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Zimmermann-Geller B, Köppert S, Kesel N, Hasseli R, Ullrich S, Lefèvre S, Frommer K, Gehrke T, Schönburg M, Rehart S, Schumacher U, Müller-Ladner U, Neumann E. Interactions between rheumatoid arthritis synovial fibroblast migration and endothelial cells. Immunol Cell Biol 2018; 97:178-189. [DOI: 10.1111/imcb.12208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 11/09/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Birgit Zimmermann-Geller
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Sina Köppert
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Nina Kesel
- Institute for Anatomy II: Experimental Morphology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Rebecca Hasseli
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Sebastian Ullrich
- Institute for Anatomy II: Experimental Morphology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Stephanie Lefèvre
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Klaus Frommer
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery; Helios ENDO-Klinik Hamburg; Hamburg Germany
| | - Markus Schönburg
- Department of Cardiac Surgery; Kerckhoff-Klinik; Bad Nauheim Germany
| | - Stephan Rehart
- Department of Orthopedics and Trauma Surgery; Agaplesion Markus Hospital; Frankfurt Germany
| | - Udo Schumacher
- Institute for Anatomy II: Experimental Morphology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology; Justus-Liebig-University Gießen; Campus Kerckhoff Bad Nauheim Germany
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152
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Chaigne B, Scirè CA, Talarico R, Alexander T, Amoura Z, Avcin T, Beretta L, Doria A, Guffroy A, Guimarães V, Hachulla É, Krieg T, Launay D, Lepri G, Moinzadeh P, Müller-Ladner U, Rednic S, Rodrigues A, Tas SW, van Vollenhoven RF, Vieira A, Bombardieri S, Fonseca JE, Galetti I, Schneider M, Smith V, Cutolo M, Mosca M, Fischer-Betz R. Mixed connective tissue disease: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000783. [PMID: 30402271 PMCID: PMC6203102 DOI: 10.1136/rmdopen-2018-000783] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 11/05/2022] Open
Abstract
Mixed connective tissue disease (MCTD) is a complex overlap disease with features of different autoimmune connective tissue diseases (CTDs) namely systemic sclerosis, poly/dermatomyositis and systemic lupus erythematous in patients with antibodies targeting the U1 small nuclear ribonucleoprotein particle. In this narrative review, we summarise the results of a systematic literature research which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines (CPGs) or recommendations. Since no specific CPGs on MCTD were found, other CPGs developed for other CTDs were taken into consideration in order to discuss what can be applied to MCTD even if designed for other diseases. Three major objectives were proposed for the future development of CPGs: MCTD diagnosis (diagnostic criteria), MCTD initial and follow-up evaluations, MCTD treatment. Early diagnosis, epidemiological data, assessment of burden of disease and QOL aspects are among the unmet needs identified by patients.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Doria
- Rheumatology Unit Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Aurelien Guffroy
- Service de rhumatologie Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest, Strasbourg, France
| | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Éric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest, Lille, France
| | - Thomas Krieg
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest, Lille, France
| | - Gemma Lepri
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine AOU Careggi, University of Florence, Florence, Italy
| | - Pia Moinzadeh
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Ana Rodrigues
- Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Sander W Tas
- Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | - Ronald F van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | | | - João Eurico Fonseca
- Rheumatology Department Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Libson, Portugal
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Milan, Italy
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | | | - Rebecca Fischer-Betz
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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153
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Frommer KW, Vasile M, Müller-Ladner U, Neumann E. The Adipokine Omentin in Late-stage Rheumatoid Arthritis and Endstage Osteoarthritis. J Rheumatol 2018; 44:539-541. [PMID: 28604350 DOI: 10.3899/jrheum.161267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Klaus W Frommer
- Department of Internal Medicine and Rheumatology, University of Giessen, Kerckhoff Clinic, Bad Nauheim, Germany;
| | - Massimilano Vasile
- Department of Internal Medicine and Rheumatology, University of Giessen, Kerckhoff Clinic, Bad Nauheim, Germany, and Department of Medical Specialties, Division of Rheumatology, Sapienza University of Rome, Rome, Italy
| | - Ulf Müller-Ladner
- Professor, University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, University of Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
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154
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Schreiber J, Müller-Ladner U. [Treatment of rheumatic diseases and pulmonary toxicity]. Pneumologe (Berl) 2018; 15:404-412. [PMID: 32288712 PMCID: PMC7101753 DOI: 10.1007/s10405-018-0209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Rheumatic diseases are treated with manifold different drugs that can potentially be pneumotoxic. Adverse effects of drug therapy may induce a wide variety of bronchopulmonary and pleural disorders, which can have a life-threatening course. These side effects rarely have pathognomonic features; therefore, drug-induced diseases are relevant differential diagnoses of pulmonary manifestations of rheumatic diseases, infections, and other independent genuine pulmonary diseases. Diagnosis is based mainly on verification of a compatible disease pattern and exclusion of differential diagnoses, as well as on assessment of the temporal relationship and the consequences of drug abstention.
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Affiliation(s)
- J. Schreiber
- Klinik für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Deutschland
| | - U. Müller-Ladner
- Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Deutschland
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155
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Jaeger VK, Valentini G, Hachulla E, Cozzi F, Distler O, Airó P, Czirják L, Allanore Y, Siegert E, Rosato E, Matucci-Cerinic M, Caimmi C, Henes J, Carreira PE, Smith V, Del Galdo F, Denton CP, Ullman S, De Langhe E, Riccieri V, Alegre-Sancho JJ, Rednic S, Müller-Ladner U, Walker UA. Brief Report: Smoking in Systemic Sclerosis: A Longitudinal European Scleroderma Trials and Research Group Study. Arthritis Rheumatol 2018; 70:1829-1834. [PMID: 29781588 DOI: 10.1002/art.40557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Data on the role of tobacco exposure in systemic sclerosis (SSc; scleroderma) severity and progression are scarce. We aimed to assess the effects of smoking on the evolution of pulmonary and skin manifestations, based on the European Scleroderma Trials and Research group database. METHODS Adult SSc patients with data on smoking history and a 12-24-month follow-up visit were included. Associations of severity and progression of organ involvement with smoking history and the Comprehensive Smoking Index were assessed using multivariable regression analyses. RESULTS A total of 3,319 patients were included (mean age 57 years, 85% female); 66% were never smokers, 23% were ex-smokers, and 11% were current smokers. Current smokers had a lower percentage of antitopoisomerase autoantibodies than previous or never smokers (31% versus 40% and 45%, respectively). Never smokers had a higher baseline forced expiratory volume in 1 second/forced vital capacity (FEV1 /FVC) ratio than previous and current smokers (P < 0.001). The FEV1 /FVC ratio declined faster in current smokers than in never smokers (P = 0.05) or ex-smokers (P = 0.01). The baseline modified Rodnan skin thickness score (MRSS) and the MRSS decline were comparable across smoking groups. Although heavy smoking (>25 pack-years) increased the odds of digital ulcers by almost 50%, there was no robust adverse association of smoking with digital ulcer development. CONCLUSION The known adverse effect of smoking on bronchial airways and alveoli is also observed in SSc patients; however, robust adverse effects of smoking on the progression of SSc-specific pulmonary or cutaneous manifestations were not observed.
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Affiliation(s)
| | | | - Eric Hachulla
- Service de Médecine Interne, Hôpital Huriez, Université de Lille, Lille, France
| | | | | | | | | | - Yannick Allanore
- Department of Rheumatology A, Paris Descartes University, Cochin Hospital, Paris, France
| | | | | | | | | | - Jörg Henes
- Eberhard-Karls-University Tübingen, Tübingen, Germany
| | | | - Vanessa Smith
- Ghent University and Ghent University Hospital, Ghent, Belgium
| | | | | | - Susanne Ullman
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Simona Rednic
- University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
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156
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Wegner F, Müller-Ladner U, Meier FMP. Dr. Wegner, et al, reply. J Rheumatol 2018; 45:875. [PMID: 29858457 DOI: 10.3899/jrheum.171439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Franz Wegner
- University Hospital Schleswig Holstein, Campus Lübeck, Department of Radiology and Nuclear Medicine, Lübeck, and University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic;
| | - Florian M P Meier
- University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic
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157
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Cutolo M, Melsens K, Herrick AL, Foeldvari I, Deschepper E, De Keyser F, Distler O, Ingegnoli F, Mostmans Y, Müller-Ladner U, Pizzorni C, Riccieri V, Ruaro B, Sulli A, Trombetta AC, Vanhaecke A, Smith V. Reliability of simple capillaroscopic definitions in describing capillary morphology in rheumatic diseases. Rheumatology (Oxford) 2018; 57:757-759. [PMID: 29361155 DOI: 10.1093/rheumatology/kex460] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Karin Melsens
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Francesca Ingegnoli
- Division of Rheumatology, Instituto Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Yora Mostmans
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Department of Dermatology, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Immunology and Allergology (CIA), Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany.,Department of Internal Medicine and Rheumatology, Justus-Liebig University Giessen, Giessen, Germany
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, University Sapienza Rome, Rome, Italy
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Amelia C Trombetta
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
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158
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Jaeger VK, Distler O, Maurer B, Czirják L, Lóránd V, Valentini G, Vettori S, Del Galdo F, Abignano G, Denton C, Nihtyanova S, Allanore Y, Avouac J, Riemekasten G, Siegert E, Huscher D, Matucci-Cerinic M, Guiducci S, Frerix M, Tarner IH, Garay Toth B, Fankhauser B, Umbricht J, Zakharova A, Mihai C, Cozzi F, Yavuz S, Hunzelmann N, Rednic S, Vacca A, Schmeiser T, Riccieri V, García de la Peña Lefebvre P, Gabrielli A, Krummel-Lorenz B, Martinovic D, Ancuta C, Smith V, Müller-Ladner U, Walker UA. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford) 2018; 57:441-450. [PMID: 28499034 DOI: 10.1093/rheumatology/kex182] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc. Methods SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions. Results The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 ⩽ SHAQ < 1), 34% in the moderate to severe disability category (1 ⩽ SHAQ < 2) and 7% in the severe to very severe disability category (2 ⩽ SHAQ ⩽ 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all vs modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15). Conclusion SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | | | - Serena Vettori
- Department of Rheumatology, Second University of Naples, Naples, Italy
| | - Francesco Del Galdo
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Giuseppina Abignano
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Christopher Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Yannick Allanore
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - Jerome Avouac
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | | | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité
| | | | | | - Serena Guiducci
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Beata Garay Toth
- Federation of European Scleroderma Associations Aisbl, Budapest, Hungary
| | | | | | | | - Carina Mihai
- Department of Internal Medicine and Rheumatology, Dr Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Altunizade-Istanbul, Turkey
| | | | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Vacca
- II Chair of Rheumatology, University of Cagliari-Policlinico Universitario, Monserrato, Italy
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Krankenhaus St Josef, Wuppertal, Germany
| | - Valeria Riccieri
- Divisione di Reumatologia, Università di Roma La Sapienza, Roma, Italy
| | | | - Armando Gabrielli
- Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Duska Martinovic
- Division of Rheumatology, University Hospital of Split, Split, Croatia
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
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159
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Peytrignet S, Denton CP, Lunt M, Hesselstrand R, Mouthon L, Silman A, Pan X, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuta C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, Inanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Herrick AL. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study. Rheumatology (Oxford) 2018; 57:370-381. [PMID: 29207002 PMCID: PMC5850714 DOI: 10.1093/rheumatology/kex410] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features. Methods Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined. Results The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (s.d.) HAQ-DI 1.1 (0.83)], with ‘grip’ and ‘activity’ being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (ρ = 0.34, P < 0.0001 and ρ = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (ρ = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (ρ = 0.40, P < 0.0001), decreasing hand function (ρ = 0.57, P < 0.0001) and increasing fatigue (ρ = −0.53, P < 0.0001). Conclusion The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.
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Affiliation(s)
- Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularités Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Edith Brown
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | - Kim Fligelstone
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rachel Ochiel
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, Hôpital Saint-Louis, Paris, France
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Heath Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Wendy Stevens
- Rheumatology Unit, St Vincent's Hospital, Melbourne, Australia
| | - Pia Moinzadeh
- Department for Dermatology, University of Cologne, Köln, Germany
| | - Frances C Hall
- Department of Clinical Medicine, Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours, Tours, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Rheumatology, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Yasmeen Ahmad
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, UK
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander J MacGregor
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Neil McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | - Jennifer Hamilton
- Department of Rheumatology, Gateshead Hospitals Foundation Trust, Gateshead, UK
| | - Murat Inanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, Scotland, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
| | - Sanjay Pathare
- Rheumatology, James Cook University Hospital, Middlesbrough, UK
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | - Tom Sheeran
- Department of Rheumatology, Cannock Chase Hospital, Cannock, UK
| | - Douglas J Veale
- Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - Claire Grange
- Department of Internal Medicine 69310, Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France
| | - Georges-Selim Trad
- Internal Medecine, Ambroise Paré Hospital, Boulogne, Billancourt, France
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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160
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Schett G, Bozec A, Bekeredjian-Ding I, Chang HD, David JP, Dörner T, Grässel S, Gunzer M, Manz R, Mei H, Mielenz D, Müller-Ladner U, Neumann E, Radbruch A, Richter W, Straub RH. [New insights into the function of bone marrow]. Z Rheumatol 2018; 77:4-7. [PMID: 29691692 DOI: 10.1007/s00393-018-0456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- G Schett
- Universitätsklinikum Erlangen, Medizinische Klinik 3 - Rheumatologie und Immunologie, Friedrich-Alexander Universität Erlangen - Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - A Bozec
- Universitätsklinikum Erlangen, Medizinische Klinik 3 - Rheumatologie und Immunologie, Friedrich-Alexander Universität Erlangen - Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - I Bekeredjian-Ding
- Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225, Langen, Deutschland
| | - H-D Chang
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz Gemeinschaft, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J-P David
- Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - T Dörner
- Med. Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - S Grässel
- Orthopädische Klinik, Exp. Orthopädie, Universität Regensburg, ZMB im Biopark 1, 93053, Regensburg, Deutschland
| | - M Gunzer
- Universitätsklinikum Essen, Institut für Experimentelle Immunologie und Bildgebung, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - R Manz
- Institut für Systemische Entzündungsforschung, Universität Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - H Mei
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz Gemeinschaft, Charitéplatz 1, 10117, Berlin, Deutschland
| | - D Mielenz
- Molekular-Immunologische Abteilung in der Medizinischen Klinik 3, Universitätsklinikum Erlangen, Glückstr. 6, 91054, Erlangen, Deutschland
| | - U Müller-Ladner
- Abt. Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2, 61231, Bad Nauheim, Deutschland
| | - E Neumann
- Abt. Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2, 61231, Bad Nauheim, Deutschland
| | - A Radbruch
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz Gemeinschaft, Charitéplatz 1, 10117, Berlin, Deutschland
| | - W Richter
- Forschungszentrum für Experimentelle Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - R H Straub
- Labor für Exp. Rheumatologie und Neuroendokrinimmunologie, Klinik für Innere Medizin, Universitätsklinikum, 93053, Regensburg, Deutschland
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161
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Herrick AL, Peytrignet S, Lunt M, Pan X, Hesselstrand R, Mouthon L, Silman AJ, Dinsdale G, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk MC, Ancuţa C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jobanputra P, Jordan AC, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov NS, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, İnanç M, McLaren JS, van Laar JM, Pathare S, Proudman SM, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Denton CP. Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study. Ann Rheum Dis 2018; 77:563-570. [PMID: 29306872 PMCID: PMC5890636 DOI: 10.1136/annrheumdis-2017-211912] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs). METHODS The modified Rodnan skin score (mRSS) was recorded every 3 months in 326 patients. 'Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (±3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV). RESULTS 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%. CONCLUSIONS Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years. TRIAL REGISTRATION NUMBER NCT02339441.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sebastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Medicine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Paris, France
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Graham Dinsdale
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Edith Brown
- University of Manchester, Manchester, Greater Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pecs, Pecs, Hungary
| | - Jörg H W Distler
- Department of Internal Medicine III, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | | | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Madelon C Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuţa
- Rheumatology 2 Department, 'Grigore T. Popa' University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Voon H Ong
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Dominique Farge
- Unite Clinique de Medicine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, Paris, France
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Paresh Jobanputra
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Wendy Stevens
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Pia Moinzadeh
- Department for Dermatology, University of Cologne Kerpener Str, Cologne, Germany
| | - Frances C Hall
- Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours, Tours, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
| | | | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Nemanja S Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust and Nottingham NHS Treatment Centre, Nottingham, UK
| | | | | | - Søren Jacobsen
- University of Copenhagen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | | | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, Victoria, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Health and Department Medicine, Monash Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | | | | | - Claire Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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162
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Cutolo M, Melsens K, Wijnant S, Ingegnoli F, Thevissen K, De Keyser F, Decuman S, Müller-Ladner U, Piette Y, Riccieri V, Ughi N, Vandecasteele E, Vanhaecke A, Smith V. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev 2018; 17:344-352. [PMID: 29427827 DOI: 10.1016/j.autrev.2017.11.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 01/03/2023]
Abstract
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Via Balbi 5, Genoa, Italy.
| | - Karin Melsens
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Sara Wijnant
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy.
| | - Kristof Thevissen
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Benekestraße 2-8, 61231 Bad Nauheim, Germany.
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialities, Sapienza University, Piazzale Aldo Moro 5, Rome, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy
| | - Els Vandecasteele
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
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163
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Müller-Ladner U. Off to On: Biologikatherapie bei systemisch-immunologischen Erkrankungen. Z Rheumatol 2018; 77:10-11. [DOI: 10.1007/s00393-017-0406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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164
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Braun J, Lorenz HM, Müller-Ladner U, Schneider M, Schulze-Koops H, Specker C, Strangfeld A, Wagner U, Dörner T. [Revised version of the statement by the DGRh on biosimilars-update 2017]. Z Rheumatol 2018; 77:81-90. [PMID: 29383440 DOI: 10.1007/s00393-017-0407-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The treatment of rheumatic diseases with bioloics has significantly improved the prognosis of patients. Currently, there are 13 preparations available in Germany for the treatment of patients with inflammatory rheumatic diseases. These original preparations generally have-depending on the individual country-15 years of patent protection. As soon as the patent has expired, approved biosimilars can be brought into use. For the approval of a biosimilar, authorities such as the European Medical Agency or the American Food and Drug Administration require proof of the best possible comparability with respect to efficacy and safety in comparison to the original or reference product. Since 2015, biosimilars of inifliximab, adalimumab, etanercept and rituximab have been granted approval in the European Union, the USA, Japan and in other countries. Further biosimilar products for these reference products are in development for treatment in rheumatology. From a societal and medical point of view, this opens up the possibility to increase the availability of biopharmaceutical products for patients through lower prices. In Germany, this possibility has already occurred-statutory health insurance physicians have introduced quotas for biosimilars, which will ultimately decrease spending and healthcare costs. This can lead to price reductions of the original products, which has already happened in Germany. Biosimilars can be prescribed for new patients or as a change from the original to the generic drug. When switching, a distinction is made between individual switching (interchangeability), which is made in individual consultation between the physician and the patient, and nonmedical switching (substitution) made at the societal or governmental level, which is made in the context of health care cost containment, and then, for example, implemented at the pharmacy level. Preliminary data from Norway and Denmark are available for substitution on the basis of results from large studies or registries in which systematic changes were made. The previous conclusion was that this does not lead to new problems for the patients. The German Society for Rheumatology recognizes the advantages of introducing biosimilars in Germany, but recommends that their use be based primarily on a joint decision by the treating physician and patient.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - H M Lorenz
- Medizinische Universitätsklinik V: Hämatologie, Onkologie, Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
| | - M Schneider
- Poliklinik und Hiller Forschungszentrum für Rheumatologie, Heinrich-Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Poliklinik und Hiller Forschungszentrum für Rheumatologie, Heinrich-Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Klinikum der Universität München, München, Deutschland
| | - Ch Specker
- Klinik für Rheumatologie und klinische Immunologie, St. Josef Krankenhaus Essen-Werden, Universitätsmedizin Essen, Essen, Deutschland
| | - A Strangfeld
- Programmbereich Epidemiologie, Leibniz-Institut, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Deutschland
| | - U Wagner
- Sektion Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - T Dörner
- Abteilung für Rheumatologie, Medizinische Klinik, Rheumatologie und klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland.,Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland
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165
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Lambova SN, Müller-Ladner U. Mosaic capillaroscopic findings in systemic sclerosis. Wien Med Wochenschr 2018; 168:248-249. [DOI: 10.1007/s10354-018-0617-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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166
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Arnold MB, Khanna D, Denton CP, van Laar JM, Frech TM, Anderson ME, Baron M, Chung L, Fierlbeck G, Lakshminarayanan S, Allanore Y, Riemekasten G, Steen V, Müller-Ladner U, Spotswood H, Burke L, Siegel J, Jahreis A, Furst DE, Pope JE. Patient acceptable symptom state in scleroderma: results from the tocilizumab compared with placebo trial in active diffuse cutaneous systemic sclerosis. Rheumatology (Oxford) 2017; 57:152-157. [PMID: 29077900 DOI: 10.1093/rheumatology/kex396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives Patient acceptable symptom state (PASS) as an absolute state of well-being has shown promise as an outcome measure in many rheumatologic conditions. We aimed to assess whether PASS may be effective in active diffuse cutaneous SSc differentiating active from placebo. Methods Data from the phase 2 Safety and Efficacy of Subcutaneous Tocilizumab in Adults with Systemic Sclerosis (faSScinate) trial were used, which compared tocilizumab (TCZ) vs placebo over 48 weeks followed by an open-label TCZ period to 96 weeks. Three different types of PASS questions were evaluated at weeks 8, 24, 48 and 96, including if a current state would be acceptable over time as a yes vs no response and Likert scales about how acceptable a current state is if remaining over time. Additional outcomes assessed included modified Rodnan skin score, HAQ disability index (HAQ-DI), physician and patient global assessments on a visual analogue scale, CRP and ESR. Results The placebo group consisted of 44 patients and the TCZ group had 43 patients. At baseline, 33% achieved a PASS for all three PASS questions, with the proportion increasing to 69, 71 and 78%, respectively, at 96 weeks. Changes in PASS scores showed a moderately negative correlation with HAQ-DI and patient and physician global assessments visual analogue scales, which indicates expected improvements as PASS improved. The PASS question, 'Considering all of the ways your scleroderma has affected you, how acceptable would you rate your level of symptoms?' showed significant correlations with patient-reported outcomes and differentiating placebo vs TCZ at 48 weeks (P = 0.023). Conclusion PASS may be used as a patient-centred outcome in SSc, especially as a 7-point Likert scale. Further validation is required to determine the utility as an outcome measure in trials and clinical practice.
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Affiliation(s)
- Michael B Arnold
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dinesh Khanna
- Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Christopher P Denton
- Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK
| | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University of Utrecht, Utrecht, The Netherlands
| | - Tracy M Frech
- Rheumatology, University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Marina E Anderson
- Rheumatology, University of Liverpool and Aintree University Hospital, Liverpool, UK
| | - Murray Baron
- Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Lorinda Chung
- Medicine and Dermatology, Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | | | | | | | - Gabriela Riemekasten
- Rheumatology, Charité University Hospital, German Rheumatism Research Center, Berlin, Germany
| | - Virginia Steen
- Rheumatology, Georgetown University, Washington, DC, USA
| | - Ulf Müller-Ladner
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | | | | | - Jeffrey Siegel
- Rheumatology and Rare Diseases, Genentech, South San Francisco
| | | | - Daniel E Furst
- Rheumatology, University of California, Los Angeles, CA, USA
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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167
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Hülser ML, Frommer K, Müller-Ladner U. Die Rolle des Metabolismus und metabolisch relevanter Faktoren in der Pathophysiologie rheumatischer Erkrankungen. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0043-121037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungBei der Entstehung und dem Verlauf rheumatischer Erkrankungen spielen Adipositas, Metabolisches Syndrom (MetS) und Stoffwechselerkrankungen wie Diabetes eine wichtige Rolle. Wichtige Faktoren sind hierbei Fettgewebshormone wie z. B. Adiponektin und Leptin, aber auch andere biologisch aktive Faktoren des Metabolismus, wie die freien und gebundenen Fettsäuren im Blut und die Cholesterinwerte, welche den Krankheitsverlauf von Patienten mit rheumatischen Erkrankungen beeinflussen. Sowohl für Patienten mit rheumatoider Arthritis (RA) und Psoriasis-Arthritis (PsA) als auch für die nicht autoimmun beeinflusste Arthrose stellt Adipositas einen anerkannten Risikofaktor dar und ist somit von pathophysiologischer Bedeutung. Ein Einfluss auf das Ansprechen auf Medikamente wurde ebenso beobachtet. So erreichen übergewichtige PsA-Patienten, v. a. bei vermehrtem abdominalem Fett, unter TNFα-Blocker-Therapie mit geringerer Wahrscheinlichkeit eine minimale Krankheitsaktivität. In der Pathophysiologie rheumatischer Erkrankungen ist Fettgewebe außerdem wichtig als IL-6-Produzent, da IL-6 zu etwa einem Drittel im Fettgewebe produziert wird und eine Reduktion des Körpergewichts auch zur Reduktion des Serum-IL-6-Spiegels führt. Die Interaktion zwischen Immunsystem und biologisch aktiven Faktoren aus dem Metabolismus bei entzündlichen Erkrankungen funktioniert in beide Richtungen, wodurch die Wirknetzwerke sehr komplex werden. Der Entzündungsmarker C-reaktives Protein (CRP) bspw. bindet im Serum an Leptin und verhindert dadurch dessen Wirkung bzw. die Signalweiterleitung an die Zielzellen. Gleichzeitig fördert Leptin in der Leber die Bildung von CRP. Über diese gegenseitigen Einflüsse kann vermutlich CRP die Adipositas und deren Komorbiditäten beeinflussen. Der CRP-Spiegel korreliert aber auch negativ mit den HDL-Werten, und die Lipidwerte im Blut werden durch akute oder chronische Entzündung signifikant verändert. Auch die neuen Therapieansätze mit „Small Molecules“ wie z. B. Tofacitinib wirken sich nicht nur auf die Entzündung, sondern auch auf den Metabolismus aus. So wurde gezeigt, dass Patienten mit RA signifikant niedrigere Werte an Gesamtcholesterin, HDL-C, LDL-C und Apo-A1 im Vergleich zu gesunden Kontrollen aufweisen. Diese werden aber unter Behandlung mit Tofacitinib signifikant erhöht und nähern sich somit den Werten der gesunden Kontrollgruppe an.
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Affiliation(s)
- Marie-Lisa Hülser
- Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik, Justus-Liebig-Universität Gießen, Bad Nauheim
| | - Klaus Frommer
- Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik, Justus-Liebig-Universität Gießen, Bad Nauheim
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik, Justus-Liebig-Universität Gießen, Bad Nauheim
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168
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Zink A, Braun J, Gromnica-Ihle E, Krause D, Lakomek HJ, Mau W, Müller-Ladner U, Rautenstrauch J, Specker C, Schneider M. [Memorandum of the German Society for Rheumatology on the quality of treatment in rheumatology - Update 2016]. Z Rheumatol 2017; 76:195-207. [PMID: 28364218 DOI: 10.1007/s00393-017-0297-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases. At least 2 internist rheumatologists are needed for the outpatient care of 100,000 adult inhabitants, equivalent to 1350 rheumatologists in Germany. With currently 776 rheumatologists, we have little more than half of what we need. The German Society for Rheumatology calls for specific requirements planning for rheumatologists in outpatient care in order to decrease the deficit. In acute inpatient care we need specialized hospitals and wards that ensure a high quality of treatment for patients with complex diseases. We need up to 50 beds per 1 million inhabitants. At least 2 full-time internist rheumatologists and 3 further physicians are needed per 30 beds. In inpatient and outpatient rehabilitation we need 40 beds or outpatient places per 1 million inhabitants with at least 1 full-time rheumatologist and 1 further physician. In order to reduce the existing deficits and to cover the increasing future need for rheumatologists, more emphasis has to be laid on primary and secondary education. Chairs for internal rheumatology are needed at each medical university and more positions for postgraduate training in rheumatology should be provided. In all segments of healthcare the treatment aims should be jointly defined between patients and physicians. The patients should be treated in an interdisciplinary network, comprising other medical specialties, health professionals as well as patient organizations.
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Affiliation(s)
- A Zink
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie und Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Deutschland
| | | | - D Krause
- Internistische und rheumatologische Gemeinschaftspraxis, Gladbeck, Deutschland
| | - H J Lakomek
- Klinik für Rheumatologie und Interdisziplinäre Geriatrie, Universitätszentrum Innere Medizin, Johannes Wesling Klinikum Minden, Minden, Deutschland
| | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - U Müller-Ladner
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
- Abteilung Rheumatologie und klinische Immunologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - J Rautenstrauch
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Rheumazentrum Rhein-Ruhr e.V., St. Josef Krankenhaus (Universitätsklinikum Essen), Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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169
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Khanna D, Denton CP, Lin CJF, van Laar JM, Frech TM, Anderson ME, Baron M, Chung L, Fierlbeck G, Lakshminarayanan S, Allanore Y, Pope JE, Riemekasten G, Steen V, Müller-Ladner U, Spotswood H, Burke L, Siegel J, Jahreis A, Furst DE. Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the open-label period of a phase II randomised controlled trial (faSScinate). Ann Rheum Dis 2017; 77:212-220. [PMID: 29066464 PMCID: PMC5867414 DOI: 10.1136/annrheumdis-2017-211682] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/16/2023]
Abstract
Objectives Assess the efficacy and safety of tocilizumab in patients with systemic sclerosis (SSc) in a phase II study. Methods Patients with SSc were treated for 48 weeks in an open-label extension phase of the faSScinate study with weekly 162 mg subcutaneous tocilizumab. Exploratory end points included modified Rodnan Skin Score (mRSS) and per cent predicted forced vital capacity (%pFVC) through week 96. Results Overall, 24/44 (55%) placebo-tocilizumab and 27/43 (63%) continuous-tocilizumab patients completed week 96. Observed mean (SD (95% CI)) change from baseline in mRSS was –3.1 (6.3 (–5.4 to –0.9)) for placebo and –5.6 (9.1 (–8.9 to–2.4)) for tocilizumab at week 48 and –9.4 (5.6 (–8.9 to –2.4)) for placebo-tocilizumab and –9.1 (8.7 (–12.5 to –5.6)) for continuous-tocilizumab at week 96. Of patients who completed week 96, any decline in %pFVC was observed for 10/24 (42% (95% CI 22% to 63%)) placebo-tocilizumab and 12/26 (46% (95% CI 27% to 67%)) continuous-tocilizumab patients in the open-label period; no patients had >10% absolute decline in %pFVC. Serious infection rates/100 patient-years (95% CI) were 10.9 (3.0 to 27.9) with placebo and 34.8 (18.0 to 60.8) with tocilizumab during the double-blind period by week 48 and 19.6 (7.2 to 42.7) with placebo-tocilizumab and 0.0 (0.0 to 12.2) with continuous-tocilizumab during the open-label period. Conclusions Skin score improvement and FVC stabilisation in the double-blind period were observed in placebo-treated patients who transitioned to tocilizumab and were maintained in the open-label period. Safety data indicated increased serious infections in patients with SSc but no new safety signals with tocilizumab. Trial registration number NCT01532869; Results.
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Affiliation(s)
- Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan, USA
| | | | | | | | - Tracy M Frech
- University of Utah, Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Marina E Anderson
- University of Liverpool and Aintree University Hospital, Liverpool, UK
| | | | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, California, USA
| | | | | | | | - Janet E Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, St Joseph's Health Care, London, Canada
| | | | | | - Ulf Müller-Ladner
- Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
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170
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Mihai C, Antic M, Dobrota R, Bonderman D, Chadha-Boreham H, Coghlan JG, Denton CP, Doelberg M, Grünig E, Khanna D, McLaughlin VV, Müller-Ladner U, Pope JE, Rosenberg DM, Seibold JR, Vonk MC, Distler O. Factors associated with disease progression in early-diagnosed pulmonary arterial hypertension associated with systemic sclerosis: longitudinal data from the DETECT cohort. Ann Rheum Dis 2017; 77:128-132. [DOI: 10.1136/annrheumdis-2017-211480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 11/03/2022]
Abstract
ObjectivePulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis (SSc). In this longitudinal study, we aimed to identify factors associated with an unfavourable outcome in patients with SSc with early PAH (SSc-PAH) from the DETECT cohort.MethodsPatients with SSc-PAH enrolled in DETECT were observed for up to 3 years. Associations between cross-sectional variables and disease progression (defined as the occurrence of any of the following events: WHO Functional Class worsening, combination therapy for PAH, hospitalisation or death) were analysed by univariable logistic regression.ResultsOf 57 patients with PAH (median observation time 12.6 months), 25 (43.9%) had disease progression. The following factors (OR (95% CI)) were associated with disease progression: male gender (4.1 (1.2 to 14.1)), high forced vital capacity % predicted/carbon monoxide lung diffusion capacity (DLCO)% predicted ratio (3.6 (1.2 to 10.7)), high Borg Dyspnoea Index (1.7 (1.1 to 2.6)) and low DLCO% predicted (non-linear relationship).ConclusionMore than 40% of early-diagnosed patients with SSc-PAH had disease progression during a short follow-up time, with male gender, functional capacity and pulmonary function tests at PAH diagnosis being associated with progression. This suggests that even mild PAH should be considered a high-risk complication of SSc.
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171
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Ehrenstein B, Müller-Ladner U. [Infections in rheumatology : Differential diagnosis or complication of immunosuppressive therapy]. Z Rheumatol 2017; 76:742-744. [PMID: 29038957 DOI: 10.1007/s00393-017-0391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Ehrenstein
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, 93077, Bad Abbach, Deutschland.
| | - U Müller-Ladner
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig Universität Gießen, Gießen, Deutschland.,Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik GmbH, 61231, Bad Nauheim, Deutschland
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172
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Lange U, Classen K, Müller-Ladner U, Richter M. Weekly oral bisphosphonates over 2 years prevent bone loss in cardiac transplant patients. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Lange
- Department of Rheumatology and Clinical Immunology; Kerckhoff Clinic; Bad Nauheim Germany
- Department of Internal Rheumatology; Osteology and Physical Medicine; Justus-Liebig University Giessen; Giessen Germany
| | - Katharina Classen
- Department of Cardiac Surgery; Kerckhoff-Clinic; Bad Nauheim Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology; Justus-Liebig University Giessen; Giessen Germany
- Department of Rheumatology and Clinical Immunology; Kerckhoff Clinic; Bad Nauheim Germany
| | - Manfred Richter
- Department of Cardiac Surgery; Kerckhoff-Clinic; Bad Nauheim Germany
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173
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Galluccio F, Müller-Ladner U, Furst DE, Khanna D, Matucci-Cerinic M. Points to consider in renal involvement in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v49-v52. [PMID: 28992172 DOI: 10.1093/rheumatology/kex201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 01/21/2023] Open
Abstract
This article discusses points to consider when undertaking a clinical trial to test therapy for renal involvement in SSc, not including scleroderma renal crisis. Double-blind, randomized controlled trials vs placebo or standard background therapy should be strongly considered. Inclusion criteria should consider a pre-specified range of renal functions or stratification of renal function. Gender and age limitations are probably not necessary. Concomitant medications including vasodilators, immunosuppressants and endothelin receptor antagonists and confounding illnesses such as diabetes, kidney stones, hypertension and heart failure need to be considered. A measure of renal function should be strongly considered, while time to dialysis, mortality, prevention of scleroderma renal crisis and progression of renal disease can also be considered, although they remain to be validated. Detailed, pre-planned analysis should be strongly considered and should include accounting for missing data.
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Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Giessen.,Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
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174
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Johnson SR, Soowamber ML, Fransen J, Khanna D, Van Den Hoogen F, Baron M, Matucci-Cerinic M, Denton CP, Medsger TA, Carreira PE, Riemekasten G, Distler J, Gabrielli A, Steen V, Chung L, Silver R, Varga J, Müller-Ladner U, Vonk MC, Walker UA, Wollheim FA, Herrick A, Furst DE, Czirjak L, Kowal-Bielecka O, Del Galdo F, Cutolo M, Hunzelmann N, Murray CD, Foeldvari I, Mouthon L, Damjanov N, Kahaleh B, Frech T, Assassi S, Saketkoo LA, Pope JE. There is a need for new systemic sclerosis subset criteria. A content analytic approach. Scand J Rheumatol 2017; 47:62-70. [DOI: 10.1080/03009742.2017.1299793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- SR Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - ML Soowamber
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - J Fransen
- The Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - D Khanna
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - F Van Den Hoogen
- The Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - M Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - M Matucci-Cerinic
- Department of Rheumatology AVC, Department of BioMedicine, Division of Rheumatology AOUC, Department of Medicine and Denothe Centre, University of Florence, Florence, Italy
| | - CP Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
| | - TA Medsger
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - PE Carreira
- Department of Rheumatology, University Hospital 12 de Octubre, Madrid, Spain
| | - G Riemekasten
- Department of Rheumatology, University of Lübeck, Lung Research Center Borstel, a Leibniz institute, Lübeck, Germany
| | - J Distler
- Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Gabrielli
- Department of Molecular and Clinical Sciences, Clinical Medicine, University of Marche, Ancona, Italy
| | - V Steen
- Department of Medicine, Division of Rheumatology, Clinical Immunology and Allergy, Georgetown University School of Medicine, Washington, DC, USA
| | - L Chung
- Department of Medicine and Dermatology, Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - R Silver
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - J Varga
- Department of Medicine, Division of Rheumatology, Clinical Immunology and Allergy, Northwestern University, Chicago, IL, USA
| | - U Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | - MC Vonk
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - UA Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - FA Wollheim
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - A Herrick
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - DE Furst
- Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - L Czirjak
- Department of Rheumatology and Immunology, University of Pécs, Clinical Center, Pécs, Hungary
| | - O Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Białystok, Poland
| | - F Del Galdo
- Scleroderma Programme, Leeds Institute of Rheumatic and Musculoskeletal Medicine, LMBRU, University of Leeds, Leeds, UK
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, IRCCS AOU S Martino, Genova, Italy
| | - N Hunzelmann
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - CD Murray
- Inflammatory Bowel Disease Unit, Royal Free London NHS Foundation Trust, London, UK
| | - I Foeldvari
- Hamburg Center for Paediatric Rheumatology, Eilbek Clinic, Hamburg, Germany
| | - L Mouthon
- Department of Internal Medicine, Paris Descartes University, the Public Hospitals of Paris, Paris, France
| | - N Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - B Kahaleh
- Division of Rheumatology, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - T Frech
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - S Assassi
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - LA Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Tulane University Lung Center, New Orleans, LA, USA
| | - JE Pope
- Division of Rheumatology, Department of Medicine, St Joseph Health Care, University of Western Ontario, London, ON, Canada
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Abstract
AbstractA multimodal treatment of rheumatic diseases without physical medicine is incomplete. However, the mechanisms underlying the beneficial effects of physical medicine are only partially understood. Modern molecular medicine offers new insights into pivotal mechanisms and mediators of the inflammatory process and into interactions between cells of the immune system and bone cells. Investigating the potential influences of different methods of physical medicine on the central regulatory processes of inflammatory rheumatic diseases is of great interest, highly fascinating and opens up new avenues of research for the future. This article focuses on the novel results of molecular physical medicine in rheumatic diseases and osteoporosis.
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Affiliation(s)
- Uwe Lange
- Department of Rheumatology, Osteology and Physical Medicine, Kerckhoff-Klinik, University Gießen, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Osteology and Physical Medicine, Kerckhoff-Klinik, University Gießen, Bad Nauheim, Germany
| | - Gabriel Dischereit
- Department of Rheumatology, Osteology and Physical Medicine, Kerckhoff-Klinik, University Gießen, Bad Nauheim, Germany
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Wegner F, Müller-Ladner U, Meier FMP. Reply to: Moyamoya disease and systemic sclerosis (MoSys syndrome): a combination of two rare entities: comment to the authors. Clin Exp Rheumatol 2017; 35 Suppl 106:217. [PMID: 28516875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Franz Wegner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany.
| | - Florian M P Meier
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
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177
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Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A, Riemekasten G, Airò P, Joven B, Vettori S, Cozzi F, Ullman S, Czirják L, Tikly M, Müller-Ladner U, Caramaschi P, Distler O, Iannone F, Ananieva LP, Hesselstrand R, Becvar R, Gabrielli A, Damjanov N, Salvador MJ, Riccieri V, Mihai C, Szücs G, Walker UA, Hunzelmann N, Martinovic D, Smith V, Müller CDS, Montecucco CM, Opris D, Ingegnoli F, Vlachoyiannopoulos PG, Stamenkovic B, Rosato E, Heitmann S, Distler JHW, Zenone T, Seidel M, Vacca A, Langhe ED, Novak S, Cutolo M, Mouthon L, Henes J, Chizzolini C, Mühlen CAV, Solanki K, Rednic S, Stamp L, Anic B, Santamaria VO, De Santis M, Yavuz S, Sifuentes-Giraldo WA, Chatelus E, Stork J, Laar JV, Loyo E, García de la Peña Lefebvre P, Eyerich K, Cosentino V, Alegre-Sancho JJ, Kowal-Bielecka O, Rey G, Matucci-Cerinic M, Allanore Y. Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis 2017; 76:1897-1905. [PMID: 28835464 DOI: 10.1136/annrheumdis-2017-211448] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/21/2017] [Accepted: 07/18/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the causes of death and risk factors in systemic sclerosis (SSc). METHODS Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. RESULTS We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. CONCLUSION Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival.
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Affiliation(s)
- Muriel Elhai
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Christophe Meune
- Department of Cardiology, Paris XIII University, INSERM UMR S-942, Bobigny Hospital, Paris, France
| | - Marouane Boubaya
- Unit of Clinical Research, Paris Seine Saint Denis University, Bobigny, France
| | - Jérôme Avouac
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, University Lille Nord-de-France, Lille Cedex, Lille, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | | | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica Spedali Civili Brescia, Brescia, Italy
| | - Beatriz Joven
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Serena Vettori
- Department of Clinical and Experimental Medicine, 'F-Magrassi' II, Naples, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Susanne Ullman
- Department of Dermatology, University Hospital of Copenhagen, Hospital Bispebjerg, Copenhagen, Denmark
| | - László Czirják
- Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary
| | - Mohammed Tikly
- Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Bari, Italy
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Radim Becvar
- Institute of Rheumatology, 1st Medical School, Charles University, Praha, Czech Republic
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Maria J Salvador
- Rheumatology Department, Hospitais da Universidade, Coimbra, Portugal
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, 'Sapienza', University of Rome, Italy, Rome, Italy
| | - Carina Mihai
- Department of Internal Medicine and Rheumatology Clinic, Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriella Szücs
- Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Unispital Basel, Basel, Switzerland
| | - Nicolas Hunzelmann
- Department of Dermatology, University Hospital Cologne, Cologne, Germany
| | - Duska Martinovic
- Department of Internal Medicine, Clinical Hospital of Split, Split, Croatia
| | - Vanessa Smith
- Department of Rheumatology, University of Ghent, Ghent, Belgium
| | | | | | - Daniela Opris
- Department of Rheumatology, St Maria Hospital, Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Francesca Ingegnoli
- Dipartimento e Cattedra di Reumatologia, Università degli Studi di Milano, Istituto Ortopedico 'Gaetano Pini', Milano, Italy
| | | | - Bojana Stamenkovic
- Institute for Prevention, Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases, Niska Banja, Serbia and Montenegro
| | - Edoardo Rosato
- Dipartimento di Medicina Clinica, Centro per la Sclerosi Sistemica, Università La Sapienza, Policlinico Umberto I, Roma, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University Hospital Erlangen, Erlangen, Germany
| | - Thierry Zenone
- Department of Medicine, Unit of Internal Medicine, Valence cedex, France
| | - Matthias Seidel
- Medizinische Klinik III, University Hospital of Bonn, Bonn, Germany
| | - Alessandra Vacca
- Rheumatology Unit, University Hospital of Cagliari, Monserrato, Italy
| | - Ellen De Langhe
- Division of Rheumatology and Department of Development and Regeneration, University Hospital Leuven and Laboratory Tissue Homeostasis and Disease, Leuven, Belgium
| | - Srdan Novak
- Department of Rheumatology and Clinical Immunology, Internal Medicine, KBC Rijeka, Rijeka, Croatia
| | - Maurizio Cutolo
- Research Laboratory and Division of Rheumatology Department of Internal Medicine, University of Genova, Genova, Italy
| | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Jörg Henes
- Medizinische Universitätsklinik, Abt II (Onkologie, Hämatologie, Rheumatologie, Immunologie, Pulmonologie), Tübingen, Germany
| | - Carlo Chizzolini
- Department of Immunology and Allergy, University Hospital, Geneva, Switzerland
| | | | - Kamal Solanki
- Rheumatology Unit, Waikato University Hospital, Hamilton City, Hamilton, New Zealand
| | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Istanbul, Turkey
| | | | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg-, Hôpital de Hautepierre, Service de Rhumatologie, Strasbourg, France
| | - Jiri Stork
- Department of Dermatology, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jacob van Laar
- Department of Rheumatology and Clinical Immunology, James Cook University Hospital, Middlesbrough, UK
| | - Esthela Loyo
- Reumatologia e Inmunologia Clinica, Hospital Regional Universitario Jose Ma Cabral y Baez, Clinica Corominas, Santiago, Dominican Republic
| | | | - Kilian Eyerich
- Department of Dermatology and Allergy of the TU Munich, Munich, Germany
| | - Vanesa Cosentino
- Department of Rheumatology and Collagenopathies, Osteoarticular Diseases and Osteoporosis Centre, Pharmacology and Clinical Pharmacological Research Centre, School of Medicine-University of Buenos Aires, Ramos Mejía Hospital, Buenos Aires, Argentina
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Grégoire Rey
- INSERM, CépiDc, Le Kremlin- Bicêtre, Le Kremlin-Bicêtre, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Section of Internal Medicine and Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence, Florence, Italy
| | - Yannick Allanore
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
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Müller-Ladner U. Aktuelle Standards und neue Entwicklungen in der Psoriasisarthritis. Z Rheumatol 2017; 76:474-476. [DOI: 10.1007/s00393-017-0346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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179
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Müller-Ladner U, Neumann E. Editorial: Tumor Necrosis Factor-Transgenic Mice: Close Enough to Human Epigenetics? Arthritis Rheumatol 2017; 69:1512-1516. [DOI: 10.1002/art.40125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ulf Müller-Ladner
- Justus Liebig University Giessen, Kerckhoff Klinik; Bad Nauheim Germany
| | - Elena Neumann
- Justus Liebig University Giessen, Kerckhoff Klinik; Bad Nauheim Germany
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180
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Lefèvre S, Schwarz M, Meier FMP, Zimmermann-Geller B, Tarner IH, Rickert M, Steinmeyer J, Sauerbier M, Rehart S, Müller-Ladner U, Neumann E. Disease-Specific Effects of Matrix and Growth Factors on Adhesion and Migration of Rheumatoid Synovial Fibroblasts. J Immunol 2017; 198:4588-4595. [PMID: 28500074 DOI: 10.4049/jimmunol.1600989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 04/10/2017] [Indexed: 01/15/2023]
Abstract
In rheumatoid arthritis (RA), cartilage and bone matrix are degraded, and extracellular matrix (ECM) proteins, acting as cellular activators, are liberated. Similar to ECM proteins, matrix-bound chemokines, cytokines, and growth factors (GFs) influence functional properties of key cells in RA, especially synovial fibroblasts. The role of these molecules on attachment, migration, and proinflammatory and prodestructive activation of RASFs was analyzed. Adhesion/migration of RASFs were examined under GF-enriched (GF+) or -reduced (GF-) conditions with or without addition of matrix-associated GFs, TGF-β, and platelet-derived GF to GF- or culture supernatants. Fibroblast adhesion and alterations in proinflammatory/prodestructive properties (e.g., IL-6/matrix metalloproteinase 3-release) in response to matrix-associated molecules were compared. Effects of GF+, GF-, and other ECM components on human RASF-mediated cartilage invasion were examined in the SCID mouse model. RASF adhesion under GF- conditions was significantly lower compared with GF+ conditions (6.8- versus 8.3-fold). This effect was specific for RA because control cells showed opposite effects (e.g., osteoarthritis synovial fibroblasts [SF]; GF- versus GF+: 10.7- versus 8-fold). Addition of TGF-β to GF- increased RASF attachment (12.7-fold) compared with other matrices and components. RASF adhesion to GF+ matrix resulted in the strongest IL-6 and matrix metalloproteinase-3 release, and was even more pronounced compared with supplementation of single GFs. In vivo, GF- matrix decreased RASF-mediated cartilage invasion compared with GF+ matrix. ECM components and especially GFs when bound within ECM actively enhance RASF attraction and cartilage adhesion. This observation was specific for RASFs as a reverse behavior was observed for controls.
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Affiliation(s)
- Stephanie Lefèvre
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Maria Schwarz
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Florian M P Meier
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Birgit Zimmermann-Geller
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Markus Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Jürgen Steinmeyer
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Michael Sauerbier
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center, 60389 Frankfurt, Germany; and
| | - Stefan Rehart
- Department of Orthopaedics and Trauma Surgery, Agaplesion Markus-Hospital, 60431 Frankfurt, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany;
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181
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Beyer C, Huscher D, Ramming A, Bergmann C, Avouac J, Guiducci S, Meier F, Vettori S, Siegert E, Jaeger VK, Maurer B, Riemekasten G, Walker U, Müller-Ladner U, Valentini G, Matucci-Cerinic M, Allanore Y, Distler O, Schett G, Distler JHW. Elevated serum levels of sonic hedgehog are associated with fibrotic and vascular manifestations in systemic sclerosis. Ann Rheum Dis 2017; 77:626-628. [DOI: 10.1136/annrheumdis-2016-210834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 01/23/2023]
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182
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Affiliation(s)
- Franz Wegner
- University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic
| | - Ulf Müller-Ladner
- Head of Department, University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic;
| | - Florian M P Meier
- University of Giessen, Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
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183
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Krumbholz G, Junker S, Meier FMP, Rickert M, Steinmeyer J, Rehart S, Lange U, Frommer KW, Schett G, Müller-Ladner U, Neumann E. Response of human rheumatoid arthritis osteoblasts and osteoclasts to adiponectin. Clin Exp Rheumatol 2017; 35:406-414. [PMID: 28079506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Adiponectin is an effector molecule in the pathophysiology of rheumatoid arthritis, e.g. by inducing cytokines and matrix degrading enzymes in synovial fibroblasts. There is growing evidence that adiponectin affects osteoblasts and osteoclasts although the contribution to the aberrant bone metabolism in rheumatoid arthritis is unclear. Therefore, the adiponectin effects on rheumatoid arthritis-derived osteoblasts and osteoclasts were evaluated. METHODS Adiponectin and its receptors were examined in bone tissue. Primary human osteoblasts and osteoclasts were stimulated with adiponectin and analysed using realtime polymerase chain-reaction and immunoassays. Effects on matrix-production by osteoblasts and differentiation and resorptive activity of osteoclasts were examined. RESULTS Immunohistochemistry of rheumatoid arthritis bone tissue showed adiponectin expression in key cells of bone remodelling. Adiponectin altered gene expression and cytokine release in osteoblasts and increased IL-8 secretion by osteoclasts. Adiponectin inhibited osterix and induced osteoprotegerin mRNA in osteoblasts. In osteoclasts, MMP-9 and tartrate resistant acid phosphatase expression was increased. Accordingly, mineralisation capacity of osteoblasts decreased whereas resorptive activity of osteoclasts increased. CONCLUSIONS The results confirm the proinflammatory potential of adiponectin and support the idea that adiponectin influences rheumatoid arthritis bone remodelling through alterations in osteoblast and osteoclast.
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Affiliation(s)
- Grit Krumbholz
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Susann Junker
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Florian M P Meier
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Markus Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Jürgen Steinmeyer
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University, Giessen, Germany
| | - Stefan Rehart
- Department of Orthopaedics and Trauma Surgery, Agaplesion Markus-Hospital, Frankfurt, Germany
| | - Uwe Lange
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Klaus W Frommer
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Georg Schett
- Department of Medicine 3, Immunology und Rheumatology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University, Giessen, and Kerckhoff-Klinik, Bad Nauheim, Germany.
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184
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Sewerin P, Klein S, Brinks R, Hoyer A, Schleich C, Miese F, Blaschke S, Edelmann E, Gao I, Georgi J, Kellner H, Keyßer G, Lorenz HM, Müller-Ladner U, Pott HG, Schulze-Koops H, Walther M, Schmidt W, Schneider M, Ostendorf B. REMISSIONPLUS eine Initiative zur Integration moderner Bildgebung in die rheumatologische Versorgung Rückblick, Einblick, Ausblick: Auswertung der Niederfeld-MRT Daten. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0042-124184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBildgebende Verfahren nehmen heute bei der Diagnosestellung und Therapiekontrolle der Rheumatoiden Arthritis (RA) eine unverzichtbare Rolle ein. Die Initiative REMISSIONPLUS hat seit 2006 über 10 Jahre das Ziel verfolgt, moderne bildgebende Verfahren wie die Arthrosonografie und die Magnetresonanztomografie (MRT) in den klinischen Alltag des Rheumatologen zu implementieren. Neben Schulungen (über 3 000 Rheumatologen in über 200 Veranstaltungen) wurden zahlreiche Bildgebungs- Studien durchgeführt. Erstmals werden jetzt zusammenhängend alle Niederfeld-MRT Daten aus der Initiative vorgestellt. Die Ergebnisse dieser multizentrischen Studie zeigen, dass die Niederfeld-MRT für RA Patienten eine komfortable Untersuchungsmethode darstellt und für den Rheumatologen die Möglichkeit bietet, effektiv und sehr genau Therapieeffekte (DMARD, Biologika) zu kontrollieren. Die MRT-Daten korrelierten hierbei signifikant mit Klinik und Labor. Mit der Methode ist es ferner möglich bei RA-Patienten subklinische Arthritiszeichen zu detektieren, zum anderen konnte fortschreitende radiologische Progression (Erosivität), trotz klinischer Remission („silent progression") erkannt werden. Diese Ergebnisse sind konventionell radiologisch nicht zu gewinnen, sodass der Einsatz der MRT neue Einblicke in die Pathogenese und konsekutiv neue Informationen für das Management der RA liefert. Die Bewertung dieser Vorteile und der Benefit für den Patienten im klinischen Alltag muss in weiteren Studien untersucht und diskutiert werden.
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Affiliation(s)
- Philipp Sewerin
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Sabine Klein
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Ralph Brinks
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Annika Hoyer
- Deutsches Diabetes Zentrum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Christoph Schleich
- Institut für diagnostische und interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Falk Miese
- Institut für diagnostische und interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | | | | | - Ino Gao
- Rheumapraxis Heidelberg, Heidelberg
| | - Joachim Georgi
- Abteilung Innere Medizin/ Rheumatologie, Helios Ostseeklinik Damp, Damp
| | - Herbert Kellner
- Schwerpunktpraxis für Rheumatologie und Gastroenterologie, Ärztlicher Leiter der Abteilung Rheumatologie im Krankenhaus Neuwittelsbach, München
| | - Gernot Keyßer
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle, Halle/Saale
| | | | - Ulf Müller-Ladner
- Kerckhoff-Klinik, Abteilung für Rheumatologie und klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim
| | - Hans-Georg Pott
- Schwerpunktpraxis für Rheumatologie, Physikalische Medizin und klinische Immunologie, Rheumatologikum Hannover, Hannover
| | - Hendrik Schulze-Koops
- Rheuma-Einheit, Medizinische Poliklinik, Universitätsklinikum München – Campus Innenstadt, München
| | - Marisa Walther
- Immanuel-Krankenhaus Rheumaklinik Berlin-Buch, Innere Medizin, Rheumatologie und Klinische Immunologie, Berlin
| | - Wolfgang Schmidt
- Immanuel-Krankenhaus Rheumaklinik Berlin-Buch, Innere Medizin, Rheumatologie und Klinische Immunologie, Berlin
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Benedikt Ostendorf
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
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Abstract
Digital ulcers (DUs) are among the most frequent and disabling vascular complications in patients with systemic sclerosis (SSc). The etiology and pathogenesis of DUs differs depending on the lesion localization. For this reason the underlying etiologic and pathogenetic factors will guide the therapeutic decision. The main pathogenic mechanism that contributes to the development of fingertip DUs is ischemia owing to SSc-related vasculopathy. DUs over bony prominences are mainly a result of skin fibrosis, epidermal thinning and mechanical friction. At the areas of subcutaneous calcinosis DUs can develop as a result of mechanical friction and inflammation. Thus, in cases of DUs over bony prominences and calcinosis, avoidance of trauma and skin care are main measures of primary prophylaxis. In pure ischemic DUs, a combination of vasodilators (calcium channel blockers (CCBs), intravenous prostanoid, phosphodiesterase inhibitors) and antiplatelet drugs should be applied. Despite the lack of controlled trials addressing the administration of antiplatelet agents and anticoagulants in DUs in the context of SSc, the current knowledge about the platelet and coagulation dysfunction leads to their frequent administration from the leading experts in the field of SSc. In our opinion, as more powerful agents, anticoagulants should be considered in severe cases of development of digital gangrenes. Analgetics and antibiotics may be indicated and local treatment is a mandatory care. Currently, the EUSTAR recommendations for the treatment of RP and DUs in SSc include CCBs, intravenous prostanoids and endothelin receptor antagonists. Although for the inclusion of other options in the official recommendations, their efficacy should be confirmed by controlled clinical trials, they are routinely used in the leading scleroderma-centers based on the current knowledge about the pathogenesis of development of DUs in SSc.
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Affiliation(s)
- Sevdalina Lambova
- Medical University - Plovdiv, Department of Propedeutics in Internal Medicine, Clinic of Rheumatology, Plovdiv, Bulgaria, Plovdiv - 4002, 15A "Vasil Aprilov" Blvd, Bulgaria.
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186
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Herrick AL, Pan X, Peytrignet S, Lunt M, Hesselstrand R, Mouthon L, Silman A, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuţa C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Jobanputra P, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, İnanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Denton CP. Treatment outcome in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study (ESOS). Ann Rheum Dis 2017; 76:1207-1218. [PMID: 28188239 PMCID: PMC5530354 DOI: 10.1136/annrheumdis-2016-210503] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 12/30/2022]
Abstract
Objectives The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches. Methods This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or ‘no immunosuppressant’. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival. Results Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: −4.0 (−5.2 to −2.7) units for methotrexate, −4.1 (−5.3 to −2.9) for MMF, −3.3 (−4.9 to −1.7) for cyclophosphamide and −2.2 (−4.0 to −0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months. Conclusions These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed. Trial registration number NCT02339441.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,University of Oxford, Oxford, UK
| | - Edith Brown
- Member of Steering Committee, contact via Professor Herrick, The University of Manchester, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pecs, Hungary
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | | | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuţa
- Rheumatology 2 Department, "Grigore T. Popa" University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, Iași, Romania
| | - Voon H Ong
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, France
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Unit, Rambam Heath Care Campus; Rappaport Faculty of Medicine, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Paresh Jobanputra
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | | | - Pia Moinzadeh
- Department for Dermatology, University of Cologne Kerpenerstr. 62, Köln, Germany
| | - Frances C Hall
- Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours Cedex, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, UK
| | | | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, and Nottingham NHS Treatment Centre, Nottingham, UK
| | | | | | - Søren Jacobsen
- University of Copenhagen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia. Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques etAuto-immunes Rares, Université de Lille, Inserm, U995, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, Lille, France
| | | | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Susannah Proudman
- Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Clayton, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | | | | | - Claire Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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187
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Dischereit G, Fetaj S, Goronzy JE, Müller-Ladner U, Tarner I, Lange U. Wirkung serieller Heiltorfbäder (Moorbäder) bei Osteoarthrose auf Parameter der funktionalen und funktionellen Gesundheit sowie auf der Zytokinebene – eine kontrollierte, randomisierte, prospektive Studie. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0042-118383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Gabriel Dischereit
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | | | - Jan-Eric Goronzy
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - Ulf Müller-Ladner
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - Ingo Tarner
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - Uwe Lange
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
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188
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Lange U, Müller-Ladner U, Dischereit G. Wirkung iterativer Ganzkörperhyperthermie mit wassergefilterter Infrarot-A-Strahlung bei ankylosierender Spondylitis – eine kontrollierte, randomisierte, prospektive Studie. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0042-116945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Uwe Lange
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie, Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - Ulf Müller-Ladner
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie, Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
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189
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Zimmermann-Geller B, Köppert S, Fischer S, Cabrera-Fuentes HA, Lefèvre S, Rickert M, Steinmeyer J, Rehart S, Umscheid T, Schönburg M, Müller-Ladner U, Preissner KT, Frommer KW, Neumann E. Correction: Influence of Extracellular RNAs, Released by Rheumatoid Arthritis Synovial Fibroblasts, on Their Adhesive and Invasive Properties. J Immunol 2017; 198:1376. [PMID: 28115592 DOI: 10.4049/jimmunol.1602075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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190
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Villiger PM, Müller-Ladner U. Ausschleichen und Beenden von immunsuppressiven Therapien. Z Rheumatol 2017; 76:6-7. [DOI: 10.1007/s00393-016-0257-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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191
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Kiltz U, Alten R, Fleck M, Krüger K, Manger B, Müller-Ladner U, Nüsslein H, Reuss-Borst M, Schwarting A, Schulze-Koops H, Tausche AK, Braun J. [Evidence-based recommendations for diagnostics and treatment of gouty arthritis in the specialist sector : S2e guidelines of the German Society of Rheumatology in cooperation with the AWMF]. Z Rheumatol 2017; 76:118-124. [PMID: 28078432 DOI: 10.1007/s00393-016-0249-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Due to the increasing prevalence of gout, particularly in old age, the disease is becoming of increasing importance in Germany. Gout is one of the most common forms of recurrent inflammatory arthritis and is induced by the deposition of monosodium urate crystals in synovial fluid and other tissues. The principal goals of therapy in chronic gout are the symptomatic treatment of the acute joint inflammation and the causal treatment of the underlying metabolic cause, the hyperuricemia. Only a consistent and permanent reduction of the serum uric acid level ultimately results in an efficient avoidance of further gout attacks and therefore the prevention of structural damage. Due to an often inadequate treatment of gout, the target of healing the disease is often not achieved. A correct and timely diagnosis and adequate assessment of comorbidities associated with gout are, however, of substantial importance for patient and physician to achieve remission of the disease. In order to create a solid basis for a timely and effective treatment of affected patients, in 2016 the German Society of Rheumatology (DGRh) initiated the development of S2e guidelines on gouty arthritis for specialists. This article summarizes these S2e guidelines on the management of gouty arthritis in the specialist sector.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - R Alten
- Rheumatologie, Klinische Immunologie, Osteologie, Physikalische Therapie und Sportmedizin, Schlosspark-Klinik, Berlin, Deutschland
| | - M Fleck
- Klinik und Poliklinik für Innere Medizin I, Klinik für Rheumatologie/Klinische Immunologie, Asklepios-Klinikum, Uniklinikum Regensburg, Bad Abbach, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - B Manger
- Medizinische Klinik 3, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - H Nüsslein
- Rheumatologische Schwerpunktpraxis, Nürnberg, Deutschland
| | - M Reuss-Borst
- Facharzt-Praxis für Rheumatologie und Onkologie, Bad Bocklet, Deutschland
| | - A Schwarting
- Rheumatologisch-immunologische Ambulanz, Universitätsklinik Mainz, Mainz, Deutschland
| | | | - A K Tausche
- Medizinische Klinik III, Abteilung für Rheumatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
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192
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Junker S, Frommer KW, Krumbholz G, Tsiklauri L, Gerstberger R, Rehart S, Steinmeyer J, Rickert M, Wenisch S, Schett G, Müller-Ladner U, Neumann E. Expression of adipokines in osteoarthritis osteophytes and their effect on osteoblasts. Matrix Biol 2016; 62:75-91. [PMID: 27884778 DOI: 10.1016/j.matbio.2016.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Osteophyte formation in osteoarthritis (OA) is mediated by increased osteoblast activity, which is -in turn- regulated by the Wnt signaling pathway. Obesity is regarded a risk factor in OA, yet little is known about the interaction between adipose tissue-derived factors, the adipokines, and bone formation, although adipokines are associated with the pathogenesis of OA. Therefore, the effect of adipokines on bone and cartilage forming cells and osteophyte development was analyzed. METHODS Human OA osteophytes were histologically characterized and adipokine expression was evaluated by immunohistochemistry. Osteoblasts and chondrocytes were isolated from OA tissue and stimulated with adiponectin, resistin, or visfatin. Cytokine and osteoblast/chondrocyte markers were quantified and activation of Wnt and p38 MAPK signaling was analyzed. RESULTS Adiponectin, resistin, and visfatin were expressed in OA osteophytes by various articular cell types. Stimulation of OA osteoblasts with adiponectin and of OA chondrocytes with visfatin led to an increased release of proinflammatory mediators but not to osteoblast differentiation or activation. Additionally, visfatin increased matrix degrading factors in chondrocytes. Wnt signaling was not altered by adipokines, but adiponectin induced p38 MAPK signaling in osteoblasts. CONCLUSION Adipokines are present in OA osteophytes, and adiponectin and visfatin increase the release of proinflammatory mediators by osteoblasts and chondrocytes. The effects of adiponectin were mediated by p38 MAPK but not Wnt signaling in osteoblasts. Therefore, the results support the idea that adipokines do not directly influence osteophyte development but the proinflammatory conditions in OA.
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Affiliation(s)
- Susann Junker
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany
| | - Klaus W Frommer
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany
| | - Grit Krumbholz
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany
| | - Lali Tsiklauri
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany
| | - Rüdiger Gerstberger
- Dept Veterinary Physiology and Biochemistry, Justus-Liebig-University Giessen, Germany
| | - Stefan Rehart
- Dept Orthopaedics and Trauma Surgery, Agaplesion-Markus-Hospital, Frankfurt, Germany
| | - Jürgen Steinmeyer
- Dept Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Markus Rickert
- Dept Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Sabine Wenisch
- Clinic for Small Animals, Institute for Veterinary Anatomy, Histology und Embryology, Justus-Liebig-University Giessen, Germany
| | - Georg Schett
- Medical Clinic 3, Rheumatology and Immunology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulf Müller-Ladner
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany
| | - Elena Neumann
- Dept Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Bad Nauheim, Germany.
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193
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Croft AP, Naylor AJ, Marshall JL, Hardie DL, Zimmermann B, Turner J, Desanti G, Adams H, Yemm AI, Müller-Ladner U, Dayer JM, Neumann E, Filer A, Buckley CD. Rheumatoid synovial fibroblasts differentiate into distinct subsets in the presence of cytokines and cartilage. Arthritis Res Ther 2016; 18:270. [PMID: 27863512 PMCID: PMC5116193 DOI: 10.1186/s13075-016-1156-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/19/2016] [Indexed: 01/26/2023] Open
Abstract
Background We investigated two distinct synovial fibroblast populations that were located preferentially in the lining or sub-lining layers and defined by their expression of either podoplanin (PDPN) or CD248, and explored their ability to undergo self-assembly and transmigration in vivo. Methods Synovial fibroblasts (SF) were cultured in vitro and phenotypic changes following stimulation with interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1 were examined. To examine the phenotype of SF in vivo, a severe combined immunodeficiency (SCID) human-mouse model of cartilage destruction was utilised. Results SF in the lining layer in rheumatoid arthritis (RA) expressed high levels of PDPN compared to the normal synovium, whereas CD248 expression was restricted to sub-lining layer cells. TNF-α or IL1 stimulation in vitro resulted in an increased expression of PDPN. In contrast, stimulation with TGF-β1 induced CD248 expression. In the SCID human-mouse model, rheumatoid SF recapitulated the expression of PDPN and CD248. Fibroblasts adjacent to cartilage expressed PDPN, and attached to, invaded, and degraded cartilage. PDPN+ CD248– SF preceded the appearance of PDPN– CD248+ cells in contralateral implants. Conclusions We have identified two distinct SF populations identified by expression of either PDPN or CD248 which are located within different anatomical compartments of the inflamed synovial membrane. These markers discriminate between SF subsets with distinct biological properties. As PDPN-expressing cells are associated with early fibroblast migration and cartilage erosion in vivo, we propose that PDPN-expressing cells may be an attractive therapeutic target in RA.
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Affiliation(s)
- Adam P Croft
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Amy J Naylor
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Jennifer L Marshall
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Debbie L Hardie
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Birgit Zimmermann
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jason Turner
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Guillaume Desanti
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Holly Adams
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Adrian I Yemm
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Jean-Michel Dayer
- Faculty of Medicine, Centre Médical Universitaire, Geneva, Switzerland
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Andrew Filer
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher D Buckley
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK. .,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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Kowal-Bielecka O, Fransen J, Avouac J, Becker M, Kulak A, Allanore Y, Distler O, Clements P, Cutolo M, Czirjak L, Damjanov N, Del Galdo F, Denton CP, Distler JHW, Foeldvari I, Figelstone K, Frerix M, Furst DE, Guiducci S, Hunzelmann N, Khanna D, Matucci-Cerinic M, Herrick AL, van den Hoogen F, van Laar JM, Riemekasten G, Silver R, Smith V, Sulli A, Tarner I, Tyndall A, Welling J, Wigley F, Valentini G, Walker UA, Zulian F, Müller-Ladner U. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2016; 76:1327-1339. [PMID: 27941129 DOI: 10.1136/annrheumdis-2016-209909] [Citation(s) in RCA: 636] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/22/2016] [Accepted: 10/09/2016] [Indexed: 12/16/2022]
Abstract
The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.
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Affiliation(s)
- Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jaap Fransen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jerome Avouac
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Mike Becker
- University Hospital Charité, Berlin, Germany.,University Hospital Zurich, Zurich, Switzerland
| | - Agnieszka Kulak
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | | | - Philip Clements
- University of California at Los Angeles, Los Angeles, California, USA
| | - Maurizio Cutolo
- Research Laboratories and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, Italy
| | - Laszlo Czirjak
- Department of Rheumatology and Immunology, Medical Center, University of Pecs, Pecs, Hungary
| | | | | | | | | | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, Germany
| | | | | | - Daniel E Furst
- University of California at Los Angeles, Los Angeles, California, USA
| | | | | | - Dinesh Khanna
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Ariane L Herrick
- University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, UK
| | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Richard Silver
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa Smith
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratories and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, Italy
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195
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Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, Czirják L, Denton CP, Distler O, Hachulla E, Herrick AL, Kowal-Bielecka O, Pope J, Müller-Ladner U, Riemekasten G, Avouac J, Frerix M, Jordan S, Minier T, Siegert E, Ong VH, Vettori S, Allanore Y. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis 2016; 76:270-276. [PMID: 27621285 DOI: 10.1136/annrheumdis-2016-209768] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/13/2016] [Accepted: 08/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Validity of European Scleroderma Study Group (EScSG) activity indexes currently used to assess disease activity in systemic sclerosis (SSc) has been criticised. METHODS Three investigators assigned an activity score on a 0-10 scale for 97 clinical charts. The median score served as gold standard. Two other investigators labelled the disease as inactive/moderately active or active/very active. Univariate-multivariate linear regression analyses were used to define variables predicting the 'gold standard', their weight and derive an activity index. The cut-off point of the index best separating active/very active from inactive/moderately active disease was identified by a receiver-operating curve analysis. The index was validated on a second set of 60 charts assessed by three different investigators on a 0-10 scale and defined as inactive/moderately active or active/very active by other two investigators. One hundred and twenty-three were investigated for changes over time in the index and their relationships with those in the summed Medsger severity score (MSS). RESULTS A weighted 10-point activity index was identified and validated: Δ-skin=1.5 (Δ=patient assessed worsening during the previous month), modified Rodnan skin score (mRss) >18=1.5, digital ulcers=1.5, tendon friction rubs=2.25, C-reactive protein >1 mg/dL=2.25 and diffusing capacity of the lung for CO (DLCO) % predicted <70%=1.0. A cut-off ≥2.5 was found to identify patients with active disease. Changes in the index paralleled those of MSS (p=0.0001). CONCLUSIONS A preliminarily revised SSc activity index has been developed and validated, providing a valuable tool for clinical practice and observational studies.
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Affiliation(s)
- Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Michele Iudici
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland
| | | | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Eric Hachulla
- Internal Medicine Department, Claude Huriez Hospital, Lille University, Lille, France
| | - Ariane L Herrick
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Janet Pope
- Department of Medicine, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | | | - Jerome Avouac
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Voon H Ong
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Serena Vettori
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Yannick Allanore
- Rheumatology A Department, INSERM U1016 UMR8104, Cochin Hospital, Paris Descartes University, Paris, France
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196
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Zimmermann-Geller B, Köppert S, Fischer S, Cabrera-Fuentes HA, Lefèvre S, Rickert M, Steinmeyer J, Rehart S, Umscheid T, Schönburg M, Müller-Ladner U, Preissner KT, Frommer KW, Neumann E. Influence of Extracellular RNAs, Released by Rheumatoid Arthritis Synovial Fibroblasts, on Their Adhesive and Invasive Properties. J Immunol 2016; 197:2589-97. [PMID: 27549172 DOI: 10.4049/jimmunol.1501580] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/27/2016] [Indexed: 11/19/2022]
Abstract
Extracellular RNA (exRNA) has been characterized as a molecular alarm signal upon cellular stress or tissue injury and to exert biological functions as a proinflammatory, prothrombotic, and vessel permeability-regulating factor. In this study, we investigated the contribution of exRNA and its antagonist RNase1 in a chronic inflammatory joint disease, rheumatoid arthritis (RA). Upon immunohistochemical inspection of RA, osteoarthritis (OA), and psoriatic arthritis synovium, exRNA was detectable only in the RA synovial lining layer, whereas extracellular DNA was detectable in various areas of synovial tissue. In vitro, exRNA (150-5000 nt) was released by RA synovial fibroblasts (RASF) under hypoxic conditions but not under normoxia or TNF-α treatment. RNase activity was increased in synovial fluid from RA and OA patients compared with psoriatic arthritis patients, whereas RNase activity of RASF and OASF cultures was not altered by hypoxia. Reduction of exRNA by RNase1 treatment decreased adhesion of RASF to cartilage, but it had no influence on their cell proliferation or adhesion to endothelial cells. In vivo, treatment with RNase1 reduced RASF invasion into coimplanted cartilage in the SCID mouse model of RA. We also analyzed the expression of neuropilins in synovial tissue and SF, as they may interact with vascular endothelial growth factor signaling and exRNA. The data support the concepts that the exRNA/RNase1 system participates in RA pathophysiology and that RASF are influenced by exRNA in a prodestructive manner.
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Affiliation(s)
- Birgit Zimmermann-Geller
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Sina Köppert
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Silvia Fischer
- Department of Biochemistry, Medical School, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Hector A Cabrera-Fuentes
- Department of Biochemistry, Medical School, Justus Liebig University Giessen, 35392 Giessen, Germany; Department of Microbiology, Kazan Federal University, Kazan 420008, Russian Federation
| | - Stephanie Lefèvre
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Markus Rickert
- Department of Orthopedics and Orthopedic Surgery, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Jürgen Steinmeyer
- Laboratory for Experimental Orthopedics, Department of Orthopedics and Orthopedic Surgery, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Stefan Rehart
- Department of Orthopedics and Trauma Surgery, Markus Hospital, 60431 Frankfurt, Germany
| | - Thomas Umscheid
- Department of Vascular Surgery, HELIOS William Harvey Clinic, 61231 Bad Nauheim, Germany; and
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Klaus T Preissner
- Department of Biochemistry, Medical School, Justus Liebig University Giessen, 35392 Giessen, Germany; Department of Microbiology, Kazan Federal University, Kazan 420008, Russian Federation
| | - Klaus W Frommer
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, 61231 Bad Nauheim, Germany;
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197
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Riemekasten G, Beissert S, Distler JHW, Kreuter A, Müller-Ladner U. [Digital ulcers in systemic sclerosis : A retrospective heath service study analysing treatment with bosentan and other vasoactive therapies]. Z Rheumatol 2016; 76:228-237. [PMID: 27535277 DOI: 10.1007/s00393-016-0177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Digital ulcers (DU) affect up to 60 % of patients with systemic sclerosis (SSc) and have a considerable impact on quality of life and morbidity. It is unclear to what extent authorised medicines are used, and if therapy guidelines are implemented in everyday practice. METHOD This retrospective health care study examined current standards of treatment for therapy and prevention of SSc-associated DU in an online survey with 83 physicians. Additionally, data from 161 case studies of SSc patients with DU were analysed, and the effect of DU treatment on the course of the disease determined. RESULTS For treatment and prevention of active DU, physicians predominantly indicated topical therapies, calcium channel blockers, iloprost and endothelin receptor antagonists. According to the case studies, 90 % of episodes with acute DU were treated with bosentan and iloprost in mono- or combination therapy. Preventive treatment was only administered during 50 % of episodes without DU, even after three or more phases with active DU. For the prevention of new DU, bosentan was used in mono- or combination therapy in 57 % of episodes without DU. Bosentan therapy during prevention shortened the following acute phase by 32 %. Additionally, continuous treatment with bosentan in acute and prevention phases reduced the duration of the following acute phase and increased the time to onset of new DU by 16 %. Moreover, bosentan stabilised the number of new DU. CONCLUSION In summary, these data confirm the efficacy of bosentan in preventing new DU when used in DU-free episodes and possibly also in phases of acute DU. Therapy recommendations for the treatment of DU are currently not fully implemented. In the future, even more attention should be paid to DU therapy.
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Affiliation(s)
- G Riemekasten
- Campus Lübeck, Klinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Zentralklinikum (Haus 40), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - S Beissert
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - J H W Distler
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, Oberhausen, Deutschland
| | - U Müller-Ladner
- Kerckhoff-Klinik GmbH, Rheumatologie u. klinische Immunologie, Osteologie, Physikalische Therapie, Justus-Liebig Universität Gießen, Bad Nauheim, Deutschland
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198
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Affiliation(s)
- U Müller-Ladner
- Abt. Rheumatologie und Klinische Immunologie, Kerckhoff Klinik Bad Nauheim, Justus-Liebig Universität Gießen, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
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199
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Capellino S, Frommer K, Rickert M, Steinmeyer J, Rehart S, Müller-Ladner U, Neumann E. OP0149 Dopamine Pathway and Bone Metabolism in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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200
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Garn H, Bahn S, Baune BT, Binder EB, Bisgaard H, Chatila TA, Chavakis T, Culmsee C, Dannlowski U, Gay S, Gern J, Haahtela T, Kircher T, Müller-Ladner U, Neurath MF, Preissner KT, Reinhardt C, Rook G, Russell S, Schmeck B, Stappenbeck T, Steinhoff U, van Os J, Weiss S, Zemlin M, Renz H. Current concepts in chronic inflammatory diseases: Interactions between microbes, cellular metabolism, and inflammation. J Allergy Clin Immunol 2016; 138:47-56. [DOI: 10.1016/j.jaci.2016.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/05/2016] [Accepted: 02/25/2016] [Indexed: 12/26/2022]
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