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Christensen R, Zobbe K, Nielsen SM, Stamp LK, Henriksen M, Overgaard AF, Dreyer L, Knop FK, Singh JA, Doherty M, Richette P, Astrup A, Ellegaard K, Bartels EM, Boesen M, Gudbergsen H, Bliddal H, Kristensen LE. Weight Loss for Patients With Gout and Concomitant Obesity: A Proof-of-Concept Randomized Trial. Arthritis Rheumatol 2024; 76:806-812. [PMID: 38169151 DOI: 10.1002/art.42790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Despite scarce evidence, guidelines recommend weight loss as a management strategy for patients with gout. We investigated the effect of an intensive dietary intervention on body weight and clinical measures of gout severity in individuals with obesity and gout. METHODS We conducted a 16-week randomized nonmasked parallel-group trial in Denmark, randomly assigning (one-to-one) individuals with obesity and gout to a low-energy diet or a control diet. The primary outcome was change in body weight. Key secondary outcomes were changes in serum urate (SU) level and visual analog scale-assessed pain and fatigue. RESULTS Between December 1, 2018, and June 1, 2019, 61 participants were included in the intention-to-treat population and randomly assigned to the intensive diet group (n = 29) or control diet group (n = 32). Participants had a mean age of 60.3 (SD 9.9) years and mean body mass index of 35.6 (SD 5.0), and 59 (97%) were men. After 16 weeks, there was a significant difference in change in body weight between the diet and control groups (-15.4 vs -7.7 kg; difference -7.7 kg [95% confidence interval -10.7 to -4.7], P < 0.001). Despite results being potentially in favor of a low-energy diet, we could not confirm differences in SU level changes and fatigue between groups. No differences in pain and gout flares were observed between groups. No serious adverse events or deaths occurred during the trial. CONCLUSION An intensive dietary intervention was safe and effectively lowered body weight in people with obesity and gout, but the weight loss did not directly translate into effects on SU level, fatigue, and pain.
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Affiliation(s)
- Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark, and University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Kristian Zobbe
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark, and University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders F Overgaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Aalborg University Hospital, Aalborg, Denmark, and University of Aalborg, Aalborg, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, Steno Diabetes Center Copenhagen, and Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, School of Medicine, University of Alabama at Birmingham (UAB), and UAB School of Public Health, Birmingham, Alabama
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière APHP Paris Nord and Université de Paris, INSERM, UMR-S 1132, Paris, France
| | | | - Karen Ellegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Else M Bartels
- The Parker Institute, and Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Boesen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Sofíudóttir BK, Harders S, Laursen CB, Lage-Hansen PR, Nielsen SM, Just SA, Christensen R, Davidsen JR, Ellingsen T. Detection of Interstitial Lung Disease in Rheumatoid Arthritis by Thoracic Ultrasound. A Diagnostic Test Accuracy study. Arthritis Care Res (Hoboken) 2024. [PMID: 38622106 DOI: 10.1002/acr.25351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The Objective was to determine the diagnostic accuracy of thoracic ultrasound (TUS) for detecting (ILD) in rheumatoid arthritis (RA) with respiratory symptoms. METHODS Individuals with RA visiting Rheumatological outpatient clinics in the Region of Southern Denmark were systematically screened for dyspnoea, cough, recurrent pneumonia, prior severe pneumonia or a chest X-ray indicating interstitial abnormalities. Eighty participants with a positive screening were consecutively included. Individuals were not eligible if they had a chest high-resolution CT (HRCT) <12 months or were already diagnosed with ILD. A blinded TUS expert evaluated TUS, and TUS was registered as positive for ILD if ≥10 B-lines or bilateral thickened and fragmented pleura were present. The primary outcomes were TUS's sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV). An ILD-specialised thoracic radiologist assessed HRCT, followed by a multi-disciplinary team discussion, which was the reference standard. The accepted window of HRCT was <30 days after TUS was performed. RESULTS 77 participants received HRCT <30 days after TUS, and 23 (30%) were diagnosed with ILD. TUS had a sensitivity of 82.6% (95% CI: 61.2% to 95.0%) and a specificity of 51.9% (95% CI: 37.8% to 65.7%), corresponding to a PPV of 42.2% (95%CI 27.7% to 57.8%) and an NPV of 87.5% (95% CI 71.0% to 96.5%). CONCLUSION To our knowledge, this prospective study is the first to use respiratory symptoms in RA as inclusion criteria. Systematic screening for respiratory symptoms combined with TUS can reduce the diagnostic delay of ILD in RA.
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Affiliation(s)
- Bjørk K Sofíudóttir
- PUlmo-RhEuma Frontline Center (PURE), Department of Rheumatology Odense University Hospital, Odense, Denmark
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Rheumatology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stefan Harders
- Department of Radiology, Aarhus University Hospital, Denmark
- Department of Radiology, Odense University Hospital, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Philip R Lage-Hansen
- Department of Rheumatology, Esbjerg Hospital
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Søren A Just
- Section of Rheumatology, Department of Medicine, Odense University Hospital - Svendborg Hospital, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Jesper R Davidsen
- Department of Rheumatology, Esbjerg Hospital
- PUlmo-RhEuma Frontline Center (PURE) Department of Respiratory Medicine, Odense University Hospital, Denmark
| | - Torkell Ellingsen
- PUlmo-RhEuma Frontline Center (PURE), Department of Rheumatology Odense University Hospital, Odense, Denmark
- Rheumatology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Berthelsen DB, Nielsen SM, Rasmussen MU, Voshaar M, Richards P, Bartlett SJ, Hazlewood GS, Shea BJ, Tugwell P, Ellingsen T, Jørgensen TS, Kristensen S, Simon LS, Christensen R, Flurey CA. "I couldn't carry on taking a drug like that": A qualitative study of patient perspectives on side effects from rheumatology drugs. Rheumatology (Oxford) 2024:keae223. [PMID: 38613847 DOI: 10.1093/rheumatology/keae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/25/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES There is growing interest in collecting outcome information directly from patients in clinical trials. This study evaluates what patients with rheumatic and musculoskeletal diseases (RMDs) consider important to know about symptomatic side effects they may experience from a new prescription drug. METHODS Patients with inflammatory arthritis, who had one or more prescribed drugs for their disease for at least 12 months, participated in focus groups and individual interviews. Discussions were analysed using reflexive thematic analysis. RESULTS We conducted seven focus groups with 34 participants across three continents. We found four overarching and two underpinning themes. The 'impact on life' was connected to participants 'daily life', 'family life', 'work life', and 'social life'. In 'psychological and physical aspects' participants described 'limitation to physical function', 'emotional dysregulation' and 'an overall mental state'. Extra tests, hospital visits and payment for medication were considered a 'time, energy and financial burden' of side effects. Participants explained important measurement issues to be 'severity', 'frequency', and 'duration'. Underpinning these issues, participants evaluated the 'benefit-harm-balance' which includes 'the cumulative burden' of having several side effects and the persistence of side effects over time. CONCLUSIONS In treatment for RMDs, there seems to be an urgent need for feasible measures of patient-reported bother (impact on life and cumulative burden) from side effects and the benefit-harm-balance. These findings contribute new evidence in support of a target domain-an outcome that represents the patient voice evaluating the symptomatic treatment-related side effects for people with RMDs enrolled in clinical trials.
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Affiliation(s)
- Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Marianne U Rasmussen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, Department of Pharmacy, Radboud UMC, Nijmegen, The Netherlands
| | - Pamela Richards
- Department of Rheumatology, University of Bristol, Bristol, United Kingdom
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute, McGill University Health Centre, Montreal, Canada
- Arthritis Research, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Arthritis Research Canada
| | - Beverly J Shea
- School of Epidemiology and Public Health, University of Ottawa, Ottawa ON, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Tanja S Jørgensen
- Value-Based Outcomes Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, and Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | | | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), Department of Clinical Research, University of Southern Denmark, Denmark
| | - Caroline A Flurey
- School of Social Sciences, University of the West of England, Bristol, United Kingdom
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Funchain P, Ni Y, Heald B, Bungo B, Arbesman M, Behera TR, McCormick S, Song JM, Kennedy LB, Nielsen SM, Esplin ED, Nizialek E, Ko J, Diaz-Montero CM, Gastman B, Stratigos AJ, Artomov M, Tsao H, Arbesman J. Germline Cancer Susceptibility in Individuals with Melanoma. J Am Acad Dermatol 2024:S0190-9622(24)00504-8. [PMID: 38513832 DOI: 10.1016/j.jaad.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/05/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Prior studies have estimated a small number of individuals with melanoma (2-2.5%) have germline cancer predisposition, yet a recent twin study suggested melanoma has the highest hereditability among cancers. OBJECTIVE To determine the incidence of hereditary melanoma and characterize the spectrum of cancer predisposition genes that may increase the risk of melanoma. METHODS 400 individuals with melanoma and personal or family history of cancers underwent germline testing of >80 cancer predisposition genes. Comparative analysis of germline data was performed on 3 additional oncologic and dermatologic datasets. RESULTS Germline pathogenic/likely pathogenic (P/LP) variants were identified in 15.3% (61) individuals with melanoma. Most variants (41, 67%) involved genes considered unrelated to melanoma (BLM, BRIP1, CHEK2, MLH1, MSH2, PMS2, RAD51C). A third (20, 33%) were in genes previously associated with familial melanoma (BAP1, BRCA2, CDKN2A, MITF, TP53). Nearly half (30, 46.9%) of P/LP variants were in HRD genes. Validation cohorts demonstrated P/LP rates of 10.6% from an unselected oncologic cohort, 15.8% from a selected commercial testing cohort and 14.5% from a highly selected dermatologic study. LIMITATIONS Cohorts with varying degrees of selection, some retrospective. CONCLUSION Germline predisposition in individuals with melanoma is common, with clinically actionable findings diagnosed in 10.6% to 15.8%.
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Affiliation(s)
- P Funchain
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Y Ni
- Center for Immunotherapy & Precision Immuno-Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B Heald
- Genomic Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Invitae Corporation, South San Francisco, CA, USA
| | - B Bungo
- Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M Arbesman
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - T R Behera
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Center for Immunotherapy & Precision Immuno-Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S McCormick
- Center Cancer Risk Assessment, Massachusetts General Hospital, Cambridge, MA, USA
| | - J M Song
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Hematology/Oncology, MetroHealth, Cleveland, USA
| | - L B Kennedy
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S M Nielsen
- Invitae Corporation, South San Francisco, CA, USA
| | - E D Esplin
- Invitae Corporation, South San Francisco, CA, USA
| | - E Nizialek
- Department of Medical Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - J Ko
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C M Diaz-Montero
- Center for Immunotherapy & Precision Immuno-Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B Gastman
- Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A J Stratigos
- A. Sygros Hospital Medical School, University of Athens, Athens, Greece
| | | | - H Tsao
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA
| | - J Arbesman
- Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Pickles T, Cowern M, Christensen R, Nielsen SM, Simon LS, Jones CMP, Maxwell LJ, Shea B, Strand V, Touma Z, Toupin-April K, Mease P, Choy E. Exploring the complexities of pain phenotypes: OMERACT 2023 chronic pain working group workshop. Semin Arthritis Rheum 2024; 64:152342. [PMID: 38128175 DOI: 10.1016/j.semarthrit.2023.152342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To educate and discuss pain mechanisms (nociceptive, neuropathic, nociplastic) illuminating its possible impact when measuring different outcomes, which may modify, confound and potentially bias the outcome measures applied across various aspects of Rheumatic Musculoskeletal Diseases (RMDs) clinical trials. METHODS In the plenary presentations, PM lectured on different pain mechanisms and impact on disease activity assessment. Data from two data sets of RMDs patients, which assessed the prevalence and impact of nociplastic pain were presented and reviewed. Audience breakout group sessions and polling were conducted. RESULTS Mixed pain etiologies may differentially influence disease activity assessment and therapeutic decision-making. Polling demonstrated a consensus on the need to assess different types of pain as a phenotype, as it constitutes an important contextual factor (a variable that is not an outcome of the trial, but needs to be recognized [and measured] to understand the study results), and to standardize across RMDs. CONCLUSION There is need for a standardized pain measure that can differentiate underlying pain mechanisms.
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Affiliation(s)
- Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | | | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Copenhagen, Denmark
| | | | - Caitlin M P Jones
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Zahi Touma
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Rheumatology, Toronto Lupus Program, University of Toronto, Toronto, Ontario, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Philip Mease
- Seattle Rheumatology Associates and Division of Rheumatology Research, Swedish Medical Center, Seattle, WA, USA
| | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Palmowski A, Pankow A, Terziyska K, Nielsen SM, Christensen R, Bliddal H, Boyadzhieva Z, Buttgereit F. Continuing versus tapering low-dose glucocorticoids in patients with rheumatoid arthritis and systemic lupus erythematosus in states of low disease activity or remission: A systematic review and meta-analysis of randomised trials. Semin Arthritis Rheum 2024; 64:152349. [PMID: 38100900 DOI: 10.1016/j.semarthrit.2023.152349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES To study the benefit and harm associated with continuing versus tapering low-dose glucocorticoids (GCs) in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who have achieved low disease activity/remission. METHODS A protocolised (PROSPEROCRD42022325175) systematic review and meta-analysis of randomised trials was performed. Trials compared, in patients with low disease activity/remission and GCs at baseline, continued low-dose GCs (≤7.5 mg/d prednisone equivalent) with a taper. Co-primary outcomes were time to flare and adverse events (AEs), accompanied by secondary benefit and harm outcomes. We performed meta-analyses and evaluated risk of bias and quality of evidence (QoE). Subgroup analyses were conducted for patients with RA. RESULTS Four trials (three: RA; one: SLE; study duration 24-104 weeks) with 472 participants were included. Tapering GCs resulted in a shorter time to flare (hazard ratio 3.41 [95 %-CI 1.96-5.93]; p<0.01; very low QoE). The risks of AEs, serious AEs, and withdrawal due to AEs were similar in both groups (very low to low QoE). There were more withdrawals due to lack of efficacy with tapered GCs (risk ratio 3.02 [1.56-5.87]; low QoE). In RA, the disease activity score-28 was lower with continued GCs (mean difference 0.49 [0.07-0.91]; low QoE). One of 238 patients in the tapering groups experienced adrenal insufficiency. Subgroup analyses yielded consistent results. CONCLUSION In RA and SLE with low disease activity, continuing low-dose GCs may provide better sustained disease control, but QoE is insufficient. Adrenal insufficiency is very rare when tapering low-dose GCs. Longer-term safety concerns for GCs remain.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany; Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Anne Pankow
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Kalina Terziyska
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Henning Bliddal
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
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Stisen ZR, Nielsen SM, Ditlev SB, Skougaard M, Egeberg A, Mogensen M, Jørgensen TS, Dreyer L, Christensen R, Kristensen LE. Treatment-related changes in serum neutrophil gelatinase-associated lipocalin (NGAL) in psoriatic arthritis: results from the PIPA cohort study. Scand J Rheumatol 2024; 53:21-28. [PMID: 37339383 DOI: 10.1080/03009742.2023.2216046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Obesity and psoriatic arthritis (PsA) have a complicated relationship. While weight alone does not cause PsA, it is suspected to cause worse symptoms. Neutrophil gelatinase-associated lipocalin (NGAL) is secreted through various cell types. Our objective was to assess the changes and trajectories in serum NGAL and clinical outcomes in patients with PsA during 12 months of anti-inflammatory treatment. METHOD This exploratory prospective cohort study enrolled PsA patients initiating conventional synthetic or biological disease-modifying anti-rheumatic drugs (csDMARDs/bDMARDs). Clinical, biomarker, and patient-reported outcome measures were retrieved at baseline, and 4 and 12 months. Control groups at baseline were psoriasis (PsO) patients and apparently healthy controls. The serum NGAL concentration was quantified by a high-performance singleplex immunoassay. RESULTS In total, 117 PsA patients started a csDMARD or bDMARD, and were compared indirectly at baseline with a cross-sectional sample of 20 PsO patients and 20 healthy controls. The trajectory in NGAL related to anti-inflammatory treatment for all included PsA patients showed an overall change of -11% from baseline to 12 months. Trajectories in NGAL for patients with PsA, divided into treatment groups, showed no clear trend in clinically significant decrease or increase following anti-inflammatory treatment. NGAL concentrations in the PsA group at baseline corresponded to the levels in the control groups. No correlation was found between changes in NGAL and changes in PsA outcomes. CONCLUSION Based on these results, serum NGAL does not add any value as a biomarker in patients with peripheral PsA, either for disease activity or for monitoring.
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Affiliation(s)
- Z R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - S B Ditlev
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - M Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - A Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - R Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - L E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Berthelsen DB, Simon LS, Ioannidis JPA, Voshaar M, Richards P, Goel N, Strand V, Nielsen SM, Shea BJ, Tugwell P, Bartlett SJ, Hazlewood GS, March L, Singh JA, Suarez-Almazor ME, Boers M, Stevens RM, Furst DE, Woodworth T, Leong A, Brooks PM, Flurey C, Christensen R. Stakeholder endorsement advancing the implementation of a patient-reported domain for harms in rheumatology clinical trials: Outcome of the OMERACT Safety Working Group. Semin Arthritis Rheum 2023; 63:152288. [PMID: 37918049 DOI: 10.1016/j.semarthrit.2023.152288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To develop an understanding of the concept of safety/harms experienced by patients involved in clinical trials for their rheumatic and musculoskeletal diseases (RMDs) and to seek input from the OMERACT community before moving forward to developing or selecting an outcome measurement instrument. METHODS OMERACT 2023 presented and discussed interview results from 34 patients indicating that up to 171 items might be important for patients' harm-reporting. RESULTS Domain was defined in detail and supported by qualitative work. Participants in the Special-Interest-Group endorsed (96 %) that enough qualitative data are available to start Delphi survey(s). CONCLUSION We present a definition of safety/harms that represents the patient voice (i.e., patients' perception of safety) evaluating the symptomatic treatment-related adverse events for people with RMDs enrolled in clinical trials.
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Affiliation(s)
- Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | | | - John P A Ioannidis
- Departments of Medicine, Epidemiology and Population Health, Biomedical Data Science, and Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, California, USA
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, Department of Pharmacy, RadboudUMC, Nijmegen, the Netherlands
| | - Pam Richards
- Department of Rheumatology, University of Bristol, Bristol, United Kingdom
| | - Niti Goel
- Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto CA, USA
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Beverly J Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program and School of Epidemiology and Public Health, University of Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, School of Epidemiology, Public Health and Community Medicine, University of Ottawa, Canada
| | | | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Arthritis Research Canada
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Kolling Institue and The University of Sydney, Sydney, Australia
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA; Department of Medicine and the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Epidemiology and the UAB School of Public Health, Birmingham, AL, USA
| | - Maria E Suarez-Almazor
- Department of Health Services Research and Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Daniel E Furst
- David Geffen School of Med. Department of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Thasia Woodworth
- David Geffen School of Med. Department of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Amye Leong
- Healthy Motivation, Santa Barbara, California USA
| | - Peter M Brooks
- Centre for Health Policy Melbourne School of Population and Global Health University of Melbourne, Australia
| | - Caroline Flurey
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark.
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Duhn PH, Wæhrens EE, Pedersen MB, Nielsen SM, Locht H, Bliddal H, Christensen R, Amris K. Effectiveness of patient education as a stand-alone intervention for patients with chronic widespread pain and fibromyalgia: a systematic review and meta-analysis of randomized trials. Scand J Rheumatol 2023; 52:654-663. [PMID: 37162478 DOI: 10.1080/03009742.2023.2192450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Patient education is recommended as an integral component of the therapeutic plan for the management of chronic widespread pain (CWP) and fibromyalgia (FM). The key purpose of patient education is to increase the patient's competence to manage his or her own health requirements, encouraging self-management and a return to desired everyday activities and lifestyle. The aim of this systematic review was to evaluate the evidence for the benefits and potential harms associated with the use of patient education as a stand-alone intervention for individuals with CWP and FM through randomized controlled trials (RCTs). METHOD On 24 November 2021 a systematic search of PubMed, MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, ClinicalTrials.gov, American College of Rheumatology, European League Against Rheumatism, and the World Health Organization International Clinical Trials Registry Platform identified 2069 studies. After full-text screening, five RCT studies were found to be eligible for the qualitative evidence synthesis. RESULTS Patient education as a stand-alone intervention presented an improvement in patients' global assessment (standardized mean difference 0.79, 95% confidence interval 0.13 to 1.46). When comparing patient education with usual care, no intervention, or waiting list, no differences were found for functioning, level of pain, emotional distress in regard to anxiety and depression, or pain cognition. CONCLUSION This review reveals the need for RCTs investigating patient education as a stand-alone intervention for patients with FM, measuring outcomes such as disease acceptance, health-related quality of life, enhancement of patients' knowledge of pain, pain coping skills, and evaluation of prioritized learning outcomes.
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Affiliation(s)
- P H Duhn
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science and Occupational Therapy, User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M B Pedersen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Orthopaedic Research Unit at Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - H Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
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10
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Stisen ZR, Nielsen SM, Skougaard M, Mogensen M, Jørgensen TS, Dreyer L, de Wit M, Christensen R, Kristensen LE. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford) 2023:kead488. [PMID: 37713434 DOI: 10.1093/rheumatology/kead488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES To compare tolerability and effectiveness of two different classes of biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs; interleukin (IL)-17- and IL-23(p19) inhibitors) relative to tumour necrosis factor inhibitors (TNFi) regarding the drug survival rates and treatment outcomes in patients with psoriatic arthritis (PsA). METHODS We emulated a target trial on comparative effectiveness using observational data from a prospective cohort study based on the Parker Institute's PsA cohort - the PIPA cohort. All patients underwent interview and clinical examination programme at baseline and at follow-up visits at four and twelve months. The primary endpoint, drug survival, was assessed up to 12 months from baseline. We estimated hazard ratios from proportional hazards model and used propensity score adjustment in an attempt to deconfound and emulate a random treatment assignment. RESULTS We included a total of 109 patients in the intention-to-monitor population at baseline initiating either TNFi (75 patients), IL17i (26 patients), or IL23(19)i (8 patients). Hazard ratios in the propensity adjusted model comparing IL-17i and IL-23(p19)i to TNFi were 1.36 (95% CI 0.59-3.14) and 0.56 (95% CI 0.10-3.24), respectively. TNFi and IL-17i had comparable effects regarding response rates and changes in clinical outcomes after 12 months, whereas IL-23(p19)i tended to perform better overall. CONCLUSION No decisive differences between drugs were observed at group level regarding drug survival and clinical outcomes after 12 months. TNFi, IL-17i, and IL-23(p19)i may all be considered equally effective in the treatment of patients with PsA, advocating for investigating more in personalised treatment strategies.
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Affiliation(s)
- Zara R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Marie Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Maarten de Wit
- Stichting Tools patient research partner, Amsterdam, The Netherlands
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Palmowski A, Nielsen SM, Boyadzhieva Z, Hartman L, Oldenkott J, Svensson B, Hafström I, Wassenberg S, Choy E, Kirwan J, Christensen R, Boers M, Buttgereit F. The Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis: Individual Patient Data From Five Randomized Trials. Ann Intern Med 2023; 176:1181-1189. [PMID: 37579312 DOI: 10.7326/m23-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Weight gain and hypertension are well known adverse effects of treatment with high-dose glucocorticoids. OBJECTIVE To evaluate the effects of 2 years of low-dose glucocorticoid treatment in rheumatoid arthritis (RA). DESIGN Pooled analysis of 5 randomized controlled trials with 2-year interventions allowing concomitant treatment with disease-modifying antirheumatic drugs. SETTING 12 countries in Europe. PATIENTS Early and established RA. INTERVENTION Glucocorticoids at 7.5 mg or less prednisone equivalent per day. MEASUREMENTS Coprimary end points were differences in change from baseline in body weight and mean arterial pressure after 2 years in intention-to-treat analyses. Difference in the change of number of antihypertensive drugs after 2 years was a secondary end point. Subgroup and sensitivity analyses were done to assess the robustness of primary findings. RESULTS A total of 1112 participants were included (mean age, 61.4 years [SD, 14.5]; 68% women). Both groups gained weight in 2 years, but glucocorticoids led, on average, to 1.1 kg (95% CI, 0.4 to 1.8 kg; P < 0.001) more weight gain than the control treatment. Mean arterial pressure increased by about 2 mm Hg in both groups, with a between-group difference of -0.4 mm Hg (CI, -3.0 to 2.2 mm Hg; P = 0.187). These results were consistent in sensitivity and subgroup analyses. Most patients did not change the number of antihypertensive drugs, and there was no evidence of differences between groups. LIMITATION Body composition was not assessed, and generalizability to non-European regions may be limited. CONCLUSION This study provides robust evidence that low-dose glucocorticoids, received over 2 years for the treatment of RA, increase weight by about 1 kg but do not increase blood pressure. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Andriko Palmowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany, Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark (A.P.)
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark (S.M.N.)
| | - Zhivana Boyadzhieva
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
| | - Linda Hartman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (L.H.)
| | - Judith Oldenkott
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
| | - Björn Svensson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden (B.S.)
| | - Ingiäld Hafström
- Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden (I.H.)
| | | | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Cardiff University, Cardiff, United Kingdom (E.C.)
| | - John Kirwan
- University of Bristol, Bristol, United Kingdom (J.K.)
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Research Unit of Rheumatology, Frederiksberg, and Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark (R.C.)
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (M.B.)
| | - Frank Buttgereit
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany (Z.B., J.O., F.B.)
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12
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Palmowski A, Boyadzhieva Z, Nielsen SM, Muche B, Hermann S, Boers M, Bliddal H, Christensen R, Wiebe E, Buttgereit F. Sex and age do not modify the association between glucocorticoids and bone mineral density in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2023; 25:98. [PMID: 37287080 DOI: 10.1186/s13075-023-03083-x] [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: 03/15/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA). METHODS We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the minimum T-score (measured by DXA) of either lumbar spine, total femur, or femoral neck. Current GC dose was the main exposure; cumulative GC dose and cumulative duration of GC use were also assessed. Following a predefined statistical analysis plan, linear regression analyses with adjustment for confounders assessed whether the association of GC use with BMD was modified by sex (men versus women) or age (≥ 65 versus < 65 years). RESULTS Four hundred eighty-three patients with RA (mean age 64 ± 12 years, 80% women) were included. 33% were not currently taking GCs, 32% were treated with a dose of 5 mg/d prednisone equivalent and 11% with more than 7.5 mg/d. 23% of patients had osteoporosis by DXA (minimum T-score ≤ -2.5). The slope, i.e., the association between changes in minimum T-scores with 1 mg/d change in current GC dose, was similar in men and women (-0.07 and -0.04, respectively; difference -0.03 [-0.11 to 0.04]; p for interaction = 0.41). Slopes were also similar for elderly and non-elderly patients (-0.03 and -0.04, respectively; difference -0.01 [-0.06 to 0.05]; p for interaction = 0.77). Using cumulative dose and duration of use as exposures did not lead to substantial changes of these results. CONCLUSIONS In our sample, the association of GC use with reduced BMD in RA was not modified by sex or age.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Burkhard Muche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Henning Bliddal
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Edgar Wiebe
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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Palmowski A, Nielsen SM, Boyadzhieva Z, Schneider A, Pankow A, Hartman L, Da Silva JAP, Kirwan J, Wassenberg S, Dejaco C, Christensen R, Boers M, Buttgereit F. Safety and efficacy associated with long-term low dose glucocorticoids in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2023:7050928. [PMID: 36810945 DOI: 10.1093/rheumatology/kead088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES To study the safety and efficacy of long-term low dose glucocorticoids (GCs) in rheumatoid arthritis (RA). METHODS A protocolised (PROSPERO [CRD42021252528]) systematic review and meta-analysis of double-blind, placebo-controlled randomised trials (RCTs) comparing a low dose of GCs (≤ 7.5mg/day prednisone) to placebo over at least two years was performed. The primary outcome was adverse events (AEs). We performed random-effects meta-analyses and used the Cochrane RoB tool and GRADE to assess risk of bias and quality of evidence (QoE). RESULTS Six trials with 1,078 participants were included. There was no evidence of an increased risk of AEs (incidence rate ratio 1.08; 95%CI 0.86 to 1.34; p = 0.52), however, QoE was low. The risks of death, serious AEs, withdrawals due to AEs, and AEs of special interest were not different from placebo (very low to moderate QoE). Infections occurred more frequently with GCs (risk ratio 1.4; 1.19 to 1.65; moderate QoE). Concerning benefit, we found moderate to high quality evidence of improvement in disease activity (DAS28: -0.23; -0.43 to -0.03), function (HAQ -0.09; -0.18 to 0.00), and Larsen scores (-4.61; -7.52 to -1.69). In other efficacy outcomes, including Sharp van der Heijde scores, there was no evidence of benefits with GCs. CONCLUSION There is very low to moderate QoE for no harm with long-term low dose GCs in RA, except for an increased risk of infections in GC users. The benefit-risk ratio might be reasonable for using low-dose long-term GCs considering the moderate to high quality evidence for disease-modifying properties.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany.,Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark.,Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Abelina Schneider
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Anne Pankow
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Linda Hartman
- Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - José A P Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal, and Institute for Clinical and Biomedical Research (i.CBR) Faculty of Medicine, University of Coimbra, Portugal
| | | | | | - Christian Dejaco
- Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy, and Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany
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14
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Pedersen MB, Thinggaard P, Geenen R, Rasmussen MU, Wit MD, March L, Mease P, Choy E, Conaghan PG, Simon L, Hansen AF, Tarp S, Schiøttz-Christensen B, Juhl CB, Nielsen SM, Amris K, Christensen R. Biopsychosocial Rehabilitation for Inflammatory Arthritis and Osteoarthritis Patients: A Systematic Review and Meta-Analysis of Randomized Trials. Arthritis Care Res (Hoboken) 2023; 75:423-436. [PMID: 34748288 DOI: 10.1002/acr.24816] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 10/13/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis and osteoarthritis (OA). METHODS We performed a systematic review and meta-analysis. Data were collected through electronic searches of Cochrane CENTRAL, MEDLINE, Embase, PsycInfo, and CINAHL databases up to March 2019. Trials examining the effect of biopsychosocial rehabilitation in adults with inflammatory arthritis and/or OA were considered eligible, excluding rehabilitation adjunct to surgery. The primary outcome for benefit was pain and total withdrawals for harm. RESULTS Of the 27 trials meeting the eligibility criteria, 22 trials (3,750 participants) reported sufficient data to be included in the quantitative synthesis. For patient-reported outcome measures, biopsychosocial rehabilitation was slightly superior to control for pain relief (standardized mean difference [SMD] -0.19 [95% confidence interval (95% CI) -0.31, -0.07]), had a small effect on patient global assessment score (SMD -0.13 [95% CI -0.26, -0.00]), with no apparent effect on health-related quality of life, fatigue, self-reported disability/physical function, mental well-being, and reduction in pain intensity ≥30%. Clinician-measured outcomes displayed a small effect on observed disability/physical function (SMD -0.34 [95% CI -0.57, -0.10]), a large effect on physician global assessment score (SMD -0.72 [95% CI -1.18, -0.26]), and no effect on inflammation. No difference in harms existed in terms of the number of withdrawals, adverse events, or serious adverse events. CONCLUSION Biopsychosocial rehabilitation produces a significant but clinically small beneficial effect on patient-reported pain among patients with inflammatory arthritis and OA, with no difference in harm. Methodologic weaknesses were observed in the included trials, suggesting low-to-moderate confidence in the estimates of effect.
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Affiliation(s)
- Morten B Pedersen
- University of Southern Denmark, Odense, and Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Peter Thinggaard
- Spine Centre of Southern Denmark, Sygehus Lillebaelt Middelfart Sygehus, Middelfart, Denmark
| | | | | | - Maarten De Wit
- Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Lyn March
- University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Philip Mease
- Swedish Medical Center/Providence St Joseph Health and University of Washington, Seattle
| | - Ernest Choy
- Cardiff University School of Medicine, Cardiff, UK
| | - Philip G Conaghan
- University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Simon Tarp
- Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Carsten B Juhl
- University of Southern Denmark, Odense, and Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, and University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Kirstine Amris
- Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, and University of Southern Denmark, Odense University Hospital, Odense, Denmark
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Henriksen M, Nielsen SM, Christensen R, Kristensen LE, Bliddal H, Bartholdy C, Boesen M, Ellegaard K, Hunter DJ, Altman R, Bandak E. Who are likely to benefit from the Good Life with osteoArthritis in Denmark (GLAD) exercise and education program? An effect modifier analysis of a randomised controlled trial. Osteoarthritis Cartilage 2023; 31:106-114. [PMID: 36089229 DOI: 10.1016/j.joca.2022.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify contextual factors that modify the treatment effect of the 'Good Life with osteoArthritis in Denmark' (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA). METHODS Secondary effect modifier analysis of a randomised controlled trial. 206 participants with symptomatic and radiographic knee OA were randomised to either the 8-week GLAD programme (n = 102) or OLP given as 4 intra-articular saline injections over 8 weeks (n = 104). The primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant or intermittent pain. RESULTS Participants who reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 points (95% CI 2.8 to 17.2)). CONCLUSIONS These results imply that patients who take analgesics or report constant knee pain, GLAD seems to yield clinically relevant benefits on knee pain when compared to OLP. The results support a stratified recommendation of GLAD as management of knee OA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843931. EudraCT number 2019-000809-71.
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Affiliation(s)
- M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - S M Nielsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - L E Kristensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - K Ellegaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - R Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
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Lynæs C, Lynæs M, Simon LS, Tugwell P, D'Agostino MA, Strand V, Juhl CB, Nielsen SM, De Witt M, Beaton D, Maxwell LJ, Meara AS, Christensen R. Physicians’ vs patients’ global assessments of disease activity in rheumatology and musculoskeletal trials: A meta-research project with focus on reasons for discrepancies. Semin Arthritis Rheum 2022; 56:152074. [DOI: 10.1016/j.semarthrit.2022.152074] [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: 05/05/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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Kassem N, Althouse SK, Monahan P, Hayes L, Nielsen SM, Heald B, Esplin E, Hatchell KE, Ballinger TJ. Racial Disparities in Family Variant Testing for Cancer Predisposition Genes. Cancer Epidemiol Biomarkers Prev 2022. [PMID: 35775219 DOI: 10.1158/1055-9965.epi-22-0476] [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: 11/16/2022] Open
Abstract
PURPOSE Despite the substantial clinical impact of genetic testing, racial disparities exist in the delivery of this service. Here, we partnered with a commercial laboratory (Invitae) to establish whether there are racial disparities in the uptake of family variant testing (FVT). We also investigated if providing FVT at no cost impacts rates of cascade testing in Black and White families. METHODS This is a retrospective analysis comparing rates of FVT in self-reporting Black probands to self-reporting White probands who underwent germline genetic testing for genes associated with hereditary cancer through Invitae. All Black and White patients found to have a pathogenic/likely pathogenic variant P/LPV) in a hereditary cancer syndrome gene were identified up to one year before and up to one year after FVT became no-charge in 1/2017. The proportion of probands with at least one at- risk family member who underwent FVT was compared between Black and White probands using logistic regression, including the interaction between covariates of cost and race. RESULTS Between 1/2016 and 1/2018, 8,530 Black and 87,846 White probands underwent genetic testing. Of these, 9.3% (n =791) Black probands and 11.4% (n=9,998) White probands had a P/LPV identified. The uptake of FVT, defined by percentage of positive probands with at least one family member undergoing testing, was significantly lower in Black participants compared to White participants (11.9% versus 21.7%, odds ratio 0.5, 95% CI 0.4-0.6, p<0.001). Period of testing before or after FVT was no-charge did not impact this difference (p=0.23 for the interaction). FVT rates were significantly lower in Black patients compared to White patients both before (8.1% versus 18.7%, OR 0.4, 95% CI 0.2-0.6, p<0.001) and after (13.6% versus 23.1%, OR 0.5, 95% CI 0.4-0.7, p<0.001) testing became no-charge. CONCLUSION While FVT rates were low overall, they were significantly lower in Black families compared to White families. Cost of FVT did not have a significant impact on the racial disparity seen, suggesting additional barriers exist. Recognizing these disparities and determining the contributing factors are crucial to developing tailored interventions that would ultimately advance racial equity in cancer care.
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Hafliðadóttir SH, Juhl CB, Nielsen SM, Henriksen M, Harris IA, Bliddal H, Christensen R. Placebo response and effect in randomized clinical trials: meta-research with focus on contextual effects. Trials 2021; 22:493. [PMID: 34311793 PMCID: PMC8314506 DOI: 10.1186/s13063-021-05454-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Contextual effects (i.e., placebo response) refer to all health changes resulting from administering an apparently inactive treatment. In a randomized clinical trial (RCT), the overall treatment effect (i.e., the post-treatment effect in the intervention group) can be regarded as the true effect of the intervention plus the impact of contextual effects. This meta-research was conducted to examine the average proportion of the overall treatment effect attributable to contextual effects in RCTs across clinical conditions and treatments and explore whether it varies with trial contextual factors. METHODS Data was extracted from trials included in the main meta-analysis from the latest update of the Cochrane review on "Placebo interventions for all clinical conditions" (searched from 1966 to March 2008). Only RCTs reported in English having an experimental intervention group, a placebo comparator group, and a no-treatment control group were eligible. RESULTS In total, 186 trials (16,655 patients) were included. On average, 54% (0.54, 95%CI 0.46 to 0.64) of the overall treatment effect was attributable to contextual effects. The contextual effects were higher for trials with blinded outcome assessor and concealed allocation. The contextual effects appeared to increase proportional to the placebo effect, lower mean age, and proportion of females. CONCLUSION Approximately half of the overall treatment effect in RCTs seems attributable to contextual effects rather than to the specific effect of treatments. As the study did not include all important contextual factors (e.g., patient-provider interaction), the true proportion of contextual effects could differ from the study's results. However, contextual effects should be considered when assessing treatment effects in clinical practice. TRIAL REGISTRATION PROSPERO CRD42019130257 . Registered on April 19, 2019.
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Affiliation(s)
- Sigurlaug H Hafliðadóttir
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,SEARCH Research Group, Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- SEARCH Research Group, Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev, Gentofte, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark. .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
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Cai K, Fuller A, Zhang Y, Hensey O, Grossberg D, Christensen R, Shea B, Singh JA, McCarthy GM, Rosenthal AK, Filippou G, Taylor WJ, Diaz-Torne C, Stamp LK, Edwards NL, Pascart T, Becce F, Nielsen SM, Tugwell P, Beaton D, Abhishek A, Tedeschi SK, Dalbeth N. Towards development of core domain sets for short term and long term studies of calcium pyrophosphate crystal deposition (CPPD) disease: A framework paper by the OMERACT CPPD working group. Semin Arthritis Rheum 2021; 51:946-950. [PMID: 34140183 DOI: 10.1016/j.semarthrit.2021.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although calcium pyrophosphate deposition (CPPD) is common, there are no published outcome domains or validated measurement instruments for CPPD studies. In this paper, we describe the framework for development of the Outcome Measures in Rheumatology (OMERACT) CPPD Core Domain Sets. METHODS The OMERACT CPPD working group performed a scoping literature review and qualitative interview study. Generated outcomes were presented at the 2020 OMERACT CPPD virtual Special Interest Group (SIG) meeting with discussion focused on whether different core domain sets should be developed for different calcium pyrophosphate deposition (CPPD) clinical presentations and how the future CPPD Core Domain Set may overlap with already established osteoarthritis (OA) domains. These discussions informed development of a future work plan for development of the OMERACT CPPD Core Domain Sets. FINDINGS Domains identified from a scoping review of 112 studies and a qualitative interview study of 36 people (28 patients with CPPD, 7 health care professionals, one stakeholder) were mapped to core areas of OMERACT Filter 2.1. The majority of SIG participants agreed there was need to develop separate core domain sets for "short term" and "long term" studies of CPPD. Although CPPD + OA is common and core domain sets for OA have been established, participants agreed that existing OA core domain sets should not influence the development of OMERACT core domain sets for CPPD. Prioritization exercises (using Delphi methodology) will consider 40 potential domains for short term studies of CPPD and 47 potential domains for long term studies of CPPD. CONCLUSION Separate OMERACT CPPD Core Domain Sets will be developed for "short term" studies for an individual flare of acute CPP crystal arthritis and for "long term" studies that may include participants with any clinical presentation of CPPD (acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and/or CPPD + OA).
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Affiliation(s)
- Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, New Zealand.
| | - Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom; Nottingham NIHR-BRC, Nottingham, United Kingdom
| | - Yiling Zhang
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, New Zealand
| | - Owen Hensey
- The Central Remedial Clinic, Dublin, Ireland
| | - David Grossberg
- Holy Cross Hospital, Silver Spring, MD, United States; Suburban Hospital, Bethesda, MD, United States
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, United States; Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States; Department of Epidemiology at the UAB School of Public Health, Birmingham, AL, United States
| | | | - Ann K Rosenthal
- Department of Medicine, Medical College of Wisconsin, Milwaukee, United States
| | - Georgios Filippou
- Rheumatology Unit, ASST-Fatebenefratelli L, Sacco University Hospital, University of Milan, Italy
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Cesar Diaz-Torne
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona, Spain
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - N Lawrence Edwards
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Tristan Pascart
- Department of Rheumatology, Hospital Saint-Philbert, Lille Catholic University, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Dorcas Beaton
- Institute for Work and Health, University of Toronto, Toronto, Canada
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom; Nottingham NIHR-BRC, Nottingham, United Kingdom
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, New Zealand
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Christensen R, Bours MJL, Nielsen SM. Effect Modifiers and Statistical Tests for Interaction in Randomized Trials. J Clin Epidemiol 2021; 134:174-177. [PMID: 34016442 DOI: 10.1016/j.jclinepi.2021.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
Statistical analyses of randomized controlled trials (RCTs) yield a causally valid estimate of the overall treatment effect, which is the contrast between the outcomes in two randomized treatment groups commonly accompanied by a confidence interval. In addition, the trial investigators may want to examine whether the observed treatment effect varies across patient subgroups (also called 'heterogeneity of treatment effects'), i.e. whether the treatment effect is modified by the value of a variable assessed at baseline. The statistical approach for this evaluation of potential effect modifiers is a test for statistical interaction to evaluate whether the treatment effect varies across levels of the effect modifier. In this article, we provide a concise and nontechnical explanation of the use of simple statistical tests for interaction to identify effect modifiers in RCTs. We explain how to calculate the test of interaction by hand, applied to a dataset with simulated data on 1,000 imaginary participants for illustration.
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Affiliation(s)
- Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark.
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Jeppesen P, Wolf RT, Nielsen SM, Christensen R, Plessen KJ, Bilenberg N, Thomsen PH, Thastum M, Neumer SP, Puggaard LB, Agner Pedersen MM, Pagsberg AK, Silverman WK, Correll CU. Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:250-260. [PMID: 33355633 PMCID: PMC7758821 DOI: 10.1001/jamapsychiatry.2020.4045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Behavioral therapy and cognitive-behavioral therapy (CBT) programs targeting a single class of problems have not been widely implemented. The population of youths with common mental health problems is markedly undertreated. OBJECTIVE To determine the effectiveness of a new transdiagnostic CBT program (Mind My Mind [MMM]) compared with management as usual (MAU) in youths with emotional and behavioral problems below the threshold for referral to mental health care. DESIGN, SETTING, AND PARTICIPANTS This pragmatic, multisite, randomized clinical trial of MMM vs MAU was conducted from September 7, 2017, to August 28, 2019, including 8 weeks of postintervention follow-up, in 4 municipalities in Denmark. Consecutive help-seeking youths were randomized (1:1) to the MMM or the MAU group. Main inclusion criteria were age 6 to 16 years and anxiety, depressive symptoms, and/or behavioral disturbances as a primary problem. Data were analyzed from August 12 to October 25, 2019. INTERVENTIONS The MMM intervention consisted of 9 to 13 weekly, individually adapted sessions of manualized CBT delivered by local psychologists. The MAU group received 2 care coordination visits to enhance usual care. MAIN OUTCOMES AND MEASURES The primary outcome was change in mental health problems reported by parents at week 18, using the Strengths and Difficulties Questionnaire (SDQ) Impact scale (range, 0-10 points, with higher scores indicating greater severity of distress and impairment). Primary and secondary outcomes were assessed in the intention-to-treat population at week 18. Maintenance effects were assessed at week 26. RESULTS A total of 396 youths (mean [SD] age, 10.3 [2.4] years; 206 [52.0%] boys) were randomized to MMM (n = 197) or MAU (n = 199), with primary outcome data available in 177 (89.8%) and 167 (83.9%), respectively, at 18 weeks. The SDQ Impact score decreased by 2.34 points with MMM and 1.23 with MAU, from initial scores of 4.12 and 4.21, respectively (between-group difference, 1.10 [95% CI, 0.75-1.45]; P < .001; Cohen d = 0.60). Number of responders (≥1-point reduction in SDQ Impact score) was greater with MMM than with MAU (144 of 197 [73.1%] vs 93 of 199 [46.7%]; number needed to treat, 4 [95% CI, 3-6]). Secondary outcomes indicated statistically significant benefits in parent-reported changes of anxiety, depressive symptoms, daily functioning, school attendance, and the principal problem. All benefits were maintained at week 26 except for school attendance. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the scalable transdiagnostic cognitive-behavioral intervention MMM outperformed MAU in a community setting on multiple, clinically relevant domains in youth with emotional and behavioral problems. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03535805.
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Affiliation(s)
- Pia Jeppesen
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Trap Wolf
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark,Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense
| | - Sabrina M. Nielsen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Niels Bilenberg
- Department for Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Hove Thomsen
- Research Center at the Department for Child- and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Centre for the Psychological Treatment of Children and Adolescents, Department of Psychology and Behavioural Sciences, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Simon-Peter Neumer
- Centre for Child and Adolescent Mental Health, Oslo, Norway,Centre for Child and Youth Mental Health and Child Welfare, The Arctic University of Norway, North Norway (RKBU North), Tromsø, Denmark
| | - Louise Berg Puggaard
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark
| | - Mette Maria Agner Pedersen
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Wendy K. Silverman
- Anxiety and Mood Disorders Program, Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Christoph U. Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York,Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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22
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MacDonald CS, Nielsen SM, Bjørner J, Johansen MY, Christensen R, Vaag A, Lieberman DE, Pedersen BK, Langberg H, Ried-Larsen M, Midtgaard J. One-year intensive lifestyle intervention and improvements in health-related quality of life and mental health in persons with type 2 diabetes: a secondary analysis of the U-TURN randomized controlled trial. BMJ Open Diabetes Res Care 2021; 9:9/1/e001840. [PMID: 33441418 PMCID: PMC7812095 DOI: 10.1136/bmjdrc-2020-001840] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/21/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The effects of lifestyle interventions in persons with type 2 diabetes (T2D) on health-related quality of life (HRQoL) and subjective well-being are ambiguous, and no studies have explored the effect of exercise interventions that meet or exceed current recommended exercise levels. We investigated whether a 1-year intensive lifestyle intervention is superior in improving HRQoL compared with standard care in T2D persons. RESEARCH DESIGN AND METHODS We performed secondary analyses of a previously conducted randomized controlled trial (April 2015 to August 2016). Persons with non-insulin-dependent T2D (duration ≤10 years) were randomized to 1-year supervised exercise and individualized dietary counseling (ie, 'U-TURN'), or standard care. The primary HRQoL outcome was change in the 36-item Short Form Health Survey (SF-36) physical component score (PCS) from baseline to 12 months of follow-up, and a key secondary outcome was changes in the SF-36 mental component score (MCS). RESULTS We included 98 participants (U-TURN group=64, standard care group=34) with a mean age of 54.6 years (SD 8.9). Between-group analyses at 12-month follow-up showed SF-36 PCS change of 0.8 (95% CI -0.7 to 2.3) in the U-TURN group and deterioration of 2.4 (95% CI -4.6 to -0.1) in the standard care group (difference of 3.2, 95% CI 0.5 to 5.9, p=0.02) while no changes were detected in SF-36 MCS. At 12 months, 19 participants (30%) in the U-TURN group and 6 participants (18%) in the standard care group achieved clinically significant improvement in SF-36 PCS score (adjusted risk ratio 2.6, 95% CI 1.0 to 4.5 corresponding to number needed to treat of 4, 95% CI 1.6 to infinite). CONCLUSION In persons with T2D diagnosed for less than 10 years, intensive lifestyle intervention improved the physical component of HRQoL, but not the mental component of HRQoL after 1 year, compared with standard care. TRIAL REGISTRATION NUMBER NCT02417012.
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Affiliation(s)
- Christopher Scott MacDonald
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jakob Bjørner
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Optum Patient Insights, Lincoln, Rhode Island, USA
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Y Johansen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Allan Vaag
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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23
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Thomsen T, Aadahl M, Beyer N, Hetland ML, Løppenthin KB, Midtgaard J, Christensen R, Nielsen SM, Østergaard M, Jennum P, Esbensen BA. Sustained Long-Term Efficacy of Motivational Counseling and Text Message Reminders on Daily Sitting Time in Patients With Rheumatoid Arthritis: Long-Term Follow-up of a Randomized, Parallel-Group Trial. Arthritis Care Res (Hoboken) 2020; 72:1560-1570. [PMID: 31507095 DOI: 10.1002/acr.24060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the 18-month postintervention efficacy following a 4-month individually tailored behavioral intervention on daily sitting time in patients with rheumatoid arthritis (RA). METHODS In an observer-blinded randomized trial, 150 RA patients were included. During 4 months, the intervention group (n = 75) received 3 motivational counseling sessions and tailored text messages aimed at increasing light-intensity physical activity through reduction of sedentary behavior. The control group (n = 75) maintained their usual lifestyle. The primary outcome was change from baseline to 18 months postintervention in objectively measured daily sitting time (using ActivPAL). Secondary outcomes included changes in clinical patient-reported outcomes and cardiometabolic biomarkers. A mixed-effect repeated measures analysis of covariance model in the intent-to-treat population was applied. RESULTS At 22 months follow-up from baseline, 12 participants were lost to follow-up. Compared to baseline, sitting time in the intervention group decreased 1.10 hours/day, whereas it increased by 1.32 hours/day in the control group, a between-group difference of -2.43 hours/day (95% confidence interval [95% CI] -2.99, -1.86; P < 0.0001) favoring the intervention group. For most secondary outcomes, between-group differences favored the intervention: visual analog scale (VAS) pain -15.51 mm (95% CI -23.42, -7.60), VAS fatigue -12.30 mm (95% CI -20.71, -3.88), physical function -0.39 Health Assessment Questionnaire units (95% CI -0.53, -0.26), total cholesterol -0.86 mmoles/liter (95% CI -1.03, -0.68), triglycerides -0.26 mmoles/liter (95% CI -0.43, -0.09), and average glucose -1.15 mmoles/liter (95% CI -1.39, -0.91). CONCLUSION The 4-month postintervention results showed that patients in the intervention reduced their daily sitting time and improved patient-reported outcomes and total cholesterol levels compared to the control group. Eighteen months after intervention, patients in the intervention group were still significantly less sedentary than controls. Findings suggest that a behavioral approach is beneficial for promoting long-term physical activity and health in patients with RA.
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Affiliation(s)
| | - Mette Aadahl
- Bispebjerg and Frederiksberg Hospitals and University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- University of Copenhagen, Copenhagen, Denmark
| | - Merete L Hetland
- The DANBIO Registry, Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
| | - Katrine B Løppenthin
- Rigshospitalet, Glostrup, and The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Julie Midtgaard
- University of Copenhagen and Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Robin Christensen
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, and Odense University Hospital, Odense, Denmark
| | - Sabrina M Nielsen
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Østergaard
- Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Bente A Esbensen
- Rigshospitalet, Glostrup, and University of Copenhagen, Copenhagen, Denmark
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24
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Palmowski A, Nielsen SM, Buttgereit T, Palmowski Y, Boers M, Christensen R, Buttgereit F. Glucocorticoid-trials in rheumatoid arthritis mostly study representative real-world patients: A systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50:1400-1405. [PMID: 32222381 DOI: 10.1016/j.semarthrit.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) are considered the gold standard in clinical research due to credible causality. Their results, however, may not be generalizable to real-world populations. While glucocorticoids (GCs) remain a mainstay of rheumatoid arthritis (RA) treatment, it is unclear whether the results of GC-RCTs are generalizable to current real-world RA patients. METHODS MEDLINE was searched for RCTs and, as comparators, cohort studies (CSs) in RA evaluating systemic GCs. Random-effects meta-analyses were performed for descriptive baseline characteristics (including general demographics, comorbidities, and disease activity) that have been shown to be able to modify the benefit-risk-ratio of various RA therapeutics. These meta-analyses were stratified by study type (RCT and CS). Stratified estimates were subsequently compared. Further sensitivity analyses were performed stratifying by disease duration. RESULTS 56 RCTs (7053 participants) and 10 CSs (14,688 participants) were included. 12 characteristics were reported frequently enough to allow for comparative analysis. In 10/12 characteristics (83%), RCT estimates did not appear to differ from CS estimates. However, RCT participants were younger (-4.7 years [95% CI -7.2 to -2.1]; p < 0.001) and had higher erythrocyte sedimentation rates (11.8 mm/h [5.7 to 17.8]; p < 0.001) than CS participants. Comorbidities could not be assessed due to insufficient reporting. CONCLUSION Our findings suggest that evidence from GC trials in RA is of acceptable generalizability to current real-world patients - especially compared to findings from biologic agents in RA. However, RCT participants were younger than real-world patients, potentially limiting the generalizability of trial results to elderly patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42019134675).
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, 5000 Odense, Denmark
| | - Thomas Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Dermatology, Venerology, and Allergology, Charité - University Medicine Berlin, 10117 Berlin, Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, 10117 Berlin, Germany
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, the Netherlands
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, 5000 Odense, Denmark
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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25
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MacDonald CS, Johansen MY, Nielsen SM, Christensen R, Hansen KB, Langberg H, Vaag AA, Karstoft K, Lieberman DE, Pedersen BK, Ried-Larsen M. Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. Mayo Clin Proc 2020; 95:488-503. [PMID: 32007295 DOI: 10.1016/j.mayocp.2019.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes. PATIENTS AND METHODS Secondary analyses of a randomized controlled exercise-based lifestyle intervention trial (April 29, 2015 to August 17, 2016). Patients with non-insulin-dependent type 2 diabetes were randomly assigned to an intensive lifestyle intervention (U-TURN) or standard-care group. Both groups received lifestyle advice and objective target-driven medical regulation. Additionally, the U-TURN group received supervised exercise and individualized dietary counseling. Of the 98 randomly assigned participants, 92 were included in the analysis (U-TURN, n=61, standard care, n=31). Participants in the U-TURN group were stratified into tertiles based on accumulated volumes of exercise completed during the 1-year intervention. RESULTS Median exercise levels of 178 (interquartile range [IQR], 121-213; lower tertile), 296 (IQR, 261-310; intermediate tertile), and 380 minutes per week (IQR, 355-446; upper tertile) were associated with higher odds of discontinuing treatment with glucose-lowering medication, with corresponding odds ratios of 12.1 (95% CI, 1.2-119; number needed to treat: 4), 30.2 (95% CI, 2.9-318.5; 3), and 34.4 (95% CI, 4.1-290.1; 2), respectively, when comparing with standard care. Cardiovascular risk factors such as glycated hemoglobin A1c levels, fitness, 2-hour glucose levels, and triglyceride levels were improved significantly in the intermediate and upper tertiles, but not the lower tertile, compared with the standard-care group. CONCLUSION Exercise volume is associated with discontinuation of glucose-lowering medication treatment in a dose-dependent manner, as are important cardiovascular risk factors in well-treated participants with type 2 diabetes and disease duration less than 10 years. Further studies are needed to support these findings. STUDY REGISTRATION ClinicalTrials.gov registration (NCT02417012).
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Affiliation(s)
- Christopher S MacDonald
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Mette Y Johansen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Robin Christensen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Katrine B Hansen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Allan A Vaag
- AstraZeneca, Early Clinical Development, Cardiovascular, Renal and Metabolic Research, Mölndal, Sweden
| | - Kristian Karstoft
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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Zhao Y, Sato TS, Nielsen SM, Beer M, Huang M, Iyer RS, McGuire M, Ngo AV, Otjen JP, Panwar J, Stimec J, Thapa M, Toma P, Taneja A, Gove NE, Ferguson PJ. Development of a Scoring Tool for Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging and Evaluation of its Interrater Reliability. J Rheumatol 2019; 47:739-747. [PMID: 31575701 DOI: 10.3899/jrheum.190186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Serial magnetic resonance imaging (MRI) examinations are often needed in chronic nonbacterial osteomyelitis (CNO) to determine the objective response to treatment. Our objectives in this study were (1) to develop a consensus-based MRI scoring tool for clinical and research use in CNO; and (2) to evaluate interrater reliability and agreement using whole-body (WB)-MRI from children with CNO. METHODS Eleven pediatric radiologists discussed definitions and grading of signal intensity, size of signal abnormality within bone marrow, and associated features on MRI through monthly conference calls and a consensus meeting, using a nominal group technique in July 2017. WB-MRI scans from children with CNO were deidentified for training reading and an interrater reliability study. The reading by each radiologist was conducted in a randomized order. Interrater reliability for abnormal signal and severity were assessed using free-marginal κ statistics. RESULTS Radiologists reached a consensus on grading CNO-specific MRI findings and on describing bone units based on anatomy. A total of 45 sets of WB-MRI scans, including 4 sets of non-CNO MRI examinations, were selected for the final reading. The mean κ of each category of bones was > 0.7 with majority > 0.9 demonstrating substantial/almost perfect interrater reliability of readings among radiologists. The agreement on signal intensity and the size of signal abnormality within the most commonly affected bones (femur and tibia) were lower than those of other bones. CONCLUSION The chronic nonbacterial osteomyelitis magnetic resonance imaging scoring (CROMRIS) tool is a comprehensive standardized scoring tool for MRI in children with CNO. Our interrater study demonstrated good interrater reliability and agreement of readings.
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Affiliation(s)
- Yongdong Zhao
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. .,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine.
| | - T Shawn Sato
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Sabrina M Nielsen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Meinrad Beer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mingqian Huang
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Ramesh S Iyer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Michael McGuire
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Anh-Vu Ngo
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jeffrey P Otjen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jyoti Panwar
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jennifer Stimec
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mahesh Thapa
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Paolo Toma
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Angela Taneja
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Nancy E Gove
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Polly J Ferguson
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
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Palmowski A, Nielsen SM, Buttgereit T, Palmowski Y, Boers M, Christensen R, Buttgereit F. Association Between Participant Retention and the Proportion of Included Elderly People in Rheumatology Trials: Results From a Series of Exploratory Meta-Regression Analyses. Arthritis Care Res (Hoboken) 2019; 72:1490-1496. [PMID: 31421022 DOI: 10.1002/acr.24051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The elderly, a population defined by an age of ≥65 years, are underrepresented in rheumatology trials, possibly due to investigators' concerns of increased premature discontinuations in higher age groups. The present study was undertaken to evaluate whether the proportion of included elderly individuals (PE) is independently associated with participant retention in rheumatology trials. METHODS Medline was searched for randomized controlled trials (RCTs) in rheumatoid arthritis (RA) and osteoarthritis (OA) of any intervention (years 2016 and 2017). PE was either extracted from the research manuscript or estimated from an assumed (truncated) normal distribution. We used mixed-effects meta-regression models including several covariates to assess whether there is an independent association between PE and participant retention. Using sensitivity analyses, we evaluated whether associations were connected to attrition due to lack of efficacy (LoE) or adverse events (AE). RESULTS In total, 243 RCTs comprising >48,000 participants were included. Pooled participant retention was 88%. PE was not associated with retention in the unadjusted (P = 0.97) or adjusted (all: P ≥ 0.14) models. Of all covariates, only study duration and type of intervention were associated with retention (both: P < 0.001). Post hoc analyses allowing for interaction revealed a small but statistically significant positive association between PE and retention in pharmacologic interventions and a negative association in physical/physiotherapeutic interventions (overall P for interaction = 0.05). No associations were found for PE and attrition due to LoE or AE. CONCLUSION Participant retention in RA and OA trials is high and not associated with PE. These findings should motivate investigators to include more elderly participants in rheumatology trials.
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Affiliation(s)
| | - Sabrina M Nielsen
- The Parker Institute, Bispebjerg Hospital, and Frederiksberg Hospital, Frederiksberg, Denmark, and University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | | | | | - Maarten Boers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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28
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Skougaard M, Bliddal H, Christensen R, Ellegaard K, Nielsen SM, Zavada J, Oreska S, Krogh NS, Holm CC, Hetland ML, Vencovsky J, Røgind H, Taylor PC, Gudbergsen H. Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I). J Rheumatol 2019; 47:658-667. [PMID: 31416921 DOI: 10.3899/jrheum.181362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. METHODS Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen's κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots. RESULTS Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83-0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training. CONCLUSION Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)].
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Affiliation(s)
- Marie Skougaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henning Bliddal
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Robin Christensen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Karen Ellegaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabrina M Nielsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jakub Zavada
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabina Oreska
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Niels S Krogh
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Christian C Holm
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Merete L Hetland
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jiri Vencovsky
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Røgind
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Peter C Taylor
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Gudbergsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform. .,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg.
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Palmowski A, Buttgereit T, Palmowski Y, Nielsen SM, Boers M, Christensen R, Buttgereit F. Applicability of trials in rheumatoid arthritis and osteoarthritis: A systematic review and meta-analysis of trial populations showing adequate proportion of women, but underrepresentation of elderly people. Semin Arthritis Rheum 2019; 48:983-989. [DOI: 10.1016/j.semarthrit.2018.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023]
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Guldberg-Møller J, Terslev L, Nielsen SM, Kønig MJ, Torp-Pedersen ST, Torp-Pedersen A, Christensen R, Bliddal H, Ellegaard K. Ultrasound pathology of the entheses in an age and gender stratified sample of healthy adult subjects: a prospective cross-sectional frequency study. Clin Exp Rheumatol 2019; 37:408-413. [PMID: 30620269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Ultrasound (US) examination of the entheses is increasingly used. However, little is known about US findings in the entheses in asymptomatic persons. The aim of this study was to investigate the appearance of US signs in the enthuses of the lower limb in asymptomatic subjects. METHODS We recruited 64 subjects, eight women and eight men whose ages covered four decades, from 20 to 60 years. None had tendon or joint disease in the lower limbs. Participants were examined by a rheumatologist and blood samples were collected to rule out enthesis pathology. The enthesis of the dominant leg were examined with grey-scale and Doppler US to evaluate increased thickness, changed structure, enthesophytes/calcifications, erosions, and colour Doppler signal. RESULTS Ultrasound examination of 320 entheses was made. At enthesis level, elementary lesions were seen at 73 (22.8%) sites, at subject-level 47 (73.4%) persons showed elementary lesions, in 27 (57%) only one enthesis was affected. Doppler activity was seen in four sites, three at the quadriceps insertion. Most common US elementary lesion was enthesophytes at the Achilles and quadriceps tendon insertion. A tendency towards more elementary lesions was seen in men, and a slight increase was seen with increasing age, however, not statistically significance. CONCLUSIONS Our findings suggest that US can be used to diagnose/examine subjects in adulthood for pathological changes in the entheses; however, caution should be taken regarding enthesophytes of the quadriceps and Achilles tendon.
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Affiliation(s)
| | - Lene Terslev
- Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Merete Juhl Kønig
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg; and Department of Radiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Søren T Torp-Pedersen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg; and Department of Radiology, Rigshospitalet Glostrup, Denmark
| | | | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Ellegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
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Nielsen SM, Tugwell P, de Wit MP, Boers M, Beaton DE, Woodworth TG, Escorpizo R, Shea B, Toupin-April K, Guillemin F, Strand V, Singh JA, Kloppenburg M, Furst DE, Wells GA, Smolen JS, Veselý R, Boonen A, Storgaard H, Voshaar M, March L, Christensen R. Identifying Provisional Generic Contextual Factor Domains for Clinical Trials in Rheumatology: Results from an OMERACT Initiative. J Rheumatol 2019; 46:1159-1163. [DOI: 10.3899/jrheum.181081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 01/13/2023]
Abstract
Objective.The Contextual Factors Working Group aims to provide guidance on addressing contextual factors in rheumatology trials within OMERACT.Methods.During the Special Interest Group session at OMERACT 2018, preliminary results were presented from a case scenario survey and semistructured interviews, including contextual factors mentioned in these. A group-based exercise sought to identify and rank important generic contextual factors.Results.A total of 79 candidate factors were listed. Across the 3 groups, gender/sex, comorbidities, and the healthcare system were ranked as most important.Conclusion.The identified important contextual factor domains may be considered a provisional list pending further research.
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Bartholdy C, Nielsen SM, Warming S, Hunter DJ, Christensen R, Henriksen M. Poor replicability of recommended exercise interventions for knee osteoarthritis: a descriptive analysis of evidence informing current guidelines and recommendations. Osteoarthritis Cartilage 2019; 27:3-22. [PMID: 30248500 DOI: 10.1016/j.joca.2018.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/28/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the reporting completeness of exercise-based interventions for knee osteoarthritis (OA) in studies that form the basis of current clinical guidelines, and examine if the clinical benefit (pain and disability) from exercise is associated with the intervention reporting completeness. DESIGN Review of clinical OA guidelines METHODS: We searched MEDLINE and EMBASE for guidelines published between 2006 and 2016 including recommendations about exercise for knee OA. The studies used to inform a recommendation were reviewed for exercise reporting completeness. Reporting completeness was evaluated using a 12-item checklist; a combination of the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT). Each item was scored 'YES' or 'NO' and summarized as a proportion of interventions with complete descriptions and each intervention's completeness was summarized as the percentage of completely described items. The association between intervention description completeness score and clinical benefits was analyzed with a multilevel meta-regression. RESULTS From 10 clinical guidelines, we identified 103 original studies of which 100 were retrievable (including 133 interventions with 6,926 patients). No interventions were completely described on all 12 items (median 33% of items complete; range 17-75%). The meta-regression analysis indicated that poorer reporting was associated with greater effects on pain and no association with effects on disability. CONCLUSION The inadequate description of recommended interventions for knee OA is a serious problem that precludes replication of effective interventions in clinical practice. By consequence, the relevance and usability of clinical guideline documents and original study reports are diminished. PROSPERO CRD42016039742.
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Affiliation(s)
- C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - S M Nielsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.
| | - S Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark.
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Bjerring PN, Morgan MY, Vilstrup H, Nielsen SM, Christensen R, Gluud LL. Medical interventions for prevention and treatment of hepatic encephalopathy in adults with cirrhosis: a network meta‐analysis. Cochrane Database Syst Rev 2018; 2018:CD013241. [PMCID: PMC6517127 DOI: 10.1002/14651858.cd013241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of medical interventions for prevention and treatment of hepatic encephalopathy in adults with cirrhosis.
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Affiliation(s)
- Peter N Bjerring
- Copenhagen University Hospital HvidovreGastrounit, Medical DivisionHvidovreDenmark
| | - Marsha Y Morgan
- Division of Medicine, Royal Free Campus, University College LondonUCL Institute for Liver & Digestive HealthRowland Hill StreetHampsteadLondonUKNW3 2PF
| | - Hendrik Vilstrup
- Aarhus University HospitalDepartment of Hepatology and GastroenterologyNørrebrogade 44AarhusDenmark
| | - Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg HospitalMusculoskeletal Statistics UnitCopenhagenDenmark2000 F
| | - Robin Christensen
- Bispebjerg and Frederiksberg HospitalMusculoskeletal Statistics Unit, The Parker InstituteCopenhagenDenmark
| | - Lise Lotte Gluud
- Copenhagen University Hospital HvidovreGastrounit, Medical DivisionHvidovreDenmark
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Thorlacius L, Ingram JR, Villumsen B, Esmann S, Kirby JS, Gottlieb AB, Merola JF, Dellavalle R, Nielsen SM, Christensen R, Garg A, Jemec GBE. A core domain set for hidradenitis suppurativa trial outcomes: an international Delphi process. Br J Dermatol 2018; 179:642-650. [PMID: 29654696 DOI: 10.1111/bjd.16672] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is no consensus on core outcome domains for hidradenitis suppurativa (HS). Heterogeneous outcome measure instruments in clinical trials likely leads to outcome-reporting bias and limits the ability to synthesize evidence. OBJECTIVES To achieve global multistakeholder consensus on a core outcome set (COS) of domains regarding what to measure in clinical trials for HS. METHODS Six stakeholder groups participated in a Delphi process that included five anonymous e-Delphi rounds and four face-to-face consensus meetings to reach consensus on the final COS. The aim was for a 1 : 1 ratio of patients to healthcare professionals (HCPs). RESULTS A total of 41 patients and 52 HCPs from 19 countries in four continents participated in the consensus process, which yielded a final COS that included five domains: pain, physical signs, HS-specific quality of life, global assessment and progression of course. A sixth domain, symptoms, was highly supported by patients and not by HCPs but is recommended for the core domain set. CONCLUSIONS Routine adoption of the COS in future HS trials should ensure that core outcomes of importance to both patients and HCPs are collected.
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Affiliation(s)
- L Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - J R Ingram
- Institute of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, U.K
| | - B Villumsen
- The Patients' Association HS Denmark, Copenhagen, Denmark
| | - S Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - J S Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, PA, U.S.A
| | - A B Gottlieb
- Department of Dermatology, New York Medical College, Valhalla, NY, U.S.A
| | - J F Merola
- Harvard Medical School, Boston, MA, U.S.A.,Department of Dermatology, Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, U.S.A.,Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - R Dellavalle
- Dermatology Service, US Department of Veteran Affairs Medical Centre, Denver, CO, U.S.A
| | - S M Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - A Garg
- Department of Dermatology, Hofstra Northwell School of Medicine, New Hyde Park, NY, U.S.A
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Themstrup L, De Carvalho N, Nielsen SM, Olsen J, Ciardo S, Schuh S, Nørnberg BMH, Welzel J, Ulrich M, Pellacani G, Jemec GBE. In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography. Exp Dermatol 2018; 27:156-165. [DOI: 10.1111/exd.13479] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Lotte Themstrup
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Sabrina M. Nielsen
- Musculoskeletal Statistics Unit; The Parker Institute; Bispebjerg and Frederiksberg Hospital; Frederiksberg Copenhagen Denmark
| | - Jonas Olsen
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Silvana Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Sandra Schuh
- Department of Dermatology and Allergology; General Hospital Augsburg; Augsburg Germany
| | | | - Julia Welzel
- Department of Dermatology and Allergology; General Hospital Augsburg; Augsburg Germany
| | | | - Giovanni Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Gregor B. E. Jemec
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Nielsen SM, Bartels EM, Henriksen M, Wæhrens EE, Gudbergsen H, Bliddal H, Astrup A, Knop FK, Carmona L, Taylor WJ, Singh JA, Perez-Ruiz F, Kristensen LE, Christensen R. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis 2017; 76:1870-1882. [PMID: 28866649 PMCID: PMC5705854 DOI: 10.1136/annrheumdis-2017-211472] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [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: 03/15/2017] [Revised: 05/29/2017] [Accepted: 07/01/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. CONCLUSIONS The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42016037937.
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Affiliation(s)
- Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Else M Bartels
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | | | - Lars E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Nielsen SM, Toftdahl NG, Nordentoft M, Hjorthøj C. Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: a nationwide population based register study. Psychol Med 2017; 47:1668-1677. [PMID: 28166863 DOI: 10.1017/s0033291717000162] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have examined whether use of substances can cause schizophrenia. However, due to methodological limitations in the existing literature (e.g. selection bias and lack of adjustment of co-abuse) uncertainties still remain. We aimed to investigate whether substance abuse increases the risk of developing schizophrenia, addressing some of these limitations. METHOD The longitudinal, nationwide Danish registers were linked to establish a cohort of 3 133 968 individuals (105 178 673 person-years at risk), identifying 204 505 individuals diagnosed with substance abuse and 21 305 diagnosed with schizophrenia. Information regarding substance abuse was extracted from several registers and did not include psychotic symptoms caused by substance abuse in the definition. This resulted in a large, generalizable sample of exposed individuals. The data was analysed using Cox regression analyses, and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnosis, parental substance abuse, psychiatric history, immigration and socioeconomic status. RESULTS A diagnosis of substance abuse increased the overall risk of developing schizophrenia [hazard ratio (HR) 6.04, 95% confidence interval (CI) 5.84-6.26]. Cannabis (HR 5.20, 95% CI 4.86-5.57) and alcohol (HR 3.38, 95% CI 3.24-3.53) presented the strongest associations. Abuse of hallucinogens (HR 1.86, 95% CI 1.43-2.41), sedatives (HR 1.68, 95% CI 1.49-1.90), and other substances (HR 2.85, 95% CI 2.58-3.15) also increased the risk significantly. The risk was found to be significant even 10-15 years subsequent to a diagnosis of substance abuse. CONCLUSION Our results illustrate robust associations between almost any type of substance abuse and an increased risk of developing schizophrenia later in life.
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Affiliation(s)
- S M Nielsen
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - N G Toftdahl
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - M Nordentoft
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - C Hjorthøj
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
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Finger ME, Boonen A, Woodworth TG, Escorpizo R, Christensen R, Nielsen SM, Leong AL, Scholte Voshaar M, Flurey CA, Milman N, Verstappen SM, Alten R, Guillemin F, Kloppenburg M, Beaton DE, Tugwell PS, March LM, Furst DE, Pohl C. An OMERACT Initiative Toward Consensus to Identify and Characterize Candidate Contextual Factors: Report from the Contextual Factors Working Group. J Rheumatol 2017; 44:1734-1739. [DOI: 10.3899/jrheum.161200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/21/2023]
Abstract
Objective.The importance of contextual factors (CF) for appropriate patient-specific care is widely acknowledged. However, evidence in clinical trials on how CF influence outcomes remains sparse. The 2014 Outcome Measures in Rheumatology (OMERACT) Handbook introduced the role of CF in outcome assessment and defined them as “potential confounders and/or effect modifiers of outcomes in randomized controlled trials.” Subsequently, the CF Methods Group (CFMG) was formed to develop guidance on how to address CF in clinical trials.Methods.First, the CFMG conducted an e-mail survey of OMERACT working groups (WG) to analyze how they had addressed CF in outcome measurement so far. The results facilitated an informed discussion at the OMERACT 2016 CFMG Special Interest Group (SIG) session, with the aim of gaining preliminary consensus regarding an operational definition of CF and to make a first selection of potentially relevant CF.Results.The survey revealed that the WG had mostly used the OMERACT Handbook and/or the International Classification of Functioning, Disability and Health (ICF) definition. However, significant heterogeneity was found in the methods used to identify, refine, and categorize CF candidates. The SIG participants agreed on using the ICF as a framework along with the OMERACT Handbook definition. A list with 28 variables was collected including person-related factors and physical and social environments. Recommendations from the SIG guided the CFMG to formulate 3 preliminary projects on how to identify and analyze CF.Conclusion.New methods are urgently needed to assist researchers to identify and characterize CF that significantly influence the interpretation of results in clinical trials. The CFMG defined first steps to develop further guidance.
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Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor ME, Lyddiatt A, Christensen R. Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2017; 9:E42. [PMID: 28067815 PMCID: PMC5295086 DOI: 10.3390/nu9010042] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 10/20/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022] Open
Abstract
Arthritis patients often take fish oil supplements to alleviate symptoms, but limited evidence exists regarding their efficacy. The objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with arthritis. Six databases were searched systematically (24 February 2015). We included randomized trials of oral supplements of all marine oils compared with a control in arthritis patients. The internal validity was assessed using the Cochrane Risk of Bias tool and heterogeneity was explored using restricted maximum of likelihood (REML)-based meta-regression analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the overall quality of the evidence. Forty-two trials were included; 30 trials reported complete data on pain. The standardized mean difference (SMD) suggested a favorable effect (-0.24; 95% confidence interval, CI, -0.42 to -0.07; heterogeneity, I² = 63%. A significant effect was found in patients with rheumatoid arthritis (22 trials; -0.21; 95% CI, -0.42 to -0.004) and other or mixed diagnoses (3 trials; -0.63; 95% CI, -1.20 to -0.06), but not in osteoarthritis patients (5 trials; -0.17; 95% CI, -0.57-0.24). The evidence for using marine oil to alleviate pain in arthritis patients was overall of low quality, but of moderate quality in rheumatoid arthritis patients.
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Affiliation(s)
- Ninna K Senftleber
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Sabrina M Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Jens R Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
| | - Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 FC Copenhagen, Denmark.
| | - Daniel E Furst
- Division of Rheumatology, University of California, Los Angeles, CA 90095, USA.
| | | | - Anne Lyddiatt
- Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON K1H 8L6, Canada.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Copenhagen F, Denmark.
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Abstract
INTRODUCTION Epilepsy has been considered to be more frequent in Greenland than in Denmark, where the prevalence among children is 0.40%. STUDY DESIGN Evaluation of the prevalence, diagnosis and treatment of epilepsy among children in Greenland aged 0-15 years. METHODS During autumn 2000, 13 out of 18 hospitals in Greenland were visited. The population of children in the areas visited was 11,965 of a total of 15,226 in Greenland. All children with the diagnosis of epilepsy were referred for evaluation and the diagnosis was confirmed. When possible, informed consent was obtained to collect data from medical records. RESULTS 43 children (18 boys) had the diagnosis of epilepsy. For 38 (15 boys) further data were obtained. Mean age was 8.5 years (3-14) for boys and 7.9 years (2-14) for girls. The age at diagnosis was 4.9 years (1-11) for boys and 4.2 years (0-10) for girls. The prevalence of epilepsy was 0.34%. In 31 cases an electroencephalograph (EEG) recording was done, comprising sleep recordings in 26 cases. Medication was according to recommendations in Denmark. CONCLUSION The prevalence of epilepsy in children and the medical treatment of epilepsy among children in Greenland is the same as in Denmark.
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Alberdi-Saugstrup M, Nielsen SM. PReS-FINAL-2334: Chronic recurrent multifocal osteomyelitis and tnf-αlfa inhibitors. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043982 DOI: 10.1186/1546-0096-11-s2-p324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mathiesen PR, Zak M, Herlin T, Nielsen SM. Clinical features and outcome in a Danish cohort of juvenile dermatomyositis patients. Clin Exp Rheumatol 2010; 28:782-789. [PMID: 21029565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 04/20/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To assess disease characteristics and outcome in Danish juvenile dermatomyositis (JDM) patients (1977-2007). METHODS Medical record review of hospital records identified from the National Patient Register. RESULTS Fifty-seven JDM patients were identified. Follow-up time was 7 years (range 0.06-30). Female:male ratio was 2.5:1. Mean age at disease onset was 7 years (SD±3.7), range 1.5-16.0 years. Diagnostic delay was 0.7 years (SD±1.6), range 0.04-9 years. Mean disease duration was 3.7 years (SD±3.5), range 0.7-9 years. Thirty-nine patients (70%) were in full remission. Three patients (5%) were deceased. Disease/treatment-induced damage was present in 35 (61%) patients. Decreased pulmonary function occurred early in the disease course (median 10 months), osteoporosis and calcinosis occurred later (median 18 and 22 months). Four patients developed persistent damage within the first 6 months, four developed calcinosis within the first year. Shorter disease duration was associated with less damage (p=0.004). In a multivariate assessment analysis age >10 years at disease onset was associated with more damage (p<0.01), OR 10.96 (CI 1.6-73.6), and disease duration >4 years was associated with calcinosis (p=0.01) OR 23.2 (CI 2.6-206.2). CONCLUSIONS We present a nationwide retrospective study of Danish JDM patients from 1977-2007. Although 70% were in remission, 61% of the patients had clinical signs of damage. Only a few patients developed damage within the first year of the disease. Longer disease duration and higher age at disease onset was correlated with more disease damage.
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Affiliation(s)
- P R Mathiesen
- Paediatric Clinic, Copenhagen University Hospital, Holbaek, Denmark.
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Larsen B, Jensen NE, Madsen P, Nielsen SM, Klastrup O, Madsen PS. Association of the M blood group system with bovine mastitis. Anim Blood Groups Biochem Genet 2009; 16:165-73. [PMID: 3935012 DOI: 10.1111/j.1365-2052.1985.tb01467.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Associations of the 11 bovine blood group systems with mastitis were examined in Red Danish dairy cattle. The mastitis status was followed during three lactational periods. A significant effect of the M blood group system on mastitis incidence was observed in the first and second lactation periods and a lower frequency of mastitis is found among animals lacking the M' factor as compared to those having the M' blood group factor. The significance of these results are discussed in view of the close relation between the M blood group system and the bovine lymphocyte antigens (BoLA), and the expected effect of eliminating the M' gene from the breed is estimated. Among the remaining 10 blood group systems, the T' system was the only system showing an overall effect on mastitis, and only in first and third lactation. However, the T' system was inconsistent with regard to the effect of the T' gene on the various mastitis diagnoses.
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Abstract
The pattern of infections in the first years of life modulates our immune system, and a low incidence of infections has been linked to an increased risk of common childhood acute lymphoblastic leukemia (ALL). We here present a new interpretation of these observations--the adrenal hypothesis--that proposes that the risk of childhood ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis that increase plasma cortisol levels. This may directly eliminate leukemic cells as well as preleukemic cells for the ALL subsets that dominate in the first 5-7 years of life and may furthermore suppress the Th1-dominated proinflammatory response to infections, and thus lower the proliferative stress on pre-existing preleukemic cells.
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Affiliation(s)
- K Schmiegelow
- The Pediatric Clinic, The University Hospital Rigshospitalet, Copenhagen, Denmark.
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Nielsen SM, Nielsen LZ, Hjorth SA, Perrin MH, Vale WW. Constitutive activation of tethered-peptide/corticotropin-releasing factor receptor chimeras. Proc Natl Acad Sci U S A 2000; 97:10277-81. [PMID: 10963687 PMCID: PMC27874 DOI: 10.1073/pnas.97.18.10277] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2000] [Indexed: 12/24/2022] Open
Abstract
Constitutive activity, or ligand-independent activity, of mutant G protein-coupled receptors (GPCRs) has been described extensively and implicated in the pathology of many diseases. Using the corticotropin-releasing factor (CRF) receptor and the thrombin receptor as a model, we present a ligand-dependent constitutive activation of a GPCR. A chimera in which the N-terminal domain of the CRF receptor is replaced by the amino-terminal 16 residues of CRF displays significant levels of constitutive activation. The activity, as measured by intracellular levels of cAMP, is blocked in a dose-dependent manner by the nonpeptide antagonist antalarmin. These results support a propinquity effect in CRF receptor activation, in which the amino-terminal portion of the CRF peptide is presented to the body of the receptor in the proper proximity for activation. This form of ligand-dependent constitutive activation may be of general applicability for the creation of constitutively activated GPCRs that are regulated by peptide ligands such as CRF. These chimeras may prove useful in analyzing mechanisms of receptor regulation and in the structural analysis of ligand activated receptors.
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Affiliation(s)
- S M Nielsen
- The Clayton Foundation Laboratories for Peptide Biology, The Salk Institute for Biological Science, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA
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Madsen TM, Greisen MH, Nielsen SM, Bolwig TG, Mikkelsen JD. Electroconvulsive stimuli enhance both neuropeptide Y receptor Y1 and Y2 messenger RNA expression and levels of binding in the rat hippocampus. Neuroscience 2000; 98:33-9. [PMID: 10858609 DOI: 10.1016/s0306-4522(00)00078-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Repeated electroconvulsive stimulations and other seizure modalities produce an increase in neuropeptide Y synthesis and local release in the rat hippocampus, and perhaps as a consequence, a change in the concentration of neuropeptide Y binding sites in the same region. The aim of the present study was to determine possible changes in the expression of neuropeptide Y receptor subtypes affected by repeated stimulations in the hippocampus. Rats were exposed to 14 daily stimulations, and the brains were removed 24h after the last stimulation. For in vitro receptor autoradiography and in situ hybridisation histochemistry, the brains were frozen, sectioned, and levels of neuropeptide Y binding sites and messenger RNA expressions were determined quantitatively on sections from the same animals. In order to determine the contribution of different neuropeptide Y receptor subtypes, serial sections were incubated with either 125I-labelled peptide YY alone or the same radio-labelled peptide mixed with an excess of a number of displacing compounds with affinity for either neuropeptide Y receptor subtype Y1, Y2, or both. Binding studies revealed that the majority of peptide YY binding sites was represented by Y2, and that electroconvulsive stimulations reduced the binding capacity or the concentration of this receptor. A prominent reduction of Y1-preferring binding sites was determined in the dentate gyrus, and to a lesser extent in the CA1 and CA3 regions. Similarly, the treatment produced a significant reduction of Y2-preferring binding sites in the CA1 and CA3 region, but not in the granular cell layer of the dentate gyrus. Using semi-quantitative in situ hybridization, Y1 receptor messenger RNA level in the granular cell layer of the dentate increased by the stimulations. In the same region, Y2 receptor messenger RNA was expressed in low to undetectable amounts, but after the repeated stimulations, this transcript was found in moderate to high levels. These data suggest that the neuropeptide Yergic system in the dentate gyrus and the pyramidal cell layer are affected by the treatment, and that this includes both Y1 and Y2 receptor subtypes. Because levels of messenger RNA and binding are distinctly regulated, the turnover of both Y1 and Y2 molecules is strongly increased under electroconvulsive stimulations, suggesting that the intrahippocampal neuropeptide Yergic neurotransmission is also increased under the stimulations.
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Affiliation(s)
- T M Madsen
- Laboratory for Experimental Neuropsychiatry, University Hospital, Rigshospitalet, Copenhagen, Denmark
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Abstract
As in most other seven-transmembrane receptors, the central disulfide bridge from the extracellular end of TM-III to the middle of the second extracellular loop was essential for ligand binding in the NK1 receptor. However, introduction of "extra", single Cys residues in the second extracellular loop, at positions where disease-associated Cys substitutions impair receptor function in the vasopressin V2 receptor and in rhodopsin, did not cause mispairing with the Cys residues involved in this central disulfide bridge. Cys residues were introduced in the N-terminal extension and in the third extracellular loop, respectively, in such a way that disulfide bridge formation could be monitored by loss of substance P binding and breakage of the bridge could be monitored by gain of ligand binding. This disulfide bridge formed spontaneously in the whole population of receptors and could be titrated with low concentrations of reducing agent, dithiothreitol. Another putative disulfide bridge "switch" was constructed at the extracellular ends of TM-V and -VI, i.e., at positions where a high-affinity zinc site previously had been constructed with His substitutions. Disulfide bridge formation at this position, monitored by loss of binding of the nonpeptide antagonist [3H]LY303.870, occurred spontaneously only in a small fraction of the receptors. It is concluded that disulfide bridges form readily between Cys residues introduced appropriately in the N-terminal extension and the third extracellular loop, whereas they form with more difficulty between Cys residues placed at the extracellular ends of the transmembrane segments even at positions where high-affinity metal ion sites can be constructed with His residues.
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Affiliation(s)
- C E Elling
- Laboratory for Molecular Pharmacology, Department of Pharmacology, Panum Institute, University of Copenhagen, DK-2200 Copenhagen, Denmark.
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Nielsen SM, Rascher C, Temlett JA, Fritz VU. Polymyositis associated with Klinefelter's syndrome. S Afr Med J 1999; 89:420-1. [PMID: 10341830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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