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Nielsen AW, Hansen IT, Nielsen BD, Kjær SG, Blegvad-Nissen J, Rewers K, Sørensen CM, Hauge EM, Gormsen LC, Keller KK. The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica-a prospective study of 101 patients. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06697-8. [PMID: 38563881 DOI: 10.1007/s00259-024-06697-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE 2-[18F]Fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) has been suggested as an imaging modality to diagnose polymyalgia rheumatica (PMR). However, the applicability of FDG-PET/CT remains unclear, especially following glucocorticoid administration. This study aimed to investigate the diagnostic accuracy of FDG-PET/CT before and during prednisolone treatment, as well as following short-term prednisolone discontinuation. METHODS Treatment naïve suspected PMR patients were clinically diagnosed at baseline and subsequently had an FDG-PET/CT performed. Patients diagnosed with PMR were administered prednisolone following the first FDG-PET/CT and had a second FDG-PET/CT performed after 8 weeks of treatment. Subsequently, prednisolone was tapered with short-term discontinuation at week 9 followed by a third FDG-PET/CT at week 10. An FDG-PET/CT classification of PMR/non-PMR was applied, utilizing both the validated Leuven score and a dichotomous PMR score. The final diagnosis was based on clinical follow-up after 1 year. RESULTS A total of 68 and 27 patients received a final clinical diagnosis of PMR or non-PMR. A baseline FDG-PET/CT classified the patients as having PMR with a sensitivity/specificity of 86%/63% (Leuven score) and 82%/70% (dichotomous score). Comparing the subgroup of non-PMR with inflammatory diseases to the PMR group demonstrated a specificity of 39%/54% (Leuven/dichotomous score). After 8 weeks of prednisolone treatment, the sensitivity of FDG-PET/CT decreased to 36%/41% (Leuven/dichotomous score), while a short-term prednisolone discontinuation increased the sensitivity to 66%/60%. CONCLUSION FDG-PET/CT has limited diagnostic accuracy for differentiating PMR from other inflammatory diseases. If FDG-PET/CT is intended for diagnostic purposes, prednisolone should be discontinued to enhance diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov (NCT04519580). Registered 17th of August 2020.
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Affiliation(s)
- Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Søren Geill Kjær
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Kate Rewers
- Department of Nuclear Medicine and PET, Odense University Hospital, Odense, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Knudsen LR, Ndosi M, Hauge EM, Lomborg K, Dreyer L, Aaboe S, Kjær MB, Sørensen L, Volsmann L, Christensen HM, de Thurah A. Effectiveness of a novel digital patient education programme to support self-management of early rheumatoid arthritis: a randomised controlled trial. Rheumatology (Oxford) 2024:keae177. [PMID: 38498833 DOI: 10.1093/rheumatology/keae177] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a novel digital patient education (PE) programme in improving self-management in patients newly diagnosed with rheumatoid arthritis (RA). METHODS This was a parallel, open-label, two arms, randomised controlled trial with superiority design. Patients from five rheumatology clinics were randomised into digital PE (intervention) or face-to-face PE (control). The primary outcome was self-efficacy, measured by average difference in the Rheumatoid Arthritis Self-Efficacy (RASE) score from baseline to month 12. Secondary outcomes were RA knowledge, health literacy, adherence, and quality of life. Healthcare utilisation data and digital PE programme usage were recorded. Self-efficacy, knowledge, and health literacy data were analysed using mixed-effects repeated measures modelling; adherence using logistic regression, and quality of life and healthcare utilization using descriptive statistics with the Wilcoxon rank-sum test. RESULTS Of the 180 patients randomised (digital PE, n = 89; face-to-face PE, n = 91), 175 had data available for analysis. Median age was 59.0 years, and 61% were women. The average difference in self-efficacy between groups from baseline to month 12 was significant by a -4.34 difference in RASE score, favouring the intervention group (95%CI -8.17 to -0.51; p= 0.026). RA knowledge, health literacy, and quality of life showed minor improvements over time but no difference between groups, except out-patient clinic contacts which were fewer in the intervention group. CONCLUSIONS The findings suggest that digital PE is effective in improving self-efficacy and therefore self-management in patients with early RA. This intervention has potential to lower healthcare costs by decreasing out-patient clinic contacts. TRIAL REGISTRATION NUMBER clinicaltrials.gov, NCT04669340.
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Affiliation(s)
- Line R Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sidsel Aaboe
- Department of Rheumatology, Randers Regional Hospital, Randers, Denmark
| | - Marie B Kjær
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lis Sørensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cosedis Enevoldsen F, Therkildsen J, Klose-Jensen R, Lynggaard Elkjær A, Uggerby Næser E, Klicman RF, Thorup Aaen K, Søndergaard KH, Hauge EM. High-resolution peripheral quantitative computed tomography for the assessment of acro-osteolysis and calcinosis in patients with systemic sclerosis. Joint Bone Spine 2024; 91:105699. [PMID: 38309517 DOI: 10.1016/j.jbspin.2024.105699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/10/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To assist the development of future treatments in systemic sclerosis (SSc), the development of reliable outcome measures is pivotal. We aimed to evaluate the use of high-resolution peripheral quantitative CT (HR-pQCT) for visualization and gradation of acro-osteolysis (AO) and calcinosis compared to conventional hand radiographs (CR) in patients with SSc. METHODS HR-pQCT scans of the 2nd to 4th fingers, CR, nail fold capillaroscopy, and a clinical examination were conducted. Images were reviewed for the presence and degree of AO and calcinosis according to semiquantitative grading scales. RESULTS Forty patients were included. Fourteen had AO according to CR, whereas HR-pQCT revealed AO in 18 patients. The sensitivity and specificity of classifying patients as having AO by HR-pQCT when CR was used as reference were 93% (95% CI: 66-99%) and 80% (95% CI: 59-93%), respectively. By CR and with HR-pQCT as reference, the sensitivity and specificity were 72% (95% CI: 47-90%) and 95% (95% CI: 76-99%). Patients with AO had more or larger calcifications than patients without AO according to the proposed HR-pQCT grading system, with a median grade of 2 (IQR: 1-3) versus 0 (IQR: 0-1) (P<0.01). Grade 3 changes were observed exclusively in patients with AO (n=6/14, 42.9%). Assessment of AO and calcinosis by HR-pQCT demonstrated moderate to excellent test-retest reliability. CONCLUSION HR-pQCT allowed precise and reliable classification and grading of acro-osteolysis and acral calcinosis. The modality could prove helpful for detecting and monitoring these lesions as well as facilitating early diagnosis and guide treatment of these patients.
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Affiliation(s)
- Frederik Cosedis Enevoldsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark.
| | - Josephine Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Amanda Lynggaard Elkjær
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Esben Uggerby Næser
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Rikke Fuglsang Klicman
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Katja Thorup Aaen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Klaus Henrik Søndergaard
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark
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Cheneymann A, Therkildsen J, Winther S, Nissen L, Thygesen J, Langdahl BL, Hauge EM, Bøttcher M. Bone Mineral Density Derived from Cardiac CT Scans: Using Contrast Enhanced Scans for Opportunistic Screening. J Clin Densitom 2024; 27:101441. [PMID: 38006641 DOI: 10.1016/j.jocd.2023.101441] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Osteoporosis is under-diagnosed and often co-exists with other diseases. Very low bone mineral density (BMD) indicates risk of osteoporosis and opportunistic screening for low BMD in CT-scans has been suggested. In a non-contrast enhanced thoracic CT scan, the scan-field-of-view includes vertebrae enabling BMD estimation. However, many CT scans are obtained by administration of contrast material. If the impact of contrast enhancement on BMD measurements could be quantified, considerably more patients are eligible for screening. METHODS This study investigated the impact of intravenous contrast on thoracic BMD measurements in cardiac CT scans pre- and post-contrast, including different contrast trigger levels of 130 and 180 Hounsfield units (HU). BMD was measured using quantitative CT with asynchronous calibration. RESULTS In 195 participants undergoing cardiac CT (mean age 57±9 years, 37 % females) contrast increased mean thoracic BMD from 116±33 mg/cm3 (non-enhanced CT) to 130±38 mg/cm3 (contrast-enhanced CT) (p<0.001). Using clinical cut-off values for very low (<80 mg/cm3) and low BMD (<120 mg/cm3) showed that 24 % (47/195 participants) were misclassified when BMD was measured on contrast-enhanced CT-scans. Of the misclassified patients, 6 % (12/195 participants) were categorized as having low BMD despite having very low BMD on the non-enhanced images. Contrast-CT using a higher contrast trigger level showed a significant increase in BMD compared to the lower trigger level (119±32 vs. 135±40 mg/cm3, p<0.01). CONCLUSION For patients undergoing cardiac CT, using contrast-enhanced images to assess BMD entails substantial overestimation. Contrast protocol trigger levels also affect BMD measurements. Adjusting for these factors is needed before contrast-enhanced images can be used clinically. MINI ABSTRACT Osteoporosis is under-diagnosed. Contrast-enhanced CT made to examine other diseases might be utilized simultaneously for bone mineral density (BMD) screening. These scans, however, likely entails overestimation of BMD due to the effect of contrast. Adjusting for this effect is needed before contrast-enhanced images can be implemented clinically for BMD screening.
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Affiliation(s)
| | - Josephine Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Louise Nissen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Bente L Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Ammitzbøll C, Thomsen MK, Andersen JB, Jensen JMB, Bayarri-Olmos R, Garred P, Hermansen MLF, Johannsen AD, Larsen ML, Mistegaard CE, Mikkelsen S, Nielsen L, Olesen R, Pérez-Alós L, Vils SR, Szabados F, Søgaard OS, Tolstrup M, Erikstrup C, Hauge EM, Troldborg A. Revaccination of patients with systemic lupus erythematosus or rheumatoid arthritis without an initial COVID-19 vaccine response elicits seroconversion in half of the patients. Clin Exp Rheumatol 2024; 42:157-165. [PMID: 37877429 DOI: 10.55563/clinexprheumatol/orpp04] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/19/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To investigate the effect of COVID-19 mRNA revaccination (two doses) on the antibody response in patients with rheumatic diseases (RD) who were initial vaccine non-responders. Further, to examine if B-cell levels or T-cell responses before revaccination predicted seroconversion. METHODS From a RD cohort vaccinated with the standard two-dose COVID-19 vaccinations, we enrolled cases without detectable antibody responses (n=17) and controls with detectable antibody response (n=29). Blood donors (n=32) were included as additional controls. Samples were collected before and six weeks after completed revaccination. Total antibodies and specific IgG, IgA, and IgM against SARS-CoV-2 spike protein, SARS-CoV-2 neutralising antibodies, and SARS-CoV-2 reacting CD4+ and CD8+ T-cells were measured before and after revaccination. B-cells (CD19+CD45+) were quantified before revaccination. RESULTS Forty-seven percent of cases had detectable neutralising antibodies after revaccination. However, antibody levels were significantly lower than in controls and blood donors. Revaccination induced an antibody class switch in cases with a decrease in IgM and increase in IgG. No significant difference was observed in T-cell responses before and after revaccination between the three groups. Only 29% of cases had measurable B-cells compared to 100% of controls and blood donors. Fifty percent of revaccinated cases who seroconverted had measurable B-cells before revaccination. CONCLUSIONS Forty-seven percent of initial non-responders seroconverted after two-dose revaccination but still had lower levels of SARS-CoV-2 antibodies compared with controls and blood donors. RD patients without a detectable serological response after the initial COVID-19 mRNA vaccine had a T-cell response similar to immunocompetent controls and blood donors.
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Affiliation(s)
- Christian Ammitzbøll
- Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Marianne Kragh Thomsen
- Department of Clinical Medicine, Aarhus University, and Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Magnus Bernth Jensen
- Department of Clinical Immunology, Aarhus University Hospital, and Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Rafael Bayarri-Olmos
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Peter Garred
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | | | | | - Mads Lamm Larsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Clara Elbæk Mistegaard
- Department of Rheumatology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Lena Nielsen
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark
| | - Rikke Olesen
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark
| | - Laura Pérez-Alós
- Department of Clinical Immunology section 7631, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Signe Risbøl Vils
- Department of Rheumatology, Aarhus University Hospital, and Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, and Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Keller KK, Mukhtyar CB, Nielsen AW, Hemmig AK, Mackie SL, Sattui SE, Hauge EM, Dua A, Helliwell T, Neill L, Blockmans D, Devauchelle-Pensec V, Hayes E, Venneboer AJ, Monti S, Ponte C, De Miguel E, Matza M, Warrington KJ, Byram K, Yaseen K, Peoples C, Putman M, Lally L, Finikiotis M, Appenzeller S, Caramori U, Toro-Gutiérrez CE, Backhouse E, Oviedo MCG, Pimentel-Quiroz VR, Keen HI, Owen CE, Daikeler T, de Thurah A, Schmidt WA, Brouwer E, Dejaco C. Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Ann Rheum Dis 2023:ard-2023-225134. [PMID: 38050004 DOI: 10.1136/ard-2023-225134] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). METHODS A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated. RESULTS Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. CONCLUSIONS These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.
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Affiliation(s)
- Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sebastian Eduardo Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Anisha Dua
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Toby Helliwell
- School of Medicine, University of Staffordshire, Stafford, UK
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Dundee, UK
| | - Daniel Blockmans
- Clinical Department of General Internal Medicine Department, Research Department of Microbiology and Immunology, Laboratory of Clinical Infectious and Inflammatory Disorders, University Hospitals Leuven, Leuven, Belgium
- Universitaire Ziekenhuis Gasthuisberg, Leuven, Belgium
| | | | - Eric Hayes
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Jansen Venneboer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sara Monti
- Rheumatology, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Cristina Ponte
- Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | | | - Mark Matza
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kevin Byram
- Vanderbilt Rheumatology, Vanderbilt Health, Nashville, Tennessee, USA
| | - Kinanah Yaseen
- Orthopedic and Rheumatologic Insitute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine Peoples
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Putman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Lally
- Hospital for Special Surgery, New York, New York, USA
| | - Michael Finikiotis
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Simone Appenzeller
- Departamento de Clínica Médica, Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Ugo Caramori
- Department of Public Health, State University of Campinas, Campinas, Brazil
| | - Carlos Enrique Toro-Gutiérrez
- Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia
| | | | | | | | | | - Claire Elizabeth Owen
- Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Daikeler
- Clinic for Rheumatology, University Hospital, Basel, Switzerland
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christian Dejaco
- Rheumatology, Brunico Hospital, Brunico, Italy
- Rheumatology, Medical University of Graz, Graz, Austria
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Knudsen LR, Lomborg K, Hauge EM, Zangi HA, de Thurah A. The WebRA study: Opportunities and challenges in digital patient education from the perspective of patients with rheumatoid arthritis: A qualitative study. Patient Educ Couns 2023; 116:107969. [PMID: 37672918 DOI: 10.1016/j.pec.2023.107969] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore patients' perceptions of digital patient education (PE), and how this contributes to self-management of rheumatoid arthritis (RA). METHODS Individual interviews based on 'interpretive description' methodology. The patients were purposively selected from a randomized controlled trial that investigated the effects of digital PE. The analysis included a descriptive section, followed by the interpretation and extraction of the main messages. RESULTS Overall, participants had positive perceptions of the e-learning program. Advantages were flexibility, the possibility for repetition, entertainment, availability, and learning in familiar surroundings. Disadvantages were unmet relational support needs due to missing dialogue with health care providers (HCPs). For the majority, a need for insight into the condition led to an active approach to using e-learning. The e-learning program facilitated knowledge acquisition about RA, but relational support from HCPs and a positive attitude toward living with RA were also important for achieving self-management. CONCLUSION Digital PE is useful for self-management support in RA, however different forms and combinations of PE must be offered in the future to accommodate various needs throughout the disease course. PRACTICE IMPLICATIONS These results may inform future development and implementation of digital PE that adequately takes individual preferences for self-management support into account.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
| | - Kirsten Lomborg
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Heidi A Zangi
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Health, VID Specialized University, Oslo, Norway
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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8
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Schougaard LMV, Knudsen LR, Grove BE, Vestergaard JM, Hjollund NH, Hauge EM, de Thurah A. Socioeconomic, Disease-Related, and Personal Factors Associated With Participation in Remote Follow-Up in Rheumatoid Arthritis: A Cross-Sectional Study. Arthritis Care Res (Hoboken) 2023; 75:2044-2053. [PMID: 36785998 DOI: 10.1002/acr.25105] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To identify socioeconomic, disease-related, and personal factors associated with participation in remote follow-up in patients with rheumatoid arthritis (RA). METHODS Following the implementation of a patient-reported outcome-based remote follow-up intervention in RA patients in Denmark, a cross-sectional study was conducted among 775 prevalent patients. In 2019, an electronic questionnaire was sent to eligible RA patients, covering health literacy and patient experience regarding involvement and confidence with remote care. Questionnaire data were linked to nationwide registries regarding socioeconomic status, labor market affiliation, and comorbidity level. Associations between registry- and questionnaire-based factors and remote follow-up were analyzed using multiple logistic regression analysis. RESULTS All 775 patients were included in the registry-based analyses, but only 394 of 646 (61%) completed the questionnaire. No attachment to the labor market or low household income was associated with lower odds of remote follow-up participation (odds ratio [OR] 0.53 [95% confidence interval (95% CI) 0.34-0.83]) and (OR 0.69 [95% CI 0.48-1.00]). Further, a high level of comorbidity was associated with lower odds of remote follow-up participation compared to a low/medium level of comorbidity (OR 0.53 [95% CI 0.34-0.81]). No association was found between health literacy and remote follow-up, but remote follow-up attendees reported more confidence in remote care (OR 1.33 [95% CI 1.21-1.47]). CONCLUSION Participation in remote follow-up was associated with attachement to the labor market, household income, degree of comorbidity, and confidence with remote care. Additional research is necessary to investigate whether a larger and more divergent group of RA patients should be considered for inclusion in remote follow-up programs.
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Affiliation(s)
| | - Line R Knudsen
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | | | - Niels H Hjollund
- Gødstrup Hospital, Herning, Denmark, and Aarhus University Hospital, Aarhus, Denmark
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9
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Uhrenholt L, Duch K, Christensen R, Dreyer L, Hauge EM, Schlemmer A, Taylor PC, Kristensen S. Predicting successful biologics tapering in patients with inflammatory arthritis: Secondary analyses based on the BIOlogical Dose OPTimisation (BIODOPT) trial. Br J Clin Pharmacol 2023; 89:3152-3164. [PMID: 37271939 DOI: 10.1111/bcp.15806] [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] [Received: 01/18/2023] [Revised: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
AIMS To evaluate predictors for successful biologic tapering among patients with inflammatory arthritis using baseline characteristics from the BIODOPT trial. METHODS Adult patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis on stable biologic dose and in low disease activity ≥12 months were enrolled. Participants were randomized (2:1) to disease activity-guided biologic tapering or continuation of baseline biologic. Patients achieving successful tapering reduced their biologic dose by ≥50%, had no protocol deviations and were in low disease activity at 18 months. Modified Poisson regression with robust variance estimator was applied. RESULTS In total, 142 patients were randomized to tapering (n = 95) or control (n = 47). Successful tapering was achieved by 32 and 2%, respectively. Tapering group was the only statistically significant independent predictor for successful tapering, risk ratio (RR): 14.0 (95% confidence interval [CI]: 1.9 to 101.3, P = .009). However, higher Short Form Health Survey 36 mental component summary (SF-36 MCS) was observed to be a predictor of potential importance, RR: 1.06 (95% CI: 0.99 to 1.13, P = .097). When limiting the analyses to the tapering group only, none of the baseline variables were statistically significant independent predictors but SF-36 MCS was still considered to be of potential importance, RR: 1.05 (95% CI: 0.99 to 1.12, P = .098). CONCLUSION Successful tapering is a reachable target for 1 in 3 patients with inflammatory arthritis who are interested in reducing their biological therapy. No statistically significant predictors (besides allocation to tapering) were identified. Future research on mental health and tapering is encouraged.
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Affiliation(s)
- Line Uhrenholt
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kirsten Duch
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette Schlemmer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Randers Regional Hospital, Randers, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Salome Kristensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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10
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Westerlind H, Glintborg B, Hammer HB, Saevarsdottir S, Krogh NS, Hetland ML, Hauge EM, Martinez Tejada I, Sexton J, Askling J. Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts. RMD Open 2023; 9:e003027. [PMID: 37673441 PMCID: PMC10496677 DOI: 10.1136/rmdopen-2023-003027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. METHODS We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. RESULTS Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. CONCLUSION Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bente Glintborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niels Steen Krogh
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Isabel Martinez Tejada
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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11
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Nielsen BD, Therkildsen P, Keller KK, Gormsen LC, Hansen IT, Hauge EM. Ultrasonography in the assessment of disease activity in cranial and large-vessel giant cell arteritis: a prospective follow-up study. Rheumatology (Oxford) 2023; 62:3084-3094. [PMID: 36651670 DOI: 10.1093/rheumatology/kead028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 10/13/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We evaluated sensitivity to change and discriminative abilities of vascular US scores in disease monitoring in the follow-up of a prospective cohort of new-onset cranial and large-vessel (LV) GCA patients. METHODS Baseline and follow-up (8 weeks, 24 weeks and 15 months) US of temporal arteries (TA), carotid and axillary arteries (LV) included assessment of halo and measurement of the intima media complex (IMC). Max IMC, max halo IMC, sum IMC, sum halo IMC, mean IMC, halo count and the Southend halo score were calculated. The provisional OMERACT US score, OGUS, was obtained, taking the average of temporal arteries and axillary arteries IMCs divided by their normal cut-off values. RESULTS Baseline US was positive in 44/47 patients (72% TA, 72% LV). Sensitivity to change of all composite US scores containing TAs was evident by week 8 onward. LVs responded poorly and new axillary US lesions emerged in six patients despite clinical remission. The OGUS showed a large magnitude of change and is considered the score least prone to potential bias. All TA-based US scores showed moderate-strong correlation with disease activity markers. OGUS, TA halo count, Southend TA halo score, TA sum IMC and TA mean IMC showed potential to discriminate remission and relapse with area under the curve ≥0.8. CONCLUSIONS The OGUS is suggested as an outcome measurement for the assessment of treatment response in clinical trials. The abilities of US scores to discriminate remission and relapse are encouraging and should be further explored.
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Affiliation(s)
- Berit Dalsgaard Nielsen
- Department of Medicine, The Regional Hospital in Horsens, Horsens, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kresten K Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars C Gormsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ib T Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ammitzbøll C, Kragh Thomsen M, Bøgh Andersen J, Jensen JMB, From Hermansen ML, Dahl Johannsen A, Larsen ML, Mistegaard CE, Mikkelsen S, Szabados F, Vils SR, Erikstrup C, Hauge EM, Troldborg A. Rituximab-treated rheumatic patients: B cells predict seroconversion after COVID-19 boost or revaccination in initial vaccine non-responders. Rheumatology (Oxford) 2023; 62:2544-2549. [PMID: 36445008 DOI: 10.1093/rheumatology/keac666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To investigate the effect of either a booster vaccine (one dose) or revaccination (two doses 3 weeks apart) on the antibody response to the COVID-19 mRNA vaccines in patients with rheumatic disease (RD) treated with rituximab (RTX) who had not produced vaccine-reactive antibodies after the initial two vaccine doses. Further, to examine if B cell levels in peripheral blood predicted seroconversion. METHODS We included 91 RTX-treated RD patients previously vaccinated against COVID-19. Patients were offered revaccination or a single booster vaccination with an mRNA vaccine. Serum total antibodies against SARS-CoV-2 spike protein were measured before and 6 weeks after the last vaccine dose. B cells (CD19+CD45+) were measured by flow cytometry at inclusion. RESULTS Of RD patients with undetectable SARS-CoV-2 antibody levels before inclusion, seroconversion was seen in 38% 6 weeks after the booster dose and 32% after revaccination. Patients receiving revaccination had significantly higher antibody levels than patients receiving a booster dose (P < 0.001). In both univariate and multivariate logistic regression analysis, only B cells higher than 10/µl before boost or revaccination were associated with seroconversion (P = 0.009 and P = 0.01, respectively). Seroconversion was independent of age, gender, diagnosis, cumulative RTX dose, RTX treatment time and time since last RTX treatment. CONCLUSION Continuously impaired humoral response to mRNA vaccines was found in most RTX-treated patients after a booster dose or revaccination. Seroconversion was observed in approximately one-third of the patients. Measurable B cells before boosting or revaccination was the strongest predictor of antibody response after boost or revaccination.
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Affiliation(s)
- Christian Ammitzbøll
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Kragh Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Magnus Berth Jensen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mads Lamm Larsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Clara Elbæk Mistegaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Signe Risbøl Vils
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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13
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Meinhardsson JM, Klose-Jensen R, Therkildsen J, Langdahl B, Hauge EM, Keller KK. High-resolution peripheral quantitative computed tomography for the evaluation of bone erosions of metatarsophalangeal joints in patients with rheumatoid arthritis. Int J Rheum Dis 2023. [PMID: 37337629 DOI: 10.1111/1756-185x.14777] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/25/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To compare if the 4th and 5th metatarsophalangeal (MTP) joints evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) could classify more patients with erosive rheumatoid arthritis (RA) compared with conventional radiography (CR) of the hands, wrists, and feet. Furthermore, we characterize and quantify bone erosions in the two MTP joints by HR-pQCT. METHODS This single-center cross-sectional study included patients with established RA (disease duration ≥5 years). Blinded to patient data, the number and volume of erosions in the 4th and 5th MTP joints were measured by HR-pQCT, whereas the erosive scores by CR of 44 joints in the hands, wrists, and feet were assessed according to the Sharp/van der Heijde method. RESULTS Among 42 participants, 30 patients were classified with erosive RA and 12 with non-erosive RA by CR. HR-pQCT of two MTP joints could classify more patients with erosive RA compared with CR of 44 joints (p = .03). The optimal cut-off value for the number and volume of erosions per patient in the 4th and 5th MTP joints by HR-pQCT was 7.5 erosions and 11.7 mm3 , respectively, for detecting erosive disease by CR. Erosions in the two MTP joints by HR-pQCT were found most frequently and were largest at the lateral quadrant of the 5th metatarsal head. CONCLUSION The superiority of HR-pQCT of the 4th and 5th MTP joints compared with CR of 44 joints for classifying erosive RA provides a basis for larger studies evaluating if HR-pQCT could be used for diagnosing erosive RA in the future.
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Affiliation(s)
| | - Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Josephine Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Langdahl
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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14
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Pedersen JM, Hansen AS, Skejø C, Juul-Madsen K, Junker P, Hørslev-Petersen K, Hetland ML, Stengaard-Pedersen K, Østergaard M, Møller BK, Dreyer L, Hauge EM, Hvid M, Greisen S, Deleuran B. Lymphocyte activation gene 3 is increased and affects cytokine production in rheumatoid arthritis. Arthritis Res Ther 2023; 25:97. [PMID: 37287025 DOI: 10.1186/s13075-023-03073-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Lymphocyte activation gene-3 (LAG-3) inhibits T cell activation and interferes with the immune response by binding to MHC-II. As antigen presentation is central in rheumatoid arthritis (RA) pathogenesis, we studied aspects of LAG-3 as a serological marker and mediator in the pathogenesis of RA. Since Galectin-3 (Gal-3) is described as an additional binding partner for LAG-3, we also aimed to study the functional importance of this interaction. METHODS Plasma levels of soluble (s) LAG-3 were measured in early RA patients (eRA, n = 99) at baseline and after 12 months on a treat-to-target protocol, in self-reportedly healthy controls (HC, n = 32), and in paired plasma and synovial fluid (SF) from chronic RA patients (cRA, n = 38). Peripheral blood mononuclear cells (PBMCs) and synovial fluid mononuclear cells (SFMCs) were examined for LAG-3 expression by flow cytometry. The binding and functional outcomes of LAG-3 and Gal-3 interaction were assessed with surface plasmon resonance (SPR) and in cell cultures using rh-LAG3, an antagonistic LAG-3 antibody and a Gal-3 inhibitor. RESULTS Baseline sLAG-3 in the plasma was increased in eRA compared to HC and remained significantly elevated throughout 12 months of treatment. A high level of sLAG-3 at baseline was associated with the presence of IgM-RF and anti-CCP as well as radiographic progression. In cRA, sLAG-3 was significantly increased in SF compared with plasma, and LAG-3 was primarily expressed by activated T cells in SFMCs compared to PBMCs. Adding recombinant human LAG-3 to RA cell cultures resulted in decreased cytokine secretion, whereas blocking LAG-3 with an antagonistic antibody resulted in increased cytokine secretion. By SPR, we found a dose-dependent binding between LAG-3 and Gal-3. However, inhibiting Gal-3 in cultures did not further change cytokine production. CONCLUSIONS sLAG-3 in the plasma and synovial fluid is increased in both early and chronic RA patients, particularly in the inflamed joint. High levels of sLAG-3 are associated with autoantibody seropositivity and radiographic progression in eRA, and LAG-3 plays a biologically active role in cRA by decreasing inflammatory cytokine production. This functional outcome is not affected by Gal-3 interference. Our results suggest that LAG-3 is a faceted regulator of inflammation in early and chronic RA.
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Affiliation(s)
- Janni Maria Pedersen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark.
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark.
| | - Aida Solhøj Hansen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Cæcilie Skejø
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Kristian Juul-Madsen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Peter Junker
- Department of Rheumatology C, Odense University Hospital & Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim Hørslev-Petersen
- Danish Hospital for the Rheumatic Diseases, University of Southern Denmark, Odense, Denmark
| | - Merete Lund Hetland
- DANBIO and Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Mikkel Østergaard
- DANBIO and Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bjarne Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Dreyer
- Center for Rheumatic Research Aalborg, Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hvid
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stinne Greisen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Deleuran
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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15
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Dejaco C, Ponte C, Monti S, Rozza D, Scirè CA, Terslev L, Bruyn GAW, Boumans D, Hartung W, Hočevar A, Milchert M, Døhn UM, Mukhtyar CB, Aschwanden M, Bosch P, Camellino D, Chrysidis S, Ciancio G, D'Agostino MA, Daikeler T, Dasgupta B, De Miguel E, Diamantopoulos AP, Duftner C, Agueda A, Fredberg U, Hanova P, Hansen IT, Hauge EM, Iagnocco A, Inanc N, Juche A, Karalilova R, Kawamoto T, Keller KK, Keen HI, Kermani TA, Kohler MJ, Koster M, Luqmani RA, Macchioni P, Mackie SL, Naredo E, Nielsen BD, Ogasawara M, Pineda C, Schäfer VS, Seitz L, Tomelleri A, Torralba KD, van der Geest KSM, Warrington KJ, Schmidt WA. The provisional OMERACT ultrasonography score for giant cell arteritis. Ann Rheum Dis 2023; 82:556-564. [PMID: 36600183 DOI: 10.1136/ard-2022-223367] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 09/15/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To develop an Outcome Measures in Rheumatology (OMERACT) ultrasonography score for monitoring disease activity in giant cell arteritis (GCA) and evaluate its metric properties. METHODS The OMERACT Instrument Selection Algorithm was followed. Forty-nine members of the OMERACT ultrasonography large vessel vasculitis working group were invited to seven Delphi rounds. An online reliability exercise was conducted using images of bilateral common temporal arteries, parietal and frontal branches as well as axillary arteries from 16 patients with GCA and 7 controls. Sensitivity to change and convergent construct validity were tested using data from a prospective cohort of patients with new GCA in which ultrasound-based intima-media thickness (IMT) measurements were conducted at weeks 1, 3, 6, 12 and 24. RESULTS Agreement was obtained (92.7%) for the OMERACT GCA Ultrasonography Score (OGUS), calculated as follows: sum of IMT measured in every segment divided by the rounded cut-off values of IMTs in each segment. The resulting value is then divided by the number of segments available. Thirty-five members conducted the reliability exercise, the interrater intraclass correlation coefficient (ICC) for the OGUS was 0.72-0.84 and the median intrareader ICC was 0.91. The prospective cohort consisted of 52 patients. Sensitivity to change between baseline and each follow-up visit up to week 24 yielded standardised mean differences from -1.19 to -2.16, corresponding to large and very large magnitudes of change, respectively. OGUS correlated moderately with erythrocyte sedimentation rate, C reactive protein and Birmingham Vasculitis Activity Score (corrcoeff 0.37-0.48). CONCLUSION We developed a provisional OGUS for potential use in clinical trials.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Steiermark, Austria
- Department of Rheumatology, Brunico Hospital, Brunico, Trentino-Alto Adige, Italy
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | | | - Dennis Boumans
- Rheumatology and Clinical Immunology, Hospital Group Twente, Almelo, The Netherlands
| | | | - Alojzija Hočevar
- Department of Rheumatology, Universitiy Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Steiermark, Austria
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Genoa, Italy
| | | | - Giovanni Ciancio
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Thomas Daikeler
- Clinic for Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Bhaskar Dasgupta
- Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, UK
| | | | - Andreas P Diamantopoulos
- Section of Rheumatology, Division of Internal Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Ana Agueda
- Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, Portugal
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Rheumatology, Odense University Hospital, Odense, Denmark
| | - Petra Hanova
- Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- Rheumatology, Hána CB spol. s r.o, Ceske Budejovice, Czech Republic
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus Copenhagen Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Nevsun Inanc
- Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital, Berlin, Germany
| | | | - Toshio Kawamoto
- Immunology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Tanaz A Kermani
- Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Minna J Kohler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Koster
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedicx, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | | | | | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Michihiro Ogasawara
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Luca Seitz
- Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kenneth J Warrington
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolfgang A Schmidt
- Rheumatology, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
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Schmidt M, Arendt-Nielsen L, Hauge EM, Sørensen HT, Pedersen L. High- vs. low-dose diclofenac and cardiovascular risks: a target trial emulation. Eur Heart J Cardiovasc Pharmacother 2023:7078560. [PMID: 36921986 DOI: 10.1093/ehjcvp/pvad018] [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] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
AIMS To examine the dose-dependency of diclofenac's cardiovascular risks. METHODS AND RESULTS Using Danish health registries and the target trial emulation design, we conducted a series of 300 nationwide cohort studies during 1996-2020, each mimicking the strict design criteria of a clinical trial. Adults eligible for inclusion had no recent NSAID prescriptions, contraindications (gastrointestinal diseases, thrombocytopenia, or heart failure), or conditions with low adherence (dementia or psychiatric disease). Diclofenac initiators were compared to healthcare-seeking non-initiators and head-to-head using an approximated high dose of ≥150 mg/day vs. low dose of <150 mg/day. Cox regression was used to compute the incidence rate ratio (IRR) of major adverse cardiovascular events (MACE) within 30 days following initiation. We adjusted for age, sex, calendar period, comorbidity, comedication, and socioeconomic position. Compared with non-initiators (n = 3,789,617), diclofenac initiators (n = 1,894,834) had an approximately 50% increased rate of MACE (IRR 1.53, 95% confidence interval [CI]: 1.43-1.63), reflecting IRRs of 1.54 (95% CI: 1.40-1.69) for myocardial infarction, 1.29 (1.14-1.45) for ischemic stroke, and 1.92 (1.71-2.16) for cardiac death. The risk increase was observed for most conditions with chronic pain, in particular headache (IRR 5.10, 95% CI: 1.46-17.85). The risk increase was similar for initiators of high- (IRR 1.55, 95% CI: 1.40-1.71) and low-dose diclofenac (IRR 1.52, 1.41-1.63), which was confirmed in a head-to-head analysis (IRR 1.01, 95% CI: 0.90-1.12). CONCLUSIONS Initiators of high- and low-dose diclofenac had comparable increased cardiovascular risks. This finding provides evidence against the assumption that low-dose diclofenac is risk-neutral.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Denmark.,Department of Cardiology, Aarhus University Hospital, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Denmark.,Department of Clinical Gastroenterology, Mech-Sense, Aalborg University Hospital, Denmark
| | - Ellen-Margrethe Hauge
- Department of Clinical Medicine, Aarhus University Hospital, Denmark.,Department of Rheumatology, Aarhus University Hospital, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Denmark
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Nielsen AW, Frølund LL, Våben C, Bonde AR, Gormsen LC, de Thurah AL, Hauge EM, Keller KK. Response: Co-occurrence of giant cell arteritis in patients with polymyalgia rheumatica. Reply letter to Castañeda and González-Gay (Letter to the Editor: Concurrent baseline diagnosis of giant cell arteritis and polymyalgia rheumatica - A systematic review and meta-analysis. Semin Arthritis Rheum. 2022;56:152069.). Semin Arthritis Rheum 2023; 58:152155. [PMID: 36580855 DOI: 10.1016/j.semarthrit.2022.152155] [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] [Received: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark; Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1, Silkeborg 8600, Denmark.
| | - Line Lier Frølund
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Christoffer Våben
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Asta Roos Bonde
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark; Department of Nuclear Medicine and PET, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Annette Ladefoged de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Denmark
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18
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de Thurah A, Jensen H, Maribo T, Jensen MB, Sandbæk A, Hauge EM, Rasmussen LA. Use of primary health care and radiological imaging preceding a diagnosis of rheumatoid arthritis: a nationwide cohort study in Denmark. Rheumatology (Oxford) 2023; 62:555-564. [PMID: 35713514 DOI: 10.1093/rheumatology/keac306] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore health-care use in the 12 months preceding a diagnosis of RA in Denmark. METHODS We conducted a population-based cohort study using data from national registries. Every patient diagnosed with RA in 2014-18 was matched to 10 reference individuals without RA from the Danish background population. Health-care use was defined as contacts to general practitioners, contacts to private practicing physiotherapists, and X-rays of hands and/or feet performed in primary or secondary care. We estimated the monthly contact rates for patients and references in the 12 months preceding the diagnosis, and we compared incidence rates for health-care use in each month between the two groups while adjusting for sociodemographic characteristics and comorbidity. RESULTS We included 7427 patients with RA and 74 270 references. Patients with RA had increasing contact rates with general practitioners and physiotherapists from 6 to 8 months before the diagnosis. Compared with references, women with RA had statistically significantly more contacts to general practitioners and physiotherapists during all 12 months. A similar contact pattern was seen in men, albeit less distinct. The number of X-rays increased slightly from 8 months before the diagnosis, with a steep increase in the last 3 months. CONCLUSION Increased contacts to general practitioners and physiotherapists were seen in all 12 months preceding the RA diagnosis, intensifying in the last 6 to 8 months. Imaging increased from 3 months before the diagnosis. This indicates an opportunity to expedite referral to specialist care and ensure earlier diagnosis of RA.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University
| | | | - Thomas Maribo
- Department of Public Health, Aarhus University.,DEFACTUM, Central Denmark Region, Aarhus
| | | | - Annelli Sandbæk
- Department of Public Health, Aarhus University.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University
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Wagner SR, Gregersen RR, Henriksen L, Hauge EM, Keller KK. Smartphone Pedometer Sensor Application for Evaluating Disease Activity and Predicting Comorbidities in Patients with Rheumatoid Arthritis: A Validation Study. Sensors (Basel) 2022; 22:9396. [PMID: 36502098 PMCID: PMC9735816 DOI: 10.3390/s22239396] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Smartphone-based pedometer sensor telemedicine applications could be useful for measuring disease activity and predicting the risk of developing comorbidities, such as pulmonary or cardiovascular disease, in patients with rheumatoid arthritis (RA), but the sensors have not been validated in this patient population. The aim of this study was to validate step counting with an activity-tracking application running the inbuilt Android smartphone pedometer virtual sensor in patients with RA. Two Android-based smartphones were tested in a treadmill test-bed setup at six walking speeds and compared to manual step counting as the gold standard. Guided by a facilitator, the participants walked 100 steps at each test speed, from 2.5 km/h to 5 km/h, wearing both devices simultaneously in a stomach pouch. A computer automatically recorded both the manually observed and the sensor step count. The overall difference in device step counts versus the observed was 5.9% mean absolute percentage error. Highest mean error was at the 2.5 km/h speed tests, where the mean error of the two devices was 18.5%. Both speed and cadence were negatively correlated to the absolute percentage error, which indicates that the greater the speed and cadence, the lower the resulting step counting error rate. There was no correlation between clinical parameters and absolute percentage error. In conclusion, the activity-tracking application using the inbuilt Android smartphone pedometer virtual sensor is valid for step counting in patients with RA. However, walking at very low speed and cadence may represent a challenge.
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Affiliation(s)
- Stefan R. Wagner
- Department of Electrical and Computer Engineering, Aarhus University, 8200 Aarhus, Denmark
| | - Rasmus R. Gregersen
- Department of Electrical and Computer Engineering, Aarhus University, 8200 Aarhus, Denmark
| | - Line Henriksen
- Department of Electrical and Computer Engineering, Aarhus University, 8200 Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Kresten K. Keller
- Department of Rheumatology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
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20
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Klose-Jensen R, Therkildsen J, Blavnsfeldt ABG, Langdahl B, Zejden A, Thygesen J, Keller KK, Hauge EM. The Minimal Erosive Volume Needed for Radiographic Identification of Erosions in the Metacarpophalangeal Joints in Patients With Rheumatoid Arthritis. J Rheumatol 2022; 50:469-477. [PMID: 36379577 DOI: 10.3899/jrheum.220623] [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] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare in images, obtained by high-resolution peripheral quantitative computed tomography (HR-pQCT) and conventional radiography (CR) of the second and third metacarpophalangeal (MCP) joints, the minimal erosive cortical break needed to differentiate between pathological and physiological cortical breaks. METHODS In this single-center cross-sectional study, patients with established rheumatoid arthritis (disease duration ≥ 5 yrs) had their second and third MCP joints of the dominant hand investigated by HR-pQCT and CR. Empirical estimation was used to find the optimal cut-off value for the number of erosions and total erosive volume, which were detectable between patients with and without erosions in the second and third MCP joints according to CR. RESULTS The total erosive volume in the second and third MCP joints by HR-pQCT for CR-detected erosive disease was estimated to be 56.4 mm3 (95% CI 3.5-109.3). The sensitivity and specificity at this cutpoint were 78% and 83%, respectively, with an area under the receiver-operating characteristic curve (AUC) of 0.81. The optimal cut-off value for the number of erosions by HR-pQCT was 8.5 (95% CI 5.9-11.1) for CR-detected erosive disease in the second and third MCP joints. The sensitivity and specificity at this cutpoint were 74% and 88%, respectively, with an AUC of 0.81. CONCLUSION Erosions by HR-pQCT were larger in patients with erosive damage in the second and third MCP joints by CR. We found that CR had poor sensitivity for detecting erosive disease when the erosive volume was < 56.4 mm3 or the number of erosions was < 8.5.
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Affiliation(s)
- Rasmus Klose-Jensen
- R. Klose-Jensen, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University
| | - Josephine Therkildsen
- J. Therkildsen, MD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University
| | - Anne-Birgitte Garm Blavnsfeldt
- A.B.G. Blavnsfeldt, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University
| | - Bente Langdahl
- B. Langdahl, MD, PhD, Department of Clinical Medicine, and Department of Endocrinology and Internal Medicine, Aarhus University
| | - Anna Zejden
- A. Zejden, MD, Department of Radiology, Aarhus University Hospital
| | - Jesper Thygesen
- J. Thygesen, PhD, Department of Clinical Engineering, Central Denmark Region, CO Aarhus University Hospital, Aarhus, Denmark
| | - Kresten Krarup Keller
- K.K. Keller, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University
| | - Ellen-Margrethe Hauge
- E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University
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Schmidt M, Arendt-Nielsen L, Hauge EM, Soerensen HT, Pedersen L. Dose-dependency of diclofenac's cardiovascular risks: a series of nationwide emulated trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2730] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The dose dependency of the adverse effects of diclofenac remains poorly understood.
Purpose
To examine the dose-related cardiovascular risks associated with diclofenac initiation
Methods
We used Danish nationwide health registries (1999–2018) to conduct a series of emulated trials (n=285). Eligible adults had no recent NSAID fillings, contraindications, or conditions with low adherence. Individuals eligible for inclusion were ≥18 years with (1) ≥90 days continuous prescription records prior to diclofenac initiation (baseline); (2) no NSAID prescriptions ≤90 days before enrollment, and (3) no exclusion criteria. Exclusion criteria reflected likelihood of low adherence to treatment (dementia, schizophrenia, or antipsychotic drug use) and labeled contraindications (ulcer disease/anti-ulcer drugs, gastrointestinal bleeding, inflammatory bowel disease, thrombocytopenia, or heart failure). Initiators of diclofenac were compared to healthcare-seeking non-initiators, but also head-to-head for initiators of high (≥75 mg pills as proxy for ≥150 mg/daily) vs. low dose (≤50 mg pills as proxy for <150 mg/daily). Cox proportional-hazards regression was used to compute the intention-to-treat hazard ratio, as measure of the incidence rate ratio (IRR), of major adverse cardiac and cerebrovascular events (MACCE) within 30 days from initiation.
Results
Among 3,177,484 diclofenac initiatiors, 31% used high and 69% used low dose. Compared with non-initiators, diclofenac initiatiors had a 70% increased rate for MACCE (IRR 1.70, 95% CI: 1.55–1.86), reflecting for the individual MACCE components an increased IRRs of 1.66 (95% CI: 1.54–1.79) for myocardial infaction, 1.32 (1.20–1.45) for ischemic stroke, and 1.69 (1.54–1.86) for cardiac death. The effect for MACCE did not differ between initiators of high (IRR 1.73, 95% CI: 1.51–1.97) and low dose (IRR 1.68, 95% CI: 1.52–1.86) (Figure 1). When comparing high and low dose diclofenac head-to-head, we found no meaningful difference in the IRR for MACCE (1.03, 95% CI: 0.89–1.19), MI (0.99, 0.87–1.11), ischemic stroke (0.95, 0.81–1.11) or cardiac death (1.04, 0.90–1.21) (Figure 2).
Conclusion
Initiation of low- and high-dose diclofenac was associated with a consistent and comparable increase in cardiovascular risk.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation
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Affiliation(s)
- M Schmidt
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - L Arendt-Nielsen
- Aalborg University, Center for Neuroplasticity and Pain , Aalborg , Denmark
| | - E M Hauge
- Aarhus University Hospital, Department of Reumatology , Aarhus , Denmark
| | - H T Soerensen
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
| | - L Pedersen
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
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22
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Rasch MNB, Szabados F, Jensen JMB, Nielsen KO, Hauge EM, Troldborg A. [VEXAS gene variants explain previously unrecognized clinical syndrome]. Ugeskr Laeger 2022; 184:V03220225. [PMID: 36205150] [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] [Indexed: 06/16/2023]
Abstract
This review aims to make clinicians aware of the newly described syndrome, VEXAS. VEXAS should become an obvious differential diagnosis in cases of unexplained inflammation, anemia, and rheumatological and/or hematological manifestations. Patients with VEXAS are typically male aged > 60, with inflammation, and macrocytic anaemia. On suspicion of cancer or infections patients have frequently been exposed to extensive diagnostic procedures and hospital admissions. In this review, we summarise the current knowledge of VEXAS regarding pathogenesis, symptoms, diagnosis, and treatment.
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Affiliation(s)
| | | | | | | | - Ellen-Margrethe Hauge
- Led- og Bindevævssygdomme, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Health, Aarhus Universitet
| | - Anne Troldborg
- Led- og Bindevævssygdomme, Aarhus Universitetshospital
- Institut for Biomedicin, Health, Aarhus Universitet
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23
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Lauper K, Iudici M, Mongin D, Bergstra SA, Choquette D, Codreanu C, Cordtz R, De Cock D, Dreyer L, Elkayam O, Hauge EM, Huschek D, Hyrich KL, Iannone F, Inanc N, Kearsley-Fleet L, Kristianslund EK, Kvien TK, Leeb BF, Lukina G, Nordström DC, Pavelka K, Pombo-Suarez M, Rotar Z, Santos MJ, Strangfeld A, Verschueren P, Courvoisier DS, Finckh A. Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration. Ann Rheum Dis 2022; 81:1358-1366. [PMID: 35705376 PMCID: PMC9484385 DOI: 10.1136/annrheumdis-2022-222586] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers. METHODS In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk. RESULTS We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA. CONCLUSION The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
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Affiliation(s)
- Kim Lauper
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneve, Switzerland
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Iudici
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Mongin
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Denis Choquette
- Institut de recherche en rhumatologie de Montréal, Montreal, Quebec, Canada
| | - Catalin Codreanu
- Rheumatology, University of Medicine and Pharmacy, Center of Rheumatic Diseases, Bucharest, Romania
| | - René Cordtz
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Diederik De Cock
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lene Dreyer
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Ori Elkayam
- Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv University, Sourasky Medical Center, Tel Aviv, Israel
| | - Ellen-Margrethe Hauge
- Departments of Clinical Medicine and Rheumatology, Aarhus University and Aarhus University Hospital, Aalborg, Denmark
- DANBIO, Glostrup, Denmark
| | - Doreen Huschek
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Kimme L Hyrich
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Florenzo Iannone
- GISEA, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Nevsun Inanc
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Galina Lukina
- V.A. Nasonova Research Institute of Rheumatology, A. S. Loginov Moscow Clinical Scientific Center, Russian Federation, Moscow, Russian Federation
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Karel Pavelka
- Rheumatology Department, Charles University, Prag, Czech Republic
| | - Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Ziga Rotar
- Department of Rheumatology, biorx.si, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maria Jose Santos
- Rheumatology Department, Hospital Garcia de Orta, on behalf of Reuma.pt, Almada, Portugal
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
- Charité University Medicine, Berlin, Germany
| | - Patrick Verschueren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Division of Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Delphine Sophie Courvoisier
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Rasch MNB, Szabados F, Jensen JMB, Nielsen KO, Hauge EM, Troldborg A. Patients with VEXAS diagnosed in a Danish tertiary rheumatology setting have highly elevated inflammatory markers, macrocytic anaemia and negative autoimmune biomarkers. RMD Open 2022. [PMCID: PMC9462080 DOI: 10.1136/rmdopen-2022-002492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) is an autoinflammatory condition with overlapping features of rheumatology and haematology caused by somatic mutations in the UBA1 gene. Patients present with highly variable symptoms and their path towards diagnosis are often complicated and characterised by extensive examinations. It is, therefore, pivotal that clinicians become familiar with the clinical presentation of VEXAS to advance identification of patients with the disease. Objectives We aimed to (1) characterise patients diagnosed with VEXAS in a tertiary rheumatology referral centre, (2) identify common rheumatological biomarkers that may distinguish VEXAS from other rheumatic diseases and (3) suggest which clinical findings should motivate genetic testing for VEXAS. Methods Patients were identified and diagnosed at the department of Rheumatology, Aarhus University Hospital (AUH), Denmark. Blood samples were examined for VEXAS-associated UBA1 variants by Sanger sequencing at the department of Clinical Immunology, AUH. Clinical and biochemical data were retrieved from the hospital electronic patient chart. Results Eleven male patients with clinical suspicion of VEXAS underwent sequencing. Five of these carried known VEXAS-associated variants. Median age at diagnosis was 84 (75–87) years. All patients had significantly elevated inflammatory markers with a median C-reactive protein (CRP) of 297 (196–386) mg/L and macrocytic anaemia. None of the patients presented common biomarkers for autoimmunity. Conclusion Danish patients with VEXAS syndrome are men with persistent inflammation, constitutional symptoms and heterogeneous clinical presentations. Shared features for all patients in this study were highly elevated inflammatory markers, macrocytic anaemia and negative autoimmune biomarkers.
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Affiliation(s)
| | - Fruzsina Szabados
- Rheumatology, Sygehus Vendsyssel i Hjørring, Hjorring, Nordjylland, Denmark
| | - Jens Magnus Bernth Jensen
- Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ellen-Margrethe Hauge
- Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Biomedicine, Aarhus University, Aarhus, Denmark
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25
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Saevarsdottir S, Stefansdottir L, Sulem P, Thorleifsson G, Ferkingstad E, Rutsdottir G, Glintborg B, Westerlind H, Grondal G, Loft IC, Sorensen SB, Lie BA, Brink M, Ärlestig L, Arnthorsson AO, Baecklund E, Banasik K, Bank S, Bjorkman LI, Ellingsen T, Erikstrup C, Frei O, Gjertsson I, Gudbjartsson DF, Gudjonsson SA, Halldorsson GH, Hendricks O, Hillert J, Hogdall E, Jacobsen S, Jensen DV, Jonsson H, Kastbom A, Kockum I, Kristensen S, Kristjansdottir H, Larsen MH, Linauskas A, Hauge EM, Loft AG, Ludviksson BR, Lund SH, Markusson T, Masson G, Melsted P, Moore KHS, Munk H, Nielsen KR, Norddahl GL, Oddsson A, Olafsdottir TA, Olason PI, Olsson T, Ostrowski SR, Hørslev-Petersen K, Rognvaldsson S, Sanner H, Silberberg GN, Stefansson H, Sørensen E, Sørensen IJ, Turesson C, Bergman T, Alfredsson L, Kvien TK, Brunak S, Steinsson K, Andersen V, Andreassen OA, Rantapää-Dahlqvist S, Hetland ML, Klareskog L, Askling J, Padyukov L, Pedersen OB, Thorsteinsdottir U, Jonsdottir I, Stefansson K. Multiomics analysis of rheumatoid arthritis yields sequence variants that have large effects on risk of the seropositive subset. Ann Rheum Dis 2022; 81:1085-1095. [PMID: 35470158 PMCID: PMC9279832 DOI: 10.1136/annrheumdis-2021-221754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/26/2021] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To find causal genes for rheumatoid arthritis (RA) and its seropositive (RF and/or ACPA positive) and seronegative subsets. METHODS We performed a genome-wide association study (GWAS) of 31 313 RA cases (68% seropositive) and ~1 million controls from Northwestern Europe. We searched for causal genes outside the HLA-locus through effect on coding, mRNA expression in several tissues and/or levels of plasma proteins (SomaScan) and did network analysis (Qiagen). RESULTS We found 25 sequence variants for RA overall, 33 for seropositive and 2 for seronegative RA, altogether 37 sequence variants at 34 non-HLA loci, of which 15 are novel. Genomic, transcriptomic and proteomic analysis of these yielded 25 causal genes in seropositive RA and additional two overall. Most encode proteins in the network of interferon-alpha/beta and IL-12/23 that signal through the JAK/STAT-pathway. Highlighting those with largest effect on seropositive RA, a rare missense variant in STAT4 (rs140675301-A) that is independent of reported non-coding STAT4-variants, increases the risk of seropositive RA 2.27-fold (p=2.1×10-9), more than the rs2476601-A missense variant in PTPN22 (OR=1.59, p=1.3×10-160). STAT4 rs140675301-A replaces hydrophilic glutamic acid with hydrophobic valine (Glu128Val) in a conserved, surface-exposed loop. A stop-mutation (rs76428106-C) in FLT3 increases seropositive RA risk (OR=1.35, p=6.6×10-11). Independent missense variants in TYK2 (rs34536443-C, rs12720356-C, rs35018800-A, latter two novel) associate with decreased risk of seropositive RA (ORs=0.63-0.87, p=10-9-10-27) and decreased plasma levels of interferon-alpha/beta receptor 1 that signals through TYK2/JAK1/STAT4. CONCLUSION Sequence variants pointing to causal genes in the JAK/STAT pathway have largest effect on seropositive RA, while associations with seronegative RA remain scarce.
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Affiliation(s)
- Saedis Saevarsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland .,Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | - Bente Glintborg
- The DANBIO registry, the Danish Rheumatologic Biobank and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helga Westerlind
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gerdur Grondal
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.,Center for Rheumatology Research, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Isabella C Loft
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Signe Bek Sorensen
- Molecular Diagnostics and Clinical Research Unit, IRS-Center Sonderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Benedicte A Lie
- Department of Medical Genetics, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
| | - Mikael Brink
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Lisbeth Ärlestig
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | | | - Eva Baecklund
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Bank
- Molecular Diagnostics and Clinical Research Unit, IRS-Center Sonderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Lena I Bjorkman
- Department of Rheumatology and Inflammation research, University of Gothenburg, Gothenburg, Sweden
| | - Torkell Ellingsen
- OPEN Explorative Network, University of Southern Denmark, Odense, Denmark.,Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Center for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Gothenburg University, Gothenburg, Sweden
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen, Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Gisli H Halldorsson
- deCODE genetics/Amgen, Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jan Hillert
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Estrid Hogdall
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Dorte Vendelbo Jensen
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte and Herlev Hospital, Rønne, Denmark
| | - Helgi Jonsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Alf Kastbom
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Kockum
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helga Kristjansdottir
- Center for Rheumatology Research, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Margit H Larsen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Asta Linauskas
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Rheumatology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne G Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjorn R Ludviksson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Immunology, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Thorsteinn Markusson
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Pall Melsted
- deCODE genetics/Amgen, Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Heidi Munk
- OPEN Explorative Network, University of Southern Denmark, Odense, Denmark.,Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Thorunn A Olafsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Tomas Olsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | | | - Helga Sanner
- Section of Rheumatology, Oslo University Hospital, Oslo, Norway.,Oslo New University College, Oslo, Norway
| | - Gilad N Silberberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Inge J Sørensen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Thomas Bergman
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tore K Kvien
- University of Oslo, Oslo, Norway.,Diakonhjemmet Hospital, Oslo, Norway
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristján Steinsson
- Center for Rheumatology Research, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Vibeke Andersen
- Molecular Diagnostics and Clinical Research Unit, IRS-Center Sonderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,OPEN Explorative Network, University of Southern Denmark, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Merete Lund Hetland
- The DANBIO registry, the Danish Rheumatologic Biobank and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Klareskog
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ole Bv Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Immunology, Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavik, Iceland .,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Ammitzbøll C, Thomsen MK, Andersen JB, Bartels LE, Hermansen MLF, Johannsen AD, Mistegaard CE, Mikkelsen S, Vils SR, Erikstrup C, Hauge EM, Troldborg A. COVID-19 Vaccination in Patients with Rheumatic Diseases Leads to a High Seroconversion Rate and Reduced Self-Imposed Isolation and Shielding Behavior. Mod Rheumatol 2022:6647614. [PMID: 35860843 PMCID: PMC9384499 DOI: 10.1093/mr/roac069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/11/2022] [Revised: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We investigated the effect of a two-dose mRNA vaccine on antibody levels against SARS-CoV-2 and patient behavior and shielding concerning fear of COVID-19 in patients with systemic lupus erythematosus or rheumatoid arthritis. METHODS Three-hundred-and-three patients and 44 blood donors were included. All patients received two doses of an mRNA vaccine and had total antibodies against SARS-CoV-2 measured before vaccination and 2 and 9 weeks after the second vaccination. Further, patients answered an electronic questionnaire before and after vaccination concerning behavior, anxiety, and symptoms of depression (PHQ-9). RESULTS Significantly fewer patients (90%) had measurable antibodies against SARS-CoV-2 compared to blood donors (100%) after the second vaccination (p<0.001). Treatment with rituximab was the strongest predictor of an unfavorable vaccine response, as only 27% had measurable antibodies. Nearly all patients (97%) not treated with rituximab experienced seroconversion. Prednisone and methotrexate had a negative effect on seroconversion, but no effect of age or comorbidity was observed. Patients experienced significant improvement after vaccination in 10 out of 12 questions regarding behavior and fear of COVID-19, while no change in PHQ-9 or anxiety was observed. CONCLUSION We find a very high seroconversion rate among rheumatic patients, and reduced self-imposed isolation and shielding after COVID-19 vaccination.
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Affiliation(s)
- Christian Ammitzbøll
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Kragh Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Erik Bartels
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Clara Elbæk Mistegaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Signe Risbøl Vils
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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27
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Troldborg A, Thomsen MK, Bartels LE, Andersen JB, Vils SR, Mistegaard CE, Johannsen AD, Hermansen MLF, Mikkelsen S, Erikstrup C, Hauge EM, Ammitzbøll C. Time Since Rituximab Treatment Is Essential for Developing a Humoral Response to COVID-19 mRNA Vaccines in Patients With Rheumatic Diseases. J Rheumatol 2022; 49:644-649. [PMID: 35232803 DOI: 10.3899/jrheum.211152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to investigate (1) whether patients with rheumatic disease (RD) treated with rituximab (RTX) raise a serological response toward the coronavirus disease 2019 (COVID-19) mRNA vaccines, and (2) to elucidate the influence of time since the last RTX dose before vaccination on this response. METHODS We identified and included 201 patients with RDs followed at the outpatient clinic at the Department of Rheumatology, Aarhus University Hospital, who had been treated with RTX in the period 2017-2021 and who had completed their 2-dose vaccination series with a COVID-19 mRNA vaccine. Total antibodies against the SARS-CoV-2 spike protein were measured on all patients and 44 blood donors as reference. RESULTS We observed a time-dependent increase in antibody response as the interval from the last RTX treatment to vaccination increased. Only 17.3% of patients developed a detectable antibody response after receiving their vaccination ≤ 6 months after their previous RTX treatment. Positive antibody response increased to 66.7% in patients who had RTX 9-12 months before vaccination. All blood donors (100%) had detectable antibodies after vaccination. CONCLUSION Patients with RDs treated with RTX have a severely impaired serological response toward COVID-19 mRNA vaccines. Our data suggest that the current recommendations of a 6-month interval between RTX treatment and vaccination should be reevaluated.
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Affiliation(s)
- Anne Troldborg
- A. Troldborg, MD, PhD, Department of Rheumatology, Aarhus University Hospital, Department of Biomedicine, and Department of Clinical Medicine, Aarhus University;
| | - Marianne Kragh Thomsen
- M.K. Thomsen, MD, Department of Clinical Medicine, Aarhus University, and Department of Clinical Microbiology, Aarhus University Hospital
| | - Lars Erik Bartels
- L.E. Bartels, MD, PhD, J.B. Andersen, MD, A.D. Johannsen, MD, M.L.F. Hermansen, MD, PhD, Department of Rheumatology, Aarhus University Hospital
| | - Jakob Bøgh Andersen
- L.E. Bartels, MD, PhD, J.B. Andersen, MD, A.D. Johannsen, MD, M.L.F. Hermansen, MD, PhD, Department of Rheumatology, Aarhus University Hospital
| | - Signe Risbøl Vils
- S.R. Vils MS, Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University
| | - Clara Elbæk Mistegaard
- C.E. Mistegaard, MD, Department of Rheumatology, and Department of Clinical Microbiology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University
| | - Anders Dahl Johannsen
- L.E. Bartels, MD, PhD, J.B. Andersen, MD, A.D. Johannsen, MD, M.L.F. Hermansen, MD, PhD, Department of Rheumatology, Aarhus University Hospital
| | - Marie-Louise From Hermansen
- L.E. Bartels, MD, PhD, J.B. Andersen, MD, A.D. Johannsen, MD, M.L.F. Hermansen, MD, PhD, Department of Rheumatology, Aarhus University Hospital
| | - Susan Mikkelsen
- S. Mikkelsen, MD, Department of Clinical Immunology, Aarhus University Hospital
| | - Christian Erikstrup
- C. Erikstrup, MD, PhD, Department of Clinical Medicine, Aarhus University, and Department of Clinical Immunology, Aarhus University Hospital
| | - Ellen-Margrethe Hauge
- E.M. Hauge, MD, PhD, C. Ammitzbøll, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Ammitzbøll
- E.M. Hauge, MD, PhD, C. Ammitzbøll, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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van Sleen Y, Therkildsen P, Nielsen BD, van der Geest KSM, Hansen I, Heeringa P, Posthumus MD, Sandovici M, Toonen EJM, Zijlstra J, Boots AMH, Hauge EM, Brouwer E. Angiopoietin-2/-1 ratios and MMP-3 levels as an early warning sign for the presence of giant cell arteritis in patients with polymyalgia rheumatica. Arthritis Res Ther 2022; 24:65. [PMID: 35255968 PMCID: PMC8900446 DOI: 10.1186/s13075-022-02754-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosing patients with giant cell arteritis (GCA) remains difficult. Due to its non-specific symptoms, it is challenging to identify GCA in patients presenting with symptoms of polymyalgia rheumatica (PMR), which is a more common disease. Also, commonly used acute-phase markers CRP and ESR fail to discriminate GCA patients from PMR and (infectious) mimicry patients. Therefore, we investigated biomarkers reflecting vessel wall inflammation for their utility in the accurate diagnosis of GCA in two international cohorts. Methods Treatment-naïve GCA patients participated in the Aarhus AGP cohort (N = 52) and the Groningen GPS cohort (N = 48). The AGP and GPS biomarker levels and symptoms were compared to patients presenting phenotypically as isolated PMR, infectious mimicry controls and healthy controls (HCs). Serum/plasma levels of 12 biomarkers were measured by ELISA or Luminex. Results In both the AGP and the GPS cohort, we found that weight loss, elevated erythrocyte sedimentation rate (ESR) and higher angiopoietin-2/-1 ratios but lower matrix metalloproteinase (MMP)-3 levels identify concomitant GCA in PMR patients. In addition, we confirmed that elevated platelet counts are characteristic of GCA but not of GCA mimicry controls and that low MMP-3 and proteinase 3 (PR3) levels may help to discriminate GCA from infections. Conclusion This study, performed in two independent international cohorts, consistently shows the potential of angiopoietin-2/-1 ratios and MMP-3 levels to identify GCA in patients presenting with PMR. These biomarkers may be used to select which PMR patients require further diagnostic workup. Platelet counts may be used to discriminate GCA from GCA look-alike patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02754-5.
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Affiliation(s)
- Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
| | - Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
| | - Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands
| | - Ib Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel D Posthumus
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands
| | | | - Jannik Zijlstra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands
| | - Annemieke M H Boots
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands
| | | | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, the Netherlands
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Andersen NH, Hauge EM, Baad-Hansen T, Groth KA, Berglund A, Gravholt CH, Stochholm K. Musculoskeletal diseases in Marfan syndrome: a nationwide registry study. Orphanet J Rare Dis 2022; 17:118. [PMID: 35248143 PMCID: PMC8898450 DOI: 10.1186/s13023-022-02272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Marfan syndrome is associated with abnormalities in the musculoskeletal system including scoliosis, pectus deformities, protrusio acetabuli, and foot deformities. Over a life span, many patients with Marfan syndrome will need treatment; however, the musculoskeletal morbidity over a life span is not well described. The aim of the present study was to assess the overall burden of musculoskeletal disease in patients with Marfan syndrome.
Materials and methods
A registry-based, nationwide epidemiological study of patients with a Ghent II verified Marfan syndrome diagnosis from 1977 to 2014. Each patient was matched on age, and sex with up to 100 controls from the background population.
Results
We identified 407 patients with Marfan syndrome and 40,700 controls and compared their musculoskeletal diagnoses and surgical treatments using Cox proportional hazards ratio (HR). The risk of a registration of a musculoskeletal diagnosis in patients with Marfan syndrome was significantly increased compared to controls (HR: 1.94 (1.69–2.24). One out of six with Marfan syndrome was registered with scoliosis (HR: 36.7 (27.5–48.9). Scoliosis was more common in women with Marfan syndrome compared to men (HR: 4.30 (1.73–1.08)). One out of 11 were registered with a pectus deformity HR: 40.8 (28.1–59.3), and one out of six with a deformity of the foot. Primarily pes planus (HR: 26.0 (15.2–44.3). The proportion of patients with Marfan syndrome (94/407) that underwent musculoskeletal surgery was also significantly higher (HR: 1.76 (1.43–2.16)). The major areas of surgery were the spine, pectups correction, and surgery of the foot/ankle. Ten patients with Marfan syndrome had elective orthopedic surgery without being recognized and diagnosed with Marfan syndrome until later in life. None of these had scoliosis, pectus deformity or a foot deformity. Among patients with an aortic dissection, the age at dissection was 34.3 years in those with at least one major musculoskeletal abnormality. In patients without a major abnormality the age at dissection was 45.1 years (p < 0.01).
Conclusions
The extent of musculoskeletal disease is quite significant in Marfan syndrome, and many will need corrective surgery during their life span. Surgeons should be aware of undiagnosed patients with Marfan syndrome when treating patients with a Marfan syndrome like-phenotype.
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30
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Raunsbæk Knudsen L, Lomborg K, Ndosi M, Hauge EM, de Thurah A. The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study-protocol for a pragmatic randomised controlled trial. BMC Rheumatol 2021; 5:57. [PMID: 34924034 PMCID: PMC8686289 DOI: 10.1186/s41927-021-00226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/31/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis.
Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00226-y.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,University Hospitals Bristol, Bristol, England
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Wittig NK, Østergaard M, Palle J, Christensen TEK, Langdahl BL, Rejnmark L, Hauge EM, Brüel A, Thomsen JS, Birkedal H. Opportunities for biomineralization research using multiscale computed X-ray tomography as exemplified by bone imaging. J Struct Biol 2021; 214:107822. [PMID: 34902560 DOI: 10.1016/j.jsb.2021.107822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/29/2022]
Abstract
Biominerals typically have complex hierarchical structures traversing many length scales. This makes their structural characterization complicated, since it requires 3D techniques that can probe full specimens at down to nanometer-resolution, a combination that is difficult - if not impossible - to achieve simultaneously. One challenging example is bone, a mineralized tissue with a highly complex architecture that is replete with a network of cells. X-ray computed tomography techniques enable multiscale structural characterization through the combination of various equipment and emerge as promising tools for characterizing biominerals. Using bone as an example, we discuss how combining different X-ray imaging instruments allow characterizing bone structures from the nano- to the organ-scale. In particular, we compare and contrast human and rodent bone, emphasize the importance of the osteocyte lacuno-canalicular network in bone, and finally illustrate how combining synchrotron X-ray imaging with laboratory instrumentation for computed tomography is especially helpful for multiscale characterization of biominerals.
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Affiliation(s)
- Nina Kølln Wittig
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus, Denmark.
| | - Maja Østergaard
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus, Denmark
| | - Jonas Palle
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus, Denmark
| | - Thorbjørn Erik Køppen Christensen
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus, Denmark; Sino-Danish College (SDC), University of Chinese Academy of Sciences, China
| | - Bente Lomholt Langdahl
- Department of Clinical Medicine - The Department of Endocrinology and Diabetes, Palle Juul-Jensens Boulevard 165, 8200 Aarhus, Denmark
| | - Lars Rejnmark
- Department of Clinical Medicine - The Department of Endocrinology and Diabetes, Palle Juul-Jensens Boulevard 165, 8200 Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Clinical Medicine - The Department of Rheumatology, Palle Juul-Jensens Boulevard 45, 8200 Aarhus, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Allé 3, 8000 Aarhus, Denmark
| | - Jesper Skovhus Thomsen
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Allé 3, 8000 Aarhus, Denmark.
| | - Henrik Birkedal
- Department of Chemistry and iNANO, Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus, Denmark.
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Uhrenholt L, Christensen R, Dinesen WKH, Liboriussen CH, Andersen SS, Dreyer L, Schlemmer A, Hauge EM, Skrubbeltrang C, Taylor PC, Kristensen S. Risk of flare after tapering or withdrawal of b-/tsDMARDs in patients with RA or axSpA: A systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:3107-3122. [PMID: 34864896 DOI: 10.1093/rheumatology/keab902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate flare risk when tapering or withdrawing biological or targeted synthetic disease-modifying antirheumatic drugs (b-/tsDMARDs) compared to continuation in patients with inflammatory arthritis (IA) in sustained remission or low disease activity. METHODS Articles were identified in Cochrane Library, PubMed, EMBASE and Web of Science. Eligible trials were randomised, controlled trials comparing tapering and/or withdrawal of b- and/or tsDMARDs with standard dose in IA. Random-effects meta-analysis was performed with risk ratio (RR), or Peto's Odds Ratio (POR) for sparse events, and 95% confidence intervals (95%CI). RESULTS The meta-analysis comprised 22 trials: 11 assessed tapering and 7 addressed withdrawal (4 assessed both). Only trials with a rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) population were identified. An increased flare risk was demonstrated when b-/tsDMARD tapering was compared to continuation, RR = 1.45 (95%CI: 1.19 to 1.77, I2 = 42.5%), and potentially increased for persistent flare, POR = 1.56 (95%CI: 0.97 to 2.52, I2 = 0%). Comparing tumour necrosis factor inhibitor (TNFi) withdrawal to continuation, a highly increased flare risk (RR = 2.28, 95%CI: 1.78 to 2.93, I2 = 78%) and increased odds of persistent flare (POR = 3.41, 95%CI: 1.91 to 6.09, I2 = 49%) was observed. No clear difference in flare risk between RA or axSpA was observed. CONCLUSION A high risk for flare and persistent flare was demonstrated for TNFi withdrawal whereas an increased risk for flare but not for persistent flare was observed for b-/tsDMARD tapering. Thus, tapering seems to be the more favourable approach. REGISTRATION PROSPERO (CRD42019136905).
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Affiliation(s)
- Line Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Section for Biostatistics and Evidence-Based Research, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | | | - Stine S Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annette Schlemmer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Rheumatology, Randers Regional Hospital, Randers, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Conni Skrubbeltrang
- Department of Medical Library, Aalborg University Hospital, Aalborg, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Therkildsen P, de Thurah A, Nielsen BD, Hansen IT, Eldrup N, Nørgaard M, Hauge EM. Increased risk of thoracic aortic complications among patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology (Oxford) 2021; 61:2931-2941. [PMID: 34918058 DOI: 10.1093/rheumatology/keab871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/17/2021] [Revised: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the risk of aortic aneurysms (AA), aortic dissections (AD) and peripheral arterial disease (PAD) among patients with GCA. METHODS In this nationwide, population-based cohort study using Danish national health registries, we identified all incident GCA patients ≥50 years between 1996 and 2018 who redeemed three or more prescriptions for prednisolone. Index date was the date of redeeming the third prednisolone prescription. Case definition robustness was checked through sensitivity analysis. We included general population referents matched 1:10 by age, sex and calendar time. Using a pseudo-observation approach, we calculated 5-, 10- and 15-year cumulative incidence proportions (CIP) and relative risks (RR) of AA, AD and PAD with death as a competing risk. RESULTS We included 9908 GCA patients and 98 204 referents. The 15-year CIP of thoracic AA, abdominal AA, AD and PAD in the GCA cohort were 1.9% (95% CI 1.5, 2.2), 1.8% (1.4-2.2), 1.0% (0.7-1.2) and 4.8% (4.2-5.3). Compared with the referents, the 15-year RR were 11.2 (7.41-16.9) for thoracic AA, 6.86 (4.13-11.4) for AD, 1.04 (0.83-1.32) for abdominal AA and 1.53 (1.35-1.74) for PAD. Among GCA patients, female sex, age below 70 years and positive temporal artery findings were risk factors for developing thoracic AA. The median time to thoracic AA was 7.5 years (interquartile range 4.4-11.2) with a number needed to be screened of 250 (167-333), 91 (71-111) and 53 (45-67) after 5, 10 and 15 years. CONCLUSION Patients with GCA have a markedly increased risk of developing thoracic AA and AD, but no increased risk of abdominal AA.
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Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | | | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen
| | - Mette Nørgaard
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
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34
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Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Christensen R, Ørnbjerg LM, Glinatsi D, Møller JM, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Larsen L, Jurik AG, Thomsen HS, Østergaard M. Effect of initiating biologics compared to intensifying conventional DMARDs on clinical and MRI outcomes in established rheumatoid arthritis patients in clinical remission: Secondary analyses of the IMAGINE-RA trial. Scand J Rheumatol 2021; 51:268-278. [PMID: 34474649 DOI: 10.1080/03009742.2021.1935312] [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: 10/20/2022]
Abstract
Objectives: To compare the effect of treat-to-target-based escalations in conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics on clinical disease activity and magnetic resonance imaging (MRI) inflammation in a rheumatoid arthritis (RA) cohort in clinical remission.Method: One-hundred patients with established RA, Disease Activity Score based on 28-joint count-C-reactive protein (DAS28-CRP) < 3.2, and no swollen joints (hereafter referred to as 'in clinical remission') who received csDMARDs underwent clinical evaluation and MRI of the wrist and second to fifth metacarpophalangeal joints every 4 months. They followed a 2 year MRI treatment strategy targeting DAS28-CRP ≤ 3.2, no swollen joints, and absence of MRI osteitis, with predefined algorithmic treatment escalation: first: increase in csDMARDs; second: adding a biologic; third: switch biologic. MRI osteitis and Health Assessment Questionnaire (HAQ) (co-primary outcomes) and MRI combined inflammation and Simplified Disease Activity Index (SDAI) (key secondary outcomes) were assessed 4 months after treatment change and expressed as estimates of group differences. Statistical analyses were based on the intention-to-treat population analysed using repeated-measures mixed models.Escalation to first biologic compared to csDMARD escalation more effectively reduced MRI osteitis (difference between least squares means 1.8, 95% confidence interval 1.0-2.6), HAQ score (0.08, 0.03-0.1), MRI combined inflammation (2.5, 0.9-4.1), and SDAI scores (2.7, 1.9-3.5).Treat-to-target-based treatment escalations to biologics compared to escalation in csDMARDs more effectively improved MRI inflammation, physical function, and clinical disease activity in patients with established RA in clinical remission. Treatment escalation in RA patients in clinical remission reduces clinical and MRI-assessed disease activity.Trial registration: Clinicaltrials.gov identifier: NCT01656278.
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Affiliation(s)
- S Møller-Bisgaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - K Hørslev-Petersen
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - B Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L M Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
| | - D Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - J M Møller
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Boesen
- Department of Radiology, Frederiksberg Hospital, Frederiksberg, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - O R Madsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - B Jensen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - J A Villadsen
- Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - E M Hauge
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - P Bennett
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - O Hendricks
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K Asmussen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Kowalski
- Department of Rheumatology, Sygehus Vendsyssel i Hjørring, Hjørring, Denmark
| | - H Lindegaard
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - T Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A H Nielsen
- Department of Radiology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - L Larsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - A G Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - H S Thomsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Trickey J, Sahbudin I, Ammitzbøll-Danielsen M, Azzolin I, Borst C, Bortoluzzi A, Bruyn GA, Carron P, Ciurtin C, Filippou G, Fliciński J, Fodor D, Gouze H, Gutierrez M, Hammer HB, Hauge EM, Iagnocco A, Ikeda K, Karalilova R, Keen HI, Kortekaas M, La Paglia G, Leon G, Mandl P, Maruseac M, Milchert M, Mortada MA, Naredo E, Ohrndorf S, Pineda C, Rasch MNB, Reátegui-Sokolova C, Sakellariou G, Serban T, Sifuentes-Cantú CA, Stoenoiu MS, Suzuki T, Terslev L, Tinazzi I, Vreju FA, Wittoek R, D'Agostino MA, Filer A. Very low prevalence of ultrasound-detected tenosynovial abnormalities in healthy subjects throughout the age range: OMERACT ultrasound minimal disease study. Ann Rheum Dis 2021; 81:232-236. [PMID: 34407928 PMCID: PMC8762026 DOI: 10.1136/annrheumdis-2021-219931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/22/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
Objectives This study aimed to determine the prevalence of ultrasound-detected tendon abnormalities in healthy subjects (HS) across the age range. Methods Adult HS (age 18–80 years) were recruited in 23 international Outcome Measures in Rheumatology ultrasound centres and were clinically assessed to exclude inflammatory diseases or overt osteoarthritis before undergoing a bilateral ultrasound examination of digit flexors (DFs) 1–5 and extensor carpi ulnaris (ECU) tendons to detect the presence of tenosynovial hypertrophy (TSH), tenosynovial power Doppler (TPD) and tenosynovial effusion (TEF), usually considered ultrasound signs of inflammatory diseases. A comparison cohort of patients with rheumatoid arthritis (RA) was taken from the Birmingham Early Arthritis early arthritis inception cohort. Results 939 HS and 144 patients with RA were included. The majority of HS (85%) had grade 0 for TSH, TPD and TEF in all DF and ECU tendons examined. There was a statistically significant difference in the proportion of TSH and TPD involvement between HS and subjects with RA (HS vs RA p<0.001). In HS, there was no difference in the presence of ultrasound abnormalities between age groups. Conclusions Ultrasound-detected TSH and TPD abnormalities are rare in HS and can be regarded as markers of active inflammatory disease, especially in newly presenting RA.
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Affiliation(s)
- Jeanette Trickey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Reserarch Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ilfita Sahbudin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Reserarch Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Irene Azzolin
- Academic Rheumatology Center, MFRU, Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Carina Borst
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy
| | - George Aw Bruyn
- MC Hospital Group, Lelystad, Netherlands.,Reumakliniek Flevoland, Lelystad, Netherlands
| | - Philippe Carron
- Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK
| | - Georgios Filippou
- University Hospital, Rheumatology Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Jacek Fliciński
- Department of Internal Medicine, Rheumatology, Diabetes, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Daniela Fodor
- 2nd Internal Medicine, UMF Iuliu Haţieganu Cluj-Napoca, Cluj-Napoca, Romania
| | - Hélène Gouze
- Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Marwin Gutierrez
- Clinica Reumatologica, Università Politecnica delle Marche, Ancona, Italy.,Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico, Mexico
| | - Hilde Berner Hammer
- Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Rositsa Karalilova
- University Hospital Kaspela, Medical University of Plovdiv Hospital, Plovdiv, Bulgaria
| | | | - Marion Kortekaas
- Leiden University Medical Center, Leiden, Netherlands.,Flevoziekenhuis, Almere, Netherlands
| | | | - Gustavo Leon
- Instituto Nacional de Rehabilitacion, Mexico, Mexico.,Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Mihaela Maruseac
- Department of Rheumatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marcin Milchert
- Department of Internal Medicine, Rheumatology, Diabetes, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Mohamed Atia Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Esperanza Naredo
- Rheumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carlos Pineda
- Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico, Mexico
| | | | - Cristina Reátegui-Sokolova
- Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico, Mexico.,Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Teodora Serban
- S.C. Reumatologia, ASL3 Genovese, Ospedale La Colletta, Genoa, Italy
| | - Cesar A Sifuentes-Cantú
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Maria S Stoenoiu
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Rheumatology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Takeshi Suzuki
- Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ruth Wittoek
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Maria-Antonietta D'Agostino
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK .,NIHR Birmingham Biomedical Reserarch Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Klose-Jensen R, Keller KK, Langdahl B, Hauge EM. Acceptance and image quality of high-resolution peripheral quantitative computed tomography of the metacarpophalangeal joints in rheumatoid arthritis. Int J Rheum Dis 2021; 24:1473-1481. [PMID: 34212506 DOI: 10.1111/1756-185x.14169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/28/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) requires longer immobilization time than conventional radiography, which challenges patient acceptance and image quality. Therefore, the aim was to investigate the acceptance of HR-pQCT in patients with rheumatoid arthritis (RA), and secondly the effect of an inflatable hand immobilization device on motion artefacts of the metacarpophalangeal (MCP) joints. METHODS Fifty patients with established RA and a median (interquartile range) age of 64.3 (55.0-71.2) years had their MCP joints scanned by HR-pQCT with the hand positioned with and without an inflatable immobilization device followed by a full radiographic examination and a questionnaire on the imaging experience. The comparability of the erosion measures was investigated with and without the immobilization device using Bland-Altman plot and intrareader repeatability by intraclass correlation coefficient. The motion artefacts were graded for each acquisition, and intrareader repeatability was investigated by Cohen's kappa coefficient. RESULTS Forty percent of the patients preferred HR-pQCT imaging, only 6% preferred conventional X-ray. Seventy-four percent reported it was not difficult to keep their fingers steady during the scan. Sixty percent of the patients reported the immobilization device helped keep their fingers steady. However, as motion artefacts were sparse, no clinically relevant difference was observed concerning the effect of the immobilization device on readability. The intrareader repeatability and comparability for the erosion measures were excellent. CONCLUSION The high patient acceptance adds to the feasibility of HR-pQCT imaging of MCP joints in RA. The inflatable immobilization device did not reduce motion-induced image degradation.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Bente Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Therkildsen P, Nielsen BD, de Thurah A, Hansen IT, Nørgaard M, Hauge EM. All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology (Oxford) 2021; 61:1195-1203. [PMID: 34164660 DOI: 10.1093/rheumatology/keab507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate whether giant cell arteritis (GCA) is associated with increased all-cause and cause-specific mortality. METHODS A nationwide, population-based cohort study in Denmark using medical and administrative registries. GCA cases were defined as patients aged ≥50 years from 1996-2018 with a first-time discharge diagnosis of GCA and ≥3 prescriptions for prednisolone within 6 months following diagnosis. Each GCA patient was matched based on age, sex and calendar time to 10 persons without a history of GCA. Index date was the date for the third prednisolone prescription. We used a pseudo-observation approach to calculate all-cause and cause-specific mortality, adjusted risk differences (RDs) and relative risks (RRs). RESULTS We included 9908 GCA patients and 98204 persons from the general population. The median time for GCA patients to redeem the third prednisolone prescription was 74 days (IQR: 49-106). Among GCA patients, the overall mortality was 6.4% (95% CI: 5.9-6.9) 1 year after index date and 45% (95% CI: 44-47) after 10 years. Compared to the reference cohort, adjusted RDs and RRs of deaths in the GCA cohort were 2.2% (95% CI: 1.7-2.7) and 1.49 (95% CI: 1.36-1.64) after 1 year, and 2.1% (95% CI: 1.0-3.3) and 1.03 (95% CI: 1.00-1.05) 10 years after index date. GCA patients had a higher risk of death due to infectious, endocrine, cardiovascular, and gastrointestinal diseases. CONCLUSIONS GCA is associated with increased all-cause mortality, particularly within the first year following the diagnosis. Cause-specific mortality indicates that mortality in GCA may in part be due to glucocorticoid-related complications.
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Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Dalsgaard Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Klose-Jensen R, Therkildsen J, Blavnsfeldt ABG, Langdahl BL, Zejden A, Thygesen J, Keller KK, Hauge EM. Diagnostic accuracy of high-resolution peripheral quantitative computed tomography and X-ray for classifying erosive rheumatoid arthritis. Rheumatology (Oxford) 2021; 61:963-973. [PMID: 34015091 DOI: 10.1093/rheumatology/keab446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate whether High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) of two metacarpophalangeal (MCP) joints can more accurately classify patients as having erosive rheumatoid arthritis (RA) compared with conventional radiography (CR) of 44 joints in the hands, wrists, and feet. METHODS In this single-centre cross-sectional study, patients with established RA (disease duration ≥ 5 years) were investigated by HR-pQCT and CR. The second and third MCP joints of the dominant hand were assessed for erosions by HR-pQCT. CR of the hands, wrists, and feet were scored according to the Sharp/van der Heijde (SHS) method. RESULTS In total, 353 patients were included, 66 (18.7%) patients were classified as having non-erosive RA, and 287 (81.3%) had erosive RA by CR. The sensitivity and specificity (95%CI) of HR-pQCT for classifying patients as having erosive RA when standard CR of hands, wrists, and feet were used as the reference was 89% (84-92)% and 30% (20-43)%, respectively. Using HR-pQCT as the reference, the sensitivity and specificity of CR for classifying patients having erosive RA were 85% (80-89)% and 38% (25-52)%, respectively. McNemar's χ2 test showed no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or by CR (2.14, p= 0.177). CONCLUSIONS The diagnostic accuracy of HR-pQCT scanning of only two MCP joints and conventional radiography of 44 joints suggest the two modalities were comparable for classifying patients with established RA as having erosive disease.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Josephine Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne-Birgitte Garm Blavnsfeldt
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente L Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ammitzbøll C, Thomsen MK, Erikstrup C, Hauge EM, Troldborg A. National differences in vaccine hesitancy: a concern for the external validity of vaccine studies. Lancet Rheumatol 2021; 3:e324. [PMID: 36569359 PMCID: PMC9767380 DOI: 10.1016/s2665-9913(21)00083-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Marianne Kragh Thomsen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus 8200, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus 8200, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus 8200, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Troldborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Møller-Bisgaard S, Georgiadis S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Ørnbjerg LM, Glinatsi D, Møller J, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Balding L, Jurik AG, Thomsen HS, Østergaard M. Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission. Rheumatology (Oxford) 2021; 60:380-391. [PMID: 32929463 DOI: 10.1093/rheumatology/keaa496] [Citation(s) in RCA: 5] [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] [Received: 03/23/2020] [Revised: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy. METHODS RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses. RESULTS In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission. CONCLUSION Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
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Affiliation(s)
- Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Kim Hørslev-Petersen
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bo Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Daniel Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - Jakob Møller
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Ole Rintek Madsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Bente Jensen
- Department of Rheumatology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Philip Bennett
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Oliver Hendricks
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Karsten Asmussen
- Department of Rheumatology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Marcin Kowalski
- Department of Rheumatology, Hjørring Hospital, Hjørring, Denmark
| | - Hanne Lindegaard
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | - Henning Bliddal
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | | | - Lone Balding
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Torp CK, Brüner M, Keller KK, Brouwer E, Hauge EM, McGonagle D, Kragstrup TW. Vasculitis therapy refines vasculitis mechanistic classification. Autoimmun Rev 2021; 20:102829. [PMID: 33872767 DOI: 10.1016/j.autrev.2021.102829] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
The primary vasculitides constitute a heterogeneous group of immune mediated diseases of incompletely understood pathogenesis currently classified by the size of blood vessels affected (Chapel Hill classification). In recent years, several drugs with well-characterized immunological targets have been tested in clinical trials in large vessel vasculitis and small vessel vasculitis. Such trials provide "reverse translational" or bedside to bench information about underlying pathogenic mechanisms. Therefore, the aim of this systematic literature review was to examine the evidence base for a more refined mechanistic immunological classification of vasculitis. A total of 40 studies (20 randomized controlled trials (RCTs), 16 prospective studies, 1 retrospective cohort study and 3 case series) were included for full qualitative assessment. RCTs concerning biologic therapy for large vessel vasculitis mainly supports interleukin 6 receptor inhibition (tocilizumab). RCTs concerning biologic therapy for granulomatosis with polyangiitis and microscopic polyangiitis mainly support anti-CD20 treatment (rituximab) and complement inhibition with a small molecule C5a receptor antagonist (avacopan) is an emerging treatment option. The biologic treatment of eosinophilic granulomatosis with polyangiitis is centered around interleukin 5 inhibition (mepolizumab). Studies on tumor necrosis factor alpha inhibition (adalimumab, infliximab, and etanercept) showed negative results in giant cell arteritis but some effect in Takayasu arteritis. Taken together, clinical studies with cytokine and cell specific drugs are dissecting the heterogeneous immunopathogenic mechanisms of vasculitis and support a mechanistic immunological classification. Especially, cytokine antagonism is pointing towards immunological distinctions between eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis/microscopic polyangiitis and differences between giant cell arteritis and Takayasu arteritis.
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Affiliation(s)
| | - Mads Brüner
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Elisabeth Brouwer
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark.
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Thomsen LK, Kejser MI, Sørensen LL, Jensen PR, Hauge EM, Bollerslev J, Boel LW, Delaissé JM, Andreasen CM, Andersen TL. Glucocorticoids prolong the reversal-resorption phase delaying bone formation in intracortical remodelling compared to postmenopausal and osteoporotic women. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100799] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Nielsen BD, Hansen IT, Keller KK, Therkildsen P, Gormsen LC, Hauge EM. Comment on: Diagnostic accuracy of ultrasound for detecting large vessel giant cell arteritis using FDG PET/CT as the reference: reply. Rheumatology (Oxford) 2021; 60:e67-e68. [PMID: 33232482 DOI: 10.1093/rheumatology/keaa765] [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] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Klose-Jensen R, Hartlev LB, Thomsen JS, Nyengaard JR, Boel LWT, Laursen M, Laurberg TB, Stengaard-Pedersen K, Hauge EM. Calcified cartilage in patients with osteoarthritis of the hip compared to that of healthy subjects. A design-based histological study. Bone 2021; 143:115660. [PMID: 32979538 DOI: 10.1016/j.bone.2020.115660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Calcified cartilage is suggested to be involved in the pathogenesis of osteoarthritis (OA) by facilitating endochondral ossification at the bone-cartilage unit. Therefore, the objective was to quantify the volume and surface area of the calcified cartilage in the femoral head in OA patients and healthy subjects. MATERIALS AND METHODS We used design-based stereological principles, i.e., systematic uniform random sampling and vertical uniform random sections of the entire femoral head. We investigated the articular and calcified cartilage and femoral head surface area and volume, excluding fovea capitis and marginal osteophytes, in 20 patients with OA and 15 healthy subjects. RESULTS The volume of the calcified cartilage was significantly larger for the patients with OA compared with the healthy subjects (mean difference [95% CI]) (284 [110,457] mm3, p = 0.002). The upper and lower surface area of the calcified cartilage, i.e. the tidemark and cement line, were both significantly larger for OA patients compared with the healthy subjects (17.8 [8.4,27.3] cm2, p < 0.001) and (38.7 [20.8,56.7] cm2, p = 0.002), respectively. The volume of the calcified cartilage and the volume of the femoral head were significantly correlated for the patients with OA (Spearman's ρ = 0.51, p = 0.021), but not for the healthy subjects (ρ = 0.41, p = 0.123). CONCLUSIONS Patients with OA had a larger femoral head surface area and more calcified cartilage compared to healthy subjects. The volume of the calcified cartilage correlated positively with the volume of the femoral head for patients with OA, but not for healthy subjects. This strongly supports the existing view that bone growth in OA is associated with endochondral ossification.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Louise Brøndt Hartlev
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | | | - Jens Randel Nyengaard
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University, Aarhus, Denmark
| | | | - Mogens Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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45
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Therkildsen P, de Thurah A, Hansen IT, Nørgaard M, Nielsen BD, Hauge EM. Giant cell arteritis: A nationwide, population-based cohort study on incidence, diagnostic imaging, and glucocorticoid treatment. Semin Arthritis Rheum 2021; 51:360-366. [PMID: 33601192 DOI: 10.1016/j.semarthrit.2021.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/21/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
AIM The study investigated the development over time of the incidence, diagnostic imaging, and treatment of giant cell arteritis (GCA). METHOD This nationwide, population-based cohort study was conducted in Denmark using medical and administrative registries. Incident GCA cases from 1996-2018 were defined as patients aged ≥50 years registered with a first-time GCA diagnosis and ≥3 prescriptions for glucocorticoids (GCs) within 6 months after diagnosis. We determined incidence rates of GCA, the proportion of patients still receiving GCs >2 years after diagnosis, the proportion of patients receiving temporal artery biopsies (TAB) and diagnostic imaging including ultrasound, positron emission tomography, magnetic resonance, and/or computed tomography angiography at the time of diagnosis. RESULTS We identified 9908 incident GCA cases. The incidence rates of GCA remained stable at 19-25 per 100,000 people aged >50 years from 1996-2018. The proportion of GCA patients receiving a TAB remained constant until 2016, after which it promptly declined from 70-80% to 29-39%. In contrast, the proportion of patients receiving diagnostic imaging increased from 2% to 66% from 2000-2018. The proportion of GCA patients remaining in GC treatment has steadily decreased from 1996-2016, but remains high at 64%, 40%, and 34% after 2, 5, and 10 years following the diagnosis, respectively. The cumulative GC dose has remained relatively stable. CONCLUSION Incidence rates of GCA have remained stable since 1996 despite increasing use of diagnostic imaging. There is a clear discrepancy between current international GCA treatment guidelines and the clinical practice up to 2018.
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Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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46
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Frederiksen AS, Jørgensen SH, Wiggers H, Hauge EM. Mitral valvulitis as a severe extra-articular manifestation of rheumatoid arthritis: a case report. Eur Heart J Case Rep 2021; 5:ytaa467. [PMID: 33501406 PMCID: PMC7809726 DOI: 10.1093/ehjcr/ytaa467] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/21/2020] [Accepted: 11/09/2020] [Indexed: 12/03/2022]
Abstract
Background Extra-articular manifestations (EAMs) are common in patients with rheumatoid arthritis (RA). Cardiac EAMs are rare but may cause complete heart block and damage to the heart valves. Case summary We present the case of a middle-aged woman with long-standing RA and EAMs as the most prominent symptoms. The patient experienced complete atrioventricular heart block and developed nodular vegetations affecting the mitral valve, ultimately leading to severe mitral regurgitation and valve replacement. Discussion The diagnosis of cardiac EAMs in RA may be challenging for the clinicians. Symptoms and findings may mimic more common conditions such as malignancy and infectious endocarditis. A multidisciplinary approach is of paramount importance in order to make an early diagnosis and to provide optimal treatment to patients with RA and cardiac complications.
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Affiliation(s)
- Anne Sofie Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Steen Hylgaard Jørgensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Ellen-Margrethe Hauge
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, 8200, Aarhus N, Denmark
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47
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Therkildsen J, Winther S, Nissen L, Jørgensen HS, Thygesen J, Ivarsen P, Frost L, Isaksen C, Langdahl BL, Hauge EM, Böttcher M. Sex Differences in the Association Between Bone Mineral Density and Coronary Artery Disease in Patients Referred for Cardiac Computed Tomography. J Clin Densitom 2021; 24:55-66. [PMID: 31668962 DOI: 10.1016/j.jocd.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022]
Abstract
Atherosclerosis and osteoporosis are both common and preventable diseases. Evidence supports a link between coronary artery disease (CAD) and low bone mineral density (BMD). This study aimed to assess the association between thoracic spine BMD and CAD in men and women with symptoms suggestive of CAD. This cross-sectional study included 1487 (mean age 57 years (range 40-80), 47% men) patients referred for cardiac computed tomography (CT). Agatston coronary artery calcium score (CACS), CAD severity (no, mild, moderate, and severe), vessel involvement (no, 1-, 2-, and 3/left main disease), and invasive measurements were evaluated. BMD of three thoracic vertebrae was measured using quantitative CT. We used the American college of radiology cut-off values for lumbar spine BMD to categorize patients into very low (<80 mg/cm3), low (80-120 mg/cm3), or normal BMD (>120 mg/cm3). BMD as a continuous variable was included in the linear regression analyses to assess associations between CACS (CACS=0, CACS 1- 399, and CACS ≥ 400) and BMD, and CAD severity and BMD. Significant lower BMD was present with increasing CACS and stenosis degree unadjusted. Multivariate linear regression analyses in women revealed a significant correlation between BMD and CACS groups (β = -4.06, p<0.05), but no correlation between BMD and CAD severity (β = -1.59, p = 0.14). No association was found between BMD and CACS (β = -1.50, p = 0.36) and CAD severity (β = 0.07, p = 0.94) in men. BMD is significantly correlated to CACS after adjusting for confounders in women, but not in men, suggesting a possible sex difference in pathophysiology.
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Affiliation(s)
| | - Simon Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Nissen
- Department of Cardiology, Hospital Unit West, Herning, Denmark
| | | | - Jesper Thygesen
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Per Ivarsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - Christin Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - Bente L Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Departments of Rheumatology, Aarhus University Hospital, and Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Böttcher
- Department of Cardiology, Hospital Unit West, Herning, Denmark
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48
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Blavnsfeldt ABG, Klose-Jensen R, Thygesen J, Therkildsen P, Langdahl BL, Keller KK, Hauge EM. Effect of radiographic disease severity in high-resolution quantitative computed tomography assessment of metacarpophalangeal joint erosion and cysts. Int J Rheum Dis 2020; 24:112-119. [PMID: 33169933 DOI: 10.1111/1756-185x.14020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/24/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 01/16/2023]
Abstract
AIM Bone erosions are the hallmark of rheumatoid arthritis (RA). High-resolution peripheral quantitative computed tomography (HR-pQCT) enables 3-dimensional visualization of arthritic bone erosions at a high resolution. However, the degree of erosive disease could influence the reliability of HR-pQCT evaluation. We aim to assess the intra- and inter-reader variability of identification of erosions in the metacarpophalangeal (MCP) joints using HR-pQCT in healthy controls and patients with RA, stratified according to van der Heijde-modified Sharp Score (HSS) of radiographic erosions. METHOD We analyzed HR-pQCT images from 78 patients with RA and 25 healthy controls. Patients were allocated to one of three groups of mild, moderate or severe disease according to HSS of MCP joints 2 and 3. Total HR-pQCT scans were analyzed twice in random order by three experienced readers, blinded to group distribution. The number of cortical interruptions and their classification as either erosions or cysts according to predefined criteria were recorded. Intraclass correlation coefficients (ICC) for cortical interruptions, erosions and cysts were calculated for each group using a 2-way random-effects model for inter-reader ICC and a 2-way mixed-effects model for intra-reader ICC. RESULTS The intra- and inter-reader ICC were good to moderate for cortical interruptions and moderate for erosions throughout disease severity groups. The ICCs for the identification of cysts decreased with increasing degree of erosive disease. CONCLUSION The detection of cortical interruptions is only minimally affected by the degree of erosive damage, whereas the distinction between erosions and cysts is more complex in patients with extensive erosive disease.
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Affiliation(s)
- Anne-Birgitte Garm Blavnsfeldt
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jesper Thygesen
- Department of Procurement and Clinical Engineering, Central Denmark Region, Aarhus C, Denmark
| | - Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Bente Lomholdt Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Klose-Jensen R, Nielsen AW, Hartlev LB, Thomsen JS, Boel LWT, Laursen M, Keller KK, Hauge EM. Histomorphometric case-control study of subarticular osteophytes in patients with osteoarthritis of the hip. BMC Musculoskelet Disord 2020; 21:653. [PMID: 33023570 PMCID: PMC7542119 DOI: 10.1186/s12891-020-03648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 01/11/2023] Open
Abstract
Objective The objective of this cross-sectional case-control study was to determine the prevalence and size of marginal and subarticular osteophytes in patients with osteoarthritis (OA), and to compare these to that of a control group. Design We investigated femoral heads from 25 patients with OA following hip replacement surgery, and 25 femoral heads from a control group obtained post-mortem. The area and boundary length of the femoral head, marginal osteophytes, and subarticular osteophytes were determined with histomorphometry. Marginal osteophytes were defined histologically as bony projections at the peripheral margin of the femoral head, while subarticular osteophytes were defined as areas of bone that expanded from the normal curvature of the femoral head into the articular cartilage. Results The prevalence of OA patients with marginal- and subarticular osteophytes were 100 and 84%, respectively. Whereas the prevalence of the participants in the control group with marginal- and subarticular osteophytes were 56 and 28%, respectively. The area and boundary length of marginal osteophytes was (median (Interquartile range)) 165.3mm2 (121.4–254.0) mm2 and 75.1 mm (50.8–99.3) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P < 0.001). For the subarticular osteophytes, the area and boundary length was 1.0 mm2 (0–4.4) mm2 and 1.4 mm (0–6.5) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P < 0.001). Conclusion As expected, both marginal- and subarticular osteophytes at the femoral head, were more frequent and larger in patients with OA than in the control group. However, in the control group, subarticular osteophytes were more prevalent than expected from the minor osteophytic changes at the femoral head margin, which may suggest that subarticular osteophytes are an early degenerative phenomenon that ultimately might develop into clinical osteoarthritis.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark
| | - Louise Brøndt Hartlev
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Randers Regional Hospital, Randers, Denmark
| | | | | | - Mogens Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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50
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Finzel S, Manske SL, Barnabe CCM, Burghardt AJ, Marotte H, Scharmga A, Hauge EM, Chapurlat R, Engelke K, Li X, van Teeffelen BCJ, Conaghan PG, Stok KS. Reliability and Change in Erosion Measurements by High-resolution Peripheral Quantitative Computed Tomography in a Longitudinal Dataset of Rheumatoid Arthritis Patients. J Rheumatol 2020; 48:348-351. [PMID: 32934121 DOI: 10.3899/jrheum.191391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this multireader exercise was to assess the reliability and change over time of erosion measurements in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS HR-pQCT scans of 23 patients with RA were assessed at baseline and 12 months. Four experienced readers examined the dorsal, palmar, radial, and ulnar surfaces of the metacarpal head (MH) and phalangeal base (PB) of the second and third digits, blinded to time order. In total, 368 surfaces (23 patients´ 16 surfaces) were evaluated per timepoint to characterize cortical breaks as pathological (erosion) or physiological, and to quantify erosion width and depth. Reliability was evaluated by intraclass correlation coefficients (ICC), percentage agreement, and Light k; change over time was defined by means ± SD of erosion numbers and dimensions. RESULTS ICC for the mean measurements of width and depth of the pathological breaks ranged between 0.819-0.883, and 0.771-0.907, respectively. Most physiological cortical breaks were found at the palmar PB, whereas most pathological cortical breaks were located at the radial MH. There was a significant increase in both the numbers and the dimensions of erosions between baseline and follow-up (P = 0.0001 for erosion numbers, width, and depth in axial plane; P = 0.001 for depth in perpendicular plane). CONCLUSION This exercise confirmed good reliability of HR-pQCT erosion measurements and their ability to detect change over time.
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Affiliation(s)
- Stephanie Finzel
- S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany;
| | - Sarah L Manske
- S.L. Manske, PhD, Assistant Professor, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl C M Barnabe
- C.C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Andrew J Burghardt
- A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California San Francisco, California, USA
| | - Hubert Marotte
- H. Marotte, MD, PhD, Professor, INSERM 1059, Université de Lyon, and Service de Rhumatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Andrea Scharmga
- A. Scharmga, PhD, Maastricht University, Maastricht, the Netherlands
| | - Ellen-Margrethe Hauge
- E.M. Hauge, MD, PhD, Professor, Department of Rheumatology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Roland Chapurlat
- R. Chapurlat, MD, PhD, Professor, INSERM 1033, Hôpital Edouard Herriot, Lyon, France
| | - Klaus Engelke
- K. Engelke, PhD, Professor, Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Xiaojuan Li
- X. Li, PhD, Professor, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bente C J van Teeffelen
- B.C. van Teeffelen, Department of Biomedical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Philip G Conaghan
- P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Kathryn S Stok
- K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland, and Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
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