis (Preventive Med) to discuss LIFE HACKS FOR BUSY RESEARCHERS. Highlights here. Do you have any tips to share? www.bumc.bu.edu/rheumatology...