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van Durme C, van Echteld IAAM, Falzon L, Aletaha D, van der Heijde DMFM, Landewé RB. Cardiovascular risk factors and comorbidities in patients with hyperuricemia and/or gout: a systematic review of the literature. J Rheumatol Suppl 2015; 92:9-14. [PMID: 25180123 DOI: 10.3899/jrheum.140457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review the available literature on the likelihood of having cardiovascular (CV) risk factors and on developing CV comorbidities in patients with gout and/or asymptomatic hyperuricemia as an evidence base for generating multinational clinical practice recommendations in the 3e (Evidence, Expertise, Exchange) Initiative in Rheumatology. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, and The Cochrane Library, and abstracts presented at the 2010/2011 meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism, searching for CV risk factors and new CV comorbidities in patients with asymptomatic hyperuricemia and/or a diagnosis of gout. Trials that fulfilled predefined inclusion criteria were systematically reviewed. RESULTS A total of 66 out of 8918 identified publications were included in this review. After assessment of the risk of bias, 32 articles with a high risk of bias were excluded. Data could not be pooled because of clinical and statistical heterogeneity. In general, both for asymptomatic hyperuricemia and for gout the hazard ratios for CV comorbidities were only modestly increased (1.5 to 2.0) as were the hazard ratios for CV risk factors, ranging from 1.4 to 2.0 for hypertension and from 1.0 to 2.4 for diabetes. CONCLUSION Unlike the common opinion that patients with gout or hyperuricemia are at higher risk of developing CV disease, the actual risk to develop CV disease is either rather weak (for hyperuricemia) or poorly investigated (for gout).
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Affiliation(s)
- Caroline van Durme
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center.
| | - Irene A A M van Echteld
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Louise Falzon
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Daniel Aletaha
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Désirée M F M van der Heijde
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Robert B Landewé
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
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Wechalekar MD, Vinik O, Moi JHY, Sivera F, van Echteld IAAM, van Durme C, Falzon L, Bombardier C, Carmona L, Aletaha D, Landewé RB, van der Heijde DMFM, Buchbinder R. The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. J Rheumatol Suppl 2015; 92:15-25. [PMID: 25180124 DOI: 10.3899/jrheum.140458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of glucocorticoids (GC), colchicine, nonsteroidal antiinflammatory drugs (NSAID), interleukin-1 (IL-1) inhibitors, and paracetamol to treat acute gout. METHODS We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to September 2011. Randomized controlled trials (RCT) or quasi-RCT in adults with acute gout that compared GC, colchicine, NSAID, IL-1 inhibitors, and paracetamol to no treatment, placebo, another intervention, or combination therapy were included. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events. Data were pooled where appropriate. RESULTS Twenty-six trials evaluating GC (N = 5), NSAID (N = 21), colchicine (N = 2), and canakinumab (N = 1) were included. No RCT assessed paracetamol or intraarticular (IA) GC. No RCT compared systemic GC with placebo. Moderate quality evidence (3 trials) concluded that systemic GC were as effective as NSAID but safer. Low quality evidence (1 trial) showed that both high- and low-dose colchicine were more effective than placebo, and low-dose colchicine was no different to placebo with respect to safety but safer than high-dose colchicine. Low quality evidence (1 trial) showed no difference between NSAID and placebo with regard to pain or inflammation. No NSAID was superior to another. Moderate quality evidence (1 trial) found that 150 mg canakinumab was more effective than a single dose of intramuscular GC (40 mg triamcinolone) and equally safe. CONCLUSION GC, NSAID, low-dose colchicine, and canakinumab all effectively treat acute gout. There was insufficient evidence to rank them. Systemic GC appeared safer than NSAID and lower-dose colchicine was safer than higher-dose colchicine.
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Affiliation(s)
- Mihir D Wechalekar
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Ophir Vinik
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - John H Y Moi
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Francisca Sivera
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Irene A A M van Echteld
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Caroline van Durme
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Louise Falzon
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Claire Bombardier
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Loreto Carmona
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Daniel Aletaha
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Robert B Landewé
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Désirée M F M van der Heijde
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Rachelle Buchbinder
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
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