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Boutsikou T, Sekkidou M, Karaglani E, Krepi A, Moschonis G, Nicolaou N, Iacovidou N, Pancheva R, Marinova-Achkar M, Popova S, Kapetanaki A, Iliodromiti Z, Papaevangelou V, Sardeli O, Papathoma E, Schaafsma A, Bos R, Manios Y, Xepapadaki P. The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial. Nutrients 2023; 15:nu15112622. [PMID: 37299585 DOI: 10.3390/nu15112622] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow's milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.
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Affiliation(s)
- Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Mikaela Sekkidou
- Asthma and Allergy Center, 3025 Limassol, Cyprus
- University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671 Athens, Greece
| | - Adamantia Krepi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Nicolaos Nicolaou
- Asthma and Allergy Center, 3025 Limassol, Cyprus
- University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Miglena Marinova-Achkar
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Simoneta Popova
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, 9000 Varna, Bulgaria
| | - Anastasia Kapetanaki
- Neonatal Intensive Care Unit, General and Maternity Hospital Elena Venizelou, 11521 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, 12462 Athens, Greece
| | - Olympia Sardeli
- Third Department of Pediatrics, National and Kapodistrian University of Athens, ATTIKON General University Hospital, 12462 Athens, Greece
| | - Evangelia Papathoma
- Neonatal Intensive Care Unit, Alexandra General Hospital, 11528 Athens, Greece
| | | | - Rolf Bos
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671 Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410 Heraklion, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15771 Athens, Greece
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Hartman L, El Alili M, Cutolo M, Opris D, Da Silva JAP, Szekanecz Z, Buttgereit F, Masaryk P, Bos R, Kok MR, Paolino S, Coupé VMH, Lems WF, Boers M. Cost-effectiveness and cost-utility of add-on, low-dose prednisolone in patients with rheumatoid arthritis aged 65+: The pragmatic, multicenter, placebo-controlled GLORIA trial. Semin Arthritis Rheum 2022; 57:152109. [DOI: 10.1016/j.semarthrit.2022.152109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
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Kieskamp S, Wilbrink R, Siderius M, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. POS1012 PATIENT CHARACTERISTICS AND CLINICAL ASSESSMENTS ASSOCIATED WITH PROGRESSION FROM NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS TO ANKYLOSING SPONDYLITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPart of the patients with non-radiographic spondyloarthritis (nr-axSpA) will progress to ankylosing spondylitis (AS). Varying factors are reported to be predictive of this progression of which the presence of elevated CRP and active sacroliitis on MRI are most often found1.ObjectivesTo explore patient characteristics and clinical assessments associated with progression from nr-axSpA to AS up to 6 years follow-up in daily clinical practice.MethodsPatients from the ongoing Groningen Leeuwarden axial SpA (GLAS) cohort classified as nr-axSpA enrolled into the cohort (baseline) between 2009 and 2018 were included in the analyses. Nr-axSpA was defined as sacroiliitis of ≥ 2 grade bilaterally or ≥ 3 unilaterally on the AP view of pelvic radiographs, according to the modified New-York (mNY) criteria. Baseline and available radiographs at 2 (n=85), 4 (n=53) and 6 years (n=30) of follow-up were randomized with radiographs of patients with AS and scored with known time sequence according to the mNY criteria by 2 trained readers (SK and RW). In case of disagreement in classification, the score of a third independent reader (AS) was used. Progression to AS was defined as progression in mNY sacroiliitis score to a score of ≥2 bilaterally or ≥3 unilaterally at any time during the 6-year follow-up period. Patient characteristics and clinical assessments at baseline were compared between patients who did and did not progress from nr-axSpA to AS, using chi-squared tests, Mann-whitney U tests or independent t-tests when appropriate.Results85 patients were classified as nr-axSpA at baseline. Mean age was 39±11 years, 52% was male, median symptom duration was 6 (IQR 3-17) years, 75% was HLA-B27+, and mean ASDAS was 2.7±1.1.After 2, 4 and 6 years, 9/85 (10.6%), 4/47 (8.5%) and 2/24 (8.3%) of nr-axSpA patients progressed to AS. In total, 15 patients progressed to AS and 31 and 19 patients did not yet reach follow-up at 4 and 6 years, respectively.Patients with nr-axSpA progressing to AS were significantly more often current smokers (62% vs. 21%, p=0.003) and had more often a history of uveitis (47 vs. 11%, p=0.001). Furthermore, patients with nr-axSpA progressing to AS tended to have higher CRP (and therefore ASDAS), more entheseal involvement, and worse lumbar spinal mobility then non-progressors; however, due to the relatively low number of progressors during the analyzed follow-up period, significance could not be reached (Table 1).Table 1.Comparison of baseline characteristics between patients with nr-axSpA who did and did not progress to AS. Values presented as mean ± SD, median (IQR) and n (%) for normally distributed, non-normally distributed and categorical variables, respectively. *p<0.05.Baseline characteristicsAll patients (n=85)No progression (n=70)Progression (n=15)pMale sex44 (52%)39 (56%)5 (33%)0.115Age38.6 ± 10.838.4 ± 10.239.5 ± 13.80.774Symptom duration6 (3 – 17)7 (3 – 16)4 (2 – 20)0.663HLA-B27+62 (75%)52 (74%)10 (67%)0.758Currently smoking22 (28%)14 (21%)8 (53%)0.003*BMI26.1 ± 4.426.2 ± 4.525.8 ± 4.20.750History of uveitis15 (18%)8 (11%)7 (47%)0.001*History of IBD7 (8%)6 (9%)1 (8%)0.808History of psoriasis12 (14%)10 (15%)2 (13%)0.923ASDAS2.7 ± 1.12.6 ± 1.13.2 ± 1.00.107- ASDAS >2.151 (72%)41 (68%)10 (91%)0.126BASDAI5.3 (3.4 – 6.7)5.4 (3.2 – 6.8)4.7 (3.6 – 6.7)0.538CRP ≥5.021 (27%)16 (25%)5 (39%)0.320Start TNFi (during first 2 years of follow-up)27 (32%)23 (33%)4 (27%)0.640Chest expansion (cm)5.2 ± 2.15.3 ± 2.14.7 ± 2.10.367Lateral spinal flexion (cm)14.4 (10.5 – 17.5)14.5 (10.7 – 17.7)11.3 (9.0 – 17.5)0.163mSchober (cm)14.1 ± 1.314.1 ± 1.313.7 ± 1.30.308ConclusionIn our cohort, active smoking and a history of uveitis were independently associated with the progression of nr-axSpA to AS. Combining data of different cohorts will help to assess a more robust picture of axSpA features and patient characteristics associated with progression to AS.References[1]Protopopov M, Poddubnyy D. Expert Rev Clin Immunol. 2018;14(6):525-533AcknowledgementsThe GLAS cohort has received unrestricted grants from Novartis.Disclosure of InterestsStan Kieskamp: None declared, Rick Wilbrink: None declared, Mark Siderius: None declared, Freke Wink: None declared, Reinhard Bos: None declared, Hendrika Bootsma Speakers bureau: Bristol-Myers Squibb, Novartis, Consultant of: Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Suzanne Arends: None declared, Anneke Spoorenberg Paid instructor for: Abbvie, Consultant of: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Grant/research support from: Novartis Pharma, Pfizer
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Bos R, Al Hasan A, Reimann F, Schilder AM, Zhang D, Wink F, Hendriks L, Maarseveen T, Knevel R. POS1438 FRYQ QUESTIONNAIRE DISTINGUISHES INFLAMMATORY FROM NON-INFLAMMATORY DISEASE IN NEWLY REFERRED PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3757] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundInflammatory Rheumatic Diseases (IRDs) affect 5% of the general population, while 35% of the population experiences Musculoskeletal Complaints (MSCs) [1]. IRDs cause early disability, reduced life-expectancy and considerable health care costs. Early diagnosis is essential to prevent long-term damage, similarly important is the early identification of patients with MSCs without IRDs to prevent unnecessary health care expenses. Of the population referred to the rheumatologist, 60% have non-inflammatory MSCs while only 20% of patients with an IRD see a rheumatologist within three months of symptom onset [2]. The need for digital predictive (triage) tools for Rheumatic and Musculoskeletal Diseases led to the development of the Frysian Questionnaire for differentiation of MSK complaints (FRYQ).ObjectivesTo assess if FRYQ questionnaire can distinguish inflammatory rheumatic disease from non-inflammatory MSCs in newly referred patients.MethodsThe Frysian Questionnaire for differentiation of MSK complaints (FRYQ) is an 87 item questionnaire (consisting of 20 open questions and 67 closed questions), which is used in regular care in the rheumatology outpatient clinic of the Medical Center Leeuwarden to triage newly referred patients. Results of FRYQ, referral work diagnosis, resulting diagnoses and demographic data of 854 patients were collected. Elastic Net regularization was used to extract the most informative questions. The data was split: 75% to construct the elastic net and 25% to perform an independent validation. The classification performance was evaluated according to the area under the ROC-curve.ResultsThe group consisted of 287 males (33%) and 570 (66%) females. Table 1 shows the characteristics of the 854 studied referrals.Table 1.Table 1Referral orwork diagnosisNumber (%)Diagnosis by rheumatologist Number (%)Correct work diagnosis GPNumber (%)Rheumatoid arthritis146 (16.9)87 (10.1)53 (36.3)Psoriatic arthritis41 (4.8)29 (3.4)17 (41.5)Spondylarthropathy64 (7.4)52 (6.0)30 (46.9)Undifferentiated oligoarthritis97 (11.2)10 (1.2)5 (5.2)Polymyalgia rheumatica55 (6.4)27 (3.1)22 (40.0)Gout55 (6.4)49 (5.7)40 (72.7)Calcium pyrophosphate deposition4 (0.5)13 (1.5)2 (50.0)Sarcoidosis10 (1.2)10 (1.2)5 (50.0)Arthralgia124 (14.4)0 (0) Varied: mostly non inflammatoryNAClinically suspect arthralgia018 (2.1)NAReactive arthritis2 (0.2)12 (1.4)1 (50.0)Sjögrens’ syndrome14 (1.6)6 (0.7)2 (14.3)Systemic sclerosis3 (0.3)5 (0.6)2 (66.7)Systemic lupus erythematosus8 (0.9)5 (0.6)3 (37.5)GPA vasculitis01 (0.1)0 (0)Suspicion systemic auto immune disease57 (6.6)0 (varied: mostly non inflammatory)0 (0)Tendomyalgia27 (3.1)117 (13.6)10 (37.0)Fibromyalgia79 (9.2)110 (12.7%)57 (72.2)Osteoarthritis29 (3.4)153 (17.7%)22 (75.9)Hypermobility syndrome023 (2.7)0 (0)Unknown60NAOther33 (3.9)127* (14.8)NAtotal854 (100)854 (100)NAInflammatory293 (34.3 %)*Non-inflammatory560 (65.7 %)**including missing dataAfter elastic net regularization the 87 items could be reduced to 33 items that were able to differentiate inflammatory disease from non-inflammatory disease with an AUC of 0.70 in the ROC curve below (Figure 1).Figure 1.ROC-curve highlighting performance of FRYQ after regularization in the validation setConclusionFRYQ questionnaire can differentiate inflammatory rheumatic disease from non-inflammatory musculoskeletal complaints. To officially validate FRYQ a prospective cohort study is needed.References[1]van der Linden, M.W, Westert G.P, de Bakker, D.H et al. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. https://www.nivel.nl/sites/default/files/bestanden/ns2_rapport1.pdf. Utrecht/Bilthoven: NIVEL/RIVM, 2004.[2]Stack RJ, Nightingale P, Jinks C, et al. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open 2019;9:e024361,2018-024361.AcknowledgementsWe thank our data managers and outpatient clinic secretariat.Disclosure of InterestsNone declared
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Boers M, Hartman L, Opris-Belinski D, Bos R, Kok MR, da Silva JAP, Griep EN, Klaasen R, Allaart C, Baudoin P, Raterman H, Szekanecz Z, Buttgereit F, Masaryk P, Klausch T, Paolino S, Schilder AM, Lems W, Cutolo M. OP0263 FAVORABLE BALANCE OF BENEFIT AND HARM OF LONG-TERM, LOW-DOSE PREDNISOLONE ADDED TO STANDARD TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS AGED 65+: THE PRAGMATIC, MULTICENTER, PLACEBO- CONTROLLED GLORIA TRIAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLow-dose glucocorticoid (GC) therapy is widely used in RA but the true balance of benefit and harm is still unknown.ObjectivesWe studied the effects of prednisolone (5 mg/day, 2 years) in RA patients aged 65+, requiring adjustment of antirheumatic therapy (DAS28≥2.60).MethodsPragmatic double-blind placebo-controlled randomized trial; all co-treatments and changes therein were allowed during the trial except long-term open label GC; Ca/D supplementation was advised in all patients. Minimal exclusion criteria were tailored to seniors.Harm outcome: the number of patients with ≥1 serious adverse event (SAE), or ≥1 ‘other adverse event of special interest’ (other AESI). Other AESI comprised any AE (except worsening of RA) causing study discontinuation, and GC-specific events (Table 1).Table 1.Adverse events of special interest (AESI).*prednisolone (n=224)placebo (n=225)Events by protocol-defined categorySAEother AESISAEother AESI Infection261241691 Urinary tract449429 Pneumonia217213 Other20581049 Cardiovascular8260 Symptomatic fracture21146 New onset Hypertension1407 Diabetes mellitus0201 Cataract0726 Glaucoma0103 Other†43433526Total8019463140*AESI: Comprises serious adverse events (SAE) and other AESI, defined by protocol.†‘Other’ other AESI: non-serious AE outside of the above predefined categories, but associated with premature discontinuation.Benefit outcomes: improvement in disease activity (DAS28) and joint damage progression (Sharp/van der Heijde).Longitudinal mixed models analyzed the data. Given prior knowledge we report one-sided 95% confidence limit (95%CL) and statistical tests, performed only for the main outcomes.ResultsWe randomized 451 RA patients in 7 EU countries, 449 received the intervention; of these 63% prednisolone vs 61% placebo patients completed 2 years of follow up. Discontinuations were similar in both groups: for AE (14%) and active disease (4%); the remainder mostly for ‘trial fatigue’ and covid-related access issues (20%). Mean time on study drug was 19 (SD 8) months.70% of patients were female, mean age was 72 (max 88) years, RA duration 11 years; 67% were RF+, 56% ACPA+, 96% had joint damage on radiographs: mean score 20, median 8. Mean DAS28 was 4.5. Most patients (79%) were on current DMARD treatment, including 14% on biologics; 47% had previously used GC, 14% changed DMARD therapy at baseline. Patients had mean 2.1 active comorbidities, and used median 7 drugs.Benefit: Disease activity rapidly declined to stabilize after 1 year (Figure 1), and was lower on prednisolone (adjusted mean difference in DAS28 over 2 years: 0.37, 95%CL 0.23, p<0.0001). The contrast in early (3-month) response was larger in 331 patients adherent to protocol on stable treatment: mean difference in DAS28 0.62 (95%CL 0.44), more responders on prednisolone (Figure 1). Significant time-treatment interaction in secondary analyses suggested a decrease in contrast after the first year, most likely caused by significantly more changes in DMARD treatment on placebo. Joint damage progression over 2 years was significantly lower on prednisolone: mean 0.6 (SD 1.9) v 1.8 (6.4) score points on placebo, difference 1.2 (95%CL 0.2, p=0.02).Harm: 60% prednisolone vs 49% placebo patients experienced the harm outcome: adjusted RR 1.24, 95%CL 1.04, p=0.02; number needed to harm 9.5 (Table 1). During the study 1 vs 2 patients died, and 3 vs 0 died within 5 months of discontinuation. Per 100 patient-years, AE totaled 278 in prednisolone vs 206 in placebo patients, and the difference was most marked for infections (Table 1); these were mostly mild or moderately severe. Other GC-specific AESI were rare without relevant differences.ConclusionAdd-on low dose prednisolone has beneficial long-term effects on disease activity and damage progression in senior RA patients on standard treatment. The tradeoff is a 24% increase in patients with mostly mild to moderate AE, suggesting a favorable balance of benefit and harm.AcknowledgementsTrial registration: NCT02585258 (clinicaltrials.gov).The trial is part of a larger project funded by the European Union’s Horizon 2020 research and innovation program under grant agreement No. 634886.Apart from the listed authors and centers, the GLORIA Trial Consortium comprises:L.M. Middelink, Middelinc BV The Netherlands, Operational Lead;V. Dekker, Amsterdam UMC, Vrije Universiteit, Financial Lead;Partners:Trial operations: N. van den Bulk, CR2O BV, The Netherlands;Study Medication (Development, Manufacturing & Supply): R.M.A. Pinto,Bluepharma – Indústria Farmacêutica, S.A., Portugal;Data management: L. Doerwald, Linical Netherlands BV, The Netherlands; S. Manger, Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, The Netherlands.Adherence monitoring: J. Redol, BeyonDevices LDA, Portugal;Safety monitoring: K. Prinsen, Clinfidence BV, The Netherlands;Patient partner: M. Scholte-Voshaar, Stichting Tools (Tools2Use), The Netherlands.Investigators (other recruiting centers):T.L.T.A. Jansen, VieCuri – location Venlo, The Netherlands;C. Codreanu, Clinical Center for Rheumatic Diseases, Bucarest, Rumania;R.M.Zandhuis-Mooij, MSc, Gelre Ziekenhuis, Apeldoorn, The Netherlands;E. Molenaar, Groene Hart Ziekenhuis, Gouda, The Netherlands;J.M. van Laar, UMC Utrecht, The Netherlands;Y.P.M. Ruiterman, Haga Ziekenhuis, Den Haag, The Netherlands;A.E.R.C.H. Boonen, MUMC, Maastricht, The Netherlands;M. Micaelo, Instituto Português de Reumatologia, Lisboa, Portugal;J. Costa, Hospital de Ponte Lima, Portugal;M. Sieburg, Rheumatologische Facharztpraxis Magdeburg, Germany;J.P.L. Spoorenberg, UMC Groningen, The Netherlands;U. Prothmann, Knappschaftsklinikum Saar GbmH, Puettlingen, Germany;M.J. Saavedra, Hospital de Santa Maria, Lisboa, Portugal;I. Silva, Hospital de Egas Moniz, Lisboa, Portugal;M.T. Nurmohamed, Reade, Amsterdam, The Netherlands;J.W.G. Jacobs, UMC Utrecht, The Netherlands; andS.W. Tas, Amsterdam UMC, University of Amsterdam, The Netherlands.Scientific Advisory Committee:J.W.J. Bijlsma, UMC Utrecht, The Netherlands;R. Christensen, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark;Y.M. Smulders, Amsterdam UMC, VU University, The Netherlands; andS.H. Ralston, University of Edinburgh, Edinburgh, UK.Radiographic assessment:D.M.F.M. van der Heijde (Imaging Rheumatology BV, the Netherlands)coordinated the reading of the hand and foot x-rays.A.F. Marsman and W.F. Lems scored the spine X-rays.Patient panel:C. Rusthoven and M. Bakkers, The NetherlandsE. Frazão Mateus, and G. Mendes, PortugalC. Elling-Audersch and D. Borucki, GermanyA. Cardone, ItalyP. Corduta and O. Constantinescu, RomaniaP. Richards, United KingdomG. Aanerud, NorwayDisclosure of InterestsMaarten Boers Consultant of: Novartis, Linda Hartman: None declared, Daniela Opris-Belinski Consultant of: Abbvie, Pfizer, MSD, Novartis, Eli Lilly, Ewo Pharma, UCB, Reinhard Bos: None declared, Marc R Kok: None declared, José Antonio P. da Silva: None declared, Eduard N. Griep: None declared, Ruth Klaasen: None declared, Cornelia Allaart: None declared, Paul Baudoin: None declared, Hennie Raterman Consultant of: Abbvie, Pfizer, MSD, Novartis, Eli Lilly, Ewo Pharma, UCB, Zoltán Szekanecz: None declared, Frank Buttgereit Consultant of: Abbvie, AstraZeneca, Gruenenthal, Horizon Therapeutics, Mundipharma, Pfizer, Roche, Pavol MASARYK: None declared, Thomas Klausch: None declared, Sabrina Paolino: None declared, Annemarie M. Schilder Consultant of: Eli Lilly, Novartis, Genzyme, WIllem Lems Consultant of: Pfizer, Galapagos, Lilly, Amgen, UCB., Maurizio Cutolo: None declared
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Almayali A, Boers M, Hartman L, Opris-Belinski D, Bos R, Kok MR, da Silva JAP, Griep EN, Klaasen R, Allaart C, Baudoin P, Raterman H, Szekanecz Z, Buttgereit F, Masaryk P, Lems W, Cutolo M, Ter Wee M. OP0270 TAPERING OF LONG-TERM, LOW-DOSE GLUCOCORTICOIDS IN SENIOR RHEUMATOID ARTHRITIS PATIENTS: FOLLOW-UP OF THE PRAGMATIC, MULTICENTRE, PLACEBO-CONTROLLED GLORIA TRIAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.663] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGuidelines suggest glucocorticoids (GC) should be used as bridge therapy in rheumatoid arthritis (RA), but many patients are treated chronically with low doses. The effects of withdrawal in such patients has not been studied extensively.ObjectivesTo study disease activity score (DAS28), disease flares and signs of adrenal insufficiency after withdrawal of blinded trial medication (prednisolone 5 mg/day or placebo for 2 years).MethodsThe 2-year, double-blind GLORIA trial evaluated the long-term benefits and harms of low dose GC added to standard care (see main GLORIA trial abstract). Senior RA patients (≥ 65 years) were randomly assigned to prednisolone 5 mg/day or placebo.After the final trial visit study medication was linearly tapered to zero in 3 months by adding a stop day every two weeks, and patients were reassessed. Those who successfully completed the trial and did not receive open-label GC during the 4 weeks after the final trial visit were included in this follow-up study.The primary outcome was change in DAS28 at follow-up compared to the final trial visit. Secondary outcomes included the occurrence of disease flares (DAS28 increase > 0.6 or open-label GC between week 4 and 12 of the taper phase) and signs of adrenal insufficiency, assessed by 9 items selected from the 57-symptom list from the MDHAQ questionnaire (1) and hypotension (systolic RR < 90 or diastolic RR < 60). In a subset of patients from 3 Dutch centres, cortisol and ACTH were measured in spot serum samples during the follow-up visit.Analysis of covariance assessed the change in DAS28. Linear regression and chi-square test were used for the remaining outcomes.Results278 participants completed the GLORIA study, 21 received GC within 4 weeks after the end of the trial, 58 had missing data, leaving 199 patients eligible for this study.34 patients received open label GC after 4 weeks and were excluded for the primary analysis. In the remaining 165 patients (80 prednisolone, 85 placebo), mean (SD) DAS28 was higher on placebo: 3.14 (1.04) vs 2.92 (1.13) prednisolone at the final trial visit. After tapering, disease activity increased significantly (p=0.02) in the prednisolone group to 3.18 (1.20) but was stable in placebo (3.14). The difference in the increase of DAS28 between the groups was 0.21 (95%CI –0.05;0.47; p=0.11).For signs of adrenal insufficiency, 33 out of 165 had missing data, leaving 60 in the prednisolone group and 72 in placebo (Table 1). Mean (SD) number of signs for prednisolone was 1.1 (1.1) versus 0.9 (1.3) for placebo at final trial visit and 0.8 (1.2) versus 0.8 (1.0) at follow-up. Difference in the change of the number of signs was –0.1 (95%CI –0.4;0.3; p=0.66).Table 1.Adrenal insufficiency signs and symptoms.prednisolone (n=60)placebo(n=72)end of trialchange after 3 monthsend of trialchange after 3 monthsFatigue (unusual)15113–1Appetite loss5–144Muscle weakness7–26–2Dizziness32101Stomach pain3431Muscle pain19–619–1Nausea5–322Vomiting1001Diarrhoea5–23–2Hypotension*2–14–2Sum**1.1 (1.1)–0.2 (1.3)0.9 (1.3)0.0 (1.3)* Systolic RR < 90 or diastolic RR < 60.**Mean (SD)No differences were seen in ACTH or cortisol levels: mean (SD) ACTH was 5.8 (4.1) in 23 prednisolone patients, and 5.1 (3.7) in 24 placebo patients; cortisol 296 (113) v 310 (166), cortisol/ACTH 67 (40) v 77 (54). Two prednisolone and one placebo patient had cortisol levels below 80. None developed clinical hypoadrenalism during further follow-up.199 patients qualified for the disease flares sample, 99 prednisolone and 100 placebo; 44 patients flared on prednisolone tapering vs 31 on placebo, relative risk 1.43 (95%CI 0.99; 2.07; p=0.07).ConclusionTapering prednisolone moderately increases disease activity to placebo levels (mean still at low disease activity levels) and numerically increases the risk of flare without any evidence of adrenal insufficiency. This suggests that withdrawal of low dose prednisolone is feasible after 2 years of administration.References[1]DeWalt DA et al. Clin Exp Rheumatol. 2004;22:453-61.AcknowledgementsThe GLORIA trial is registered at clinicaltrials.gov under NCT02585258.The GLORIA project is funded by the European Union’s Horizon 2020 research and innovation programme under the topic ‘’Personalizing Health and Care’’, grant agreement No 634886.Disclosure of InterestsAbdullah Almayali: None declared, Maarten Boers Consultant of: Novartis, Linda Hartman: None declared, Daniela Opris-Belinski Consultant of: Abbvie, Pfizer, MSD, Novartis, Eli Lilly, Ewo Pharma, UCB, Reinhard Bos: None declared, Marc R Kok: None declared, José Antonio P. da Silva: None declared, Eduard N. Griep: None declared, Ruth Klaasen: None declared, Cornelia Allaart: None declared, Paul Baudoin: None declared, Hennie Raterman Consultant of: AbbVie, Amgen, Celgene, Roche, Sandoz, Sanofi Genzyme and UCB, Zoltán Szekanecz: None declared, Frank Buttgereit Consultant of: Abbvie, AstraZeneca, Gruenenthal, Horizon Therapeutics, Mundipharma, Pfizer, Roche, Pavol MASARYK: None declared, WIllem Lems Consultant of: Pfizer, Galapagos, Lilly, Amgen, UCB., Maurizio Cutolo: None declared, Marieke ter Wee: None declared
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Hartman L, El Alili M, Cutolo M, Opris-Belinski D, Da Silva JAP, Szekanecz Z, Buttgereit F, Masaryk P, Bos R, Kok MR, Paolino S, Coupé VMH, Lems W, Boers M. POS1402 COST-EFFECTIVENESS AND COST-UTILITY OF ADD-ON, LOW-DOSE PREDNISOLONE IN RA PATIENTS AGED 65+: THE PRAGMATIC, MULTICENTER, PLACEBO-CONTROLLED GLORIA TRIAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.764] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRheumatoid arthritis (RA) is a disease with substantial impact on quality of life, healthcare and societal costs [1]. Current treatment strategies, especially biologic drugs, result in high costs [2]. Previous studies have already found that a combination treatment strategy of disease-modifying antirheumatic drug(s) with initially medium-to-high doses of prednisolone resulted in better effects and lower costs compared to the treatment strategies without prednisolone [3, 4]. However, to our knowledge the cost-effectiveness of low-dose glucocorticoids (GCs), and that of GC overall in established RA has not been examined separately.ObjectivesTo evaluate the cost-effectiveness and cost-utility of low-dose prednisolone in RA patients aged 65+.MethodsThe economic evaluation was performed as part of the placebo-controlled GLORIA trial of RA patients aged 65+ with a disease activity score in 28 joints (DAS28) ≥2.60. Eligible patients were randomized to 2 years 5 mg/day prednisolone or placebo. Patients were recruited from 28 clinical centers in seven European countries. All co-treatment, except for chronic oral GC, was allowed.The economic evaluation had a societal perspective with a time horizon of two years. Cost data were collected with questionnaires and from recorded events, and valued with unit prices of 2017. The primary effectiveness outcome was the DAS28. For cost-utility, quality-adjusted life years (QALYs) were estimated from the EuroQol-5 Dimension (EQ-5D) questionnaire.Standard regression models were used to estimate incremental costs and effects between the treatment groups. Bootstrapping assessed the uncertainty around the average differences in costs and health outcomes.ResultsIn total, 444 of 451 randomized patients were included in the modified-intention-to-treat analysis (see main GLORIA study abstract). Patients were on average 72 years and had median 4 active comorbidities at baseline. Mean total costs over 2 years were k€10.8 in the prednisolone group, k€0.4 (95% CI –3.7; 1.9) lower than in the placebo group. Total direct medical costs were k€0.5 (95% CI –4.0; 1.5) lower in the prednisolone group. The mean number of QALYs was similar in both groups (difference 0.02 [–0.03; 0.06] in favor of prednisolone). The DAS28 was 0.38 lower in the prednisolone group than in the placebo group (0.19;0.56).The cost-effectiveness plane shows that the majority of the bootstrapped cost-effect pairs was situated in the southwest quadrant of the plane confirming the larger effects (i.e. decrease in DAS28) and non-significant lower costs in the prednisolone group (Figure 1). The cost-utility plane shows that the number of QALYs was similar for both groups and that the bootstrapped cost-utility pairs were slightly more located in the southeast quadrant confirming a very small increase in QALYs and slightly lower costs in the prednisolone group (Figure 1).ConclusionWith greater effectiveness at non-significantly lower costs, low-dose, add-on prednisolone is cost-effective for RA compared to placebo over two years. QALYs were equal in both groups, most likely due to the impact of multiple comorbidities.References[1]Kobelt G. Elsevier. 2009;83-9.[2]Souliotis K et al. PLoS One. 2019;14:e0226287.[3]Ter Wee MM et al. RMD Open. 2017;3:e000502.[4]Verhoeven AC et al. Br J Rheumatol. 1998;37:1102-9.AcknowledgementsThe GLORIA project is funded by the European Union’s Horizon 2020 research and innovation programme under the topic ‘’Personalizing Health and Care’’, grant agreement No 634886.Disclosure of InterestsLinda Hartman: None declared, Mohamed El Alili: None declared, Maurizio Cutolo: None declared, Daniela Opris-Belinski Speakers bureau: Abbvie, Pfizer, MSD, Novartis, Eli Lilly, Ewo Pharma, UCB, José Antonio P. da Silva: None declared, Zoltán Szekanecz: None declared, Frank Buttgereit Speakers bureau: Abbvie, AstraZeneca, Gruenenthal, Horizon Therapeutics, Mundipharma, Pfizer, Roche, Pavol MASARYK: None declared, Reinhard Bos: None declared, Marc R Kok: None declared, Sabrina Paolino: None declared, Veerle M. H. Coupé: None declared, WIllem Lems Speakers bureau: Pfizer, Galapagos, Lilly, Amgen, UCB, Maarten Boers Speakers bureau: BMS, Novartis, Pfizer
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Kieskamp S, Siderius M, Wilbrink R, Maas F, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. POS1010 SPINAL RADIOGRAPHIC PROGRESSION AND ITS ASSOCIATION WITH PROGRESSION TO ANKYLOSING SPONDYLITIS IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPrevention of structural damage of the axial skeleton is an important goal of treatment in axial spondyloarthritis (axSpA)1. Most studies concerning spinal radiographic progression focused on ankylosing spondylitis (AS). Data on spinal radiographic progression in patients with non-radiographic (nr)-axSpA is limited and data on the relation between spinal and sacroiliac radiographic progression in this population is lacking.ObjectivesTo assess long-term spinal radiographic progression in patients with nr-axSpA. Secondly, to explore the association between radiographic progression to AS and spinal radiographic progression in these patients.MethodsPatients enrolled in the ongoing Groningen Leeuwarden Axial SpA (GLAS) cohort, classified as nr-axSpA at baseline, with pelvic and spinal (lumbar and cervical) radiographs available at baseline and at least one follow-up visit at 2, 4 or 6 years were selected for analyses. Progression from nr-axSpA to AS was defined as progression to modified New York (mNY) sacroiliitis score ≥2 bilaterally or ≥3 unilaterally. Radiographs of nr-axSpA patients were randomized with radiographs of AS patients and scored in known time sequence by two trained readers blinded for patient characteristics. SK and RW scored the SI joints and in case of disagreement in axSpA classification, the score of a third independent reader (AS) was used. SK and MS scored the spinal radiographs according to the modified stoke ankylosing spondylitis spinal score (mSASSS; 0-72), and the mean of both total scores was calculated. In case of >5 points discrepancy between both readers, the mSASSS of a third independent reader (FM) together with the closest of the scores of the primary readers was used. The mSASSS change of nr-axSpA patients who did en did not progress to AS was compared with Mann-Whitney U tests.ResultsIncluded were 60 patients with a clinical diagnosis of nr-axSpA, confirmed by their sacroiliac radiographic score at baseline. Mean age was 37±10 years, 53% were male, median symptom duration was 9 (IQR 2-17) years, 75% were HLA-B27+, and mean ASDAS was 2.6±1.1.In total 15 patients progressed to AS. Median mSASSS at baseline was 1.5 (IQR 0.5 – 4.4). Median change in mSASSS from baseline was 0.0 (IQR 0.0 – 1.0) vs. 1.0 (IQR 0.0 – 1.5) at 2 years; 1.2 (IQR 0.3 – 3.5) vs. 2.0 (0.5 – 2.7) at 4 years; and 1.8 (1.0 – 3.8) vs. 2.5 (0.5 – 3.5) at 6 years for non-AS progressors and AS progressors, respectively (Figure 1). These mSASSS changes weres were not significantly different at any timepoint (p = 0.456, p=0.814, p=0.929 for 2-, 4-, and 6-year follow-up, respectively).Figure 1.Comparison of mSASSS progression between patients with and without progression to AS during the first 6 years of follow-up.ConclusionIn our observational cohort of patients with nr-axSpA with up to 6 years of follow-up, mSASSS progression was low (< 1 mSASSS unit/year) and was not different between patients who did and did not progress to AS.References[1]Van der Heijde D. et al. Ann Rheum Dis. 2017;76(6):978-991.AcknowledgementsThe GLAS cohort was supported by an unrestricted grant from Novartis.Disclosure of InterestsStan Kieskamp: None declared, Mark Siderius: None declared, Rick Wilbrink: None declared, Fiona Maas: None declared, Freke Wink: None declared, Reinhard Bos: None declared, Hendrika Bootsma Speakers bureau: Bristol-Myers Squibb, Novartis, Consultant of: Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Suzanne Arends: None declared, Anneke Spoorenberg Paid instructor for: Abbvie, Consultant of: Abbvie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Grant/research support from: Novartis Pharma, Pfizer
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Bos R, Jansen T, Bridges I, De Jong S, Vis M. AB0884 Disease outcomes in patients with psoriatic arthritis completing 12 months of apremilast treatment - Real-world data from the REWARD study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with moderately active psoriatic arthritis (PsA) and limited joint involvement have considerable disease burden1,2. Recent data shows these patients have a high likelihood of achieving treatment goals if treated with apremilast3. This is the first report of outcomes in patients with PsA who received apremilast for 12 months in Dutch clinical practice.ObjectivesWe report disease outcomes, including the PsA Impact of Disease (PsAID) 12-item questionnaire, swollen joint count (SJC), tender joint count (TJC), dactylitis and enthesitis, among patients in the prospective, multicenter, observational REWARD study who completed 12 months of apremilast treatment.MethodsThe ongoing REWARD study enrolled patients who had initiated apremilast for the treatment of PsA in the Netherlands between 13 April 2017 and 24 March 2021, and includes up to 12 months follow-up1,4. We report interim data from patients with data available as of 16 September 2021. Baseline data are summarized separately for patients who discontinued apremilast before their month 12 study visit (stoppers) and patients still receiving apremilast at their month 12 visit (completers). Post baseline data are summarized for completers. Continuous data are summarized using mean and SD, categorical data are summarized using n and percent.Results98 patients were included in this interim analysis; 32 had completed 12 months of apremilast treatment (completers), 54 had discontinued apremilast before month 12 (stoppers), 12 were ongoing in the study. Compared with stoppers, completers were more likely to be biologic naïve and have dactylitis, and had lower BSA. All other baseline characteristics were similar (Table 1). Among completers, all PsAID domains improved after 3 months of apremilast treatment and these improvements were maintained through month 12 (Figure 1). Mean SJC and TJC decreased between baseline and month 12 (SJC, 4.2 and 1.0 at baseline and month 12, respectively; TJC, 7.1 and 3.3, respectively). The proportion of completers with SJC, TJC, enthesitis and dactylitis scores of 0 increased from baseline to month 12 (Figure 1B). The proportion of completers reporting at least one adverse event (AE) was comparable to the overall study population (14/32 [44%] and 48/98 [49%], respectively); the reported adverse events were similar to the known safety profile of apremilast.Table 1.Baseline characteristicsAll=all patients included in this interim analysis; Completers= patients that received apremilast for 12 months; Stoppers= patients that stopped apremilast treatment prior to 12 months.BMI=Body Mass Index, PsO=Psoriasis, BSA PsO= Body Surface Area Psoriasis, SJC=Swollen Joint Count, TJC=Tender Joint Count, PsAID=Psoriatic Arthritis Impact of Disease, VAS=Visual Analog Scale, CRP= C-reactive protein, cDAPSA=Clinical Disease Activity in Psoriatic Arthritis, Rem=Remission, Mod=Moderate, PsA= Psoriatic ArthritisFigure 1.(A) PSAID scores in completers and (B) percentage of completers with no swollen joints, no tender joints, no dactylitis and no enthesitis at baseline (BSL), month 3, 6 and 12 (M3, M6, M12).ConclusionIn this interim analysis of the REWARD study, patients completing 12 months of apremilast treatment were more likely to be biologic naïve than patients who discontinued apremilast within 12 months of initiation, and had significant decreases in TJC, SJC, dactylitis and enthesis during apremilast treatment. Completed patients also reported decreased PsAID scores during apremilast treatment, indicating improvements in their quality of life.References[1]Jansen TL, et al. Ann Rheum Dis. 2019; 78:913 [abstract FRI0442][2]Wervers et al. J Rheumatol. 2018;45:1526.[3]Mease PJ, et al. Arthritis Care Res. 2020; 72, 6, 814–821[4]Bos R, et al. Ann Rheum Dis. 2021; 80:805 [POS1053]AcknowledgementsSylvia de Jong and Claire Desborough, Amgen employees, provided medical writing and editorial assistance.Disclosure of InterestsReinhard Bos Consultant of: AbbVie BV, Genzyme Europe, Grant/research support from: Galapagos, Tim Jansen Speakers bureau: Grunenthal, Sobi, Consultant of: AbbVie, Celgene Corporation, Grant/research support from: ReumaNederland, Olatec, Grunenthal, Ian Bridges Shareholder of: Amgen, Employee of: Amgen, Sylvia de Jong Shareholder of: Amgen, Employee of: Amgen, Novartis, Marijn Vis Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Grant/research support from: Novartis, Pfizer
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Parikh P, Semba R, Manary M, Swaminathan S, Udomkesmalee E, Bos R, Poh BK, Rojroongwasinkul N, Geurts J, Sekartini R, Nga TT. Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries. Matern Child Nutr 2021; 18:e13264. [PMID: 34467645 PMCID: PMC8710096 DOI: 10.1111/mcn.13264] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low‐ and middle‐income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)‐sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low‐quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient‐dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.
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Affiliation(s)
| | - Richard Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark Manary
- Department of Paediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | | | - Rolf Bos
- FrieslandCampina, Amersfoort, The Netherlands
| | - Bee Koon Poh
- Nutritional Sciences Programme & Centre for Community Health, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Jan Geurts
- FrieslandCampina, Amersfoort, The Netherlands
| | - Rini Sekartini
- Faculty of Medicine, Department of Pediatrics, University of Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tran Thuy Nga
- Department of Occupational and School Nutrition, National Institute of Nutrition (NIN), Hanoi, Vietnam
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Boers M, Hartman L, Opris-Belinski D, Bos R, Kok MR, Da Silva JAP, Griep EN, Klaasen R, Allaart C, Baudoin P, Raterman H, Szekanecz Z, Buttgereit F, Masaryk P, Klausch T, Paolino S, Schilder A, Lems W, Cutolo M. AB0160 HIGH NUMBER OF CONCOMITANT MEDICATIONS AND COMORBIDITIES AT BASELINE IN THE GLUCOCORTICOID LOW-DOSE OUTCOME IN RHEUMATOID ARTHRITIS (GLORIA) STUDY: AN OLDER POPULATION WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2013] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Treatment with low-dose glucocorticoids (GCs) (≤7.5 mg prednisolone) in combination with standard care is highly effective in rheumatoid arthritis (RA), but despite 70 years of clinical experience, evidence-based information on its balance of benefit and harm is incomplete. This leads to an ongoing debate, with under- and over-use of GCs as result. The GLORIA pragmatic trial was developed to assess harm, benefit and costs of low-dose GCs added to the standard treatment of older RA patients.Objectives:The objective of this abstract is to document the baseline status and frequency of comorbid conditions in the GLORIA study population. The results of the unblinded data will be submitted as late-breaking abstract.Methods:This double-blind, randomized, placebo-controlled, multicenter trial (1) was open for patients with RA according to the 1987 or 2010 (2) criteria, age ≥65 years, and disease activity score of 28 joints (DAS28) of ≥2.6. Patients were recruited from rheumatology clinics in Germany, Hungary, Italy, The Netherlands, Portugal, Romania and Slovakia. Eligible patients were randomized to two years of treatment with daily 5 mg prednisolone or matching placebo. All other medication was allowed, except for GCs. The presented data are blinded because the database is not closed yet.Results:The population consists of 451 patients with mean disease duration 10.6 (Q1-Q3: 3-15) years. The majority (70%) is female, mean age is 72.5 (Q1-Q3: 68-76, range: 65-88) years, 66% were positive for rheumatoid factor and 56% for ACPA. Patients had a mean of 4.3 (SD 2.8) comorbidities besides RA (3.4 active) and therefore used multiple concomitant medications (3.9 (SD 3.4)) (Table 1). The most common comorbidities (provisional data of 161 patients with complete coding) in this older population are: vascular disorders (58%), musculoskeletal and connective tissue disorders (57%) and a history of surgical and medical procedures (45%). Patients were most frequently on beta blocking agents (22%, mainly metoprolol) and HMG CoA reductase inhibitors (20%, mainly simvastatin). Most patients also have an extensive history of anti-rheumatic treatment. At the start of the trial most patients (82%) were on cDMARD treatment; 15% were on bDMARDs/tsDMARDs. Almost half of the patients previously had been treated with GCs, with a mean duration of 3.4 years and a mean last dose of 4.6 mg/day.Conclusion:The baseline data shows that we have an older study population who have relatively many other comorbidities next to RA and who are almost all treated with multiple concomitant medications in addition to the study medication. Therefore, we expect to report a high adverse event rate. Research among older patients is urgently needed, but the frailty of this population as represented by the multiple comorbidities and concomitant medications have to be taken into account in the analyses and interpretation of the results.References:[1]Hartman L, Rasch LA, Klausch T, Bijlsma HWJ, Christensen R, Smulders YM, et al. Harm, benefit and costs associated with low-dose glucocorticoids added to the treatment strategies for rheumatoid arthritis in elderly patients (GLORIA trial): study protocol for a randomised controlled trial. Trials. 2018;19:67.[2]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-81.Table 1.Comorbidities and concomitant medications at baseline in the
GLORIA trial.MeanSDRangeComorbidities 4.32.8 0-15 Active 3.4 Past 1.9Concomitant medications (count) 3.93.4 0-15 Beta blocking agents (%)22 HMG CoA reductase inhibitors (%)20 Platelet aggregation inhibitors (%)16 ACE inhibitors (%)12 Angiotensin II antagonists (%)11DAS28 4.521.05DAS28CRP 4.060.97HAQ (0-3) 1.20.7RA treatmentCurrent (%)Previous (%) cDMARD8492 bDMARD/tsDMARD1522 NSAID5129 Glucocorticoids 049Acknowledgements:The GLORIA project is funded by the European Union’s Horizon 2020 research and innovation programme under the topic ‘’Personalizing Health and Care’’, grant agreement No 634886.Disclosure of Interests:None declared
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Bos R, Jansen T, De Jong S, Castiglia A, Vis M. POS1053 COMPARISON OF BASELINE CHARACTERISTICS BETWEEN PATIENTS CONTINUING OR DISCONTINUING APREMILAST AT TWELVE MONTHS IN THE REWARD STUDY (THE NETHERLANDS). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Previous analysis of the REWARD study reported that patients with limited joint involvement have a considerable burden of disease1. Recent data suggest that patients with moderately active psoriatic arthritis (PsA) and a limited joint involvement have a high likelihood of achieving treatment goals when treated with apremilast2. According to EULAR recommendations a PDE4 inhibitor may be considered in patients with mild disease and an inadequate response to at least one csDMARD, in whom neither a bDMARD nor a JAK inhibitor is appropriate and the value of apremilast may be found in treating patients with relatively mild disease (oligoarticular)3.Objectives:The objective of this prospective, multicentre, non-interventional study is to describe patient reported outcomes, effectiveness and real-life use of apremilast in patients with PsA. Patients will be followed up for a maximum of 12 months. This interim analysis compared the baseline characteristics and experience on apremilast for two subgroups of patients, those remaining on apremilast versus the ones that discontinued.Methods:In this interim analysis we included patients with data available at cut-off date of 03 November 2020. Patient enrollment and follow up of current subjects is ongoing. Descriptive statistics (n’s and percents for categorical data, means for continuous data) were used to summarize the baseline data by subgroup. Kaplan Meier plots are presented to show patients’ experience on apremilast by subgroup.Results:85 patients were included in the analysis. 30 patients have completed the study, 39 patients have discontinued and 16 are ongoing. At baseline 22 (26%) patients were biologic experienced and 62 (74%) were biologic naïve. Both groups had a comparable disease activity measured with clinical disease activity in psoriatic arthritis (cDAPSA) scores. Biologic experienced patients had a longer disease duration compared to biologic naïve patients (mean 9.7 vs 6.2 years). Inefficacy of previous medication was the main reason for starting apremilast in both subgroups. Overall, 86% (n=69) of patients were still receiving apremilast at month 3, 60% (n=46) at month 6, and 41% (n=26) at month 12 (Figure 1). Drug survival (length of time until discontinuation of apremilast) for biologic naïve patients was 93% at month 3, 73% at month 6 and 58% at month 12. Drug survival of biologic experienced patients was 67%, 20%, and 0% at months 3, 6, and 12, respectively. At baseline mean values of body mass index (BMI), swollen joint count (SJC), tender joint count (TJC), psoriatic arthritis impact of disease (PsAID) were comparable between both groups (Table 1). Reasons for discontinuation were mainly lack of efficacy (49%) and adverse events (44%). In this analysis the nature and frequency of adverse events is in line with the known profile of apremilast.Conclusion:In this interim analysis, patients who were biologic naïve had a better probability to remain on treatment than those who were biologic experienced. Baseline characteristics were similar between the two groups, apart from disease duration that was longer in the biologic experienced group. Best drug survival is achieved when apremilast is prescribed earlier in the PsA treatment course, before biologics and after csDMARDs, as per apremilast EU label.References:[1]Jansen TL, et al. Ann Rheum Dis. 2019;78:913 [abstract FRI0442][2]Mease PJ, et al. Arthritis Care Res 2020 72 6 814–821[3]Gossec L, et al. Ann Rheum Dis 2020;79:700–712Disclosure of Interests:Reinhard Bos Consultant of: AbbVie BV, Genzyme Europe, Janssen-Cilag, Novartis, Pfizer, Grant/research support from: Galapagos, Tim Jansen Consultant of: AbbVie, Celgene Corporation – consultant, Speakers bureau: Grunenthal, Sobi – speakers bureau, Grant/research support from: ReumaNederland, Olatec, Grunenthal – grant/research support, Sylvia de Jong Shareholder of: Employee of Amgen Inc, Employee of: Employee of Amgen Inc, Antonio Castiglia Shareholder of: Employee of Amgen Inc, Employee of: Employee of Amgen Inc, Marijn Vis Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Grant/research support from: Novartis, Pfizer, AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer.
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Kieskamp S, Paap D, Carbo M, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. POS1014 CENTRAL SENSITIZATION HAS MAJOR IMPACT ON QUALITY OF LIFE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Maintaining optimal health-related quality of life (QoL) is the ultimate goal of treatment in axial spondyloarthritis (axSpA). Chronic pain has a large potential impact on QoL. Central sensitization (CS) may explain part of the chronic pain in axSpA. However, the role of central sensitization (CS) herein has only been studied to a limited degree and current axSpA guidelines pay little attention to identification and treatment of CS.Objectives:To explore the relationship between CS and QoL in axSpA.Methods:Consecutive outpatients with axSpA from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were included. CS was assessed with the Central Sensitization Inventory (CSI; 0-100), QoL with the AS Quality of Life questionnaire (ASQoL; 0-18) and disease activity with the AS Disease Activity Score (ASDASCRP). A high probability of CS was defined as CSI score ≥40 and active disease as ASDASCRP score ≥2.1. Patient characteristics and clinical assessments were compared between groups with CSI score <40 and ≥40.(1) Multivariable regression analysis was conducted to investigate the relationship between CSI and ASQoL scores, correcting for potential confounders.Results:Of the 178 axSpA patients with available CSI score, 149 completed the ASQoL. Mean age of the 178 included patients was 47.4 ± 14.1 years, 78 (44%) were female, mean symptom duration was 21.4 ± 13.6 years and 88 (52%) were using bDMARDS. Mean CSI score was 38.0 ± 14.1, mean ASQoL 6.0 ± 5.3 and mean ASDASCRP 2.1 ± 1.0. CSI score ≥40 was significantly associated with higher mean ASQoL (9.7 vs. 3.3), higher mean ASDASCRP (2.6 vs. 1.7), female gender (60% vs. 29%) and more often entheseal involvement (61% vs. 26%) (Table 1).Table 1.Selection of patient characteristics, disease activity and clinical outcome variables for patients with axSpA, divided in subgroups for CSI score with a cutoff point of 40.CharacteristicsAll patientsn = 178CSI<40n = 98 (55%)CSI≥40n = 80 (45%)Age (years)47.4 ± 14.148.7 ± 15.045.8 ± 12.7Female78 (44)27 (29)44 (60)*Symptom duration (years)21.4 ± 13.621.5 ± 13.521.2 ± 13.8HLA-B27+133 (79)70 (79)54 (79)Smoker45 (27)28 (32)15 (23)BMI (kg/m2)26.7 ± 5.026.2 ± 4.427.5 ± 5.8Completed higher education181 (71)48 (70)34 (76)Biological use88 (52)49 (52)39 (51)RDCI (0-9)0.0 (0.0 – 1.0)0.0 (0.0 – 1.0)0.0 (0.0 – 1.8)Peripheral arthritis210 (6)5 (6)5 (8)Entheseal involvement364 (40)23 (26)38 (61)*ASDASCRP2.1 ± 1.01.7 ± 0.92.6 ± 1.0*CRP (mg/ml)2.9 (1.1 – 6.8)2.6 (1.1-6.0)3.6 (1.4 – 7.0)ASQoL (0-18)6.0 ± 5.33.3 ± 3.69.7 ± 4.9*CSI (0-100)38.0 ± 14.128.0 (23 – 34)50.0 (43.0 –56.0)N/AValues are n (%), mean ± SD or median (IQR).1International Standard Classification of Education (ISCED) level >4; 2Swollen Joint Count >0; 3Maastricht Ankylosing Spondylitis Enthesitis Score >0. *p<0.001. ASDASCRP: Ankylosing Spondylitis Disease Activity Score; ASQoL: Ankylosing Spondylitis Quality of Life questionnaire; CRP: C-reactive protein; CSI: Central Sensitization Inventory; RDCI: Rheumatic Disease Comorbidity Index.Patients with low ASDASCRP (<2.1) and also low CSI score (<40) showed good QoL (median ASQoL 1.1). Patients with low ASDASCRP combined with high CSI score (≥40) and patients with high ASDASCRP (≥2.1) combined with low CSI score reported worse QoL (median ASQoL 5.6 and 4.1, respectively). Patients with high ASDASCRP and also high CSI score reported the worst QoL (median ASQoL 12.0). (Figure 1).Figure 1.ASQoL score in patients with axSpA with CSI score ≥40 and <40, divided for ASDASCRP (cutoff 2.1)Additionally, in univariable analysis, the CSI score explained a large proportion of the variation of the ASQoL (R2=0.46). This association remained significant after correction for ASDASCRP, gender, symptom duration, entheseal involvement, smoking status, BMI category, educational level and comorbidities in multivariable analysis (CSI p<0.001).Conclusion:In daily clinical practice, CS seems strongly related to patient-reported QoL in patients with long-term axSpA.References:[1]Neblett R et al. J Pain. 2013;14:438–45.Acknowledgements:The authors would like to thank all patients who participated in the GLAS cohort. Furthermore, the authors wish to acknowledge Mrs. B. Burmania, Mrs. B. Hollander, Mrs. S. Katerbarg, Mrs. S. Lange, Mrs. E. Markenstein, Mrs. R. Rumph and Mrs. M. de Vries-Veldman for their contribution to clinical data collection.Disclosure of Interests:Stan Kieskamp: None declared, Davy Paap: None declared, Marlies Carbo: None declared, Freke Wink Consultant of: Abbvie, Reinhard Bos: None declared, Hendrika Bootsma Grant/research support from: Roche, Suzanne Arends Grant/research support from: Pfizer, Anneke Spoorenberg Consultant of: Abbvie, Pfizer, MSD, UCB, Lilly, Novartis, Grant/research support from: Abbvie, Pfizer, UCB, Novartis.
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Karaglani E, Thijs-Verhoeven I, Gros M, Chairistanidou C, Zervas G, Filoilia C, Kampani TM, Miligkos V, Matiatou M, Valaveri S, Sakellariou A, Babilis G, Bos R, Manios Y. A Partially Hydrolyzed Whey Infant Formula Supports Appropriate Growth: A Randomized Controlled Non-Inferiority Trial. Nutrients 2020; 12:nu12103056. [PMID: 33036201 PMCID: PMC7650565 DOI: 10.3390/nu12103056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of the current study was to investigate the effects of a partially hydrolyzed whey infant formula (PHF) on growth in healthy term infants as compared to a standard infant formula with intact protein (IPF). In a double-blind, non-inferiority, randomized controlled trial, a total of 163 healthy formula-fed infants, 55–80 days old, were recruited and randomly allocated to either the PHF (test) or the IPF (control) group. They were followed up for three months during which they were evaluated monthly on growth and development. In total, 21 infants discontinued the study, while 142 infants completed the study (test n = 72, control n = 70). The primary outcome was daily weight gain during the three months. Secondary outcomes included additional anthropometric indices at every timepoint over the intervention period. Daily weight gain during the three-month intervention period was similar in both groups with the lower bound of 95% confidence interval (CI) above the non-inferiority margin of −3 g/day [mean difference (95% CI) test vs. control: −0.474 (−2.460, 1.512) g/day]. Regarding secondary outcomes, i.e., infants’ weight, length, head circumference, body mass index (BMI), and their Z-scores, no differences were observed between the two groups at any time point. The PHF resulted in similar infant growth outcomes as the standard IPF. Based on these results, it can be concluded that the partially hydrolyzed whey infant formula supports adequate growth in healthy term infants.
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Affiliation(s)
- Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Inge Thijs-Verhoeven
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Marjan Gros
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Christina Chairistanidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Giorgos Zervas
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Christina Filoilia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Tarek-Michail Kampani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Vasileios Miligkos
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Maria Matiatou
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Stavroula Valaveri
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Alexandros Sakellariou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
| | - Georgios Babilis
- Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Athens, Greece; (G.Z.); (V.M.); (M.M.); (S.V.); (G.B.)
| | - Rolf Bos
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, The Netherlands; (I.T.-V.); (M.G.); (R.B.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17671 Athens, Greece; (E.K.); (C.C.); (C.F.); (T.-M.K.); (A.S.)
- Correspondence: ; Tel.: +30-210-9549156
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Manios Y, Karaglani E, Thijs-Verhoeven I, Vlachopapadopoulou E, Papazoglou A, Maragoudaki E, Manikas Z, Kampani TM, Christaki I, Vonk MM, Bos R, Parikh P. Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials. BMC Nutr 2020; 6:46. [PMID: 32944265 PMCID: PMC7489008 DOI: 10.1186/s40795-020-00365-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Palmitic acid (PA) is predominantly esterified at the SN-2 position of triacylglycerols in human milk. PA at the SN-2 position is more efficiently absorbed and results in reduced formation of PA soaps, as well as reduced fatty acid (FA) and calcium malabsorption. Bovine milk fat (MF), a natural source of SN-2-palmitate, was used in the fat blend of infant formulae (IF) in the current study to investigate its effect on stool fatty acid soaps, calcium excretion and stool characteristics. Methods Two double-blind, randomised cross-over trials (CS1, CS2) were conducted in parallel with healthy term, formula-fed infants aged 9-14 weeks. After a two-week run-in period, infants in CS1 (n = 17) were randomly allocated to receive either a 50% MF-based formula (50MF) or a 100% vegetable fat (VF) formula; in CS2 (n = 18), infants received either a 20% MF-based formula (20MF) or the VF formula, in a 2 × 2-week cross-over design. At the end of each two-week intervention period, stool samples were collected for FA, FA soaps and calcium excretion analysis and stool consistency was assessed according to the Amsterdam Infant Stool Scale (AISS). Results MF-based groups showed no significant difference in PA in stools compared to VF group, although reduced stool PA soaps (CS1: 111.28 ± 18.33 vs. 220.25 ± 29.35 mg/g dry weight, p < 0.0001; CS2: 216.24 ± 25.16 vs. 233.94 ± 35.12 mg/g dry weight, p = 0.0023), total FA soaps and calcium excretion (CS1: 46.40 ± 5.27 vs. 49.88 ± 4.77 mg/g dry weight, p = 0.0041; CS2: 46.20 ± 4.26 vs. 50.47 ± 6.71 mg/g dry weight, p = 0.0067) were observed. Furthermore, the 50MF group showed a favourable lower mean stool consistency score compared to the VF group (1.64 ± 0.49 vs. 2.03 ± 0.19, p = 0.0008). Conclusions While the use of bovine MF in IF did not affect PA concentrations in stool, lower excretion of palmitate soaps, total FA soaps and calcium was seen in healthy term infants. 50MF formula also showed improved stool consistency. The use of MF in IF could be an interesting approach to improve gut comfort and stool characteristics in infants, warranting further research. Trial registration Netherlands Trial Registry Identifier: NTR6702. Date registered: December 01, 2017.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, Children's Hospital P. & A. Kyriakou, Athens, Greece
| | - Anastasia Papazoglou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eleni Maragoudaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Zafeiris Manikas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Tarek-Michail Kampani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iliana Christaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marlotte M Vonk
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
| | - Rolf Bos
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
| | - Panam Parikh
- FrieslandCampina, Stationsplein 1, 3818 LE Amersfoort, the Netherlands
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Hartman L, Alessandri E, Bos R, Opris-Belinski D, Kok MR, Griep-Wentink H, Klaasen R, Allaart C, Bruyn G, Raterman H, Voshaar M, Gomes N, Pinto R, Klausch T, Lems W, Boers M. AB1165 MEDICATION ADHERENCE DATA IN A RANDOMIZED TRIAL: LARGE CHALLENGES TO COME FROM RAW DATA TO A WORKABLE AND RELIABLE DATASET. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3638] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Medication adherence in the GLORIA trial, among elderly patients with rheumatoid arthritis, is measured with caps that register openings of the medication bottle. At each study visit, one or two medication bottles with cap (kits) are dispensed, each containing 90 capsules. Multiple steps are needed to come to a workable dataset to describe adherence.Objectives:To describe the steps that are needed to come from raw data to a workable dataset to analyze adherence data that are recorded by electronic caps.Methods:The medication bottle contains a cap with the ability to register cap openings. The raw dataset from the caps consist of an excel file with one opening event per row, recorded as date and time. One cap yields approximately 90 rows. First, the kit numbers were matched to the corresponding patient numbers, that are recorded in another excel file. Instances where two kits were dispensed were recorded with two kit numbers in one cell and need to be copied to two cells with one kit number. Second, the VLOOKUP function was used to combine dates and kit numbers. One row now contains all openings from one kit. Then, the number of days between first opening and each next opening date was calculated. A range of 90 days was made to calculate how many times the bottle was opened on each day of the 90-days period. The results were color-coded to visualize instances of zero, one or ≥two openings on a day.Results:The colored calendar matrix (Figure 1) can now be used to categorize adherence patterns.Conclusion:A monitoring cap seems a simple instrument to measure adherence. However, multiple steps and a lot of time are needed to come to a workable dataset for the study of adherence patterns.Acknowledgments:The GLORIA project is funded by the European Union’s Horizon 2020 research and innovation programme under the topic ‟Personalizing Health and Care’’, grant agreement No 634886.Disclosure of Interests:Linda Hartman: None declared, Elisa Alessandri: None declared, Reinhard Bos: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Griep-Wentink: None declared, Ruth Klaasen: None declared, Cornelia Allaart: None declared, George Bruyn: None declared, Hennie Raterman Grant/research support from: UCB, Consultant of: Abbvie, Amgen, Bristol-Myers Sqibb, Cellgene and Sanofi Genzyme, Marieke Voshaar Grant/research support from: part of phd research, Speakers bureau: conducting a workshop (Pfizer), Nuno Gomes: None declared, Rui Pinto: None declared, Thomas Klausch: None declared, WIllem Lems Grant/research support from: Pfizer, Consultant of: Lilly, Pfizer, Maarten Boers: None declared
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Hartman L, Paolino S, Bos R, Opris-Belinski D, Kok MR, Griep-Wentink H, Klaasen R, Allaart C, Bruyn G, Raterman H, Voshaar M, Gomes N, Pinto R, Klausch T, Lems W, Boers M. FRI0581 IN ELDERLY PATIENTS, CAPS THAT RECORD MEDICATION BOTTLE OPENINGS ARE UNRELIABLE AND THUS NOT THE GOLD STANDARD FOR ADHERENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3598] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Adherence is a serious problem in treatment of inflammatory diseases. To measure adherence, caps that record medication bottle openings may be superior to capsule counts (1). In the ongoing two-year GLORIA trial on the addition of low-dose (5 mg) prednisolone or placebo to standard of care in elderly patients (65+ years) with rheumatoid arthritis, adherence was measured in both ways during the whole trial.Objectives:To describe adherence patterns, and to compare adherence as assessed with adherence caps and with capsule counts in the GLORIA trial.Methods:The recorded adherence patterns of patients (blinded for treatment group) were classified according to descriptive categories. Overall adherence according to number of bottle openings was compared with adherence according to the capsule count. Good adherence was defined as 80%: i.e. for caps 80% of days one opening recorded, and for counts less than 20% of prescribed tablets returned at the subsequent visit. Each patient has a maximum of 8 periods of 90 days.Results:Trial inclusion has closed in 2018 at 452 patients; the current dataset contains adherence data of 385 patients. Mean number of recorded 90-day periods per patient was 4 (range 1-8). Based on capsule counts over all periods, 90% of the patients met the 80% threshold of adherence; based on cap data only 31% met this criterion.The four adherence patterns are shown in a calendar matrix, with yellow for zero, green for one and blue for ≥two openings on a day (Figure 1). Bottles were supposed to be opened once a day.Patients were categorized according to the opening pattern seen in at least 50% of assessed periods:32% non-use(<20% of the days an opening);26% stable use(≥80% of the days 1 opening);40% irregular use(different adherence patterns, in or between periods);2% weekly use(1 opening per week).Conclusion:In our trial of elderly rheumatoid arthritis patients, patients appeared to be mostly adherent according to conventional capsule counts. Results from adherence caps were highly discrepant with the capsule counts, with patterns suggesting patients did not use the bottle for daily dispensing, despite specific advice to do so.References:[1] El Alili M, Vrijens B, Demonceau J, Evers SM, Hiligsmann M. A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence. Br J Clin Pharmacol 2016;82:268-79.Acknowledgments:The GLORIA project is funded by the European Union’s Horizon 2020 research and innovation programme under the topic ‘’Personalizing Health and Care’’, grant agreement No 634886.Disclosure of Interests:Linda Hartman: None declared, Sabrina Paolino: None declared, Reinhard Bos: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Griep-Wentink: None declared, Ruth Klaasen: None declared, Cornelia Allaart: None declared, George Bruyn: None declared, Hennie Raterman Grant/research support from: UCB, Consultant of: Abbvie, Amgen, Bristol-Myers Sqibb, Cellgene and Sanofi Genzyme, Marieke Voshaar Grant/research support from: part of phd research, Speakers bureau: conducting a workshop (Pfizer), Nuno Gomes: None declared, Rui Pinto: None declared, Thomas Klausch: None declared, WIllem Lems Grant/research support from: Pfizer, Consultant of: Lilly, Pfizer, Maarten Boers: None declared
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Kieskamp S, Paap D, Carbo M, Wink F, Bos R, Bootsma H, Arends S, Spoorenberg A. OP0080 CENTRAL SENSITIZATION AND ILLNESS PERCEPTIONS SHOULD BE TAKEN INTO ACCOUNT WHEN INTERPRETING DISEASE ACTIVITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Up to 40% of ankylosing spondylitis patients report persistently high pain scores of >4 (scale of 0-10) even after responding to long-term TNF-alpha blocking therapy.[1] In other rheumatic diseases, nociplastic pain (due to altered functioning of the nervous system leading to peripheral and central sensitization) is common.[2] In axial spondyloarthritis (axSpA), patient illness and pain perceptions were shown to influence disease outcome.[3] Therefore, we hypothesized that central sensitization and patients’ illness perceptions are associated with persistently high disease activity in axSpA.Objectives:To investigate to what extent central sensitization, pain catastrophizing and patients’ perceptions play a role in axSpA and to explore associations with disease activity.Methods:Between April and September 2019, consecutive outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort,[4] an ongoing large prospective cohort, were included in this study. Besides the standardized assessments, patients filled out three additional questionnaires: Central Sensitization Inventory (CSI), Pain Catastrophizing Scale (PCS) and Revised Illness Perception Questionnaire (IPQ-R). Univariable and multivariable linear regression analyses were used to investigate the association of CSI, PCS and each of the eight subscales of the IPQ-R, and disease activity assessments ASDAS-CRP, BASDAI, and CRP. We corrected for the following potential confounders: gender, symptom duration, BMI, educational level, smoking status and HLA-B27 status.Results:Of 171 included patients, 58% were male, 79% were HLA-B27 positive, median symptom duration was 21 (IQR 10-32), mean ASDAS-CRP 2.1 ± 1.0, mean BASDAI 3.9 ± 2.2 and median CRP 2.9 (IQR 1.2-6.3). Mean CSI score was 37.8 ± 14.1 (scale of 0-100), and 44% of patients scored ≥40 on the CSI.[5] Median PCS score was 15 (IQR 7-22) (scale of 0-52), median IPQ-R illness identity subscore 3 (IQR 2-4) (scale of 0-14) and mean IPQ-R treatment control subscore 18.1 ± 3.4 (scale of 5-25). In univariable regression analysis, CSI and PCS scores and IPQ-R subscores all showed significant associations with ASDAS-CRP, and all except the IPQ-R subscale personal control showed significant associations with BASDAI. Only IPQ-R treatment control was significantly associated with CRP. Central sensitization, two IPQ-R subscales (perceived treatment control and the number of symptoms patients attributed to their axSpA: illness identity) and BMI were independently associated with disease activity assessments BASDAI (R2=0.46) and ASDAS-CRP (R2=0.36) (Figure 1).Conclusion:In this axSpA population with long-term disease, 44% scored above the CSI cutoff point of 40, indicating a high probability of central sensitization. CSI score, illness identity and treatment control were independently associated with disease activity assessments.References:[1]Arends Set al.Clin Exp Rheumatol 2017;35(1):61-8.[2]Meeus Met al.Semin Arthritis Rheum 2012;41(4):556-67.[3]Van Lunteren Met al. Arthritis Care Res (Hoboken) 2018;70(12):1829-39.[4]Arends Set al.Arthritis Res Ther 2011;13(3):R94.[5]Neblett Ret al.J Pain 2013;14(5):438-45.Disclosure of Interests:Stan Kieskamp: None declared, Davy Paap: None declared, Marlies Carbo: None declared, Freke Wink Consultant of: Abbvie, Janssen, Reinhard Bos: None declared, Hendrika Bootsma Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Consultant of: Consultant for Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Speakers bureau: Speaker for Bristol-Myers Squibb and Novartis., Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Anneke Spoorenberg: None declared
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Atzeni IM, Hogervorst EM, Swart GM, De Leeuw K, Bijl M, Bos R, Westra J, Diercks G, Van Goor H, Bolling MC, Slart R, Mulder DJ. SAT0285 VISUALISATION OF THE ACTIVE CALCIFICATION PROCESS WITH 18-F SODIUM FLUORIDE PET/CT IN LIMITED CUTANEOUS SYSTEMIC SCLEROSIS WITH CALCINOSIS CUTIS IS FEASIBLE: A PILOT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4629] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Calcinosis cutis is a major daily challenge to patients with longstanding systemic sclerosis (SSc), negatively affecting their quality of life. Unfortunately, treatment options are very limited due to lack of understanding of the pathogenetic process. Currently, calcinosis cutis is only detected at its irreversible end-stage. Early detection of calcinosis cutis could putatively allow early disease-modifying interventions and monitor treatment effects.Objectives:The aim of the current study is to assess the feasibility of visualising “active” micro-calcifications with 18-F Sodium Fluoride (NaF) PET scanning, compared to low-dose CT in patients with clinically overt calcinosis cutis.Methods:This was a cross-sectional, observational, pilot study. All patients met 2013 ACR/EULAR criteria for SSc. Patients underwent a whole body NaF PET/low-dose CT scan, scanned 90 minutes post-injection. (Sub)cutaneous calcifications were described and assessed on NaF PET, which was compared to CT images by two independent investigators.Results:A total of 10 female patients with limited cutaneous SSc [median age 56 years (IQR 52-66), median disease duration 17 years (8-19), PAH 10%, ILD 20%] were included, and compared to 10 controls [70 years (65-73)]. NaF uptake showed normal distribution throughout the skeletal bones, arterial tree, and visceral organs, which was comparable between patients and controls. Additionally, NaF uptake was visible in the skin of all SSc patients, but in none of the controls. Cutaneous NaF uptake largely correlated with clinical calcifications. Most common sites of cutaneous NaF uptake were fingers (6 patients) and knees (7 patients). Only 5% of the NaF positive lesions were not accompanied by visible calcifications on CT. Furthermore, of all calcified lesions seen on CT, 51% showed uptake on NaF PET. Small lesions (<1 cm), were generally only visible on CT, due to lower resolution of NaF PET.Conclusion:Imaging of “active” calcinosis cutis in limited cutaneous systemic sclerosis is feasible using NaF PET scanning. Most clinically overt calcifications and half of those seen on CT were positive for NaF uptake. Whether these “active” calcifications behave differently in terms of faster progression, clinical complaints, and infection risk, and whether these are potentially suitable for disease modifying interventions is subject to future study.Disclosure of Interests:None declared
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Woo J, Chan R, Ong S, Bragt M, Bos R, Parikh P, de Groot LCPGM. Randomized Controlled Trial of Exercise and Nutrition Supplementation on Physical and Cognitive Function in Older Chinese Adults Aged 50 Years and Older. J Am Med Dir Assoc 2020; 21:395-403. [DOI: 10.1016/j.jamda.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 01/20/2023]
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Ong S, Woo J, Parikh P, Chan R, Sun J, Mun CY, Wee SL, Thu NN, Thang P, Setiati S, Huang YC, Wahlqvist ML, Bos R, de Groot LC. Addressing nutritional requirements of ageing consumers in Asia-recommendations from an expert workshop. Asia Pac J Clin Nutr 2020; 28:204-213. [PMID: 31192548 DOI: 10.6133/apjcn.201906_28(2).0001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to support the older persons, most of these efforts targeted the general population rather than the older persons population segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different countries, initiatives, and programs to further evaluate the available data to underpin future research.
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Affiliation(s)
- Sherlin Ong
- FrieslandCampina Amersfoort, The Netherlands.
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Chinese University of Hong Kong, China
| | | | - Ruth Chan
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Chinese University of Hong Kong, China
| | - Jianqin Sun
- Clinical Nutrition Centre, Huadong Hospital, Fudan University, China
| | - Chan Yoke Mun
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia,Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Malaysia.,Research Centre of Excellent, Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | | | - Nghiem Nguyet Thu
- Clinical Nutrition and Dietetics Department, National Institute of Nutrition, Vietnam
| | - Pham Thang
- Geriatric Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | - Siti Setiati
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Hospital Jakarta, Indonesia
| | - Yi-Chen Huang
- Department of Nutrition, China Medical University, Taichung, Taiwan
| | - Mark L Wahlqvist
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Monash Asia Institute, Monash University, Melbourne, Victoria, Australia
| | - Rolf Bos
- FrieslandCampina Amersfoort, The Netherlands
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Poitevin E, Nicolas M, Graveleau L, Richoz J, Andrey D, Monard F, Abrahamson A, Baillon A, Barrios J, Berger S, Berrocal R, Bos R, Brullebaut L, Caseiro C, Choo LF, Cole G, Daix G, Dekussche C, Dhillon GS, Fortineau A, Gaudin C, Gonzales MJ, Leal R, Mabiog RO, Noorlos T, Reba R, Senechal C. Improvement of AOAC Official Method 984.27 for the Determination of Nine Nutritional Elements in Food Products by Inductively Coupled Plasma-Atomic Emission Spectroscopy After Microwave Digestion: Single-Laboratory Validation and Ring Trial. J AOAC Int 2019. [DOI: 10.1093/jaoac/92.5.1484] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A single-laboratory validation (SLV) and a ring trial (RT) were undertaken to determine nine nutritional elements in food products by inductively coupled plasma-atomic emission spectroscopy in order to improve and update AOAC Official Method 984.27. The improvements involved optimized microwave digestion, selected analytical lines, internal standardization, and ion buffering. Simultaneous determination of nine elements (calcium, copper, iron, potassium, magnesium, manganese, sodium, phosphorus, and zinc) was made in food products. Sample digestion was performed through wet digestion of food samples by microwave technology with either closed or open vessel systems. Validation was performed to characterize the method for selectivity, sensitivity, linearity, accuracy, precision, recovery, ruggedness, and uncertainty. The robustness and efficiency of this method was proved through a successful internal RT using experienced food industry laboratories. Performance characteristics are reported for 13 certified and in-house reference materials, populating the AOAC triangle food sectors, which fulfilled AOAC criteria and recommendations for accuracy (trueness, recovery, and z-scores) and precision (repeatability and reproducibility RSD and HorRat values) regarding SLV and RT. This multielemental method is cost-efficient, time-saving, accurate, and fit-for-purpose according to ISO 17025 Norm and AOAC acceptability criteria, and is proposed as an improved version of AOAC Official Method 984.27 for fortified food products, including infant formula.
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Affiliation(s)
- Eric Poitevin
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
| | - Marine Nicolas
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
| | - Laetitia Graveleau
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
| | - Janique Richoz
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
| | - Daniel Andrey
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
| | - Florence Monard
- Nestlé Research Center, Vers-Chez-Les-Blanc, CH-1000 Lausanne 26, Switzerland
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Hartman L, Bos R, Buttgereit F, Güler-Yuksel M, Ionescu R, Kok MR, Lems WF, Micaelo M, Opris-Belinski D, Pusztai A, Santos E, Da Silva J, Szekanecz Z, Zeiner K, Zhang D, Boers M. Remarkable international variability in reasons for ineligibility and non-participation in the GLORIA trial. Scand J Rheumatol 2019; 48:340-341. [PMID: 31132016 DOI: 10.1080/03009742.2018.1559880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- L Hartman
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centre, VU University Medical Centre , Amsterdam , The Netherlands.,b Department of Epidemiology and Biostatistics , Amsterdam University Medical Centre, VU University Medical Centre , Amsterdam , The Netherlands
| | - R Bos
- c Department of Rheumatology , Medical Centre Leeuwarden , Leeuwarden , The Netherlands
| | - F Buttgereit
- d Department of Rheumatology and Clinical Immunology , Charité University Medicine Berlin , Berlin , Germany
| | - M Güler-Yuksel
- e Department of Rheumatology and Clinical Immunology , Maasstad Hospital , Rotterdam , The Netherlands
| | - R Ionescu
- f Department of Internal Medicine and Rheumatology , Sfanta Maria Hospital , Bucharest , Romania
| | - M R Kok
- e Department of Rheumatology and Clinical Immunology , Maasstad Hospital , Rotterdam , The Netherlands
| | - W F Lems
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centre, VU University Medical Centre , Amsterdam , The Netherlands
| | - M Micaelo
- g Department of Rheumatology , Portuguese Institute of Rheumatology , Lisbon , Portugal
| | - D Opris-Belinski
- f Department of Internal Medicine and Rheumatology , Sfanta Maria Hospital , Bucharest , Romania
| | - A Pusztai
- h Department of Rheumatology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - Ejf Santos
- i Department of Rheumatology , Coimbra University Hospital , Coimbra , Portugal
| | - Jap Da Silva
- i Department of Rheumatology , Coimbra University Hospital , Coimbra , Portugal
| | - Z Szekanecz
- h Department of Rheumatology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - K Zeiner
- d Department of Rheumatology and Clinical Immunology , Charité University Medicine Berlin , Berlin , Germany
| | - D Zhang
- c Department of Rheumatology , Medical Centre Leeuwarden , Leeuwarden , The Netherlands
| | - M Boers
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centre, VU University Medical Centre , Amsterdam , The Netherlands.,b Department of Epidemiology and Biostatistics , Amsterdam University Medical Centre, VU University Medical Centre , Amsterdam , The Netherlands
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Laterveer-Vreeswijk GH, Lockwood D, Szewczyk K, Nieuwenhuizen W, Bos R. A New Enzyme Immunoassay for Soluble Fibrin in Plasma, with a High Discriminating Power for Thrombotic Disorders. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryFibrin formation is a multistep process initiated by thrombin. At first thrombin converts fibrinogen to fibrin molecules which in vivo form soluble complexes with fibrinogen. Soluble fibrin is considered to be an early biochemical marker for intravascular fibrin formation and impending thrombotic events, such as deep venous thrombosis (DVT), pulmonary embolism (PE) and disseminated intravascular coagulopathy (DIC).A new enzyme immunoassay (EIA) was developed on the basis of a monoclonal antibody directed against a fibrin specific neo-epitope located on the gamma-chain of fibrinogen; γ-(312-324). In addition, it was possible to prepare a lyophilized reference material of thrombin-generated soluble fibrin, that allowed for full antigen recovery after reconstitution with buffer. Assay conditions, e.g. solid phase-Ig concentration and buffer composition, sample and conjugate dilution, and incubation times were optimised.The present assay was found to be specific (no interference of homologous antigens) and reproducible (intra-assay CV 4-8%, inter-assay CV 4-9%), and therefore highly suited for measuring soluble fibrin levels in a plasma milieu. The median normal value for soluble fibrin was determined in plasma samples obtained from apparently healthy volunteers (n = 81) and found to be 0.040 μg/ml, with a range (10-90 percentiles) of 0.026-0.059 μg/ml.A retrospective study showed that soluble fibrin levels were highly significantly increased in patients with a confirmed diagnosis of DIC (median 1.042 μg FEU/ml, range 0.160-2.319 μg/ml, n = 21, P <0.0001 vs normal), PE (median 0.527 μg FEU/ml, range 0.084-1.234 μg/ml, n = 29, P <0.0001 vs normal) and DVT (median 0.126 μg FEU/ml, range 0.059-0.878 μg/ml, n = 36, P <0.0001 vs normal), as determined by the Mann-Whitney U-Test.
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1257-1266. [DOI: 10.1016/j.ijom.2017.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/06/2017] [Accepted: 06/09/2017] [Indexed: 12/16/2022]
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Prüss-Ustün A, Wolf J, Corvalán C, Neville T, Bos R, Neira M. Diseases due to unhealthy environments: an updated estimate of the global burden of disease attributable to environmental determinants of health. J Public Health (Oxf) 2017; 39:464-475. [PMID: 27621336 PMCID: PMC5939845 DOI: 10.1093/pubmed/fdw085] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [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: 07/21/2016] [Revised: 06/20/2016] [Accepted: 07/16/2016] [Indexed: 12/31/2022] Open
Abstract
Background The update of the global burden of disease attributable to the environment is presented. The study focuses on modifiable risks to show the potential health impact from environmental interventions. Methods Systematic literature reviews on 133 diseases and injuries were performed. Comparative risk assessments were complemented by more limited epidemiological estimates, expert opinion and information on disease transmission pathways. Population attributable fractions were used to calculate global deaths and global disease burden from environmental risks. Results Twenty-three percent (95% CI: 13-34%) of global deaths and 22% (95% CI: 13-32%) of global disability adjusted life years (DALYs) were attributable to environmental risks in 2012. Sixty-eight percent of deaths and 56% of DALYs could be estimated with comparative risk assessment methods. The global disease burden attributable to the environment is now dominated by noncommunicable diseases. Susceptible ages are children under five and adults between 50 and 75 years. Country level data are presented. Conclusions Nearly a quarter of global disease burden could be prevented by reducing environmental risks. This analysis confirms that eliminating hazards and reducing environmental risks will greatly benefit our health, will contribute to attaining the recently agreed Sustainable Development Goals and will systematically require intersectoral collaboration to be successful.
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Affiliation(s)
- A. Prüss-Ustün
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization
, 1211Geneva, Switzerland
| | - J. Wolf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute
, 4051Basel, Switzerland
- University of Basel, 4003Basel, Switzerland
- Present address: World Health Organization, Geneva, Switzerland
| | - C. Corvalán
- Faculty of Health, University of Canberra, ACT2617, Australia
| | - T. Neville
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization
, 1211Geneva, Switzerland
| | - R. Bos
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization
, 1211Geneva, Switzerland
| | - M. Neira
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization
, 1211Geneva, Switzerland
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Bos R, van Arnhem A, van Leeuwen A. Osteoinductivity of calcium phosphate ceramics in a sheep model plus clinical application. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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van Bakelen N, Gareb B, de Visscher J, Hoppenreijs T, Bergsma E, Bos R. Long-term clinical performance of a biodegradable versus a titanium fixation system in maxillofacial surgery: a multicentre randomised clinical trial. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maas F, Arends S, Wink F, van der Veer E, Bos R, Bootsma H, Brouwer E, Spoorenberg A. AB0658 Influence of Known Risk Factors on Spinal Radiographic Progression in Ankylosing Spondylitis Patients Receiving Long-Term Treatment with TNF Inhibitors: Results from The Glas Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maas F, Spoorenberg A, van der Slik B, van der Veer E, Brouwer E, Bootsma H, Bos R, Wink F, Arends S. FRI0413 Clinical Risk Factors for The Presence and Development of Vertebral Fractures in Patients with Ankylosing Spondylitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arends S, Veneberg J, Wink F, Bos R, Brouwer E, van der Veer E, Bootsma H, van Roon E, Maas F, Spoorenberg A. SAT0418 The Effect of Bisphosphonates on Bone Mineral Density in Patients with Ankylosing Spondylitis in Daily Clinical Practice. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Troesch B, Biesalski HK, Bos R, Buskens E, Calder PC, Saris WHM, Spieldenner J, Verkade HJ, Weber P, Eggersdorfer M. Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity. Nutrients 2015; 7:6016-37. [PMID: 26197337 PMCID: PMC4517043 DOI: 10.3390/nu7075266] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.
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Affiliation(s)
- Barbara Troesch
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Hans K Biesalski
- Institut für Biologische Chemie und Ernährungswissenschaft, Universität Hohenheim, Stuttgart 70599, Germany.
| | - Rolf Bos
- FrieslandCampina, Bronland 20, Wageningen 6708 WH, The Netherlands.
| | - Erik Buskens
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Wim H M Saris
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht 6200MD, The Netherlands.
| | - Jörg Spieldenner
- Nestlé Research Center, Vers-chez-les Blanc, Lausanne 26 1000, Switzerland.
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
| | - Peter Weber
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
| | - Manfred Eggersdorfer
- DSM Nutritional Products Ltd., Wurmisweg 576, Kaiseraugst 4303, Switzerland.
- Department of Pediatrics, Beatrix Children's Hospital/University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen 9700 RB, The Netherlands.
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Hopman J, Bos R, Voss A, Kolwijck E, Sturm P, Pickkers P, Tostmann A, Hoeven HVD. Reduced rate of MDROs after introducing ‘water-free patient care’ on a large intensive care unit in the Netherlands. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474688 DOI: 10.1186/2047-2994-4-s1-o40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Manders S, van de Laar M, Rongen-van Dartel S, Bos R, Visser H, Brus H, Jansen T, Vonkeman H, van Riel P, Kievit W. FRI0345 Tapering MTX in Patients with RA Using TNFI Treatment is Possible: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arends S, Brouwer E, Wink F, Bos R, Maas F, Bootsma H, van der Veer E, Spoorenberg A. THU0239 Drug Survival and Clinical Efficacy of 7 Years Etanercept Treatment in Patients with Ankylosing Spondylitis: Results from the Glas Cohort: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manios Y, Moschonis G, Grammatikaki E, Mavrogianni C, van den Heuvel EGHM, Bos R, Singh-Povel C. Food group and micronutrient intake adequacy among children, adults and elderly women in Greece. Nutrients 2015; 7:1841-58. [PMID: 25768954 PMCID: PMC4377885 DOI: 10.3390/nu7031841] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/31/2014] [Accepted: 02/26/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to record the percentage of children, adults and elderly women in Greece meeting food and micronutrient intake recommendations. Additionally, the present study was aiming to identify the main food contributors of micronutrient intakes and assess the degree up to which meeting food intake recommendations also ensures micronutrient intake adequacy. Dietary intake data from three studies conducted in Greece (on 9-13-year-old children; 40-60-year-old adults; and 50-75-year-old women) were used to estimate mean intakes, the percentages of subjects meeting food and nutrient intake recommendations and the contribution of six core food groups to nutrient intake adequacy. The present study showed that more than 50% of children, adults and elderly women were failing to consume the recommended portions of vegetables, dairy and grains. Furthermore, children and adults consuming the recommended portions of individual core food groups had significantly lower percentages of inadequate micronutrient intakes compared to their counterparts not meeting food intake recommendations (p < 0.05). Nevertheless, even among those consuming the recommended portions from a specific core food group, the recommended intake of the corresponding micronutrient (for which this food group is the main contributor) was not always met. Indicatively, 18.2%-44.1% and 4.2%-7.0% of the populations under study were not meeting calcium and vitamin C intake recommendations, although they were consuming the recommended portions of dairy and fruits, respectively. In conclusion, these findings highlight the importance for public health policy makers to take all necessary initiatives to support the population in achieving the recommended intakes from all core food groups, but also emphasize on food variety to ensure adequate intake for all micronutrients.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea 17671, Athens, Greece; E-Mails: (G.M.); (E.G.); (C.M.)
| | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea 17671, Athens, Greece; E-Mails: (G.M.); (E.G.); (C.M.)
- EnviNHealth S.A., Vasilissis Sofias 22, Marousi 151 24, Athens, Greece
| | - Evangelia Grammatikaki
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea 17671, Athens, Greece; E-Mails: (G.M.); (E.G.); (C.M.)
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea 17671, Athens, Greece; E-Mails: (G.M.); (E.G.); (C.M.)
| | - Ellen GHM van den Heuvel
- FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, the Netherlands; E-Mails: (E.H.); (R.B.); (C.S.-P.)
| | - Rolf Bos
- FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, the Netherlands; E-Mails: (E.H.); (R.B.); (C.S.-P.)
| | - Cecile Singh-Povel
- FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, the Netherlands; E-Mails: (E.H.); (R.B.); (C.S.-P.)
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Manios Y, Moschonis G, Mavrogianni C, Bos R, Singh-Povel C. Micronutrient intakes among children and adults in Greece: the role of age, sex and socio-economic status. Nutrients 2014; 6:4073-92. [PMID: 25285410 PMCID: PMC4210908 DOI: 10.3390/nu6104073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/07/2014] [Accepted: 09/03/2014] [Indexed: 01/03/2023] Open
Abstract
The aim of the present study was to report the usual nutrient intakes of sixteen micronutrients by schoolchildren, adults and the elderly in Greece and to further explore the role of age, sex and socio-economic status (SES) on meeting the recommended nutrient intakes. Dietary intake, demographic and SES data from three existing studies conducted in Greece (in 9–13-year-old children; 40–60-year-old adults; and 50–75-year-old women) were collected. The prevalence of study participants with inadequate micronutrient intakes were assessed using the estimated average requirement (EAR) cut-point method. Regarding sex and age differences, the highest prevalences of inadequate nutrient intakes occurred in post-menopausal women. In both sexes and all age groups, the prevalence of vitamin D intake below EAR reached 100%. Furthermore, nutrient intakes of 75% or more below EAR were found for vitamin E in all age groups, folate in women and for calcium and magnesium in post-menopausal women (p < 0.05). Regarding SES differences, the prevalences of inadequate calcium and vitamin C intakes were higher for children and postmenopausal women of lower SES compared to their higher SES counterparts (p < 0.05). The current study reported the highest prevalences of inadequate intakes for both sexes and all age and SES groups for calcium, folate and vitamins D and E. These findings could provide guidance to public health policy makers in terms of updating current dietary guidelines and fortifying foods to meet the needs of all population subgroups.
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Affiliation(s)
- Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Rolf Bos
- FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, The Netherlands.
| | - Cécile Singh-Povel
- FrieslandCampina, Stationsplein 4, Post Box 1551, Amersfoort 3800 BN, The Netherlands.
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Maas F, Spoorenberg A, Brouwer E, Bos R, Efde M, Chaudhry R, Veeger N, Bootsma H, van der Veer E, Arends S. SAT0343 Spinal Radiographic Progression during 6 Years of Tnf-Alpha Blocking Therapy in Patients with Ankylosing Spondylitis: Results from the GLAS Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Carbo M, Arends S, Brouwer E, Bos R, Efde M, Leijsma M, Bootsma H, van der Veer E, Spoorenberg A. SAT0354 Nsaid Use in Patients with Ankylosing Spondylitis Treated with and without Tnf-Alpha Blocking Therapy during 2-Year Follow-Up in Daily Clinical Practice. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maas F, van der Veer E, Brouwer E, Bos R, Efde M, Chaudhry R, Bootsma H, Spoorenberg A, Arends S. FRI0116 Prevalence of Vertebral Fractures and the Relation to Clinical and Radiological Outcome in Ankylosing Spondylitis Patients with Active Disease. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arends S, Maas F, van der Veer E, Bos R, Efde M, Leijsma M, Bootsma H, Brouwer E, Spoorenberg A. FRI0142 Patient-Reported Disease Activity and Outcome in Male versus Female Patients of the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) Cohort: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maas F, Spoorenberg A, van der Veer E, Bos R, Efde M, Leijsma M, Bootsma H, Brouwer E, Arends S. THU0077 Prevalence of Obesity and the Relation to Disease Activity, Physical Function, and Quality of Life in Patients with Axial Spondyloarthritis: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
An adequate use of coping strategies could help patients to deal with disease-related stress. The study aim was to explore coping behaviour in adult patients with severe haemophilia and its possible determinants. Coping was assessed through three basic dimensions (task-oriented, emotion-oriented and avoidance coping), using the short version of the Coping Inventory for Stressful Situations (CISS-21). Patients' scores were compared with Dutch working men (N = 374), according to three categories: low use (<P25 of normal), average use (P25-P75) and high use (>P75). Determinants were measured using questionnaires on activities (Haemophilia Activities List), participation (Impact on Participation and Autonomy Questionnaire), physical functioning [physical component of the Dutch Arthritis Impact Measurement Scales-2 (D-AIMS2)] and socio-psychological health (psychological component of the D-AIMS2). In total, 86 adults with severe haemophilia (FVIII/IX<1%) were included. The median age was 38 years (range: 18-68) with 85% affected with haemophilia A and 75% using prophylaxis. Patients with haemophilia used task-oriented coping as frequently as the control group (P = 0.13); but used significantly less emotion-oriented coping (57% vs. 25%, P < 0.05) and avoidance coping (P < 0.05). Emotion-oriented coping showed a strong correlation with socio-psychological health (r = 0.67) and weak correlations with participation (r = 0.32) and social interaction (r = 0.29). Other associations of coping strategies with patient characteristics of health status could not be demonstrated. Overall, patients predominantly used the task-oriented approach to deal with their disease; the use of this strategy was comparable to the control group. Having a poor psychological health, less social interaction and/or less participation in daily life was associated with an increased use of emotion-oriented coping.
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Affiliation(s)
- M Binnema
- Van Creveldkliniek, Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
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Manders S, Kievit W, Jansen T, Stolk J, Visser H, Bos R, van de Laar M, van Riel P. OP0069 Significantly Better Results for TNFI Combination Therapy with MTX Than TNFI Mono- and Combination Without MTX Therapy in Patients with RA: Results from the Dream Registry. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vaessen SFC, Verkoeijen S, Vandebriel RJ, Bruysters MWP, Pennings JLA, Bos R, Krul CAM, Akkermans AM. Identification of biomarkers to detect residual pertussis toxin using microarray analysis of dendritic cells. Vaccine 2013; 31:5223-31. [PMID: 24055089 DOI: 10.1016/j.vaccine.2013.08.082] [Citation(s) in RCA: 6] [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: 04/27/2013] [Revised: 08/18/2013] [Accepted: 08/27/2013] [Indexed: 12/01/2022]
Abstract
In this study we aimed to identify genes that are responsive to pertussis toxin (PTx) and might eventually be used as biological markers in a testing strategy to detect residual PTx in vaccines. By microarray analysis we screened six human cell types (bronchial epithelial cell line BEAS-2B, fetal lung fibroblast cell line MRC-5, primary cardiac microvascular endothelial cells, primary pulmonary artery smooth muscle cells, hybrid cell line EA.Hy926 of umbilical vein endothelial cells and epithelial cell line A549 and immature monocyte-derived dendritic cells) for differential gene expression induced by PTx. Immature monocyte-derived dendritic cells (iMoDCs) were the only cells in which PTx induced significant differential expression of genes. Results were confirmed using different donors and further extended by showing specificity for PTx in comparison to Escherichia coli lipopolysaccharide (LPS) and Bordetella pertussis lipo-oligosaccharide (LOS). Statistical analysis indicated 6 genes, namely IFNG, IL2, XCL1, CD69, CSF2 and CXCL10, as significantly upregulated by PTx which was also demonstrated at the protein level for genes encoding secreted proteins. IL-2 and IFN-γ gave the strongest response. The minimal PTx concentrations that induced production of IL-2 and IFN-γ in iMoDCs were 12.5 and 25IU/ml, respectively. High concentrations of LPS slightly induced IFN-γ but not IL-2, while LOS and detoxified pertussis toxin did not induce production of either cytokine. In conclusion, using microarray analysis we evaluated six human cell lines/types for their responsiveness to PTx and found 6 PTx-responsive genes in iMoDCs of which IL2 is the most promising candidate to be used as a biomarker for the detection of residual PTx.
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Affiliation(s)
- S F C Vaessen
- Centre for Technology and Innovation, Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences, Utrecht, The Netherlands.
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Bos R, Tinga F. Success rate of custom made PMMA implants for cranial reconstruction: a follow up study and comparison with the literature. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Leeuwen A, Slater JH, de Jong J, Grijpma D, Bos R. Guided bone regeneration in rat mandibular defects using resorbable poly(trimethylene carbonate) barrier membranes. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Leeuwen A, Ong H, Vissink A, Grijpma D, Bos R. Reconstruction of orbital wall defects: recommendations based on a mathematical model. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Broekema F, van Minnen B, Jansma J, Bos R. Risk of rebleeding after dentoalveolar surgery in patients on anticoagulant therapy compared to patients without anticoagulant therapy. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Bakelen N, Buijs J, Jansma J, Stegenga B, Bos R. Biodegradable versus titanium osteosynthesis in maxillofacial surgery: results of a multicenter randomized controlled trial. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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