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Werth VP, Furie RA, Romero-Diaz J, Navarra S, Kalunian K, van Vollenhoven RF, Nyberg F, Kaffenberger BH, Sheikh SZ, Radunovic G, Huang X, Clark G, Carroll H, Naik H, Gaudreault F, Meyers A, Barbey C, Musselli C, Franchimont N. Trial of Anti-BDCA2 Antibody Litifilimab for Cutaneous Lupus Erythematosus. N Engl J Med 2022; 387:321-331. [PMID: 35939578 DOI: 10.1056/nejmoa2118024] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Blood dendritic cell antigen 2 (BDCA2) is a receptor that is exclusively expressed on plasmacytoid dendritic cells, which are implicated in the pathogenesis of lupus erythematosus. Whether treatment with litifilimab, a humanized monoclonal antibody against BDCA2, would be efficacious in reducing disease activity in patients with cutaneous lupus erythematosus has not been extensively studied. METHODS In this phase 2 trial, we randomly assigned adults with histologically confirmed cutaneous lupus erythematosus with or without systemic manifestations in a 1:1:1:1 ratio to receive subcutaneous litifilimab (at a dose of 50, 150, or 450 mg) or placebo at weeks 0, 2, 4, 8, and 12. We used a dose-response model to assess whether there was a response across the four groups on the basis of the primary end point, which was the percent change from baseline to 16 weeks in the Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score (CLASI-A; scores range from 0 to 70, with higher scores indicating more widespread or severe skin involvement). Safety was also assessed. RESULTS A total of 132 participants were enrolled; 26 were assigned to the 50-mg litifilimab group, 25 to the 150-mg litifilimab group, 48 to the 450-mg litifilimab group, and 33 to the placebo group. Mean CLASI-A scores for the groups at baseline were 15.2, 18.4, 16.5, and 16.5, respectively. The difference from placebo in the change from baseline in CLASI-A score at week 16 was -24.3 percentage points (95% confidence interval [CI] -43.7 to -4.9) in the 50-mg litifilimab group, -33.4 percentage points (95% CI, -52.7 to -14.1) in the 150-mg group, and -28.0 percentage points (95% CI, -44.6 to -11.4) in the 450-mg group. The least squares mean changes were used in the primary analysis of a best-fitting dose-response model across the three drug-dose levels and placebo, which showed a significant effect. Most of the secondary end points did not support the results of the primary analysis. Litifilimab was associated with three cases each of hypersensitivity and oral herpes infection and one case of herpes zoster infection. One case of herpes zoster meningitis occurred 4 months after the participant received the last dose of litifilimab. CONCLUSIONS In a phase 2 trial involving participants with cutaneous lupus erythematosus, treatment with litifilimab was superior to placebo with regard to a measure of skin disease activity over a period of 16 weeks. Larger and longer trials are needed to determine the effect and safety of litifilimab for the treatment of cutaneous lupus erythematosus. (Funded by Biogen; LILAC ClinicalTrials.gov number, NCT02847598.).
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MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Dose-Response Relationship, Drug
- Double-Blind Method
- Herpes Zoster/etiology
- Humans
- Lectins, C-Type/antagonists & inhibitors
- Lectins, C-Type/immunology
- Lupus Erythematosus, Cutaneous/drug therapy
- Membrane Glycoproteins/antagonists & inhibitors
- Membrane Glycoproteins/immunology
- Receptors, Immunologic/antagonists & inhibitors
- Receptors, Immunologic/immunology
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
- Victoria P Werth
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Richard A Furie
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Juanita Romero-Diaz
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Sandra Navarra
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Kenneth Kalunian
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Ronald F van Vollenhoven
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Filippa Nyberg
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Benjamin H Kaffenberger
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Saira Z Sheikh
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Goran Radunovic
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Xiaobi Huang
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - George Clark
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Hua Carroll
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Himanshu Naik
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Francois Gaudreault
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Adam Meyers
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Catherine Barbey
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Cristina Musselli
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Nathalie Franchimont
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
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Mecoli CA, Park JK, Alexanderson H, Regardt M, Needham M, de Groot I, Sarver C, Lundberg IE, Shea B, de Visser M, Song YW, Bingham CO, Christopher-Stine L. Perceptions of Patients, Caregivers, and Healthcare Providers of Idiopathic Inflammatory Myopathies: An International OMERACT Study. J Rheumatol 2018; 46:106-111. [PMID: 30219767 DOI: 10.3899/jrheum.180353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROM) that incorporate the patient perspective have not been well established in idiopathic inflammatory myopathies (IIM). As part of our goal to develop IIM-specific PROM, the Outcome Measures in Rheumatology (OMERACT) Myositis special interest group sought to determine which aspects of disease and its effects are important to patients and healthcare providers (HCP). METHODS Based on a prior qualitative content analysis of focus groups, an initial list of 24 candidate domains was constructed. We subsequently conducted an international survey to identify the importance of each of the 24 domains to be assessed in clinical research. Patients with IIM, their caregivers, and HCP treating IIM completed the survey. RESULTS In this survey, a total of 638 respondents completed the survey, consisting of 510 patients, 101 HCP, and 27 caregivers from 48 countries. Overall, patients were more likely to rank "fatigue," "cognitive impact," and "difficulty sleeping" higher compared with HCP, who ranked "joint symptoms," "lung symptoms," and "dysphagia" higher. Both patients and providers rated muscle symptoms as their top domain. In general, patients from different countries were in agreement on which domains were most important. One notable exception was that patients from Sweden and the Netherlands ranked lung symptoms significantly higher compared to other countries including the United States and Australia (mean weighted rankings of 2.86 and 2.04 vs 0.76 and 0.80, respectively; p < 0.0001). CONCLUSION Substantial differences exist in how IIM is perceived by patients compared to HCP, with different domains prioritized. In contrast, patients' ratings across the world were largely similar.
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Affiliation(s)
- Christopher A Mecoli
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea. .,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors.
| | - Jin Kyun Park
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Helene Alexanderson
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Malin Regardt
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Merrilee Needham
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Ingrid de Groot
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Catherine Sarver
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Ingrid E Lundberg
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Beverley Shea
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Marianne de Visser
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Yeong Wook Song
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Clifton O Bingham
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
| | - Lisa Christopher-Stine
- From the Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet; Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; Department of Learning, Informatics and Medical Education, Karolinska Institutet, Solna, Sweden; Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University, Murdoch, Australia; Patient Research Partner, the Netherlands and USA; Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University, Karolinska Institutet, Solna, Sweden; Center for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Neurology, Academic Medical Center, University of Amsterdam, the Netherlands; Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea.,C.A. Mecoli, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; J.K. Park, MD, Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital; H. Alexanderson, PhD, Physiotherapist, Department of Neurology, Care Science and Society, Division of Physiotherapy, and Department of Medicine, Rheumatology Unit, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Regardt, PhD, Occupational Therapist, Department of Learning, Informatics and Medical Education, Karolinska Institutet, and Function Area Occupational Therapy and Physical Therapy, Allied Health Professionals Function, Karolinska University Hospital; M. Needham, MD, Department of Neurology, Fiona Stanley Hospital, IIID Murdoch University and Notre Dame University; I. de Groot, Patient Research Partner, the Netherlands;C. Sarver, Patient Research Partner, USA; I.E. Lundberg, MD, PhD, Division of Rheumatology, Rheumatology Unit, Department of Medicine, Karolinska University Hospital in Solna, Karolinska Institutet; B. Shea, MSN, Center for Global Health, University of Ottawa; M. de Visser, MD, Department of Neurology, Academic Medical Center, University of Amsterdam; Y.W. Song, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Medical Research Center, College of Medicine, Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University; C.O. Bingham 3rd, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University; L. Christopher-Stine, MD, Division of Rheumatology, Department of Medicine, Johns Hopkins University. Dr. Mecoli and Dr. Park are co-first authors
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