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Distler O, Bonderman D, Coghlan JG, Denton CP, Grünig E, Khanna D, McLaughlin VV, Müller-Ladner U, Pope JE, Vonk MC, Di Scala L, Lemarie JC, Perchenet L, Hachulla É. Performance of DETECT Pulmonary Arterial Hypertension Algorithm According to the Hemodynamic Definition of Pulmonary Arterial Hypertension in the 2022 European Society of Cardiology and the European Respiratory Society Guidelines. Arthritis Rheumatol 2024; 76:777-782. [PMID: 38146100 DOI: 10.1002/art.42791] [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: 04/26/2022] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The evidence-based DETECT pulmonary arterial hypertension (PAH) algorithm is frequently used in patients with systemic sclerosis (SSc) to help clinicians screen for PAH by using noninvasive data to recommend patient referral to echocardiography and, if applicable, for a diagnostic right-sided heart catheterization. However, the hemodynamic definition of PAH was recently updated in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines. The performance of DETECT PAH in identifying patients with a high risk of PAH according to this new definition was assessed. METHODS In this post hoc analysis of DETECT, which comprised 466 patients with SSc, the performance of the DETECT PAH algorithm in identifying patients with a high risk of PAH as defined in the 2022 ESC/ERS guidelines (mean pulmonary arterial pressure [mPAP] >20 mm Hg, pulmonary capillary wedge pressure [PCWP] ≤15 mm Hg, and pulmonary vascular resistance >2 Wood units) was assessed using summary statistics and was descriptively compared to the known performance of DETECT PAH as defined in 2014, when it was developed (mPAP ≥25 mm Hg and PCWP ≤15 mm Hg). RESULTS The sensitivity of DETECT PAH in identifying patients with a high risk of PAH according to the 2022 ESC/ERS definition was lower (88.2%) compared to the 2014 definition (95.8%). Specificity improved from 47.8% to 50.8%. CONCLUSION The performance of the DETECT algorithm to screen for PAH in patients with SSc is maintained when PAH is defined according to the 2022 ESC/ERS hemodynamic definition, indicating that DETECT remains applicable to screen for PAH in patients with SSc.
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Affiliation(s)
- Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | - Ekkehard Grünig
- Heidelberg University Hospital and Deutsches Zentrum für Lungenforschung, Heidelberg, Germany
| | | | | | - Ulf Müller-Ladner
- Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Janet E Pope
- Western University of Canada, London, Ontario, Canada
| | - Madelon C Vonk
- Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Arnold S, Wallmeier P, Tais A, Ihorst G, Janoschke M, Schubach F, Aries P, Bergner R, Bremer JP, Görl N, Gutdeutsch E, Hellmich B, Henes J, Hoyer BF, Kangowski A, Kötter I, Krusche M, Magnus T, Metzler C, Müller-Ladner U, Petersen J, Reichelt de Tenorio A, Schaier M, Schirmer JH, Schönermarck U, Thiel J, Unger L, Venhoff N, Weinmann-Menke J, Iking-Konert C, Lamprecht P. The Joint Vasculitis Registry in German-speaking countries (GeVas): subgroup analysis of 266 AAV-patients. Clin Exp Rheumatol 2024:20455. [PMID: 38607682 DOI: 10.55563/clinexprheumatol/suxkyq] [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: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Prospective long-term observational data on the disease course of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were missing in Germany to date. Therefore, the Joint Vasculitis Registry in German-speaking countries (GeVas) has been established to follow the course of patients with AAV. The aim of this study is to present baseline data of patients with newly diagnosed and relapsing AAV enrolled in the GeVas registry. METHODS GeVas is a prospective, web-based, multicentre, clinician-driven registry for the documentation of organ manifestations, damage, long-term outcomes, and therapy regimens in various types of vasculitis. Recruitment started in June 2019. RESULTS Between June 2019 and October 2022, 266 patients with AAV were included in the GeVas registry, hereof 173 (65%) with new-onset and 93 (35%) with relapsing AAV. One hundred and sixty-two (61%) patients were classified as granulomatosis with polyangiitis (GPA), 66 (25%) as microscopic polyangiitis (MPA), 36 (13%) as eosinophilic granulomatosis with polyangiitis (EGPA), and 2 (1%) as renal limited AAV. The median age was 59 years (51-70 years, IQR), 130 (51%) patients were female. Most patients were ANCA positive (177; 67%) and affected by general symptoms, pulmonary, ear nose throat (ENT), renal and neurological involvement. For induction of remission, the majority of patients received glucocorticoids (247, 93%) in combination with either rituximab (118, 45%) or cyclophosphamide (112, 42%). CONCLUSIONS Demographic characteristics are comparable to those in other European countries. Differences were found regarding ANCA status, frequencies of organ manifestations, and therapeutic regimens. The GeVas registry will allow longitudinal observations and prospective outcome measures in AAV.
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Affiliation(s)
- Sabrina Arnold
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany.
| | - Pia Wallmeier
- Department of Nephrology, Asklepios Klinikum Barmbek, Hamburg; and III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arlette Tais
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Marco Janoschke
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Schubach
- Interdisciplinary Medical Intensive Care, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Peer Aries
- Immunologikum, Department of Rheumatology, Hamburg, Germany
| | - Raoul Bergner
- Klinikum Ludwigshafen, Department of Internal Medicine, Haemato-oncology, Nephrology, Infectiology and Rheumatology, Ludwigshafen am Rhein, Germany
| | | | - Norman Görl
- Klinikum Südstadt Rostock, Department of Internal Medicine, Rheumatology and Immunology, Rostock, Germany
| | - Eva Gutdeutsch
- Department of Rheumatology, Barmherzige Brüder Regensburg, Germany
| | - Bernhard Hellmich
- Vasculitis Centre South, Medius Kliniken, Teaching Hospital University of Tübingen, Department of Internal Medicine, Rheumatology, Pulmonology, Nephrology and Diabetology, Kirchheim unter Teck, Germany
| | - Jörg Henes
- University Medical CentreTübingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II, Tübingen, Germany
| | | | - Antje Kangowski
- Klinikum Südstadt Rostock, Department of Internal Medicine, Rheumatology and Immunology, Rostock, Germany
| | - Ina Kötter
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, Germany
| | - Martin Krusche
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Claudia Metzler
- Immunologikum, Department of Rheumatology, Hamburg, and Department of Internal Medicine and Rheumatology, Klinikum Bielefeld, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Jana Petersen
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, and MEDIZINICUM, Hamburg, Germany
| | - Anke Reichelt de Tenorio
- Vasculitis Centre South, Medius Kliniken, Teaching Hospital University of Tübingen, Department of Internal Medicine, Rheumatology, Pulmonology, Nephrology and Diabetology, Kirchheim unter Teck, Germany
| | - Matthias Schaier
- Department of Nephrology, University Medical Centre Heidelberg, Germany
| | | | - Ulf Schönermarck
- Department of Medicine IV, Nephrology Division, LMU University Hospital, LMU Munich, Germany
| | - Jens Thiel
- Clinical Department of Rheumatology and Immunology, University Medical Centre Graz, Austria
| | - Leonore Unger
- Medical Department 1, Städtisches Klinikum Dresden, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Julia Weinmann-Menke
- Department of Nephrology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Christof Iking-Konert
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Rheumatology, Stadtspital Zürich, Switzerland
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
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Hasseli R, Hanses F, Stecher M, Specker C, Weise T, Borgmann S, Hasselberger M, Hertenstein B, Hower M, Hoyer BF, Koll C, Krause A, von Lilienfeld-Toal M, Lorenz HM, Merle U, Nunes de Miranda SM, Pletz MW, Regierer AC, Richter JG, Rieg S, Roemmele C, Ruethrich MM, Schmeiser T, Schulze-Koops H, Strangfeld A, Vehreschild MJ, Voit F, Voll RE, Vehreschild JJ, Müller-Ladner U, Pfeil A. The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population-A comparison of two German registries. Front Med (Lausanne) 2024; 11:1332716. [PMID: 38510457 PMCID: PMC10953502 DOI: 10.3389/fmed.2024.1332716] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Objectives To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) infected patients covering inpatients from the general population with SARS-CoV-2 infections were compared. Methods 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: n = 366 and IRD registry: n = 366) were included for analyses in total. Results Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65°years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19. Conclusion Inflammatory rheumatic diseases (IRD) patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.
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Affiliation(s)
- Rebecca Hasseli
- Section of Rheumatology and Clinical Immunology, Department of Internal Medicine D, University Hospital Münster, Münster, Germany
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Frank Hanses
- Emergency Department and Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | | | | | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, Dortmund, Germany
| | - Bimba F. Hoyer
- Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein, Kiel, Germany
| | - Carolin Koll
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Anne C. Regierer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Jutta G. Richter
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria M. Ruethrich
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Maria J.G.T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Müller-Ladner U, Edwards CJ, Erkens A. International Survey to Evaluate Current Options for Subcutaneous Injection of Methotrexate (MTX) and a New Button-Free MTX Autoinjector. Patient Prefer Adherence 2024; 18:579-590. [PMID: 38463400 PMCID: PMC10924829 DOI: 10.2147/ppa.s440818] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. A new MTX pen with modernized button-free autoinjection technology was developed as a successor to a button-activated pen (metoject®/metex® PEN). To assess the needs of users and the relevance of features of the new MTX autoinjector an international online survey was performed. Methods A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations and information about features of the new MTX autoinjector. Results In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories "dosing/administration" and "ease of use". The first impression of the new MTX autoinjector was positive in 82% of physicians, 87% of nurses, and 76% of patients, respectively. The four most important features of the new MTX autoinjector were 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 chips of a total of 100 chips), small injection volume (9.7 to 11.7 chips), 10 different doses for dose flexibility (8.0 to 13.2 chips), and short injection time below 5 seconds (8.5 to 11.1 chips). Conclusion Arguments for the use of MTX pens as opposed to PFS predominantly refer to dosing/administration and ease of use. The new button-free MTX autoinjector combines a number of advantageous features identified by the international survey.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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Yazdany J, Ware A, Wallace ZS, Bhana S, Grainger R, Hachulla E, Richez C, Cacoub P, Hausmann JS, Liew JW, Sirotich E, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Ribeiro SLE, Al-Emadi S, Hasseli R, Müller-Ladner U, Specker C, Schulze-Koops H, Bernardes M, Fraga VM, Rodrigues AM, Sparks JA, Ljung L, Di Giuseppe D, Tidblad L, Wise L, Duarte-García A, Ugarte-Gil MF, Colunga-Pedraza IJ, Martínez-Martínez MU, Alpizar-Rodriguez D, Xavier RM, Isnardi CA, Pera M, Pons-Estel G, Izadi Z, Gianfrancesco MA, Carrara G, Scirè CA, Zanetti A, Machado PM. Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res (Hoboken) 2024; 76:274-287. [PMID: 37643903 DOI: 10.1002/acr.25220] [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: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. RESULTS Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell-depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell-depleting therapy was associated with worse outcomes. CONCLUSION Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
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Affiliation(s)
| | - Anna Ware
- National Center for Collaborative Healthcare Innovation, Palo Alto Department of Veterans Affairs Healthcare System, Palo Alto, California
| | | | | | - Rebecca Grainger
- University of Otago Wellington and Te Whatu Ora, Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire (CHU) de Lille, pour la Filière des maladies Auto-Immunes et Autoinflammatoires Rares, Lille, France
| | - Christophe Richez
- Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux, pour la Société Française de Rhumatologie, Bordeaux, France
| | - Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Société Nationale Française de Médecine Interne, Paris, France
| | - Jonathan S Hausmann
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center and Charité University Hospital, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European Alliance of Associations for Rheumatology, Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Rebecca Hasseli
- University Hospital Munster, Munster, Germany, and Justus Liebig University Giessen, Kerckhoff, Germany
| | | | | | | | - Miguel Bernardes
- University of Porto and Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Ana Maria Rodrigues
- Sociedade Portuguesa de Reumatologia and Comprehensive Health Research Centre, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lotta Ljung
- Karolinska Institutet and Academic Specialist Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Manuel F Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémica, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | | | | | | | - Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Mariana Pera
- Hospital Angel C. Padilla, San Miguel de Tucuman, Tucuman, Argentina
| | - Guillermo Pons-Estel
- Universidad Nacional de Rosario, Rosario, Argentina, and College of Physicians of the Province of Santa Fe 2nd, Santa Fe, Argentina
| | | | | | | | - Carlo Alberto Scirè
- Italian Society for Rheumatology and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024; 18:1-37. [PMID: 37351850 DOI: 10.1093/ecco-jcc/jjad108] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, London, Centre for Immunobiology, Blizard Institute, Faculty of Medicine, Barts & The London Medical School, Queen Mary University of London, UK
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre Hospital, University of Copenhagen, Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgos Bamias
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Manuel Barreiro-de Acosta
- University Hospital Santiago De Compostela CHUS, Department of Gastroenterology - IBD Unit, Santiago De Compostela, Spain
| | - Tasanee Braithwaite
- School of Immunology and Microbiology, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, GZO - Zurich Regional Health Center, Wetzikon, Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Pascal Juillerat
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland; Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent; Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Nurulamin Noor
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gianluca Pellino
- Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Christoph Schramm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Soriano
- Gastroenterology Division and IBD Center, Internal Medicine Department, Azienda Unità Sanitaria Locale - IRCCS, 42122 Reggio Emilia, Italy
| | - Jürgen Michael Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - Mathieu Uzzan
- Department of Gastroenterology, Hôpital Henri Mondor, APHP, Créteil, France
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephane Zuily
- Vascular Medicine Division and French Referral Center for Rare Auto-Immune Diseases, Université de Lorraine, INSERM, DCAC and CHRU-Nancy, Nancy, France
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Münster, Lüneburg, Germany
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Neumann E, Heck C, Müller-Ladner U. Recent developments in the synovial fibroblast pathobiology field in rheumatoid arthritis. Curr Opin Rheumatol 2024; 36:69-75. [PMID: 37720975 DOI: 10.1097/bor.0000000000000978] [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] [Indexed: 09/19/2023]
Abstract
PURPOSE OF REVIEW Synovial fibroblasts are the central cells of connective tissue homeostasis. In rheumatoid arthritis (RA) tissue, synovial fibroblasts are activated because of the proinflammatory environment very early in the disease. Epigenetic alterations in RASF result in a permanently activated stage, and activated RASF are involved in many processes of RA pathophysiology. Therefore, several recent findings of the last 18 months with focus on RASF activation and function are summarized. RECENT FINDINGS RASF activation because of a profoundly altered epigenome leads to an invasive phenotype with increased migration, adhesion and invasion into cartilage, which was further characterized in several studies. RASF subtypes and subtype dynamics were evaluated using high-resolution techniques to better understand RASF pathophysiology. Many studies addressing interactions with immune or stromal cell types have been published showing that RASF interact with many different cell types contributing not only to their own activation and pro-inflammatory response but also to the activation of the other cells. SUMMARY Highly interesting findings revealing mechanisms of RASF activation and altered functions have been published, RASF subsets further characterized, and interactions with cell types elucidated, which all contribute to a better understanding of the role of RASF in RA development and progression.
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Affiliation(s)
- Elena Neumann
- Department of Rheumatology and Clinical Immunology, Justus Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
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Moinzadeh P, Bonella F, Oberste M, Weliwitage J, Blank N, Riemekasten G, Müller-Ladner U, Henes J, Siegert E, Günther C, Kötter I, Pfeiffer C, Schmalzing M, Zeidler G, Korsten P, Susok L, Juche A, Worm M, Jandova I, Ehrchen J, Sunderkötter C, Keyßer G, Ramming A, Schmeiser T, Kreuter A, Lorenz HM, Hunzelmann N, Kreuter M. Impact of Systemic Sclerosis-Associated Interstitial Lung Disease With and Without Pulmonary Hypertension on Survival: A Large Cohort Study of the German Network for Systemic Sclerosis. Chest 2024; 165:132-145. [PMID: 37582424 DOI: 10.1016/j.chest.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD with pulmonary hypertension [ILD-PH]). The aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis. RESEARCH QUESTION Does SSc-associated ILD-PH or ILD without PH affect survival differently, and are there any risk factors that have an additional impact? STUDY DESIGN AND METHODS Clinical data of 5,831 patients with SSc were collected in the German Network for Systemic Sclerosis registry. Kaplan-Meier estimates were used to compare overall survival in patients with SSc-associated ILD-PH and ILD without PH with patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival. RESULTS Clinical data of 3,257 patients with a mean follow-up time of 3.45 ± 1.63 years have been included in our analysis. At baseline, ILD was present in 34.5%, whereas PH without ILD had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of patients with SSc had ILD, 15.2% had ILD-PH, and 6.5% had PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), whereas PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs ILD-PH vs ILD without PH were found for age at diagnosis, sex, SSc subsets, antibody status, FVC, diffusing capacity of the lung for carbon monoxide, and therapy. Overall survival at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD without PH, PAH, and being worst in patients with ILD-PH. Female sex (hazard ratio [HR], 0.3), higher BMI (HR, 0.9), and higher diffusing capacity of the lung for carbon monoxide values (HR, 0.98) were associated with a lower mortality risk. INTERPRETATION ILD is the most prevalent pulmonary involvement in SSc, whereas the combination of ILD and PH is associated with the most detrimental survival.
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Affiliation(s)
- Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany.
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Jithmi Weliwitage
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Nobert Blank
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriela Riemekasten
- Clinic for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | | | - Jörg Henes
- Centre for Interdisciplinary Rheumatology, Auto-inflammatory Diseases and Internal Medicine 2, University Hospital Tübingen, Tübingen, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg, Rheumatology Clinic, Bad Bramstedt, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Medical Center Ulm, Ulm, Germany
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Osteology and Pain Therapy, Center for Rheumatology Brandenburg, Johanniter-Hospital Treuenbrietzen, Treuenbrietzen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital Bochum, Bochum, Germany
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital Berlin-Buch, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ilona Jandova
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Cord Sunderkötter
- Departments of Dermatology, University Hospital Halle (Saale), Halle, Germany
| | - Gernot Keyßer
- Internal Medicine, Division of Rheumatology, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Tim Schmeiser
- Internal Medicine - Rhematology and Osteology, Hospital St. Josef, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
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Guler S, Sarbu AC, Stalder O, Allanore Y, Bernardino V, Distler J, Gabrielli A, Hoffmann-Vold AM, Matucci-Cerinic M, Müller-Ladner U, Ortiz-Santamaria V, Rednic S, Riccieri V, Smith V, Ullman S, Walker UA, Geiser TK, Distler O, Maurer B, Kollert F. Phenotyping by persistent inflammation in systemic sclerosis associated interstitial lung disease: a EUSTAR database analysis. Thorax 2023; 78:1188-1196. [PMID: 37798114 DOI: 10.1136/thorax-2023-220541] [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: 05/31/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a heterogeneous disease with frequently associated interstitial lung disease (SSc-ILD). We aimed to determine the prognostic potential of phenotyping patients with SSc and SSc-ILD by inflammation and to describe disease trajectories stratified by inflammation and immunosuppressive treatment. METHODS Patients from the European Scleroderma Trials and Research (EUSTAR) group cohort were allocated to persistent inflammatory, intermediate and non-inflammatory phenotypes if C-reactive protein (CRP) levels were ≥5 mg/L at ≥80%, at 20-80% and at <20% of visits, respectively. Cox regression models were used to analyse mortality risk and mixed effect models to describe trajectories of FVC and diffusing capacity for carbon monoxide (DLCO) %-predicted stratified by inflammation and immunosuppressive treatment. RESULTS 2971 patients with SSc and 1171 patients with SSc-ILD had at least three CRP measurements available. Patients with SSc-ILD with a persistent inflammatory phenotype had a 6.7 times higher risk of mortality within 5 years compared with those with a persistent non-inflammatory phenotype (95% CI 3 to 15). In the inflammatory phenotype, FVC %-predicted was declining without (-1.11 (95% CI -2.14 to -0.08)/year), but stable with immunosuppressive treatment (-0.00 (95% CI -0.92 to 0.92)/year). In the non-inflammatory phenotype, patients with and without immunosuppressive treatment had a significant decline in FVC %-predicted, which was more pronounced in those with immunosuppressive treatment (-1.26 (95% CI -1.87 to -0.64) and -0.84 (95% CI -1.35 to -0.33)/year, respectively). CONCLUSIONS Phenotyping by persistent inflammation provides valuable prognostic information, independent of demographics, disease duration, cutaneous subtype, treatment and SSc-ILD severity. The findings from this study support early immunosuppressive treatment in patients with SSc-ILD with persistent inflammation.
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Affiliation(s)
- Sabina Guler
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Adela-Cristina Sarbu
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | - Vera Bernardino
- Internal Medicine Department 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Joerg Distler
- Department of Rheumatology and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Armando Gabrielli
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
| | | | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), San Raffaele Hospital, Milano, Italy
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, University of Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Vera Ortiz-Santamaria
- Unidad de Enfermedades Sistémicas, Reumatología, Hospital General de Granollers, Granollers, Spain
| | - Simona Rednic
- Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valeria Riccieri
- Clinical Medicine and Therapy, Sapienza University of Rome, Roma, Italy
| | - Vanessa Smith
- Rheumatology, Ghent University Hospital, Gent, Belgium
| | - Susanne Ullman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Thomas K Geiser
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Florian Kollert
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
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10
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Tani C, Cardelli C, Depascale R, Gamba A, Iaccarino L, Doria A, Bandeira M, Dinis SP, Romão VC, Gotelli E, Paolino S, Cutolo M, Di Giosaffatte N, Ferraris A, Grammatico P, Cavagna L, Codullo V, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Peretti S, Guiducci S, Matucci-Cerinic M, Bombardieri S, Burmester GR, Fonseca JE, Frank C, Galetti I, Hachulla E, Müller-Ladner U, Schneider M, Smith V, Tamirou F, Van Laar JM, Vieira A, D'Urzo R, Cannizzo S, Gaglioti A, Marinello D, Talarico R, Mosca M. Long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases: The ERN-ReCONNET VACCINATE study. J Transl Autoimmun 2023; 7:100221. [PMID: 38162456 PMCID: PMC10755036 DOI: 10.1016/j.jtauto.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Vaccination is one of the most important measures to contain the COVID-19 pandemic, especially for frail patients. VACCINATE is a multicentre prospective observational study promoted by the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET) aimed at assessing the long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases (rcCTDs) in terms of efficacy and safety. Methods Adult rcCTDs patients were eligible for recruitment. Demographic, clinical and vaccination data were collected at enrolment. Follow-up visits were scheduled 4, 12, 24, 36 and 48 weeks after completion of the first vaccination cycle; data on adverse events, disease exacerbations and the occurrence of new SARS-CoV-2 infections were collected at these time-points. Findings 365 rcCTDs patients (87 % female, mean age 51.8 ± 14.6 years) were recruited. Overall, 200 patients (54.8 %) experienced at least one adverse event, generally mild and in most cases occurring early after the vaccination. During follow-up, 55 disease exacerbations were recorded in 39 patients (10.7 %), distributed over the entire observation period, although most frequently within 4 weeks after completion of the vaccination cycle. The incidence of new SARS-CoV-2 infections was 8.9 per 1000 person-months, with no cases within 12 weeks from vaccine administration and an increasing trend of infections moving away from the primary vaccination cycle. Only one case of severe COVID-19 was reported during the study period. Interpretation COVID-19 vaccination seems effective and safe in rcCTDs patients. The rate of new infections was rather low and serious infections were uncommon in our cohort. No increased risk of disease flares was observed compared to previous disease history; however, such exacerbations may be potentially severe, emphasising the need for close monitoring of our patients.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Anna Gamba
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Sara Paiva Dinis
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Emanuele Gotelli
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Niccolò Di Giosaffatte
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Alessandro Ferraris
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Paola Grammatico
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Longo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Lorenzo Beretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Silvia Peretti
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | | | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - João E. Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Louvain, Belgium
| | - Jacob M. Van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Rossella D'Urzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Cannizzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Gaglioti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diana Marinello
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Müller-Ladner U, Dignass A, Gaffney K, Jadon D, Matucci-Cerinic M, Lobaton T, Carron P, Gisbert JP, Pande I, Utzinger M, Addison J. The PROPER Study: A 48-Week, Pan-European, Real-World Study of Biosimilar SB5 Following Transition from Reference Adalimumab in Patients with Immune-Mediated Inflammatory Disease. BioDrugs 2023; 37:873-889. [PMID: 37632666 PMCID: PMC10581927 DOI: 10.1007/s40259-023-00616-3] [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] [Accepted: 07/07/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The non-interventional PROPER study generated real-world evidence on clinical outcomes following transition in routine practice from reference adalimumab to the EMA-approved SB5 biosimilar adalimumab in patients with immune-mediated inflammatory disease. METHODS Adults with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), Crohn's disease (CD), or ulcerative colitis (UC) were enrolled at 63 sites across Europe. Eligible patients received ≥ 16 weeks of routine treatment with reference adalimumab before transitioning to SB5, and were followed for 48 weeks post-transition. The primary objective was to evaluate candidate predictors (clinically relevant baseline variables with incidence ≥ 15% by indication cohort) associated with persistence on SB5 at 48 weeks post-initiation. Key primary outcome measures were persistence on SB5 (estimated by Kaplan-Meier methodology) and clinical characteristics and disease activity scores at the time of transition to SB5 treatment (baseline). RESULTS A total of 955 eligible patients were enrolled (RA, n = 207; axSpA, n = 127; PsA, n = 162; CD, n = 447; UC, n = 12), of whom 932 (97.6%) completed follow-up and 722 (75.6%) were still receiving SB5 at week 48. Kaplan-Meier estimates (95% confidence interval, CI) of persistence on SB5 at week 48 for RA, axSpA, PsA, and CD were 0.86 (0.80-0.90), 0.80 (0.71-0.86), 0.81 (0.74-0.86), and 0.72 (0.67-0.76), respectively. The single candidate predictor associated with probability of SB5 discontinuation before week 48 was female sex [RA, axSpA, and CD cohorts; HR (95% CI): 3.53 (1.07-11.67), 2.38 (1.11-5.14), and 2.21 (1.54-3.18), respectively]. Disease activity scores remained largely unchanged throughout the study, with proportions by cohort in remission at baseline versus week 48 being 59.2% versus 57.2%, 81.0% versus 78.0%, 94.7% versus 93.7%, and 84.0% versus 85.1% for patients with RA, axSpA, PsA, and CD, respectively. Similarly, the SB5 dosing regimen remained unchanged for the majority of patients from baseline to week 48, the most common regimen being 40 mg every 2 weeks. In total, 232 patients (24.3%) reported at least one adverse drug reaction, and most events were mild; eight patients (3.9%) in the RA cohort experienced nine serious adverse events (SAEs; two possibly related to SB5); eight patients (4.9%) in the PsA cohort experienced nine SAEs (one possibly related to SB5); 22 patients (4.9%) in the CD cohort experienced 27 SAEs (four possibly related to SB5); and no SAEs were observed in the UC cohort. CONCLUSIONS With the exception of female sex in RA, axSpA, and CD, none of the candidate predictors were associated with SB5 discontinuation. Persistence on SB5 was high, treatment effectiveness was maintained, and no safety signals were detected. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov: NCT04089514.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Deepak Jadon
- Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marco Matucci-Cerinic
- Department of Internal Medicine, University of Florence, Florence, Italy
- UNIRAR, Hospital San Raffaele, Milan, Italy
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, Center for Inflammation Research, VIB-UGent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ira Pande
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Pfeil A, Klemm P, Hueber AJ, Hoffmann T, Weise T, Oelzner P, Knop S, Müller-Ladner U, Lange U, Wolf G, Schett G, Simon D, Kleyer A. Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial. Rheumatology (Oxford) 2023:kead508. [PMID: 37740288 DOI: 10.1093/rheumatology/kead508] [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: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymised patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA). METHODS The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO!® app. All participants evaluated the course after completion, assessing the benefit of the app from a student´s perspective using a questionnaire with 16 questions covering six subject areas. RESULTS The use of the AR-based app Rheumality GO!® improved the understanding of pathologies in RA, PsA, and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. CONCLUSION The results of our survey showed that from medical students' perspective, an AR-based concept like the Rheumality GO!® app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Axel J Hueber
- Department Internal Medicine 5. Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Knop
- Department Internal Medicine 5, Hemato-Oncology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ulf Müller-Ladner
- Department Internal Medicine 5. Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Uwe Lange
- Department Internal Medicine 5. Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
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13
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El Miedany Y, Ismail S, wadie fawzy M, Müller-Ladner U, Giacomelli R, Liakouli V, Hermann W, Fathy N, El Gaafary M, Fouad NA, Saber S, Abu-Zaid MH. Towards a consensus on the clinical applications and interpretations of the nailfold capillaroscopy standards in clinical practice: An initiative by the Egyptian Society of Microcirculation. Arch Rheumatol 2023; 38:451-460. [PMID: 38046253 PMCID: PMC10689008 DOI: 10.46497/archrheumatol.2023.9875] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives Based on the mainstream adoption of nailfold capillaroscopy as an investigative tool for rheumatologists, this work was carried out by a panel of experts in the field of capillaroscopy and microcirculation to issue a consensus view on capillaroscopic image acquisition and analysis standardization. Patients and methods After the key clinical questions were identified by the core team, a systematic review of the published research was carried out focusing on variable capillaroscopic techniques, definitions, and characteristics, including capillary density (number of capillaries), capillary morphology (shape of each capillary), capillary dimensions (width of apical, arterial, and venous limb of the capillary), and the presence of hemorrhages. The expert panel attained a consensus and developed recommendations for the standardization of capillaroscopy in clinical practice. These included recommendations for normality and abnormality and the different capillaroscopic patterns. It also involved recommendations for scoring systems, reliability, and reporting. Results A panel of 11 experts participated in the two rounds with a response rate of 100%. A total of nine recommendations were obtained. The agreement with the recommendations (a score of 7-9) ranged from 81.8 to 90.9%. A consensus (i.e., ≥75% of respondents strongly agreed or agreed) was reached on all the clinical standards. Conclusion This work highlighted the main NFC indications, the technical equipment that should be used, how to carry out the procedure, standardization of the terminology of the parameters, and the interpretation of NFC findings. An evidence-based consensus incorporating the advice and experience of a diverse international expert panel was reached.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, Rheumatology, London, United Kingdom
| | - Sherif Ismail
- Department of Rheumatology and Rehabilitation, National Research Center, Cairo, Egypt
| | | | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-liebig University of Giessen, Campus Kerckhoff, Giessen, Germany
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology and Clinical Immunology, University of Rome, Rome, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Sciences, University of L'aquila, Unit of Rheumatology, L'Aquila, Italy
| | - W Hermann
- Kerckhoff-klinik Gmbh, Benekestr, Abteilung Für Rheumatologie Und Klinische Immunologie, Bad Nauheim, Germany
| | - Nihal Fathy
- Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | - Maha El Gaafary
- Ain Shams University, Community and Public Health, Cairo, Egypt
| | - Nermin A Fouad
- Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
| | - Sally Saber
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
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Urban AM, Müller-Ladner U, Schulz N. [61-year-old female patient with diffuse and painless swelling adjacent to the joints]. Dtsch Med Wochenschr 2023; 148:1135-1136. [PMID: 37611580 DOI: 10.1055/a-2061-4882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Anne Maria Urban
- Klinik für Innere Medizin und Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim
| | - Ulf Müller-Ladner
- Klinik für Innere Medizin und Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim
| | - Nils Schulz
- Klinik für Innere Medizin und Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim
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15
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Kreuter M, Bonella F, Blank N, Riemekasten G, Müller-Ladner U, Henes J, Siegert E, Günther C, Kötter I, Pfeiffer C, Schmalzing M, Zeidler G, Korsten P, Susok L, Juche A, Worm M, Jandova I, Ehrchen J, Sunderkötter C, Keyßer G, Ramming A, Schmeiser T, Kreuter A, Kuhr K, Lorenz HM, Moinzadeh P, Hunzelmann N. Anti-acid therapy in SSc-associated interstitial lung disease: long-term outcomes from the German Network for Systemic Sclerosis. Rheumatology (Oxford) 2023; 62:3067-3074. [PMID: 36708008 PMCID: PMC10473195 DOI: 10.1093/rheumatology/kead023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) occurs frequently in patients with SSc. We investigated whether the presence of GERD and/or the use of anti-acid therapy, specifically proton-pump inhibitors (PPIs), are associated with long-term outcomes, especially in SSc-associated interstitial lung disease (SSc-ILD). METHODS We retrospectively analysed patients with SSc and SSc-ILD from the German Network for Systemic Sclerosis (DNSS) database (2003 onwards). Kaplan-Meier analysis compared overall survival (OS) and progression-free survival (PFS) in patients with GERD vs without GERD (SSc and SSc-ILD), and PPI vs no PPI use (SSc-ILD only). Progression was defined as a decrease in either percentage predicted forced vital capacity of ≥10% or single-breath diffusing capacity for carbon monoxide of ≥15%, or death. RESULTS It was found that 2693/4306 (63%) registered patients with SSc and 1204/1931 (62%) with SSc-ILD had GERD. GERD was not associated with decreased OS or decreased PFS in patients in either cohort. In SSc-ILD, PPI use was associated with improved OS vs no PPI use after 1 year [98.4% (95% CI: 97.6, 99.3); n = 760 vs 90.8% (87.9-93.8); n = 290] and after 5 years [91.4% (89.2-93.8); n = 357 vs 70.9% (65.2-77.1); n = 106; P < 0.0001]. PPI use was also associated with improved PFS vs no PPI use after 1 year [95.9% (94.6-97.3); n = 745 vs 86.4% (82.9-90.1); n = 278] and after 5 years [66.8% (63.0-70.8); n = 286 vs 45.9% (39.6-53.2); n = 69; P < 0.0001]. CONCLUSION GERD had no effect on survival in SSc or SSc-ILD. PPIs improved survival in patients with SSc-ILD. Controlled, prospective trials are needed to confirm this finding.
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Norbert Blank
- Division of Rheumatology, Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriela Riemekasten
- Clinic for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | | | - Jörg Henes
- Centre for Interdisciplinary Rheumatology, Immunology and Auto-inflammatory Diseases and Department of Internal Medicine 2, University Hospital Tübingen, Tübingen, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité – Universitaetsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg, Rheumatology Clinic, Bad Bramstedt, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital of Munich (LMU), Munich, Germany
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Osteology and Pain Therapy, Center for Rheumatology Brandenburg, Johanniter-Hospital Treuenbrietzen, Treuenbrietzen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital Bochum, Bochum, Germany
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital Berlin-Buch, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Ilona Jandova
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Cord Sunderkötter
- Department of Dermatology, University Hospital Halle (Saale), Halle, Germany
| | - Gernot Keyßer
- Department of Internal Medicine, Division of Rheumatology, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Tim Schmeiser
- Department for Rheumatology, Immunology and Osteology, St. Josef Hospital Wuppertal, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital Cologne, Cologne, Germany
| | - Hanns-Martin Lorenz
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
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16
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Schmalzing M, Sander O, Seidl M, Marks R, Blank N, Kötter I, Tiemann M, Backhaus M, Manger B, Hübel K, Müller-Ladner U, Henes J. [Castleman's disease in the rheumatological practice]. Z Rheumatol 2023:10.1007/s00393-023-01393-8. [PMID: 37624374 DOI: 10.1007/s00393-023-01393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 08/26/2023]
Abstract
The term Castleman's disease encompasses a group of rare lymphoproliferative diseases that show histopathological similarities in lymph node biopsy. Diagnostic criteria and a specific ICD-10 code have been available for a few years. Case studies listed at the beginning illustrate that close cooperation between clinicians and pathologists is required to enable a reliable diagnosis. For an optimal histopathological assessment, the pathologist is also dependent on the removal of a complete lymph node. Before distinguishing a potentially fatal multicentric idiopathic Castleman's disease from the resectable unicentric form, which is important in terms of prognosis and treatment, early diagnosis presupposes that Castleman's disease is considered in the differential diagnosis. Various immune phenomena and overlaps with autoimmune diseases can increase the probability of misdiagnosis or undetected cases in the clinical routine of rheumatologists. The intention of the present overview is therefore to point out the similarities with autoimmune diseases that are relevant for differential diagnoses and to point out situations that justify a review of the previous diagnosis.
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Affiliation(s)
- M Schmalzing
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - O Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Seidl
- Institut für Pathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - R Marks
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Blank
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Tiemann
- Institut für HämatoPathologie Hamburg, Hamburg, Deutschland
| | - M Backhaus
- Abt. Innere Medizin - Rheumatologie und klinische Immunologie, Park-Klinik Weissensee (Berlin), Berlin, Deutschland
| | - B Manger
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - K Hübel
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Deutschland
| | - J Henes
- Medizinische Universitätsklinik Abt. II, Universitätsklinikum Tübingen, Tübingen, Deutschland
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17
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Hoyer BF, Müller-Ladner U. [Immunology in rheumatology]. Z Rheumatol 2023; 82:267-268. [PMID: 37145194 DOI: 10.1007/s00393-023-01354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Bimba F Hoyer
- Klinik für Innere Medizin I, Rheumatologie/klinische Immunologie und Exzellenzzentrum Entzündungsmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Ulf Müller-Ladner
- Lehrstuhl für Innere Medizin, Schwerpunkt Rheumatologie, Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Campus Kerckhoff, Justus-Liebig-Universität Gießen, Benekestr. 2, 61231, Bad Nauheim, Deutschland
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18
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Schulz N, Müller-Ladner U, Klemm PCM. [30-year-old patient with discolored, painfully swollen fingers]. Dtsch Med Wochenschr 2023; 148:595-596. [PMID: 37105186 DOI: 10.1055/a-2045-5772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Nils Schulz
- Klinik für Innere Medizin und Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim
| | - Ulf Müller-Ladner
- Klinik für Innere Medizin und Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim
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19
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Hasseli R, Richter JG, Hoyer BF, Lorenz HM, Pfeil A, Regierer AC, Schmeiser T, Strangfeld A, Voll RE, Krause A, Reckert S, Gräßler A, Saar P, Kapelle A, Backhaus M, Blank N, Henes J, Osiek S, Knothe A, Hoese G, Brandt-Jürgens J, Maltzahn A, Specker C, Müller-Ladner U, Schulze-Koops H. Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases. RMD Open 2023; 9:rmdopen-2023-002998. [PMID: 37068915 PMCID: PMC10111193 DOI: 10.1136/rmdopen-2023-002998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs). METHODS Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients' vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression. RESULTS In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14-347) days in patients being double-vaccinated, and after 88 (range 14-270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p<0.001). Mortality was 2% in unvaccinated, 1.8% in the double-vaccinated and 0.6% in triple-vaccinated patients. Compared with unvaccinated patients, double-vaccinated (OR 0.43, 95% CI 0.29 to 0.62) and triple-vaccinated (OR 0.13, 95% CI 0.08 to 0.21) patients showed a significant lower risk of COVID-19-related hospitalisation. Using multivariable analysis, the third vaccination was significantly associated with a lower risk for COVID-19-related death (OR 0.26; 95% CI 0.01 to 0.73). CONCLUSIONS Our cross-sectional data of COVID-19 infections in patients with IRD showed a significant reduction of hospitalisation due to infection in double-vaccinated or triple-vaccinated patients compared with those without vaccination and even a significant reduction of COVID-19-related deaths in triple-vaccinated patients. These data strongly support the beneficial effect of COVID-19 vaccination in patients with IRD. TRIAL REGISTRATION NUMBER EuDRACT 2020-001958-21.
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Affiliation(s)
- Rebecca Hasseli
- Department of Internal Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Munster, Munster, Germany
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Jutta G Richter
- Clinic for Rheumatology, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Hiller Research Center, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bimba Franziska Hoyer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | | | - Tim Schmeiser
- Rheumatology, Private Practice "Rheumatologie im Veedel" Cologne, Cologne, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Centre of Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | | | | | - Petra Saar
- Rheumatology, Private Practice Endokrinologikum, Frankfurt, Germany
| | | | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Academic Hospital of the Charité Berlin, Berlin, Germany
| | - Norbert Blank
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases (INDIRA) and Department of Internal Medicine II (Oncology, Haematology, Rheumatology and Clinical Immunology), University Hospital Tuebingen, Tuebingen, Germany
| | - Silke Osiek
- Rheumatology, Private Practice Dialysezentrum, Schweinfurt, Germany
| | - Anna Knothe
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Guido Hoese
- Rheumatology, Private Practice, Stadthagen, Germany
| | | | | | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University, Munich, Germany
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20
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Müller-Ladner U. [Think systemic-treat individually]. Inn Med (Heidelb) 2023; 64:301-303. [PMID: 36952030 PMCID: PMC10034883 DOI: 10.1007/s00108-023-01494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Ulf Müller-Ladner
- Lehrstuhl für Innere Medizin, Schwerpunkt Rheumatologie, Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2, 61231, Bad Nauheim, Deutschland.
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21
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Huizinga T, Choy E, Praestgaard A, van Hoogstraten H, LaFontaine PR, Guyot P, Aletaha D, Müller-Ladner U, Tanaka Y, Curtis JR, Fleischmann R. Clinical Efficacy of Sarilumab Versus Upadacitinib Over 12 weeks: An Indirect Treatment Comparison. Rheumatol Ther 2023; 10:539-550. [PMID: 36725768 PMCID: PMC10140231 DOI: 10.1007/s40744-022-00521-1] [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: 09/16/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The efficacy of sarilumab and upadacitinib, in combination with disease-modifying antirheumatic drugs (DMARDs), was demonstrated in phase 3 clinical trials of patients with rheumatoid arthritis (RA) refractive to previous biologic DMARDs. In the absence of head-to-head clinical trials, the matching-adjusted indirect comparison (MAIC) and simulated treatment comparison (STC) estimate the relative efficacy of sarilumab and upadacitinib in patients with RA who had an inadequate response to previous biologic DMARDs. METHODS Patient-level data for sarilumab were obtained from the TARGET trial (NCT01709578) and published aggregate data for upadacitinib were obtained from the SELECT-BEYOND trial (NCT02706847). For the MAIC, individual patient data from the TARGET trial were assigned weights such that weighted mean baseline characteristics of the treatment effect modifiers matched those from SELECT-BEYOND. For the STC, the TARGET patient-level data and mean baseline values from SELECT-BEYOND were used to simulate sarilumab treatment effects for a SELECT-BEYOND population. Endpoints evaluated included the American College of Rheumatology (ACR) response criteria ACR20/50/70, Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP) < 3.2, DAS28-CRP < 2.6, Simple Disease Activity Index (SDAI) < 3.3, and Clinical Disease Activity Index (CDAI) < 2.8 at 12 weeks. RESULTS The analysis included 365 patients from TARGET and aggregated data of 333 patients from SELECT-BEYOND. Matching for potential treatment effect baseline modifiers (i.e., age, oral glucocorticoid use, tender joint count of 68 counts, swollen joint count of 66 counts, serum CRP level, and patient global assessment of disease activity) resulted in a reduction of the effective sample size of TARGET population to 166. Following MAIC and STC analysis, the odds of achieving all aforementioned clinical outcomes versus placebo at week 12 were similar for sarilumab and upadacitinib. CONCLUSION In the MAIC and STC analyses from TARGET and SELECT-BEYOND trials, the efficacy of sarilumab and upadacitinib were comparable.
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Affiliation(s)
| | - Ernest Choy
- CREATE Centre, Cardiff University, Cardiff, UK
| | | | | | | | | | | | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University, Campus Kerckhoff, Bad Nauheim, Germany
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX, USA
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22
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Koehm M, Foldenauer AC, Rossmanith T, Alten R, Aringer M, Backhaus M, Burmester GR, Feist E, Kellner H, Krueger K, Müller-Ladner U, Rubbert-Roth A, Tony HP, Wassenberg S, Burkhardt H, Behrens F. Effectiveness of Different Rituximab Doses Combined with Leflunomide in the Treatment or Retreatment of Rheumatoid Arthritis: Part 2 of a Randomized, Placebo-Controlled, Investigator-Initiated Clinical Trial (AMARA). J Clin Med 2022; 11:jcm11247316. [PMID: 36555933 PMCID: PMC9784147 DOI: 10.3390/jcm11247316] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The optimal dose of rituximab in combination with leflunomide in patients with rheumatoid arthritis (RA) is not known. METHODS In Part 1 (previously reported) of the investigator-initiated AMARA study (EudraCT 2009-015950-39; ClinicalTrials.gov NCT01244958), improvements at week (W)24 were observed in patients randomized to rituximab + leflunomide compared with placebo + leflunomide. In the study reported here (Part 2), Part 1 responders received rituximab 500 or 1000 mg at W24/26 plus ongoing leflunomide. Patients were randomized at baseline to their eventual W24 treatment group. The Part 2 primary outcome was the mean Disease Activity Score-28 joints (DAS28) at W52, based on the last observation carried forward (LOCF) analyses and a two-sided analysis of variance. Patient-reported outcomes (PROs) and adverse events were evaluated. RESULTS Eighty-three patients received rituximab at W24/26 (31 rituximab→rituximab 1000 mg; 29 rituximab→rituximab 500 mg; 10 placebo→rituximab 1000 mg; 13 placebo→rituximab 500 mg). At W52, there were no significant differences in DAS28 between rituximab doses in patients originally treated with rituximab or those originally treated with placebo. In the Part 1 placebo group, the higher rituximab dose was associated with greater improvements in ACR response rates and some PROs. Adverse events were similar regardless of rituximab dose. CONCLUSIONS Retreatment with rituximab 500 mg and 1000 mg showed comparable efficacy, whereas an initial dose of rituximab 500 mg was associated with lower response rates versus 1000 mg. Reduced treatment response with the lower dose in patients initially treated with placebo may have been influenced by small numbers and baseline disease activity.
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Affiliation(s)
- Michaela Koehm
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology ITMP, 60596 Frankfurt am Main, Germany
- Division of Rheumatology, University Hospital Frankfurt, Goethe University, 60596 Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), 60596 Frankfurt am Main, Germany
| | - Ann C. Foldenauer
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology ITMP, 60596 Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), 60596 Frankfurt am Main, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology ITMP, 60596 Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), 60596 Frankfurt am Main, Germany
| | | | - Martin Aringer
- Department of Medicine III, University Medical Centre, Faculty of Medicine, Dresden University of Technology, 01307 Dresden, Germany
| | | | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | | | | | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University, Campus Kerckhoff, 61231 Bad Nauheim, Germany
| | - Andrea Rubbert-Roth
- Division of Rheumatology and Clinical Immunology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Hans-Peter Tony
- Department of Rheumatology/Immunology, University of Würzburg, 97080 Würzburg, Germany
| | | | - Harald Burkhardt
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology ITMP, 60596 Frankfurt am Main, Germany
- Division of Rheumatology, University Hospital Frankfurt, Goethe University, 60596 Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), 60596 Frankfurt am Main, Germany
| | - Frank Behrens
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology ITMP, 60596 Frankfurt am Main, Germany
- Division of Rheumatology, University Hospital Frankfurt, Goethe University, 60596 Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), 60596 Frankfurt am Main, Germany
- Correspondence:
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23
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Talarico R, Aguilera S, Alexander T, Amoura Z, Antunes AM, Arnaud L, Avcin T, Beretta L, Bombardieri S, Burmester GR, Cannizzo S, Cavagna L, Chaigne B, Cornet A, Costedoat-Chalumeau N, Doria A, Ferraris A, Fischer-Betz R, Fonseca JE, Frank C, Gaglioti A, Galetti I, Grunert J, Guimarães V, Hachulla E, Houssiau F, Iaccarino L, Krieg T, Limper M, Malfait F, Mariette X, Marinello D, Martin T, Matthews L, Matucci-Cerinic M, Meyer A, Montecucco C, Mouthon L, Müller-Ladner U, Rednic S, Romão VC, Schneider M, Smith V, Sulli A, Tamirou F, Taruscio D, Taulaigo AV, Terol E, Tincani A, Ticciati S, Turchetti G, van Hagen PM, van Laar JM, Vieira A, de Vries-Bouwstra JK, Cutolo M, Mosca M. Publisher Correction: The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET. Nat Rev Rheumatol 2022; 18:734. [PMID: 36203063 PMCID: PMC9540116 DOI: 10.1038/s41584-022-00862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome (SAF España), Elche, Spain
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, French National Referral Center for SLE and APS, Paris, France
| | - Ana M Antunes
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Sara Cannizzo
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lorenzo Cavagna
- Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Benjamin Chaigne
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | | | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandro Ferraris
- Medical Genetics Laboratory, Molecular Medicine Department, San Camillo Forlanini Hospital, Sapienza University, Rome, Italy
| | - Rebecca Fischer-Betz
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - João E Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Andrea Gaglioti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | | | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Thomas Krieg
- Department of Dermatology, Universitätsklinikum, Cologne, Germany
| | - Marteen Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des infections virales et des maladies auto-immunes; AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Rheumatology Department, Le Kremlin Bicêtre, Paris, France
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thierry Martin
- Clinical immunology department, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Lisa Matthews
- Relapsing Polychondritis Awareness and Support, Worcester, UK
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Alain Meyer
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus Liebig University of Giessen, Bad Nauheim, Germany
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital Department of Internal Medicine, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Anna V Taulaigo
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Enrique Terol
- Directorate-General for Health and Food Safety, European Commission, Brussels, Belgium
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Simone Ticciati
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - P Martin van Hagen
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | | | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. .,Rheumatology Unit, University of Pisa, Pisa, Italy.
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24
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Izadi Z, Gianfrancesco MA, Schmajuk G, Jacobsohn L, Katz P, Rush S, Ja C, Taylor T, Shidara K, Danila MI, Wysham KD, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Al-Emadi S, Sparks JA, Hsu TYT, Patel NJ, Wise L, Gilbert E, Duarte-García A, Valenzuela-Almada MO, Ugarte-Gil MF, Ljung L, Scirè CA, Carrara G, Hachulla E, Richez C, Cacoub P, Thomas T, Santos MJ, Bernardes M, Hasseli R, Regierer A, Schulze-Koops H, Müller-Ladner U, Pons-Estel G, Tanten R, Nieto RE, Pisoni CN, Tissera YS, Xavier R, Lopes Marques CD, Pileggi GCS, Robinson PC, Machado PM, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Gore-Massy M, Wallace ZS, Yazdany J. Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study. Lancet Rheumatol 2022; 4:e603-e613. [PMID: 35909441 PMCID: PMC9313519 DOI: 10.1016/s2665-9913(22)00192-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. Funding American College of Rheumatology and European Alliance of Associations for Rheumatology.
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Affiliation(s)
- Zara Izadi
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Milena A Gianfrancesco
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Gabriela Schmajuk
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Patricia Katz
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Stephanie Rush
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Clairissa Ja
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Tiffany Taylor
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Kie Shidara
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine D Wysham
- VA Puget Sound Health Care System and Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- INSERM, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Rheumatology Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, UK
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Martin Schaefer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leanna Wise
- University of Southern California, Los Angeles, CA, USA
| | - Emily Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Científica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Lotta Ljung
- Department of Public Health and Clinical Medicine and Department of Rheumatology, Umeå University, Umeå, Sweden
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Carlo A Scirè
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Eric Hachulla
- INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France, U1286-INFINITE-Institute for Translational Research in Inflammation, Université de Lille, Lille, France
| | - Christophe Richez
- Department of Rheumatology, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeux, France
- UMR-CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Patrice Cacoub
- INSERM 959, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
| | - Thierry Thomas
- Département de Médecine Interne et Immunologie Clinique, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Centre National de Références Maladies Autoimmunes systémiques rares, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Inflammation-Immunopathology-Biotherapy Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
- Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire Saint-Etienne, INSERM U1059, Lyon University, Saint-Etienne, France
| | - Maria J Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
- Instituto de Medicina Molecular, Faculdade Medicina Lisboa, University of Lisbon, Lisbon, Portugal
| | - Miguel Bernardes
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Rheumatology Department, Centro Hospitalar-Universitário de São João, Porto, Portugal
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
| | - Anne Regierer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
| | | | - Romina Tanten
- Hospital Francisco Lopez Lima, General Roca, Argentina
| | - Romina E Nieto
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Santa Fe, Argentina
| | - Cecilia N Pisoni
- Rheumatology and Immunology Section, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno", Buenos Aires, Argentina
| | - Yohana S Tissera
- Servicio de Clínica Médica, Unidad de Reumatología del Hospital Córdoba and Sanatorio Parque de Córdoba, Córdoba, Argentina
| | - Ricardo Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Philip C Robinson
- University of Queensland Medical School, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Pedro M Machado
- University College London, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, London North-West University Healthcare NHS Trust, London, UK
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jean W Liew
- Boston University School of Medicine, Boston, MA, USA
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | | | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA
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Melsens K, Cutolo M, Schonenberg-Meinema D, Foeldvari I, Leone MC, Mostmans Y, Badot V, Cimaz R, Dehoorne J, Deschepper E, Frech T, Hernandez-Zapata J, Ingegnoli F, Khan A, Krasowska D, Lehmann H, Makol A, Mesa-Navas MA, Michalska-Jakubus M, Müller-Ladner U, Nuño-Nuño L, Overbury R, Pizzorni C, Radic M, Ramadoss D, Ravelli A, Rosina S, Udaondo C, van den Berg MJ, Herrick AL, Sulli A, Smith V. Standardised nailfold capillaroscopy in children with rheumatic diseases: a worldwide study. Rheumatology (Oxford) 2022; 62:1605-1615. [PMID: 36005889 PMCID: PMC10070071 DOI: 10.1093/rheumatology/keac487] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To standardly assess and describe nailfold videocapillaroscopy (NVC) assessment in children and adolescents with juvenile rheumatic and musculoskeletal diseases (jRMD) versus healthy controls (HC). METHODS In consecutive jRMD children and matched HC from 13 centres worldwide, 16 NVC images per patient were acquired locally and read centrally per international consensus standard evaluation of the EULAR Study Group on Microcirculation in Rheumatic Diseases. 95 patients with juvenile idiopathic arthritis (JIA), 22 with dermatomyositis (JDM), 20 with systemic lupus erythematosus (cSLE), 13 with systemic sclerosis (jSSc), 21 with localized scleroderma (lSc), 18 with mixed connective tissue disease (MCTD) and 20 with primary Raynaud's phenomenon (PRP) were included. NVC differences between juvenile subgroups and HC were calculated through multivariable regression analysis. RESULTS A total number of 6474 images were assessed from 413 subjects (mean age 12.1-years, 70.9% female). The quantitative NVC-characteristics were significantly lower (↓) or higher (↑) in the following subgroups compared to HC: For density: ↓ in jSSc, JDM, MCTD, cSLE and lSc; For dilations: ↑ in jSSc, MCTD and JDM; For abnormal shapes: ↑ JDM and MCTD; For haemorrhages: ↑ in jSSc, MCTD, JDM and cSLE. The qualitative NVC-assessment of JIA, lSc and PRP did not differ from HC, whereas the cSLE and jSSc, MCTD, JDM, cSLE subgroups showed more non-specific and scleroderma patterns respectively. CONCLUSION This analysis resulted from a pioneering registry of NVC in jRMD. The NVC-assessment in jRMD differed significantly from HC. Future prospective follow up will further elucidate the role of NVC in jRMD.
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Affiliation(s)
- Karin Melsens
- Dpt of Rheumatology, Ghent University Hospital; Dpt of Internal Medicine, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Dieneke Schonenberg-Meinema
- Dpt of Pediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Ivan Foeldvari
- Centre for Paediatric and Adolescent Rheumatology, An der Schön Klinik, Hamburg, Germany
| | - Maria C Leone
- Dpt of Rheumatology, Ghent University Hospital, Ghent, Belgium; Medical and rheumatological clinic, S. Maria Hospital, Terni, Italy
| | - Yora Mostmans
- Dpt of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB); Dpt of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valérie Badot
- Dpt of Rheumatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rolando Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Dpt of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Joke Dehoorne
- Dpt of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deschepper
- Dpt of Public Health and Primary Care, Biostatistics Unit, Ghent University, Ghent, Belgium
| | - Tracy Frech
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology; Salt Lake Veterans Affair Medical Centre, Utah Vascular Research Laboratory, Salt Lake City, Utah, USA
| | | | - Francesca Ingegnoli
- Clinical Rheumatology Unit, Gaetano Pini Hospital, Dpt of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Archana Khan
- Dpt of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Dorota Krasowska
- Dpt of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Hartwig Lehmann
- Dpt of Pediatrics, University Medicine Gießen, Gießen, Germany
| | - Ashima Makol
- Div of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Miguel A Mesa-Navas
- Rheumatology Section, Clínica Universitaria Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Ulf Müller-Ladner
- Dpt of Rheumatology and clinical immunology, Campus Kerckhoff, Justus-Liebig University, Gießen; Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Rebecca Overbury
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology; University of Utah, Dpt of Pediatrics, Div of Pediatric Rheumatology, Salt Lake City, Utah, USA
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Mislav Radic
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology, Salt Lake City, Utah, USA; University Hospital Split, Split, Croatia
| | - Divya Ramadoss
- Dpt of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini; University of Genoa, Genoa, Italy; Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clara Udaondo
- Pediatric Rheumatology Dept., La Paz Children's Hospital, Madrid, Spain
| | - Merlijn J van den Berg
- Dpt of Pediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Vanessa Smith
- Dpt of Rheumatology, Ghent University Hospital; Dpt of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, Inflammation Research Centre, VIB-Ghent University, Ghent, Belgium
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Thomalla M, Schmid A, Hehner J, Koehler S, Neumann E, Müller-Ladner U, Schäffler A, Karrasch T. Toll-like Receptor 7 (TLR7) Is Expressed in Adipocytes and the Pharmacological TLR7 Agonist Imiquimod and Adipocyte-Derived Cell-Free Nucleic Acids (cfDNA) Regulate Adipocyte Function. Int J Mol Sci 2022; 23:ijms23158475. [PMID: 35955609 PMCID: PMC9369246 DOI: 10.3390/ijms23158475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
Endosome-localized Toll-like receptors (TLRs) 3 and 9 are expressed and functionally active in adipocytes. The functionality and role of TLR7 in adipocyte biology and innate immunity of adipose tissue (AT) is poorly characterized. We analyzed TLR7 mRNA and protein expression in murine 3T3-L1 and primary adipocytes, in co-cultures of 3T3-L1 adipocytes with murine J774A.1 monocytes and in human AT. The effects of TLR7 agonists imiquimod (IMQ) and cell-free nucleic acids (cfDNA) on adipokine concentration in cell-culture supernatants and gene expression profile were investigated. We found that TLR7 expression is strongly induced during adipocyte differentiation. TLR7 gene expression in adipocytes and AT stroma-vascular cells (SVC) seems to be independent of TLR9. IMQ downregulates resistin concentration in adipocyte cell-culture supernatants and modulates gene expression of glucose transporter Glut4. Adipocyte-derived cfDNA reduces adiponectin and resistin in cell-culture supernatants and potentially inhibits Glut4 gene expression. The responsiveness of 3T3-L1 adipocytes to imiquimod is preserved in co-culture with J774A.1 monocytes. Obesity-related, adipocyte-derived cfDNA engages adipocytic pattern recognition receptors (PRRs), modulating AT immune and metabolic homeostasis during adipose inflammation.
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Affiliation(s)
- Miriam Thomalla
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
| | - Andreas Schmid
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
| | - Julia Hehner
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
| | - Sebastian Koehler
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
| | - Elena Neumann
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, 61231 Bad Nauheim, Germany; (E.N.); (U.M.-L.)
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, 61231 Bad Nauheim, Germany; (E.N.); (U.M.-L.)
| | - Andreas Schäffler
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
| | - Thomas Karrasch
- Department of Internal Medicine III, Justus-Liebig-University Giessen, 35390 Gießen, Germany; (M.T.); (A.S.); (J.H.); (S.K.); (A.S.)
- Correspondence:
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Fuchs J, Arnold M, Frommer K, Aykara I, Laibe T, Rehart S, Müller-Ladner U, Neumann E. POS0429 ACTIVATED RHEUMATOID ARTHRITIS SYNOVIAL FIBROBLASTS ALTER OSTEOCLAST DIFFERENTIATION AND ACTIVITY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn rheumatoid arthritis (RA), osteoclasts are one of the most important mediators of bone erosion. In addition, RA synovial fibroblasts (RASF) have a major influence on joint erosion in RA. They affect osteoclast differentiation e.g. by increased RANKL production or secretion of other pro-osteoclastogenic factors such as IL-6. In addition to the pro-osteoclastogenic effect of soluble factors such as RANKL and IL-1, visfatin inhibits osteoclast differentiation. Furthermore, visfatin increases the secretion of pro-inflammatory factors by RASF, such as IL-6 or matrix degrading enzymes.ObjectivesIn this study, the effect of RASF with/without activation by visfatin and IL-1 on osteoclastogenesis was evaluated.MethodsBlood from healthy donors and RA patients was used for PBMC isolation. RANKL, TGF-β and hM-CSF were added to induce osteoclast differentiation. RASF-conditioned media (CM) were prepared from confluent RASF cultured for 48h. Differentiating PBMCs in monoculture were compared to PBMC cultured with CM from RASF (CM: 10%, 20%, 30%) as well as in direct co-culture with RASF with/without stimulation with IL-1 (0.05ng/ml), visfatin (25ng/ml). After two weeks in culture, cells were stained using TRAP staining. 3-5 images per well were used for quantification dependent on the variability of the wells. IL-6 was measured by ELISA in supernatants collected at day 14.ResultsIL-6 production increased by IL-1 (e.g. co-culture: 2,8-fold) and visfatin (CM-visfatin: 10%=4,3-fold, 20%=5,4-fold, 30%=4,2-fold; co-culture: 9,5-fold) compared to unstimulated control in all settings. In addition, IL-6 was increased with the addition of CM compared to unstimulated controls (healthy donors CM 30%: unstimulated p=0.0342, IL-1 p=0.0133, visfatin p=0,0133; RA: unstimulated p=0.0133, IL-1 p=0.0342, visfatin p=0.0133, n=3 each). Of note, baseline IL-6 concentrations were higher in PBMC from RA patients compared to healthy donors. Co-culture showed an additional increase in IL-6 levels in all settings (e.g. monoculture: IL-1 4.71±5.75pg/ml, visfatin 141.09±182.79pg/ml; co-culture: IL-1 7241±10398pg/ml, visfatin 24535±16994pg/ml;). During osteoclast differentiation, addition of CM showed similar osteoclastogenesis with similar proportion of osteoclasts with 2 and 3-5 vs. higher numbers of nuclei per cell compared to control. In coculture with RASF osteoclasts showed a stronger TRAP signal compared to monoculture especially for unstimulated and IL-1 stimulated co-cultures.ConclusionBoth, in monoculture with CM and in coculture, IL-6 levels were increased compared to control, whereas in RA patients the IL-6 levels were higher compared to healthy donors. The CM containing secreted factors of RASF did not have a prominent influence on osteoclastogenesis. However, the presence of RASF increased the TRAP signal showing an increased activity of differentiated osteoclasts especially in unstimulated and IL-1 stimulated co-cultures but not with addition of visfatin.ReferencesNone.Disclosure of InterestsNone declared.
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Sarbu AC, Guler S, Stadler O, Allanore Y, Bernardino V, Distler JHW, Gabrielli A, Hoffmann-Vold AM, Matucci-Cerinic M, Müller-Ladner U, Ortiz-Santamaria V, Rednic S, Riccieri V, Smith V, Ullman S, Walker U, Geiser T, Distler O, Maurer B, Kollert F. POS0873 PERSISTENT INFLAMMATION IN SYSTEMIC SCLEROSIS IS STRONGLY ASSOCIATED WITH SEVERE DISEASE AND MORTALITY: AN ANALYSIS FROM THE EUSTAR DATABASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic sclerosis (SSc) is a heterogeneous autoimmune disease, with a high disease-related mortality and morbidity. A subset of patients show elevated CRP levels (20-35%), which has been reported as inflammatory SSc. Preliminary data suggest that this subset is characterized by a severe phenotype.ObjectivesTo analyse the phenotype and the survival of inflammatory compared with non-inflammatory SSc patient subsets.MethodsData from 8571 SSc patients with available CRP measurement from the EUSTAR cohort were analysed. Exclusion criteria included acute infection, missing follow-up and tocilizumab treatment. Patients with a CRP ≥5mg/l at ≥80% of visits were stratified as persistent inflammatory and as non-inflammatory if CRP was ≥5 mg/l at <20% of visits (as described previously (1)). As a sensitivity analysis, patients were defined as inflammatory and non-inflammatory based on a single CRP measurement at baseline only (CRP ≥5 or <5mg/l, respectively). We compared baseline characteristics using Chi-square and non-parametric Kruskal–Wallis tests as appropriate. Kaplan Meier curves with log-rank tests were used to estimate time from baseline to death or censoring, and Cox regression to compare mortality risks adjusted for time from diagnosis to baseline.ResultsOut of 2883 patients with more than two visits, 404 (14%) showed persistent inflammation and 1032 (36%) a non-inflammatory phenotype. Out of 5619 patients with more than one visit, 1830 (33%) were stratified as inflammatory as defined by as single CRP measurement at baseline and 3789 (67%) as non-inflammatory. With both definitions, the inflammatory subset revealed a more severe phenotype than non-inflammatory patients, including more frequent diffuse-cutaneous disease, anti-Scl-70 autoantibodies, pulmonary fibrosis, pulmonary hypertension, higher modified Rodnan skin score, and lower forced vital capacity and diffusing capacity for carbon monoxide. Patients with persistent inflammation had a strongly increased risk of all-cause mortality (HR 7.1 [95%CI 3.7 to 13.5], p<0.001) compared to non-inflammatory patients, whereas this association was weaker when based on a single CRP measurement (HR 2.6 [95%CI 2.1 to 3.2], p<0.001).ConclusionThe severe phenotype and decreased survival of the inflammatory SSc subset, which was most prominent in patients with persistently elevated CRP levels, suggest a distinct disease subset. Therefore both, the need for more regular monitoring of inflammatory parameters and implications for immune-modulating treatment, needs to be carefully analysed.References[1]Mitev, A., et al., Inflammatory stays inflammatory: a subgroup of systemic sclerosis characterized by high morbidity and inflammatory resistance to cyclophosphamide. Arthritis Res Ther, 2019. 21(1): p. 262. PMID: 31791379Figure 1.Overall mortality from baseline onward a. by persistent inflammatory phenotype, b. by inflammatory phenotype at baselineDisclosure of InterestsAdela-Cristina Sarbu: None declared, Sabina Guler: None declared, Odile Stadler: None declared, Yannick Allanore: None declared, Vera Bernardino: None declared, Jörg H.W. Distler: None declared, Armando Gabrielli: None declared, Anna-Maria Hoffmann-Vold: None declared, Marco Matucci-Cerinic: None declared, Ulf Müller-Ladner: None declared, Vera Ortiz-Santamaria: None declared, Simona Rednic: None declared, Valeria Riccieri: None declared, Vanessa Smith: None declared, Susanne Ullman: None declared, Ulrich Walker: None declared, Thomas Geiser: None declared, Oliver Distler: None declared, Britta Maurer Speakers bureau: Boehringer-Ingelheim, Consultant of: Novartis, Boehringer Ingelheim, Janssen-Cilag, Grant/research support from: AbbVie, Protagen, Novartis Biomedical Research, Florian Kollert Shareholder of: Roche, Consultant of: BMS, Actelion, Boehringer-Ingelheim, Pfizer, Grant/research support from: Roche, Gilead, Pfizer, Employee of: Roche
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Di Cianni F, Cardelli C, Italiano N, Laurino E, Moretti M, Depascale R, Gamba A, Iaccarino L, Doria A, Sousa Bandeira MJ, Dinis SP, C Romão V, Alessandri E, Gotelli E, Paolino S, DI Giosaffatte N, Grammatico P, Ferraris A, Cavagna L, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Tincani A, D’urzo R, Bombardieri S, Burmester GR, Cutolo M, Fonseca JE, Frank CH, Galetti I, Hachulla E, Houssiau F, Marinello D, Müller-Ladner U, Schneider M, Smith V, Talarico R, Van Laar JM, Vieira A, Tani C, Mosca M. POS1232 LONG-TERM OUTCOMES OF COVID-19 VACCINATION IN PATIENTS WITH RARE AND COMPLEX CONNECTIVE TISSUE DISEASES: AN AD-INTERIM ANALYSIS OF ERN-ReCONNET VACCINATE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSince the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefits of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group).ObjectivesTo evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://brightoncollaboration.us/wp-content/uploads/2021/01/SO2_D2.1.2_V1.2_COVID-19_AESI-update-23Dec2020-review_final.pdf)MethodsThe first ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defined as at least one of the following: new manifestations attributable to disease activity, hospitalization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants.ResultsA cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren’s syndrome (SS,12%), idiopathic inflammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Danlos’s syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the first and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%).ConclusionThis preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the first month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.Table 1.AEs and disease exacerbations per diseaseDiagnosisPatients enrolled (%) (n=300)EAs after 1st and 2nd dose (%)Exacerbations (%)APS25714EDS45033IIM10527MCTD44225SS12598SLE44698SSC16492UCTD850-AcknowledgementsVACCINATE is a study promoted by the European Reference Network on rare and complex connective tissue diseases, ERN ReCONNET. This publication was funded by the European Union’s Health Programme (2014-2020)Disclosure of InterestsNone declared
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Müller-Ladner U, Gaffney K, Jadon D, Matucci-Cerinic M, Chamizo Carmona E, Freudensprung U, Addison J. AB0348 THE PROPER STUDY: A 48-WEEK ANALYSIS OF A PAN-EU REAL-WORLD STUDY OF SB5 BIOSIMILAR FOLLOWING TRANSITION FROM REFERENCE ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS OR PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSB5, a biosimilar to reference adalimumab (ADL), received EU marketing authorisation in 2017, based on pre-clinical and clinical phase I and III studies that demonstrated bioequivalence and comparable efficacy, safety and immunogenicity to ADL.ObjectivesThe real-world study ‘PROPER’ is designed to provide insights into outcomes of the transition from ADL to SB5 outside the randomised, controlled, clinical trial setting.MethodsUnder an umbrella design, 1000 patients with immune-mediated inflammatory disease were enrolled at centres in Belgium, Germany, Ireland, Italy, Spain and the UK, and followed for 48 weeks post-transition. Eligible patients with a diagnosis of rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), ulcerative colitis or Crohn’s disease had been transitioned to SB5 as part of routine treatment following a minimum of 16 weeks’ treatment with ADL. Data were captured from patient charts retrospectively for 24 weeks prior to and prospectively and/or retrospectively up to 48 weeks after SB5 initiation. This analysis of the rheumatology cohort reports clinical characteristics, disease scores, persistence on SB5, clinical management and safety up to the closing date of November 30th, 2021.ResultsOf the 496 patients included in this analysis, the majority were enrolled in UK (n=174), Germany (n=145) and Spain (n=73); Italy, Ireland and Belgium enrolled 45, 44 and 15 patients respectively. At study close, 487 patients had completed 48 weeks of follow-up; 397 of those remained on SB5 throughout.Methotrexate was received as concomitant therapy by 37% of patients and 20% had received a biologic therapy prior to reference ADL. Most patients (89.3% of RA, 92.1% of axSpA, 97.3% of PsA) transitioned to SB5 at the same dose regimen received for ADL.Clinical characteristics, SB5 dose and flare are detailed in Table 1, disease scores in Figure 1.Table 1.Patient clinical characteristics, SB5 dose, flareRA (N=207)axSpA (N=127)PsA (N=162)Age at SB5 initiation (years), mean (SD); IQR60.1 (11.8)53.0, 68.050.3 (13.4)38.0, 61.053.3 (12.0)45.0, 62.0Duration of disease (years), mean (SD); IQR13.3 (11.4)5.0, 19.518.8 (13.5)9.0, 25.012.2 (9.9)4.0, 19.0n%n%n%Women15072.54031.57345.1Patients receiving SB5 40mg Q2WBaseline15273.411590.614992.0Week 4813272.59387.712491.9Episodes of Flare018790.310784.313985.81209.71814.22012.3200.021.631.9How was Flare diagnosedDisease score1155.0731.81038.5Patient-reported symptoms1995.022100.026100.0Secondary Loss of Response315.000.0726.9Action taken for FlareBiologic therapy dose adjusted420.029.1519.2Non-biologic therapy dose adjusted840.0313.6934.6Clinical investigation00.014.5311.5Other*945.01359.11661.5*Includes cessation of therapy, prescription of corticosteroids, physical exercise, no action.IQR, interquartile range; SD, standard deviation; Q2W once two-weekly.Figure 1.Disease scores (paired patients), mean (95% CI)Fifteen patients each experienced one unrelated Serious Adverse Event (SAE): 2 in the axSpA cohort [tachycardia, intracranial haemorrhage]; 6 in the PsA cohort [myocardial infarct (2), breast carcinoma, COVID-19, gallbladder calculus, dyspnoea]; 7 in the RA cohort [facial numbness, depression, COVID-19, pneumonia, diverticulitis, parvovirus, coronary occlusion]. Two patients reported SAEs considered causally related to SB5: Herpes zoster and pneumonia (RA cohort), and ALS with worsening (PsA cohort).ConclusionThis analysis of a large, contemporary cohort of EU patients with established RA, axSpA or PsA shows treatment effectiveness maintained at 48 weeks after switching from ADL to SB5, with most patients continuing on SB5 Q2W throughout. Episodes of flare were uncommon, and the importance of patient-reported symptoms in recognition of flare is evident. No new safety signals were observed.AcknowledgementsStatistical services were provided by FGK Clinical Research GmbH, Munich, Germany. Data management services were provided by Worldwide Clinical trial, Research Triangle Park, NC, USA. Funding was provided by Biogen International GmbH.Disclosure of InterestsUlf Müller-Ladner Consultant of: Biogen, Grant/research support from: Biogen, Karl Gaffney Speakers bureau: Novartis, UCB, AbbVie, Lilly, Consultant of: Novartis, UCB, AbbVie, Lilly, Pfizer, Grant/research support from: NAAS, AbbVie, Pfizer, UCB, Novartis, Lilly, Cellgene, Celltrion, Janssen, Gilead, Biogen, Deepak Jadon Consultant of: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Marco Matucci-Cerinic Consultant of: Chemomab, Biogen, Pfizer, Lilly, Behring, Janssen, MSD, Eugenio Chamizo Carmona Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Fresenius-Kabi, Galapagos, Janssen, MSD, Novartis, Pfizer, and UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Fresenius-Kabi, Galapagos, Janssen, MSD, Novartis, Pfizer, and UCB, Ulrich Freudensprung Shareholder of: May hold stock in Biogen, Employee of: Biogen, Janet Addison Shareholder of: May hold stock in Biogen, Employee of: Biogen
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Hasseli R, Hoyer BF, Lorenz HM, Pfeil A, Regierer A, Richter J, Schmeiser T, Strangfeld A, Voll R, Schulze-Koops H, Krause A, Specker C, Müller-Ladner U. POS1246 COVID-19 IN RITUXIMAB TREATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAt the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic, the influence of anti-inflammatory therapy on the course of SARS-CoV-2 infection in patients with inflammatory rheumatic diseases (IRD) was unknown. In the meantime, several data indicate an association of severe courses of COVID-19 with the use of rituximab (RTX).ObjectivesTo gather further knowledge about SARS-CoV-2 infections in RTX-treated IRD patients, data from the German COVID-19-IRD-registry were analysed.MethodsHospitalisation was used as a surrogate of COVID-19 severity. Baseline characteristics, disease features, medication and outcome of COVID-19 were compared in RTX-treated inpatients and outpatients.ResultsIn total, 3592 cases were reported in the registry, which included 130 RTX patients (3.6%) for our analysis. RTX-treated inpatients were older than RTX-treated outpatients (median age 63 y vs 56 y, p=0.007). Patients with granulomatosis with polyangiitis treated with RTX (n=32) showed a significant higher COVID-19 related hospitalisation rate (33% vs 11%, p=0.005), which was not the case for patients with rheumatoid arthritis (49% vs 50%). Cardiovascular comorbidities were reported more frequently in hospitalised RTX-treated patients (20% vs. 6%, p=0.032). More than 50% of the RTX-treated inpatients developed COVID-19 related complications, e.g. acute respiratory distress syndrome. The median time period between the last RTX treatment and SARS-CoV-2 infection was shorter in inpatients than in non-hospitalised patients (3 (range 0-17) vs. 4 months (range -29), p=0.039). The COVID-19 related mortality rate was 14% (n=19) in RTX-treated IRD patients. In RTX-treated inpatients and outpatients, there were no relevant differences with respect to the use of concomitant glucocorticoids or other disease modifying anti-rheumatic drugs, disease activity, median last RTX dose or median number of immunomodulatory drugs prior to RTX treatment.ConclusionIn addition to general risk factors, such as age and comorbidities, it is already known that IRD patients treated with RTX show a higher rate of severe COVID-19. In our registry, RTX-treated patients with granulomatosis with polyangiitis appear to be at even higher risk to develop severe COVID-19 compared to other IRD. Moreover, the shorter the time since the last RTX treatment, the higher seems to be the risk of developing severe COVID-19. This might be explained by a more profound B-cell depletion in the first weeks after RTX treatment warranting further studies.Disclosure of InterestsNone declared
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Lazzaroni MG, Wilson M, Hensor E, Distler JHW, Cuomo G, Siegert E, Müller-Ladner U, Allanore Y, Salvador MJ, Anic B, Walker U, Czirják L, Ribi C, Tanaseanu CM, Gabrielli A, Hoffmann-Vold AM, Distler O, Del Galdo F. POS0893 FACTORS TO CONSIDER FOR MEASURING THE EFFECT OF LUNG FUNCTION ON PATIENT REPORTED OUTCOMES IN SYSTEMIC SCLEROSIS PATIENTS: ANALYSIS OF THE EUSTAR DATABASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatient Reported Outcomes (PROs) are central to measure how patients feel and function especially when determining the effect of disease modifying agents. In patients with Systemic Sclerosis associated Interstitial Lung Disease (SSc-ILD), dyspnea is the main driver of HAQ decline but the effect of reduced lung function on both generic and specific measures of functional impairment is not well defined, and there are many potential confounding biases that could distort the apparent extent and direction of this relationship. Moreover, collider biases potentially induced by selection into the cohort and in clinical trials can also play a role.ObjectivesTo define within the EUSTAR database, the correlation of Forced Vital Capacity (FVC) and functional impairment PROs and identify potential confounders to be considered in casual inference studies.MethodsA cross-sectional analysis included for each patient with SSc-ILD (by X-ray and/or HRCT) in the EUSTAR registry the last visit with at least one PRO (Health Assessment Questionnaire Disability Index [HAQ-DI], Cochin hand function scale [CHFS] and/or dyspnoea visual analogue scale [VAS]) and % predicted FVC (%pFVC), if available. Patients with LVEF≤50% or pulmonary arterial hypertension at RHC were excluded. SSc-ILD with restricted lung volume was defined as %pFVC≤70 [1]. Spearman’s correlation analysis was performed. Results of this analysis and literature review were integrated to design a directed acyclic graph (DAG) and identify the appropriate confounder adjustment set for the total causal effect of FVC on functional impairment PROs.ResultsAmong 17.338 SSc patients in the EUSTAR registry (extracted in November 2019), 727 SSc-ILD patients fulfilled the inclusion criteria (median %pFVC 90 (IQR 74-104), median %pDLCO 60 (IQR 47-52)). Patients with %pFVC<70 (n=149), as compared to those with %pFVC≥70 (n=578) had worse HAQ-DI, CHFS and VAS-dyspnoea scores (Table 1). In unadjusted analysis, %pFVC showed a weak correlation with HAQ-DI (r=-0.21) and CHFS (r=-0.17), but a stronger correlation with VAS dyspnoea (r=-0.33).Table 1.Results are reported as number/number available (%) for dichotomic variables, or as median (IQR) (n available) for continuous variables.%pFVC≥70 (n=578)%pFVC<70 (n=149)Age at disease onset (years)60.6 (52.3-69.3) (546)52.5 (45.6-63-7) (137)Disease duration (months)134.4 (77.5-212.2) (546)110.3 (66.3-199.7) (137)Male sex84/578 (14.5)32/149 (21.5)Anti-Scl70+231/468 (40.7)81/122 (66.4)Smoker ever52/389 (13.4)17/107 (15.9)Caucasian ethnicity545/569 (95.8)131/145 (90.3)dcSSc167/559 (29.9)74/147 (50.3)Oesophageal symptoms319/571 (55.9)93/147 (63.3)Muscle weakness78/565 (13.8)37/149 (24.8)CRP elevation141/540 (26.1)53/134 (39.6)Elevated sPAP (ECHO)45/456 (9.9)21/121 (17.2)Pericardial effusion2/448 (0.4)4/110 (3.6)Diastolic function abnormality151/431 (35.0)31/102 (30.4)Conduction blocks78/480 (16.3)35/120 (29.2)%pDLCO62 (52-74) (527)42 (35-53) (118)CHFS7 (1-23) (493)16 (2-34.8) (114)HAQ-DI0.63 (0.13-1.13) (578)1.25 (0.38-2) (139)VAS dyspnoea (0-100)15 (10-45) (391)40 (20-70) (109)NYHA stage 3/447/561 (8.4)37/143 (25.9)Subsequently, we created a DAG showing the proposed causal pathway considered relevant to the relationship between FVC and HAQ (Figure 1).ConclusionLung function as measured by FVC appears to correlate with worse patient-reported function in our unadjusted analysis of the large multicentre EUSTAR dataset. However, to estimate the total causal effect we must consider a multitude of potentially confounding factors, which need to be integrated and analysed in a causal inference framework. The proposed DAG will inform the development of simulations of the potential impact of bias (confounding, collider and omitted variable) on effect estimates we could obtain from EUSTAR cohort.References[1]Goh NS, et al. Am J Respir Crit Care Med, 2008.Disclosure of InterestsMaria Grazia Lazzaroni Grant/research support from: Research grant from Boehringer-Ingelheim, Michelle Wilson Grant/research support from: Research grant from Boehringer-Ingelheim, Elizabeth Hensor: None declared, Jörg H.W. Distler: None declared, Giovanna Cuomo: None declared, Elise Siegert: None declared, Ulf Müller-Ladner: None declared, Yannick Allanore: None declared, Maria Joao Salvador: None declared, Branimir Anic: None declared, Ulrich Walker: None declared, László Czirják: None declared, Camillo Ribi: None declared, Cristina-Mihaela Tanaseanu: None declared, Armando Gabrielli: None declared, Anna-Maria Hoffmann-Vold: None declared, Oliver Distler: None declared, Francesco Del Galdo: None declared
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Bjørkekjær HJ, Bruni C, Carreira P, Airò P, Simeón-Aznar CP, Truchetet ME, Giollo A, Balbir-Gurman A, Martin M, Denton CP, Gabrielli A, Fretheim H, Barua I, Bitter H, Midtvedt Ø, Broch K, Andreassen A, Tanaka Y, Riemekasten G, Müller-Ladner U, Matucci-Cerinic M, Castellví I, Siegert E, Hachulla E, Distler O, Hoffmann-Vold AM. POS0387 RISK STRATIFICATION APPROACHES PERFORM DIFFERENTLY IN SSc-ASSOCIATED PAH IN EUSTAR. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPulmonary arterial hypertension (PAH) is a major clinical challenge in systemic sclerosis (SSc), and is associated with high mortality. Risk stratification provides an estimate for individual patient risk of 1-year mortality. The aim is to detect patients with the worst prognosis to optimize management strategies. Nine risk stratification approaches have been proposed in PAH, but have not been validated in SSc-PAH.ObjectivesTo assess four risk stratification models and their performance to predict 1- and 3- year mortality and to identify the best risk assessment approach for SSc-PAH.MethodsWe included all patients with SSc diagnosed with PAH by right heart catheterization (RHC) from the European scleroderma trial and research (EUSTAR) database from 2001 to February 2021. PAH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg, pulmonary artery wedge pressure (PAWP) ≤15mmHg, and pulmonary vascular resistance (PVR) >3 Wood units (WU) in the absence of significant interstitial lung disease. We applied four different approaches for risk stratification at time of PAH diagnosis. Risk parameters included New York Heart Association (NYHA) class, 6-minute walk distance (6MWD), NT-proBNP or BNP, and echocardiographic and hemodynamic parameters with cut-off values based on the 2015 ESC/ERS Guidelines. Model 1 and 2 stratified patients into low, intermediate and high-risk categories; while Model 3 and 4 stratified the patients into four categories (low, intermediate-low, intermediate-high and high).Model 1: Patients with ≥ 1 high-risk parameter were considered at high risk; with ≥ 1 intermediate-risk parameter at intermediate risk, otherwise at low risk1Model 2: Each variable was graded from 1 to 3 representing low to high risk. The mean of available risk parameters was rounded to the nearest integer to define the risk category2Model 3: Equals Model 2, but the intermediate risk group was divided into intermediate-low and intermediate-high based on the mean score3Model 4: Stratifies patients into four risk categories based on the proportion of low-risk parameters3We performed analysis of 1- and 3- year mortality in patients with a minimum follow-up of 1 and 3 years, respectively.ResultsOf 911 patients who conducted RHC, 273 (30%) were diagnosed with SSc-PAH according to the inclusion criteria (Table 1). Median follow-up time was 2.8 years (IQR 1.3-5.3). The models varied in their ability to predict mortality (Figure 1). Model 1 and 4 either over- or underestimated mortality. Model 2 stratified patients according to the expected 1-year mortality of <5%, 5-10% and >10% suggested by the ESC/ERS Guidelines. Model 3, which divided the intermediate risk group in two different risk groups, segregated the risk of mortality further within this group.Table 1.Demographic and clinical characteristics of patients segregated by risk stratification (Model 3)NAll patients (n=273)Low-risk (n=78)Intermediate-low (n=118)Intermediate-high (n=56)High-risk (n=21)Age, years (SD)27365 (10.7)65 (10.3)65 (10.7)65 (10.8)67 (12.8)Female sex, n (%)273230 (84)64 (82)98 (83)48 (86)20 (95)lcSSc, n (%)263221 (84)60 (80)99 (86)47 (90)15 (71)NYHA 3 or 4, n (%)261155 (59)12 (16)75 (68)49 (89)19 (95)NT-proBNP, pg/ml (IQR)1111941 (230-1485)215 (103-377)763 (325-1418)1926 (1051-5681)3314 (1129-6553)6MWD, m (SD)196321 (124.1)404 (119.7)314 (99.9)262 (128.6)215 (96.0)RHC:- mPAP, mmHg (SD)27340 (11.0)35 (8.8)41 (11.5)41 (10.8)45 (11.6)- PAWP, mmHg (SD)2739 (3.2)9 (3.0)9 (3.4)9 (3.2)8 (3.1)- Cardiac index, l/min/m2(SD)2602.8 (0.8)3.2 (0.7)2.7 (0.8)2.6 (1.0)2.0 (0.5)- PVR, WU (SD)2737.4 (4.1)5.3 (2.8)7.9 (4.0)7.9 (4.2)11.3 (4.7)Figure 1.1- and 3-year mortality according to risk category in the four different modelsConclusionModel 3 provides signals for a better risk stratification of patients with newly diagnosed SSc-PAH, with progressively increasing mortality across the categories. This may provide guidance for optimized management in clinical practice.References[1]Hoffmann-Vold, Rheum 2018[2]Kylhammar, Eur Heart J 2018[3]Kylhammar, ERJ open 2021AcknowledgementsThe authors thank all EUSTAR collaborators.Disclosure of InterestsHilde Jenssen Bjørkekjær: None declared, Cosimo Bruni Speakers bureau: Actelion, Consultant of: Boehringer-Ingelheim, Patricia Carreira: None declared, Paolo Airò Speakers bureau: Boehringer Ingelheim, Bristol-Myers-Squibb, Consultant of: Bristol-Myers-Squibb, Grant/research support from: Bristol-Myers-Squibb, Roche, Janssen, CSL Behring, Carmen Pilar Simeón-Aznar Speakers bureau: Janssen, Boehringer Ingelheim and MSD, Consultant of: Janssen, Boehringer Ingelheim, Marie-Elise Truchetet: None declared, Alessandro Giollo: None declared, Alexandra Balbir-Gurman: None declared, Mickael Martin: None declared, Christopher P Denton Speakers bureau: Boehringer Ingelheim; Janssen, Consultant of: Boehringer Ingelheim; GSK; Corbus; Sanofi; Roche; Horizon; CSL Behring; Acceleron, Grant/research support from: CSL Behring; Horizon; GSK; Servier, Armando Gabrielli: None declared, Håvard Fretheim Consultant of: Bayer, GSK, Actelion, Imon Barua: None declared, Helle Bitter Speakers bureau: Boehringer Ingelheim, Øyvind Midtvedt: None declared, Kaspar Broch: None declared, Arne Andreassen: None declared, Yoshiya Tanaka Speakers bureau: Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Consultant of: Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie, Grant/research support from: Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, Gabriela Riemekasten: None declared, Ulf Müller-Ladner: None declared, Marco Matucci-Cerinic: None declared, Ivan Castellví: None declared, Elise Siegert: None declared, Eric Hachulla Speakers bureau: Johnson & Johnson, GlaxoSmithKline, Roche-Chugai, Consultant of: Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Grant/research support from: CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim
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Abouyahya I, Liem S, Amoura Z, Fonseca JE, Chaigne B, Cutolo M, Doria A, Fischer-Betz R, Guimaraes V, Hachulla E, Huizinga T, van Laar JM, Martin T, Matucci-Cerinic M, Montecucco C, Schneider M, Smith V, Tincani A, Müller-Ladner U, de Vries-Bouwstra J. AB0675 Health related quality of life in patients with mixed connective tissue disease: A comparison with matched systemic sclerosis patients. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMixed connective tissue disease (MCTD) is a systemic auto-immune disorder, being probably the least common among the connective tissue diseases. Symptoms can be severe and could affect health-related quality of life (HRQoL). Identification of the burden of MCTD patients is of key importance to provide appropriate pharmacological and non-pharmacological care. No reports on HRQoL have been published in adult patients with MCTD.ObjectivesTo perform an explorative study to evaluate HRQoL and its main determinants in MCTD patients, and compare HRQoL between MCTD and matched systemic sclerosis (SSc) patients.MethodsMCTD patients fulfilling the Kahn criteria and participating in the MCTD prospective follow-up cohort of the Leiden University Medical Center were included. In addition, SSc patients matched for age, gender and disease duration were included for comparison. Data on disease characteristics, functional disability and HRQoL were collected annually for both disease groups. HRQoL was evaluated using the 36-Item Short Form Health Survey (SF36) and EuroQol (EQ5D). At baseline, HRQoL, as reflected by SF36 mental component score (MCS), SF 36 physical component score (PCS) and EQ5D were compared between MCTD and SSc patients. For MCTD patients, factors associated with HRQoL at baseline were identified using linear regression and change in HRQoL over 3 years was evaluated using linear mixed models. In addition, characteristics of MCTD patients who showed worsening of MCS and/or had PCS superior to the minimal clinical important difference of three points were identified.ResultsThirty-four MCTD patients (121 visits; 82% female, mean age 42 years, median disease duration 45 months) and 102 SSc patients (424 visits; 82% female, mean age 45 years, median disease duration 49 months) were included. At baseline, MCTD-patients more often had ILD (47% vs. 34%, p=0.027), cardiac involvement (30% vs. 2%, p<0.001), synovitis (26% vs. 11%, p=0.004) and myositis (15% vs. 1%, p=0.001) compared to SSc patients, whereas SSc patients more often used immunosuppressive treatments except for hydroxychloroquine (MCTD:18% vs. SSc:7%, p=0.007).Baseline HRQoL in MCTD was comparable to HRQoL in SSc, with mean SF36-PCS of 40.2 (SD:9.1) and mean SF36-MCS of 44.9 (SD:9.9), which is (nearly) one standard deviation lower than the general Dutch population. The SF36 subscore “general health perception” was the most impacted in both groups (MCTD: 38.5 [SD:7.0], SSc: 39.9 [SD:8.9]). The median EQ5DNL was 0.38 (IQR:0.14 – 0.54) and comparable between SSc and MCTD.At baseline, in MCTD, ILD was significantly associated with SF36-PCS (β:6.98, 95% CI: 1.10 to 12.86) and SF36-MCS (β:-8.10, 95% CI:-14.93 to -1.26). Sclerodactyly was significantly associated with EQ5DNL (β:0.006; 95% CI:0.002 to 0.010) and SF36-PCS (β:0.12, 95% CI:0.03 to 0.21). No other significant associations were identified.Over time, in MCTD, both the SF36-MCS and SF36-PCS improved significantly (MCS: β:2.35/year [95% CI:0.58 to 4.13], PCS: β:1.34/year [95% CI:0.03 to 2.65), whereas EQ5DNL was stable. Explorative analyses did not reveal a specific clinical characteristic with significant impact on the change of HRQoL over time. With an MCID of 3 points on the MCS and PCS, 7 MCTD-patients worsened on the MCS and 3 on the PCS. Patients who showed worsening of MCS over time tended to be older, more often had ILD, sclerodactyly and GI complaints, and had worse exercise tolerance. All these differences did not reach statistical significance. The patients who decreased PCS more often had ILD (100% vs. 41%, p=0.015), and used glucocorticoids more often (33% vs. 0%, p=0.046), were slightly older and had a worse exercise tolerance as compared to those who showed a stable/improving PCS over time.ConclusionLike in SSc, HRQoL is significantly impaired in MCTD, especially the general health perception of patients. Cardiac involvement, ILD, age and worse functional disability might specifically impact HRQoL in MCTD. However, these associations need further evaluations in larger cohorts.Disclosure of InterestsNone declared
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Arnold S, Wallmeier P, Schubach F, Ihorst G, Aries P, Bergner R, Bremer JP, Görl N, Hellmich B, Henes J, Hoyer B, Kangowski A, Kötter I, Metzler C, Müller-Ladner U, Schaier M, Schönermark U, Thiel J, Unger L, Venhoff N, Weinmann-Menke J, Petersen J, Iking-Konert C, Lamprecht P. AB0622 The Joint Vasculitis Registry in German-speaking countries (GeVas) – subgroup analysis of 113 GPA-patients. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGranulomatosis with polyangiitis (GPA) is the second most frequent vasculitis in Germany with an annual incidence of 34 per million and a prevalence of 210 per million [1]. GPA is characterized by its chronic course, frequent relapses, significant overall morbidity and mortality, and substantial socio-economic impact. Multiorgan involvement affecting the respiratory tract, kidney, and other organs is common. Limited variants also occur [2]. So far, prospective long-term observational data on the disease course of GPA are missing in Germany. Therefore, the Joint Vasculitis Registry in German-speaking countries (GeVas) has been established to follow the course of patients recently diagnosed with vasculitis or a change of their treatment due to a relapse (inception cohort). The GeVas registry allows long-term follow-up of a substantial cohort of vasculitis patients in a multicenter setting.ObjectivesTo present the first data on the follow-up of newly diagnosed and relapsing GPA enrolled in the GeVas registry.MethodsGeVas is a prospective, web-based, multicenter, clinician-driven registry for the documentation of organ manifestations, damage, long-term outcomes, and therapy regimens in various types of vasculitis. Recruitment started in June 2019. By January 2022, 17 centers in Germany were initiated and started enrolling patients. Meanwhile, more than 350 patients have been documented in the registry. Sites in Austria and the German-speaking cantons of Switzerland will be integrated soon [3].ResultsBy mid-October 2021, the participating centers included 113 patients with GPA. The majority of patients were PR3-ANCA positive and affected by general symptoms, ENT, lung, renal, and neurological involvement. Patients commonly received cyclophosphamide or rituximab in combination with glucocorticoids for the induction of remission. Fewer patients received methotrexate or other immunosuppressants. Patient characteristics and therapy are summarized in Table 1.Table 1.Patient characteristics (n = 113). *Unless otherwise specified.CategoryFeaturen (%)*AgeAge (years); median [range]60 [51 - 70]GenderMale61 (54.0)Female52 (46.0)Reason for inclusion in the registryNewly diagnosed vasculitis57 (51.4)Relapse56 (49.6)ANCA statusPR3-ANCA99 (87.6)MPO-ANCA4 (3.6)ANCA negative9 (7.9)Organ manifestationGeneral symptoms86 (76.1)ENT69 (61.1)Lung/chest66 (58.4)Renal35 (31.0)Cardiovascular7 (6.2)GI3 (2.7)Neurological27 (23.9)TherapyGlucocorticoid102 (90.3)Rituximab56 (49.6)Cyclophosphamide37 (32.7)Methotrexate and other immunosuppressants, respectively26 (23.0) and 19 (16.8), respectivelyConclusionHere, we present the first interim analysis of the GeVas registry. Clinical manifestations of GPA reported herein show less frequent renal involvement in comparison with a recent report from another European registry (POLVAS) and an UK study [4, 5]. This is potentially related to the predominance of recruiting rheumatology centers thus far. By contrast, respiratory tract involvement is more frequent and PR3-ANCA less common in Japan [5]. Further data are prospectively documented and a follow up analysis is in progress.References[1]Hellmich B, et al. New insights into the epidemiology of ANCA-associated vasculitides in Germany: results from a claims data study. Rheumatology 2021;60:4868-73.[2]Kitching AR, et al. ANCA-associated vasculitis. Nat Rev Dis Primers 2020;6:71.[3]Iking-Konert C, et al. The Joint Vasculitis Registry in German-speaking countries (GeVas) – a prospective, multicenter registry for the follow-up of long-term outcomes in vasculitis. BMC Rheumatol 2021;5:40.[4]Wójcik K, et al. Clinical characteristics of Polish patients with ANCA-asscoiated vasculitides – retrospective analysis of POLVAS registry. Clin Rheumatol 2019;38:2553-63.[5]Furuta S, et al. Comparison of the phenotype and outcome of granulomatosis with polyangiitis between UK and Japanese cohorts. J Rheumatol 2017;44:216-22.AcknowledgementsGeVas was supported by unrestricted grants by: DGRh, John Grube Foundation, Vifor and Roche PharmaDisclosure of InterestsSabrina Arnold: None declared, Pia Wallmeier: None declared, Fabian Schubach: None declared, Gabriele Ihorst: None declared, Peer Aries: None declared, Raoul Bergner Consultant of: VIFOR, Jan Philip Bremer: None declared, Norman Görl: None declared, Bernhard Hellmich: None declared, Jörg Henes: None declared, Bimba Hoyer: None declared, Antje Kangowski: None declared, Ina Kötter: None declared, Claudia Metzler: None declared, Ulf Müller-Ladner: None declared, Matthias Schaier: None declared, Ulf Schönermark: None declared, Jens Thiel: None declared, Leonore Unger: None declared, Nils Venhoff Speakers bureau: Roche and Vifor: speaker honoraries, Consultant of: Roche and Vifor: advisory boards, Grant/research support from: John-Grube Research Award 2021, Julia Weinmann-Menke: None declared, Jana Petersen: None declared, Christof Iking-Konert Speakers bureau: Lecture fees from: Chugai, GSK, Roche, and Vifor, Consultant of: Consulting fees from: Chugai, GSK, Roche, and Vifor, Grant/research support from: Research grants for GeVas: Roche, Vifor, DGRh, John Grube Foundation, Peter Lamprecht Speakers bureau: Chugai, GSK, Roche, and Vifor, Consultant of: Chugai, GSK, Roche, and Vifor, Grant/research support from: DGRh, John Grube Foundation, Roche, and Vifor
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Wallmeier P, Arnold S, Schubach F, Ihorst G, Aries P, Bergner R, Bremer JP, Görl N, Hellmich B, Henes J, Hoyer B, Kangowski A, Kötter I, Magnus T, Metzler C, Müller-Ladner U, Schaier M, Schönermark U, Thiel J, Unger L, Venhoff N, Weinmann-Menke J, Petersen J, Lamprecht P, Iking-Konert C. POS0800 THE JOINT VASCULITIS REGISTRY IN GERMAN-SPEAKING COUNTRIES (GeVas) – SUBGROUP ANALYSIS OF 131 GCA-PATIENTS REFERENCES:. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe most frequent form of vasculitis in elderly people is giant cell arteritis (GCA) with an annual incidence rate less than 10 per 100,000 persons over the age of 50. Like most vasculitides, GCA is characterized by chronicity and relapses, leading to significant overall morbidity and higher mortality in a subset of patients with aortic involvement and dissection. Most studies carried out so far have been retrospective, used monocentric study designs and small patient cohorts. Therefore, the Joint Vasculitis Registry in German-speaking countries (GeVas) has been established to record patients, who have been recently diagnosed with vasculitis or who have changed their treatment due to a relapse (inception cohort). The GeVas-Registry allows a long-term follow-up of a substantial cohort of vasculitis patients in a prospective and multicenter manner.ObjectivesTo describe the subgroup of GCA and its characteristics within the GeVas registry.MethodsGeVas is a prospective, web-based, multicenter, clinician-driven registry for the documentation of organ manifestations, damage, long-term outcomes, and therapy regimens in various types of vasculitis. Recruitment started in June 2019. By January 2022, 17 centers in Germany were initiated and have begun enrolling patients. Meanwhile, more than 350 patients have been documented in the registry. Sites in Austria and the German-speaking cantons of Switzerland will be integrated soon (1).ResultsBy mid-October 2021, the participating centers recruited 131 GCA patients into the registry. 21.7% of patients (n=28) were enrolled in the registry due to relapse, and 78.3% (n=101) due to a first-time diagnosis. In accordance with long-standing epidemiology data, the majority of patients (67,2%), were female (n=88), and 32.8% (n=43) were male. Mean age was 74 years (max. 92y, min. 52y). The most frequently recorded organ manifestations in GCA patients addressed cranial and ophthalmic symptoms, and the cardiovascular system. However, vascular lung/chest involvement was also observed in 3% of cases (n=4). Out of the 131 patients, 97.7% (n=128) received immunosuppressive therapy, three refused to take any medication. An equal number of patients were treated with glucocorticoid (GC) therapy. While about two equal parts were treated by stable long term oral GC therapy (47,7%, n=62) or by i.v. pulse therapy followed by tapering (49,2%, n=64), only about 2.3% (n=3) were treated by oral GC therapy with intermittent i.v. pulses. 48.5% (n=63) of patients received tocilizumab as additional immunosuppressive therapy, 19.2% (n=25) methotrexate, and 18.5% (n=24) cyclophosphamide i.v. pulses.ConclusionIn June 2019, we successfully established the prospective multicenter vasculitis registry GeVAS. It describes the first systematically recorded prospective GCA cohort in German-speaking countries. Its characteristics correspond to those that can be expected from the literature, with some unexpected finding e.g. the high proportion of patients treated with cyclosphosphamid, probably reflecting a sicker patient population with e.g. aortic or central nervous involvement. After 2.5 years of follow-up documentation, the first long-term results will be systematically evaluated and interpreted. The newly acquired data on disease manifestation, diagnostics and therapy regimens will provide important insights into the treatment of GCA patients in Germany and may generate further research goals.ReferencesTrial registration: German Clinical Trials Register (Deutsches Register Klinischer Studien): DRKS00011866. Registered 10 May 2019. 3[1]C Iking-Konert; P Wallmeier; S Arnold; S Adler; K de Groot; B Hellmich; B Hoyer; K Holl-Ulrich; Ihorst; M Kaufmann; I Kötter; U Müller-Ladner; T Magnus; J. Rech; H. Schulze-Koops; N. Venhoff; T. Wiech; P. Villiger; F. Schubach; P. Lamprecht. The Joint Vasculitis Registry in German-speaking countries (GeVas) – a prospective, multicenter registry for the follow-up of long-term outcomes in vasculitis. BMC Rheumatol. 2021 Jul 31;5(1):40. doi: 10.1186/s41927-021-00206-2.AcknowledgementsGeVas was supported by unrestricted grants by: DGRh, John Grube Foundation, Vifor and Roche PharmaDisclosure of InterestsPia Wallmeier: None declared, Sabrina Arnold: None declared, Fabian Schubach: None declared, Gabriele Ihorst: None declared, Peer Aries: None declared, Raoul Bergner Consultant of: Advisory Board VIFOR, Grant/research support from: John-Grube Research Award 2021, Jan Philip Bremer: None declared, Norman Görl: None declared, Bernhard Hellmich: None declared, Jörg Henes: None declared, Bimba Hoyer: None declared, Antje Kangowski: None declared, Ina Kötter: None declared, Tim Magnus: None declared, Claudia Metzler: None declared, Ulf Müller-Ladner: None declared, Matthias Schaier: None declared, Ulf Schönermark: None declared, Jens Thiel: None declared, Leonore Unger: None declared, Nils Venhoff Speakers bureau: Roche and Vifor, Consultant of: Roche and Vifor, Grant/research support from: John-Grube Research Award 2021, Julia Weinmann-Menke: None declared, Jana Petersen: None declared, Peter Lamprecht Speakers bureau: Lecture fees from: Chugai, GSK, Roche, Consultant of: Consulting & lecture fees from: Chugai, GSK, Roche, and Vifor., Grant/research support from: Research grants for GeVas: DGRh, John Grube Foundation, Roche, and Vifor, Christof Iking-Konert Speakers bureau: lecture fees from: Chugai, GSK, Roche, and Vifor., Consultant of: Consulting fees from: Chugai, GSK, Roche, and Vifor., Grant/research support from: Research grants for GeVas: DGRh, John Grube Foundation, Roche, and Vifor;
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Hasseli R, Hoyer BF, Lorenz HM, Pfeil A, Regierer A, Richter J, Schmeiser T, Strangfeld A, Krause A, Voll R, Schulze-Koops H, Müller-Ladner U, Specker C. OP0179 CHARACTERISTICS AND OUTCOMES OF SARS-CoV-2 BREAKTHROUGH INFECTIONS AMONG DOUBLE AND TRIPLE VACCINATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSARS-CoV-2 vaccines offer the most effective way to reduce the risk of severe COVID-19. Recent data indicate sufficient immune response after vaccination in most patients with inflammatory rheumatic diseases (IRD) on immunomodulatory treatments.ObjectivesTo investigate the clinical profile of SARS-CoV-2 breakthrough infections among double and triple vaccinated patients with IRD.MethodsData from the German COVID-19-IRD registry, collected by treating rheumatologists between February 2021 and January 2022 were analysed. Patients double or triple vaccinated against COVID-19 ≥14 days prior to proven SARS-CoV-2 infection were identified, and type of IRD, vaccine, immunomodulation, comorbidities and outcome of the infection were compared with 737 unvaccinated IRD-patients with COVID-19.ResultsIn total, 271 cases of breakthrough infections were reported, 250 patients (91%) had received two doses of vaccines, 21 (9%) patients three. More than 70% of the patients received Pfizer/Biontech vaccine for the first, second and third vaccination. The median time from second/third vaccine dose to infection was 148 days (range 14-302) days. Most of the patients were diagnosed with inflammatory joint diseases (Table 1). Most of the patients were treated with methotrexate (Table 1). The use of Januskinase inhibitors(i) was more frequently reported in double vaccinated patients (10.4% vs 4.8%), whereas tumor necrosis (TNF)i were reported more often in triple vaccinated patients (33.3% vs. 22.8). Hospitalisation rate was higher in unvaccinated IRD-patients than in vaccinated ones, while fatality rate was similar in unvaccinated and double vaccinated patients. Although the rate of comorbidities and median age were higher in triple-vaccinated patients, infected patients showed a lower rate of hospitalisation, neither COVID-19 related complications, nor the need of oxygen treatment or death.Table 1.Profile of vaccinated IRD patientsunvaccinated2ndvaccination3rdvaccinationNumber (737)%Number (250)%Number (21)%Age56 (18-93)57 (22-90)63 (35-88)Female47864.915863.21361.9BMI26.8 (17-53)26.7 (17-55)25.4 (18-41)Inflammatory rheumatic disease (multiple selections possible)Inflammatory joint diseases56175.918674.41676.2Connective tissue diseases10112.8301229.6Vasculitis719.6228.8314.3Other IRD638.52911.614.8Immunomodulation (multiple selections possible)Glucocorticoid21228.86726.8523.8Methotrexate27036.69036838.1Azathioprine192.672.8//Cyclosporine30.410.4//Leflunomide506.872.8//Hydroxychloroquine7910.7239.214.8Sulfasalazine202.793.6//JAKi547.32610.414.8TNFi15821.45722.8733.3Abatacept91.231.2//Rituximab212.8114.414.8Other biologics597.93212.829.6Mycophenolate15241.6//Immunoglobulines20.310.4//Apremilast40.5////Cyclophosphamide10.110.4//No immunomodulation7410228.814.8No/low disease activity62584.822389.21885.7Moderate/high disease activity10213.82710.8314.3ComorbiditiesCardiovascular diseases32944.6130521361.9Diabetes mellitus7610.32510//Osteoporosis435.8218.429.5Chronic renal failure405.4166.4419Cancer/history of cancer152.0104314.3COPD253.4104//ILD162.272.8//Bronchial asthma344.6166.4//Pregnancy70.910.414.8No comorbidity25434.59738.8523.8Complications due to COVID-19Hospitalisation13518.32911.629.5Oxygen treatment11415.5249.6//Invasive ventilation253.493.6//Death162.272.8//ConclusionIn this cohort of triple-vaccinated IRD patients no fatal courses and no COVID-19 related complications were reported, although median age and rate of comorbidities were higher compared to double-vaccinated and unvaccinated patients. These results support the general recommendations to reduce the risk of severe COVID-19 disease by administering three doses of vaccine, especially in patients with older age, presence of comorbidities, and on immunomodulatory treatment.Disclosure of InterestsNone declared
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Abouyahya I, Liem SI, Amoura Z, Fonseca JE, Chaigne B, Cutolo M, Doria A, Fischer-Betz R, Guimaraes V, Huizinga TW, van Laar JM, Martin T, Matucci-Cerinic M, Montecucco C, Schneider M, Smith V, Müller-Ladner U, de Vries-Bouwstra JK. Health-related quality of life in patients with mixed connective tissue disease: a comparison with matched systemic sclerosis patients. Clin Exp Rheumatol 2022; 40 Suppl 134:66-70. [DOI: 10.55563/clinexprheumatol/x5aras] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Imane Abouyahya
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Sophie I.E. Liem
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.
| | - Zahir Amoura
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) APHP-CUP, Hôpital Cochin, Université de Paris, France
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) APHP-CUP, Hôpital Cochin, Université de Paris, France
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Italy
| | - Andrea Doria
- Rheumatology Unit Department of Medicine, AO Padova and University of Padova, Italy
| | | | - Vera Guimaraes
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | | | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Thierry Martin
- Clinical Immunology Department, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Department of Geriatric Medicine, Division of Rheumatology, AOUC, Florence, Italy
| | | | | | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus Liebig University of Giessen, Bad Nauheim, Germany
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Bandeira M, Vieira A, Guimarães V, Bento T, Amoura Z, Arnaud L, Beretta L, Cere A, Chehab G, Hachulla E, Milas-Ahić J, Müller-Ladner U, Nagy G, Piette Y, Rednic S, Schneider M, Smith V, Cutolo M, Fonseca JE, Romão VC. Off-label use of mycophenolate mofetil in the treatment of rare and complex rheumatic connective tissue diseases. Clin Exp Rheumatol 2022; 40 Suppl 134:32-39. [DOI: 10.55563/clinexprheumatol/v1e7s2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, and Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal, and ePAG Representative for Sjögren’s Syndrome, ERN-ReCONNET
| | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal, and ePAG Representative for Mixed Connective Tissue Disease, ERN-ReCONNET
| | - Tatiana Bento
- Clinical Trial Unit, Serviço de Gestão Técnico-Farmacêutica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, French National Referral Centre for SLE and APS, Paris, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Auto-Immunes (RESO), Strasbourg, France
| | - Lorenzo Beretta
- Referral Centre for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, and IRCCS Polyclinic Hospital San Martino, Genoa, Italy
| | - Gamal Chehab
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Université de Lille, Inserm, CHU Lille, U1286, and INFINITE, Institute for Translational Research in Inflammation, Lille, France
| | - Jasminka Milas-Ahić
- Department of Rheumatology, Clinical Immunology and Allergology, Internal Clinic, University Hospital Osijek, Medical School Osijek, Croatia
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Germany
| | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Yves Piette
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital, and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, and IRCCS Polyclinic Hospital San Martino, Genoa, Italy
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, and Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, and Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Talarico R, Aguilera S, Alexander T, Amoura Z, Andersen J, Arnaud L, Avcin T, Marsal Barril S, Beretta L, Bombardieri S, Bortoluzzi A, Bouillot C, Bulina I, Burmester GR, Cannizzo S, Cavagna L, Chaigne B, Cornet A, Corti P, Costedoat-Chalumeau N, Dāvidsone Z, Doria A, Fenech C, Ferraris A, Fischer-Betz R, Fonseca JE, Frank C, Gaglioti A, Galetti I, Guimarães V, Hachulla E, Holmner M, Houssiau F, Iaccarino L, Jacobsen S, Limper M, Malfait F, Mariette X, Marinello D, Martin T, Matthews L, Matucci-Cerinic M, Meyer A, Milas-Ahić J, Moinzadeh P, Montecucco C, Mouthon L, Müller-Ladner U, Nagy G, Patarata E, Pileckyte M, Pruunsild C, Rednic S, Romão VC, Schneider M, Scirè CA, Smith V, Sulli A, Tamirou F, Tani C, Taruscio D, Taulaigo AV, Tincani A, Ticciati S, Turchetti G, van Hagen PM, van Laar JM, Viera A, de Vries-Bouwstra JK, Zschocke J, Cutolo M, Mosca M. The added value of a European Reference Network on rare and complex connective tissue and musculoskeletal diseases: insights after the first 5 years of the ERN ReCONNET. Clin Exp Rheumatol 2022; 40 Suppl 134:3-11. [DOI: 10.55563/clinexprheumatol/d2qz38] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome (SAF España), Elche, Spain
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, French National Referral Center for SLE and APS, Paris, France
| | | | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Alessandra Bortoluzzi
- Department of Medical Sciences, Rheumatology Section, University of Ferrara, Azienda Ospedaliero-Universitaria Sant’Anna di Cona, Ferrara, Italy
| | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sara Cannizzo
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lorenzo Cavagna
- Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Benjamin Chaigne
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | | | - Paolo Corti
- Relapsing Polychondritis Awareness and Support, Worcester, UK
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | - Zane Dāvidsone
- Departement of Paediatrics, Riga Stradiņš University (RSU), Riga, Latvia
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | | | - Alessandro Ferraris
- Medical Genetics Laboratory, Molecular Medicine Department, San Camillo Forlanini Hospital, Sapienza University, Rome, Italy
| | - Rebecca Fischer-Betz
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Andrea Gaglioti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Université de Lille, CHU Lille, France
| | - Monica Holmner
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen, Denmark
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital and Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des infections virales et des maladies auto-immunes; AP-HP, Hôpital Bicêtre, Rheumatology Department, Le Kremlin Bicêtre, France
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thierry Martin
- Service d’Immunologie Clinique, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Autoimmunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Lisa Matthews
- Relapsing Polychondritis Awareness and Support, Worcester, UK
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alain Meyer
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Jasminka Milas-Ahić
- Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Osijek, Croatia
| | - Pia Moinzadeh
- Department of Dermatology, Universitätsklinikum, Cologne, Germany
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus Liebig University of Giessen, Bad Nauheim, Germany
| | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Eunice Patarata
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Margarita Pileckyte
- Department of Rheumatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Chris Pruunsild
- Children’s Clinic, Tartu University Hospital, Tartu, Estonia
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital Department of Internal Medicine, Ghent, Belgium, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Italy
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Anna V. Taulaigo
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Italy
| | - Simone Ticciati
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - P. Martin van Hagen
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Ana Viera
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | | | - Johannes Zschocke
- Institute of Human Genetics, Medical University of Innsbruck, Austria
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Rheumatology Unit, University of Pisa, Italy. ,
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Geyer M, Schönfeld C, Schreiyäck C, Susanto S, Michel C, Looso M, Braun T, Borchardt T, Neumann E, Müller-Ladner U. Comparative transcriptional profiling of regenerating damaged knee joints in two animal models of the newt Notophthalmus viridescens strengthens the role of candidate genes involved in osteoarthritis. Osteoarthritis and Cartilage Open 2022; 4:100273. [DOI: 10.1016/j.ocarto.2022.100273] [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: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022] Open
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Müller-Ladner U. [Basic immunology for routine clinical practice]. Internist (Berl) 2022; 63:493-503. [PMID: 35384453 PMCID: PMC8985061 DOI: 10.1007/s00108-022-01320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
Das Immunsystem ist ein den äußeren Gegebenheiten anpassbares und nahezu ubiquitär vorhandenes Abwehrsystem höherer Organismen, das vor allem Schädigungen durch Krankheitserreger oder Toxine verhindern soll. Zudem kann es fehlerhafte oder entartete körpereigene Zellen erkennen und zerstören. Das immunologische Netzwerk des Menschen besteht aus verschiedenen Organen und Organsystemen, verschiedenen immunaktiven Zelltypen sowie extra- und intrazellulären Signalmolekülen und Signalkomplexen. Unterteilt wird das Immunsystem in das angeborene und erworbene Immunsystem. Pathologische Zustände, die kurz oder länger andauern können, reichen von den angeborenen Störungen der Autoinflammationserkrankungen bis hin zu den zahlreichen Autoimmunerkrankungen. Diese überschießenden Immunreaktionen werden durch verschiedenste Stimuli getriggert. Therapeutisch können bei überschießenden Reaktionen unspezifische Immunsuppressiva oder direkte Immunzellhemmer bzw. Antikörper eingesetzt werden.
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Affiliation(s)
- Ulf Müller-Ladner
- Professur für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestraße 2, 61231, Bad Nauheim, Deutschland.
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Müller-Ladner U, Manger B. [The rubric "Pioneers of rheumatology" becomes "Milestones of rheumatology"]. Z Rheumatol 2022; 81:145-146. [PMID: 35239023 DOI: 10.1007/s00393-021-01152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ulf Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig Universität Gießen, Campus Kerckhoff, Benekestr. 2, 61231, Bad Nauheim, Deutschland.
| | - Bernhard Manger
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
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Hughes M, Heal C, Henes J, Balbir-Gurman A, Distler JHW, Airò P, Müller-Ladner U, Hunzelmann N, Kerzberg E, Rudnicka L, Truchetet ME, Stebbings S, Tanaka Y, Hoffman-Vold AM, Gabrielli A, Distler O, Matucci-Cerinic M, Ananieva LPJ, de Vries-Bouwstra C, Bruni FP, Cantatore I, Castellví M, Cutolo N, Damjanov D, Farge-Bancel AM, Gheorghiu E, Hachulla VM, Hsu F, Iannone F, Ingegnoli R, Ionescu PG, de la Peña Lefebvre M, Li WAAA, Mohamed C, Montecucco L, Mouthon R, Pellerito SB, Randone V, Riccieri G, Riemekasten E, Siegert F, Spertini V, Smith B, Stamenkovic M, Tikly S, Ullman M, Vanthuyne U, Walker . Corrigendum to: Digital pitting scars are associated with a severe disease course and death in systemic sclerosis: a study from the EUSTAR cohort. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keab892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Calvin Heal
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute, Rambam Health Care Campus and Rappaport Faculty of Medicine - Technion, Haifa, Israel
| | - Jörg H W Distler
- Department of Internal Medicine 3 and Institute for Clinical Immunology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim
| | | | - Eduardo Kerzberg
- Servicio de Reumatología, Hospital J. M. Ramos Mejía, Urquiza 609, Buenos Aires, Argentina
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Yoshiya Tanaka
- Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Armando Gabrielli
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Blank N, Schmalzing M, Moinzadeh P, Oberste M, Siegert E, Müller-Ladner U, Riemekasten G, Günther C, Kötter I, Zeidler G, Pfeiffer C, Juche A, Jandova I, Ehrchen J, Susok L, Schmeiser T, Sunderkötter C, Distler JHW, Worm M, Kreuter A, Keyßer G, Lorenz HM, Krieg T, Hunzelmann N, Henes J. Autologous hematopoietic stem cell transplantation improves long-term survival-data from a national registry. Arthritis Res Ther 2022; 24:258. [PMID: 36424638 PMCID: PMC9685870 DOI: 10.1186/s13075-022-02948-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current recommendations on the management of systemic sclerosis (SSc) suggest that autologous hematopoietic stem cell therapy (HSCT) can be a rescue therapy for patients with rapidly progressive SSc. OBJECTIVES To assess the safety and efficacy of HSCT for patients with SSc and to compare these with non-HSCT patients in a control cohort with adjusted risk factors. METHODS A retrospective analysis of data from the multicentric German network for systemic scleroderma (DNSS) with 5000 patients with SSc. Control groups consisted of all patients with diffuse cutaneous (dc)-SSc (group A) and an adjusted high-risk cohort of male patients with Scl70-positive dc-SSc (group B). RESULTS Eighty SSc patients received an HSCT 4.1 ± 4.8 years after SSc diagnosis. Among them, 86.3% had dc-SSc, 43.5% were males, and 71.3% were positive for Scl70 antibodies. The control group A (n=1513) showed a significant underrepresentation of these risk factors for mortality. When the survival of the control group B (n=240) was compared with the HSCT group, a lower mortality of the latter was observed instead. Within 5 years after HSCT, we observed an improvement of the mRSS from 17.6 ± 11.5 to 11.0 ± 8.5 (p=0.001) and a stabilization of the DLCO. We did not see differences in transplant-related mortality between patients who received HSCT within 3 years after SSc diagnosis or later. CONCLUSION Our analysis of real-life data show that the distribution of risk factors for mortality is critical when HSCT cohorts are compared with non-HSCT control groups.
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Affiliation(s)
- Norbert Blank
- grid.5253.10000 0001 0328 4908Internal Medicine 5, Division of Hematology, Oncology and Rheumatology, Department of Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marc Schmalzing
- grid.411760.50000 0001 1378 7891Department of Rheumatology/Clinical Immunology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Pia Moinzadeh
- grid.411097.a0000 0000 8852 305XDepartment of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Max Oberste
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Elise Siegert
- grid.6363.00000 0001 2218 4662Department of Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Müller-Ladner
- grid.8664.c0000 0001 2165 8627Campus Kerckhoff, Department of Rheumatology and Clinical Immunology, Justus Liebig University Giessen, Bad Nauheim, Germany
| | | | - Claudia Günther
- grid.412282.f0000 0001 1091 2917Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ina Kötter
- Department of Rheumatology and Immunology, University Hospital, Hamburg-Eppendorf and Rheumatology Hospital Bad Bramstedt, Bad Bramstedt, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Johanniter-Krankenhaus im Flaeming Treuenbrietzen, Treuenbrietzen, Germany
| | - Christiane Pfeiffer
- grid.411095.80000 0004 0477 2585Department of Dermatology, University Hospital Munich, Munich, Germany
| | - Aaron Juche
- grid.473656.50000 0004 0415 8446Department of Rheumatology, Immanuel Krankenhaus Berlin-Buch, Berlin, Germany
| | - Ilona Jandova
- grid.7708.80000 0000 9428 7911Department of Rheumatology, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | - Jan Ehrchen
- grid.16149.3b0000 0004 0551 4246Department of Dermatology and Venerology, University Hospital Muenster, Muenster, Germany
| | - Laura Susok
- grid.5570.70000 0004 0490 981XDepartment of Dermatology and Venereology, Ruhr-University-Bochum, Bochum, Germany
| | - Tim Schmeiser
- grid.416438.cDepartment of Dermatology, St. Josef Hospital Wuppertal, Wuppertal, Germany
| | - Cord Sunderkötter
- grid.461820.90000 0004 0390 1701Dermatology, University Hospital Halle, Halle, Germany
| | - Jörg H. W. Distler
- grid.411668.c0000 0000 9935 6525Department of Rheumatology, University Hospital Erlangen, Erlangen, Germany
| | - Margitta Worm
- grid.6363.00000 0001 2218 4662Department of Dermatology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Kreuter
- grid.412581.b0000 0000 9024 6397Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Witten, Germany
| | - Gernot Keyßer
- grid.461820.90000 0004 0390 1701Rheumatology, University Hospital Halle, Halle, Germany
| | - Hanns-Martin Lorenz
- grid.5253.10000 0001 0328 4908Internal Medicine 5, Division of Hematology, Oncology and Rheumatology, Department of Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Thomas Krieg
- grid.411097.a0000 0000 8852 305XDepartment of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Nicolas Hunzelmann
- grid.411097.a0000 0000 8852 305XDepartment of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Jörg Henes
- grid.411544.10000 0001 0196 8249Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
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Pfeil A, Franz M, Hoffmann T, Klemm P, Oelzner P, Müller-Ladner U, Hueber AJ, Lange U, Wolf G, Schett G, Simon D, Kleyer A. Virtual teaching for medical students during SARS-CoV-2 pandemic. Clin Exp Rheumatol 2021; 39:1447-1448. [DOI: 10.55563/clinexprheumatol/0dbnx5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Germany.
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital – Friedrich Schiller University Jena, Germany
| | - Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Axel J. Hueber
- Section Rheumatology, Sozialstiftung Bamberg, and Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Germany
| | - Uwe Lange
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, and German Center Immune Therapy, University Hospital Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, and German Center Immune Therapy, University Hospital Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, and German Center Immune Therapy, University Hospital Erlangen, Germany
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Sattui SE, Conway R, Putman MS, Seet AM, Gianfrancesco MA, Beins K, Hill C, Liew D, Mackie SL, Mehta P, Neill L, Gomez G, Salinas MIH, Maldonado FN, Mariz HA, de Sousa Studart SA, Araujo NC, Knight A, Rozza D, Quartuccio L, Samson M, Bally S, Maria AT, Chazerain P, Hasseli R, Müller-Ladner U, Hoyer BF, Voll R, Torres RP, Luis M, Ribeirio SLE, Al-Emadi S, Sparks JA, Hsu TYT, D'Silva KM, Patel NJ, Wise L, Gilbert E, Almada MV, Duarte-García A, Ugarte-Gil M, Jacobsohn L, Izadi Z, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Sirotich E, Hausmann JS, Sufka P, Bhana S, Liew JW, Grainger R, Machado PM, Wallace ZS, Yazdany J, Robinson PC. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. Lancet Rheumatol 2021; 3:e855-e864. [PMID: 34778843 PMCID: PMC8570701 DOI: 10.1016/s2665-9913(21)00316-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31-1·57]), were male compared with female (1·38 [1·05-1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23-1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50-3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49-3·02]). Risk factors varied among different disease subtypes. Interpretation Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding American College of Rheumatology and the European Alliance of Associations for Rheumatology.
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Affiliation(s)
- Sebastian E Sattui
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | | | - Andrea M Seet
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Milena A Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | | | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - David Liew
- Department of Rheumatology, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, VIC, Australia
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna Neill
- Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Perth, Scotland, UK
| | - Gimena Gomez
- Research Unit Argentine Society of Rheumatology, Buenos Aires, Argentina
| | | | | | | | | | - Nafice Costa Araujo
- Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo, Sao Paulo, Brazil
| | - Ann Knight
- Rheumatology, Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Davide Rozza
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, University of Udine, School of Rheumatology, Santa Maria della Misericordia Academic Hospital, Udine, Italy
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Stéphane Bally
- Nephrology and Dialysis Service, Metropole Savoie Hospital Center, Chambery, France
| | - Alexandre Tj Maria
- Department of Internal Medicine and Multi-Organic Diseases, Saint-Eloi University Hospital of Montpellier, Montpellier, France
| | - Pascal Chazerain
- Department of Rheumatology and Internal Medicine, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Reinhard Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Rita Pinheiro Torres
- CEDOC, Nova Medical School, Lisbon, Portugal
- Rheumatology Service, Egas Moniz Hospital, Lisboa Occidental Hospital Centre, Lisbon, Portugal
| | - Mariana Luis
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- School of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | | | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M D'Silva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naomi J Patel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leanna Wise
- Los Angeles County Hospital, Los Angeles, CA, USA
- University of South California Medical Center, Los Angeles, CA, USA
| | - Emily Gilbert
- Division of Rheumatology, Mayo Clinic Health System, Jacksonville, FL, USA
| | | | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic Health System, Rochester, MN, USA
| | - Manuel Ugarte-Gil
- School of Medicine, University Cientifica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Zara Izadi
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
| | - Kimme L Hyrich
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Trust, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | - Martin Schaefer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Emily Sirotich
- McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | | | | | - Jean W Liew
- Boston University School of Medicine, Boston, MA, USA
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Zachary S Wallace
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Philip C Robinson
- University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
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49
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Køster D, Egedal JH, Lomholt S, Hvid M, Jakobsen MR, Müller-Ladner U, Eibel H, Deleuran B, Kragstrup TW, Neumann E, Nielsen MA. Phenotypic and functional characterization of synovial fluid-derived fibroblast-like synoviocytes in rheumatoid arthritis. Sci Rep 2021; 11:22168. [PMID: 34772990 PMCID: PMC8590001 DOI: 10.1038/s41598-021-01692-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022] Open
Abstract
Fibroblast-like synoviocytes (FLS) play an important pathological role in persistent inflammatory joint diseases such as rheumatoid arthritis (RA). These cells have primarily been characterized in the RA synovial membrane. Here we aim to phenotypically and functionally characterize cultured synovial fluid-derived FLS (sfRA-FLS). Paired peripheral blood mononuclear cells (PBMC) and sfRA-FLS from patients with RA were obtained and monocultures of sfRA-FLS and autologous co-cultures of sfRA-FLS and PBMC were established. The in situ activated sfRA-FLS were CD34-, CD45-, Podoplanin+, Thymocyte differentiation antigen-1+. SfRA-FLS expressed uniform levels of NFкB-related pathway proteins and secreted several pro-inflammatory cytokines dominated by IL-6 and MCP-1. In a co-culture model with autologous PBMC, the ICAM-1 and HLA-DR expression on sfRA-FLS and secretion of IL-1β, IL-6, and MCP-1 increased. In vivo, human sfRA-FLS were cartilage invasive both at ipsilateral and contralateral implantation site. We conclude that, sfRA-FLS closely resemble the pathological sublining layer FLS subset in terms of surface protein expression, cytokine production and leukocyte cross-talk potential. Further, sfRA-FLS are comparable to tissue-derived FLS in their capabilities to invade cartilage at implantation sites but also spread tissue destruction to a distant site. Collectively, sfRA-FLS can serve as a an easy-to-obtain source of pathological sublining FLS in RA.
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Affiliation(s)
- Ditte Køster
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - Johanne Hovgaard Egedal
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - Søren Lomholt
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - Malene Hvid
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin R Jakobsen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Hermann Eibel
- Department of Rheumatology and Clinical Immunology and Center for Chronic Immunodeficiency, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bent Deleuran
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Morten Aagaard Nielsen
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark. .,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
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50
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Behrens F, Koehm M, Rossmanith T, Alten R, Aringer M, Backhaus M, Burmester GR, Feist E, Herrmann E, Kellner H, Krueger K, Lehn A, Müller-Ladner U, Rubbert-Roth A, Tony HP, Wassenberg S, Burkhardt H. Rituximab plus leflunomide in rheumatoid arthritis: a randomized, placebo-controlled, investigator-initiated clinical trial (AMARA study). Rheumatology (Oxford) 2021; 60:5318-5328. [PMID: 33738492 PMCID: PMC8566251 DOI: 10.1093/rheumatology/keab153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of rituximab + LEF in patients with RA. METHODS In this investigator-initiated, randomized, double-blind, placebo-controlled phase 3 trial, patients with an inadequate response to LEF who had failed one or more DMARD were randomly assigned 2:1 to i.v. rituximab 1000 mg or placebo on day 1 and 15 plus ongoing oral LEF. The primary efficacy outcome was the difference between ≥50% improvement in ACR criteria (ACR50 response) rates at week 24 (P ≤ 0.025). Secondary endpoints included ACR20/70 responses, ACR50 responses at earlier timepoints and adverse event (AE) rates. The planned sample size was not achieved due to events beyond the investigators' control. RESULTS Between 13 August 2010 and 28 January 2015, 140 patients received rituximab (n = 93) or placebo (n = 47) plus ongoing LEF. Rituximab + LEF resulted in an increase in the ACR50 response rate that was significant at week 16 (32 vs 15%; P = 0.020), but not week 24 (27 vs 15%; P = 0.081), the primary endpoint. Significant differences favouring the rituximab + LEF arm were observed in some secondary endpoints, including ACR20 rates from weeks 12 to 24. The rituximab and placebo arms had similar AE rates (71 vs 70%), but the rituximab arm had a higher rate of serious AEs (SAEs 20 vs 2%), primarily infections and musculoskeletal disorders. CONCLUSION The primary endpoint was not reached, but rituximab + LEF demonstrated clinical benefits vs LEF in secondary endpoints. Although generally well tolerated, the combination was associated with additional SAEs and requires monitoring. TRIAL REGISTRATION EudraCT: 2009-015950-39; ClinicalTrials.gov: NCT01244958.
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Affiliation(s)
- Frank Behrens
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | - Michaela Koehm
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | - Tanja Rossmanith
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
| | | | - Martin Aringer
- Department of Medicine III, University Medical Centre and Faculty of Medicine at the TU Dresden, Dresden
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Berlin
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité–Universitätsmedizin Berlin, Berlin
| | - Eva Herrmann
- Institute of Biostatistics and Mathematic Modeling, Goethe University, Frankfurt
| | | | | | - Annette Lehn
- Institute of Biostatistics and Mathematic Modeling, Goethe University, Frankfurt
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University, Bad Nauheim, Germany
| | | | - Hans-Peter Tony
- Department of Rheumatology/Immunology, University of Würzburg, Würzburg
| | | | - Harald Burkhardt
- Division of Rheumatology, University Hospital Frankfurt, Goethe University
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine & Pharmacology TMP and Fraunhofer Cluster of Exellence for Immunemediated Diseases (CIMD), Frankfurt am Main
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