A woman with Sjogren's syndrome and a new diagnosis of Evans syndrome: a case report.

Background: Evans syndrome (ES) is a rare disease characterized by the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) with immune thrombocytopenia (ITP), and less frequently autoimmune neutropenia. ES can be primary or secondary to another disease. Isolated immune cytopenias have been reported with Sjogren's syndrome (SS) in the past, but the association with ES has very rarely been reported. Case Description: We present a patient with a known history of SS who presented with mild bleeding symptoms, such as heavier menses and new ecchymoses. She was found to have a very low haptoglobin, spherocytes on peripheral smear, positive direct antiglobulin test, and positive eluate testing. The findings were consistent with severe ITP and AIHA, leading to a diagnosis of secondary ES. She was treated with high-dose steroids for 4 days concurrent with 2 days of intravenous immunoglobulin (IVIG) with marked improvement in her hematological function. She was discharged on a steroid taper and remained in remission at follow-up visits. Conclusions: Although ES is a rare presentation of autoimmune disease, it is associated with high mortality and necessitates prompt clinical identification and appropriate therapy selection. Further research is necessary to understand the associated clinical characteristics, determine prognosis, and provide management recommendations.

Enhancing Care Partnerships Using a Rheumatology Dashboard: Bringing Together What Matters Most to Both Patients and Clinicians.

OBJECTIVE: Dashboards can support person-centered care by helping people partner with their clinicians to coproduce care based on preferences, shared decision-making, and evidence-based treatments. We engaged caregivers of children with juvenile idiopathic arthritis (JIA), adults with rheumatoid arthritis (RA), and clinicians in a pilot study to assess their experiences and the utility and impact of an electronic previsit questionnaire and point-of-care dashboard to support coproduction of rheumatology care. METHODS: We employed a mixed-methods design to assess users' perceptions of a customized electronic health record rheumatology module at four pediatric rheumatology practices and two adult rheumatology practices. We surveyed a convenience sample of caregivers of children with JIA (n = 113), adults with RA (n = 116), and clinicians (n = 12). We conducted semistructured interviews with 13 caregivers and patients and six care teams. Experiences were evaluated using descriptive statistics and thematic analyses. RESULTS: Caregivers of children with JIA and adults with RA reported the dashboards were useful during discussions (88%) and helped them talk about what mattered most (82%), make health care decisions (83%), and create a treatment plan (77%). Clinicians provided similar feedback. Two-thirds (67%) of caregivers and adults and 55% of clinicians would recommend the dashboard to peers. System usability scores (77.1 ± 15.6) were above average. Dashboards helped users make sense of health information, communicate more effectively, and make decisions. Improvements to the dashboards and workflows could enhance patient self-management and clinician efficiency. CONCLUSION: Visual point-of-care dashboards can support caregivers, patients, and clinicians to coproduce rheumatology care. Findings demonstrate a need to spread and scale for broader benefit and impact.