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Jayne D, Walsh M, Merkel PA, Peh CA, Szpirt W, Puéchal X, Fujimoto S, Hawley C, Khalidi N, Jones R, Flossmann O, Wald R, Girard L, Levin A, Gregorini G, Harper L, Clark W, Pagnoux C, Specks U, Smyth L, Ito-Ihara T, de Zoysa J, Brezina B, Mazzetti A, McAlear CA, Reidlinger D, Mehta S, Ives N, Brettell EA, Jarrett H, Wheatley K, Broadhurst E, Casian A, Pusey CD. Plasma exchange and glucocorticoids to delay death or end-stage renal disease in anti-neutrophil cytoplasm antibody-associated vasculitis: PEXIVAS non-inferiority factorial RCT. Health Technol Assess 2022; 26:1-60. [PMID: 36155131 DOI: 10.3310/pnxb5040] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anti-neutrophil cytoplasm antibody-associated vasculitis is a multisystem, autoimmune disease that causes organ failure and death. Physical removal of pathogenic autoantibodies by plasma exchange is recommended for severe presentations, along with high-dose glucocorticoids, but glucocorticoid toxicity contributes to morbidity and mortality. The lack of a robust evidence base to guide the use of plasma exchange and glucocorticoid dosing contributes to variation in practice and suboptimal outcomes. OBJECTIVES We aimed to determine the clinical efficacy of plasma exchange in addition to immunosuppressive therapy and glucocorticoids with respect to death and end-stage renal disease in patients with severe anti-neutrophil cytoplasm antibody-associated vasculitis. We also aimed to determine whether or not a reduced-dose glucocorticoid regimen was non-inferior to a standard-dose regimen with respect to death and end-stage renal disease. DESIGN This was an international, multicentre, open-label, randomised controlled trial. Patients were randomised in a two-by-two factorial design to receive either adjunctive plasma exchange or no plasma exchange, and either a reduced or a standard glucocorticoid dosing regimen. All patients received immunosuppressive induction therapy with cyclophosphamide or rituximab. SETTING Ninety-five hospitals in Europe, North America, Australia/New Zealand and Japan participated. PARTICIPANTS Participants were aged ≥ 16 years with a diagnosis of granulomatosis with polyangiitis or microscopic polyangiitis, and either proteinase 3 anti-neutrophil cytoplasm antibody or myeloperoxidase anti-neutrophil cytoplasm antibody positivity, and a glomerular filtration rate of < 50 ml/minute/1.73 m2 or diffuse alveolar haemorrhage attributable to active anti-neutrophil cytoplasm antibody-associated vasculitis. INTERVENTIONS Participants received seven sessions of plasma exchange within 14 days or no plasma exchange. Oral glucocorticoids commenced with prednisolone 1 mg/kg/day and were reduced over different lengths of time to 5 mg/kg/day, such that cumulative oral glucocorticoid exposure in the first 6 months was 50% lower in patients allocated to the reduced-dose regimen than in those allocated to the standard-dose regimen. All patients received the same glucocorticoid dosing from 6 to 12 months. Subsequent dosing was at the discretion of the treating physician. PRIMARY OUTCOME The primary outcome was a composite of all-cause mortality and end-stage renal disease at a common close-out when the last patient had completed 10 months in the trial. RESULTS The study recruited 704 patients from June 2010 to September 2016. Ninety-nine patients died and 138 developed end-stage renal disease, with the primary end point occurring in 209 out of 704 (29.7%) patients: 100 out of 352 (28%) in the plasma exchange group and 109 out of 352 (31%) in the no plasma exchange group (adjusted hazard ratio 0.86, 95% confidence interval 0.65 to 1.13; p = 0.3). In the per-protocol analysis for the non-inferiority glucocorticoid comparison, the primary end point occurred in 92 out of 330 (28%) patients in the reduced-dose group and 83 out of 325 (26%) patients in the standard-dose group (partial-adjusted risk difference 0.023, 95% confidence interval 0.034 to 0.08; p = 0.5), thus meeting our non-inferiority hypothesis. Serious infections in the first year occurred in 96 out of 353 (27%) patients in the reduced-dose group and in 116 out of 351 (33%) patients in the standard-dose group. The rate of serious infections at 1 year was lower in the reduced-dose group than in the standard-dose group (incidence rate ratio 0.69, 95% confidence interval 0.52 to 0.93; p = 0.016). CONCLUSIONS Plasma exchange did not prolong the time to death and/or end-stage renal disease in patients with anti-neutrophil cytoplasm antibody-associated vasculitis with severe renal or pulmonary involvement. A reduced-dose glucocorticoid regimen was non-inferior to a standard-dose regimen and was associated with fewer serious infections. FUTURE WORK A meta-analysis examining the effects of plasma exchange on kidney outcomes in anti-neutrophil cytoplasm antibody-associated vasculitis is planned. A health-economic analysis of data collected in this study to examine the impact of both plasma exchange and reduced glucocorticoid dosing is planned to address the utility of plasma exchange for reducing early end-stage renal disease rates. Blood and tissue samples collected in the study will be examined to identify predictors of response to plasma exchange in anti-neutrophil cytoplasm in antibody-associated vasculitis. The benefits associated with reduced glucocorticoid dosing will inform future studies of newer therapies to permit further reduction in glucocorticoid exposure. Data from this study will contribute to updated management recommendations for anti-neutrophil cytoplasm antibody-associated vasculitis. LIMITATIONS This study had an open-label design which may have permitted observer bias; however, the nature of the end points, end-stage renal disease and death, would have minimised this risk. Despite being, to our knowledge, the largest ever trial in anti-neutrophil cytoplasm antibody-associated vasculitis, there was an insufficient sample size to assess clinically useful benefits on the separate components of the primary end-point: end-stage renal disease and death. Use of a fixed-dose plasma exchange regimen determined by consensus rather than data-driven dose ranging meant that some patients may have been underdosed, thus reducing the therapeutic impact. In particular, no biomarkers have been identified to help determine dosing in a particular patient, although this is one of the goals of the biomarker plan of this study. TRIAL REGISTRATION This trial is registered as ISRCTN07757494, EudraCT 2009-013220-24 and Clinicaltrials.gov NCT00987389. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Michael Walsh
- Department of Nephrology, McMaster University, Hamilton, ON, Canada
| | - Peter A Merkel
- Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chen Au Peh
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Wladimir Szpirt
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
| | - Xavier Puéchal
- National Referral Centre for Rare Systemic Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Carmel Hawley
- Department of Nephrology, The University of Queensland, Brisbane, QLD, Australia
| | - Nader Khalidi
- Department of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Rachel Jones
- Renal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ron Wald
- Department of Rheumatology, St Michael's Hospital, Toronto, ON, Canada
| | - Louis Girard
- Department of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Adeera Levin
- Department of Nephrology, St Paul's Hospital, Vancouver, BC, Canada
| | - Gina Gregorini
- Department of Nephrology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Lorraine Harper
- Department of Nephrology, University of Birmingham, Birmingham, UK
| | - William Clark
- Department of Nephrology, University of Western Ontario, London, ON, Canada
| | - Christian Pagnoux
- Department of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ulrich Specks
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lucy Smyth
- Department of Nephrology, The Royal Devon and Exeter Hospital, Exeter, UK
| | - Toshiko Ito-Ihara
- Clinical and Translational Research Centre, Kyoto Prefecture University of Medicine, Kyoto, Japan
| | - Janak de Zoysa
- Department of Nephrology, North Shore Hospital, Auckland, New Zealand
| | - Biljana Brezina
- Renal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Mazzetti
- The Research Institute, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Carol A McAlear
- Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Reidlinger
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD, Australia
| | - Samir Mehta
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Hugh Jarrett
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Alina Casian
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Charles D Pusey
- Department of Nephrology, Imperial College London, London, UK
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2
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Pierce JL, Sharma AK, Roberts RL, Yu K, Irsik DL, Choudhary V, Dorn JS, Bensreti H, Benson RD, Kaiser H, Khayrullin A, Davis C, Wehrle CJ, Johnson MH, Bollag WB, Hamrick MW, Shi X, Isales CM, McGee-Lawrence ME. The Glucocorticoid Receptor in Osterix-Expressing Cells Regulates Bone Mass, Bone Marrow Adipose Tissue, and Systemic Metabolism in Female Mice During Aging. J Bone Miner Res 2022; 37:285-302. [PMID: 34747055 PMCID: PMC9976194 DOI: 10.1002/jbmr.4468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 12/18/2022]
Abstract
Hallmarks of aging-associated osteoporosis include bone loss, bone marrow adipose tissue (BMAT) expansion, and impaired osteoblast function. Endogenous glucocorticoid levels increase with age, and elevated glucocorticoid signaling, associated with chronic stress and dysregulated metabolism, can have a deleterious effect on bone mass. Canonical glucocorticoid signaling through the glucocorticoid receptor (GR) was recently investigated as a mediator of osteoporosis during the stress of chronic caloric restriction. To address the role of the GR in an aging-associated osteoporotic phenotype, the current study utilized female GR conditional knockout (GR-CKO; GRfl/fl :Osx-Cre+) mice and control littermates on the C57BL/6 background aged to 21 months and studied in comparison to young (3- and 6-month-old) mice. GR deficiency in Osx-expressing cells led to low bone mass and BMAT accumulation that persisted with aging. Surprisingly, however, GR-CKO mice also exhibited alterations in muscle mass (reduced % lean mass and soleus fiber size), accompanied by reduced voluntary physical activity, and also exhibited higher whole-body metabolic rate and elevated blood pressure. Moreover, increased lipid storage was observed in GR-CKO osteoblastic cultures in a glucocorticoid-dependent fashion despite genetic deletion of the GR, and could be reversed via pharmacological inhibition of the mineralocorticoid receptor (MR). These findings provide evidence of a role for the GR (and possibly the MR) in facilitating healthy bone maintenance with aging in females. The effects of GR-deficient bone on whole-body physiology also demonstrate the importance of bone as an endocrine organ and suggest evidence for compensatory mechanisms that facilitate glucocorticoid signaling in the absence of osteoblastic GR function; these represent new avenues of research that may improve understanding of glucocorticoid signaling in bone toward the development of novel osteogenic agents. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jessica L Pierce
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Anuj K Sharma
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Rachel L Roberts
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Kanglun Yu
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Debra L Irsik
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA.,Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Vivek Choudhary
- Department of Physiology, Augusta University, Augusta, GA, USA
| | - Jennifer S Dorn
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Husam Bensreti
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Reginald D Benson
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Helen Kaiser
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Andrew Khayrullin
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Colleen Davis
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Chase J Wehrle
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Maribeth H Johnson
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA
| | - Wendy B Bollag
- Charlie Norwood VA Medical Center, Augusta, GA, USA.,Department of Physiology, Augusta University, Augusta, GA, USA
| | - Mark W Hamrick
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Xingming Shi
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA
| | - Carlos M Isales
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA
| | - Meghan E McGee-Lawrence
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA.,Department of Orthopaedic Surgery, Augusta University, Augusta, GA, USA
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Peng Y, Lv S, Li Y, Zhu J, Chen S, Zhen G, Cao X, Wu S, Crane JL. Glucocorticoids Disrupt Skeletal Angiogenesis Through Transrepression of NF-κB-Mediated Preosteoclast Pdgfb Transcription in Young Mice. J Bone Miner Res 2020; 35:1188-1202. [PMID: 32078184 PMCID: PMC8554682 DOI: 10.1002/jbmr.3987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/28/2022]
Abstract
In the growing skeleton, angiogenesis is intimately coupled with osteogenesis. Chronic, high doses of glucocorticoids (GCs) are associated with decreased bone vasculature and induce osteoporosis and growth failure. The mechanism of GC-suppression of angiogenesis and relationship to osteoporosis and growth retardation remains largely unknown. Type H vessels, which are regulated by preosteoclast (POC) platelet-derived growth factor-BB (PDGF-BB), are specifically coupled with bone formation and development. We determined the effect of GCs on POC synthesis of PDGF-BB in relation to type H vessel formation, bone mass, and bone growth in the distal femur of 2-week-old young mice receiving prednisolone or vehicle for 2, 4, or 6 weeks. After 2 weeks of prednisolone, the number of POCs were unchanged while POC synthesis of PDGF-BB was reduced. Longer treatment with prednisolone reduced POCs numbers and PDGF-BB. These changes were associated with a reduction in type H vessels, bone formation rate, bone mass, and bone length at each time point. In vitro, excessive concentrations of prednisolone (10-6 M) resulted in decreased PDGF-BB concentration and POC numbers. Conditioned medium from POC cultures treated with control concentration of prednisolone (10-7 M) or recombinant PDGF-BB stimulated endothelial tube formation, whereas conditioned medium from control concentration of prednisolone-treated POC cultures neutralized by PDGF-BB antibody or excessive prednisolone inhibited endothelial tube formation. Administration of excessive prednisolone attenuated the P65 subunit of nuclear factor kappa B (NF-κB) binding to the Pdgfb promoter, resulting in lower Pdgfb transcription. Co-treatment with excessive prednisolone and the glucocorticoid receptor (GR) antagonist (RU486), GR siRNA, or TNFα rescued NF-κB binding to the Pdgfb promoter and endothelial tube formation. These results indicate that PDGF-BB synthesis in POCs is suppressed by GCs through transrepression of GR/NF-κB, thus inhibiting type H vessel formation and associated osteoporosis and growth failure. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Yi Peng
- Department of Orthopedic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shan Lv
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Geriatric Endocrinology, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yusheng Li
- Department of Orthopedic Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jianxi Zhu
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Geriatric Endocrinology, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Shijie Chen
- Department of Orthopedic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Gehua Zhen
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xu Cao
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Song Wu
- Department of Orthopedic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Janet L Crane
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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4
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Cheah JTL, Black RJ, Robson JC, Navarro-Millán IY, Young SR, Richards P, Beard S, Simon LS, Goodman SM, Mackie SL, Hill CL. Toward a Core Domain Set for Glucocorticoid Impact in Inflammatory Rheumatic Diseases: The OMERACT 2018 Glucocorticoid Impact Working Group. J Rheumatol 2019; 46:1179-1182. [PMID: 30647165 PMCID: PMC6629524 DOI: 10.3899/jrheum.181082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Accepted: 11/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand the effects of glucocorticoids (GC), which are of importance to patients. METHODS The results of 2 literature reviews, a patient survey, and a qualitative study were presented. RESULTS No validated instrument exists to evaluate GC effect on patients. Survey data revealed skin thinning/bruising, sleep disturbance, and weight gain as the most frequent adverse effects. The qualitative research yielded rich data covering rapid benefits and physical and emotional consequences of GC. CONCLUSION It was agreed that a patient-reported outcome to measure GC effect was required and a research agenda was developed for this goal.
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Affiliation(s)
- Jonathan T L Cheah
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK.
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide.
| | - Rachel J Black
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Joanna C Robson
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Iris Y Navarro-Millán
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Sarah R Young
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Pamela Richards
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Susan Beard
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Lee S Simon
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Susan M Goodman
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Sarah L Mackie
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
| | - Catherine L Hill
- From the Division of Rheumatology, Hospital for Special Surgery; Department of Medicine, and the Division of General Internal Medicine, Weill Cornell Medicine, New York; Department of Social Work, Binghamton University, Binghamton, New York; SDG LLC, Cambridge, Massachusetts, USA; Rheumatology Unit, Royal Adelaide Hospital; Discipline of Medicine, The University of Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine; Chapel Allerton Hospital, University of Leeds, Leeds, UK
- J.T. Cheah, MBBS, Fellow, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; R.J. Black, MBBS, Consultant Rheumatologist, Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; I.Y. Navarro-Millán, MD, MSPH, Assistant Professor of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, and Division of Rheumatology, Hospital for Special Surgery; S.R. Young, PhD, LMSW, Assistant Professor, Department of Social Work, Binghamton University; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner; S. Beard, BMus, OMERACT Patient Research Partner; L.S. Simon, MD, Principal, SDG LLC; S.M. Goodman, MD, Professor of Clinical Medicine, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine; S.L. Mackie, MB BCh, PhD, MRCP, Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, and University of Leeds; C.L. Hill, MBBS, MSc, MD, FRACP, Clinical Professor, Rheumatology Unit, The Queen Elizabeth Hospital, and Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, The University of Adelaide
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Yoon SH, Grynpas MD, Mitchell J. Growth Hormone Increases Bone Toughness and Decreases Muscle Inflammation in Glucocorticoid-Treated Mdx Mice, Model of Duchenne Muscular Dystrophy. J Bone Miner Res 2019; 34:1473-1486. [PMID: 31188496 DOI: 10.1002/jbmr.3718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 01/03/2023]
Abstract
The absence of functional dystrophin with mutations of the dystrophin-encoding gene in Duchenne muscular dystrophy (DMD) results in muscle inflammation and degeneration, as well as bone fragility. Long-term glucocorticoid therapy delays the muscular disease progression but suppresses growth hormone secretion, resulting in short stature and further deleterious effects on bone strength. This study evaluated the therapeutic potential of daily growth hormone therapy in growing mdx mice as a model of DMD. Growth hormone treatment on its own or in combination with glucocorticoids significantly improved muscle histology and function and decreased markers of inflammation in mdx mice. Glucocorticoid treatment thinned cortical bone and decreased bone strength and toughness. Despite the minimal effects of growth hormone on bone microarchitecture, it significantly improved biomechanical properties of femurs and vertebrae, even in the presence of glucocorticoid treatment. Together these studies suggest that the use of growth hormone in DMD should be considered for improvements to muscle and bone health. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sung-Hee Yoon
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Health System, Toronto, Canada
| | - Marc D Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Health System, Toronto, Canada
| | - Jane Mitchell
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
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Dumont A, Parienti JJ, Delmas C, Boutemy J, Maigné G, Martin Silva N, Sultan A, Planchard G, Aouba A, de Boysson H. Factors Associated with Relapse and Dependence on Glucocorticoids in Giant Cell Arteritis. J Rheumatol 2019; 47:108-116. [PMID: 30877210 DOI: 10.3899/jrheum.181127] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA). METHODS We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. RESULTS The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008). CONCLUSION In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
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Affiliation(s)
- Anael Dumont
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jean-Jacques Parienti
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Claire Delmas
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jonathan Boutemy
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gwénola Maigné
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Nicolas Martin Silva
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Audrey Sultan
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gaétane Planchard
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Achille Aouba
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Hubert de Boysson
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France. .,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital.
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7
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Horton DB, Taxter AJ, Davidow AL, Groh BP, Sherry DD, Rose CD. Intraarticular Glucocorticoid Injection as Second-line Treatment for Lyme Arthritis in Children. J Rheumatol 2019; 46:952-959. [PMID: 30824649 DOI: 10.3899/jrheum.180829] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/18/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine whether second-line intraarticular glucocorticoid (IAGC) injection improves outcomes in children with persistently active Lyme arthritis after initial antibiotics. METHODS We conducted an observational comparative effectiveness study through chart review within 3 pediatric rheumatology centers with distinct clinical approaches to second-line treatment of Lyme arthritis. We primarily compared children receiving second-line IAGC to children receiving a second course of antibiotics alone. We evaluated the risk of developing antibiotic-refractory Lyme arthritis (ARLA) using logistic regression and the time to clinical resolution of Lyme arthritis using Cox regression. RESULTS Of 112 children with persistently active Lyme arthritis after first-line antibiotics, 18 children received second-line IAGC (13 with concomitant oral antibiotics). Compared to children receiving second-line oral antibiotics alone, children treated with IAGC had similar baseline characteristics but lower rates of ARLA (17% vs 44%; OR 0.3, 95% CI 0.1-0.95; p = 0.04) and faster rates of clinical resolution (HR 2.2, 95% CI 1.2-3.9; p = 0.01). Children in IAGC and oral antibiotic cohorts did not differ in treatment-associated adverse events. Among children receiving second-line IAGC, outcomes appeared similar irrespective of use of concomitant antibiotics. Outcomes were also similar between intravenous (IV) and oral antibiotic-treated cohorts, but older children seemed to respond more favorably to IV therapy. IV antibiotics were also associated with higher rates of toxicity. CONCLUSION IAGC injection appears to be an effective and safe second-line strategy for persistent Lyme arthritis in children, associated with rapid clinical resolution and reduced need for additional treatment.
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Affiliation(s)
- Daniel B Horton
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA. .,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University.
| | - Alysha J Taxter
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University
| | - Amy L Davidow
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University
| | - Brandt P Groh
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University
| | - David D Sherry
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University
| | - Carlos D Rose
- From the Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, New Brunswick; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick; Rutgers School of Public Health, Piscataway; Rutgers School of Public Health, Newark, New Jersey; Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Penn State Milton S. Hershey Medical Center, Hershey; Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.,D.B. Horton, MD, MSCE, Division of Pediatric Rheumatology, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, and Rutgers School of Public Health; A.J. Taxter, MD, MSCE, Brenner Children's Hospital, Wake Forest Baptist Medical Center; A.L. Davidow, PhD, Rutgers School of Public Health; B.P. Groh, MD, Penn State Milton S. Hershey Medical Center; D.D. Sherry, MD, Children's Hospital of Philadelphia, Division of Pediatric Rheumatology, Perelman School of Medicine, University of Pennsylvania; C.D. Rose, MD, Division of Rheumatology, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University
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8
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Giollo A, Rossini M, Bettili F, Ghellere F, Fracassi E, Idolazzi L, Gatti D, Viapiana O. Permanent Discontinuation of Glucocorticoids in Polymyalgia Rheumatica Is Uncommon but May Be Enhanced by Amino Bisphosphonates. J Rheumatol 2018; 46:318-322. [PMID: 30385701 DOI: 10.3899/jrheum.180324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The duration of treatment with glucocorticoids (GC) in polymyalgia rheumatica (PMR) is often longterm. Amino bisphosphonates (N-BP) are used in PMR for the prevention of GC-induced osteoporosis, but they coulsd also have immunomodulatory properties. Whether they can be effective as an adjuvant treatment in PMR is unknown. We aimed to establish whether the use of N-BP in our PMR cohort may be associated with GC discontinuation. METHODS We conducted a retrospective review of all patients diagnosed with PMR recorded in our electronic medical notes. Cox regression analyses were used to examine the association between the use of N-BP and discontinuation of GC. RESULTS Data were retrieved for 385 patients (mean age 71 ± 10 yrs, 64% females, mean initial prednisone dose 19 ± 9 mg/day). The median followup time was 38 months (range 9-57); more than 60% of patients were exposed to N-BP. GC were discontinued in 47% of patients after a median time of 20 months (range 14-27), but subsequently restarted in 39%. Overall, 276/385 patients (72%) were actively treated at their last available evaluation (mean prednisone dose 4.9 ± 5.5 mg/day), while 123/205 (60%) were still receiving GC after 24 months of followup. The use of N-BP was associated with the discontinuation of GC (adjusted HR 0.66, 95% CI 0.50-0.88), independent of age, initial GC dose, and osteoporosis. CONCLUSION Unlike current guidelines, longterm treatment with GC is often necessary. These preliminary data suggest that N-BP may be involved in the management of PMR.
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Affiliation(s)
- Alessandro Giollo
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy. .,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona.
| | - Maurizio Rossini
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Francesco Bettili
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Francesco Ghellere
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Elena Fracassi
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Luca Idolazzi
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Davide Gatti
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
| | - Ombretta Viapiana
- From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.,A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona
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Whyte MP, Lim E, McAlister WH, Gottesman GS, Trinh L, Veis DJ, Bijanki VN, Boden MG, Nenninger A, Mumm S, Buchbinder D. Unique Variant of NOD2 Pediatric Granulomatous Arthritis With Severe 1,25-Dihydroxyvitamin D-Mediated Hypercalcemia and Generalized Osteosclerosis. J Bone Miner Res 2018; 33:2071-2080. [PMID: 29933504 PMCID: PMC6636828 DOI: 10.1002/jbmr.3532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/27/2018] [Indexed: 12/18/2022]
Abstract
Pediatric granulomatous arthritis (PGA) refers to two formerly separate entities: autosomal dominant Blau syndrome (BS) and its sporadic phenocopy early-onset sarcoidosis (EOS). In 2001 BS and in 2005 EOS became explained by heterozygous mutations within the gene that encodes nucleotide-binding oligomerization domain-containing protein 2 (NOD2), also called caspase recruitment domain-containing protein 15 (CARD15). NOD2 is a microbe sensor in leukocyte cytosol that activates and regulates inflammation. PGA is characterized by a triad of autoinflammatory problems (dermatitis, uveitis, and arthritis) in early childhood, which suggests the causal NOD2/CARD15 mutations are activating defects. Additional complications of PGA were recognized especially when NOD2 mutation analysis became generally available. However, in PGA, hypercalcemia is only briefly mentioned, and generalized osteosclerosis is not reported, although NOD2 regulates NF-κB signaling essential for osteoclastogenesis and osteoclast function. Herein, we report a 4-year-old girl with PGA uniquely complicated by severe 1,25(OH)2 D-mediated hypercalcemia, nephrocalcinosis, and compromised renal function together with radiological and histopathological features of osteopetrosis (OPT). The classic triad of PGA complications was absent, although joint pain and an antalgic gait accompanied wrist, knee, and ankle swelling and soft non-tender masses over her hands, knees, and feet. MRI revealed tenosynovitis in her hands and suprapatellar effusions. Synovial biopsy demonstrated reactive synovitis without granulomas. Spontaneous resolution of metaphyseal osteosclerosis occurred while biochemical markers indicated active bone turnover. Anti-inflammatory medications suppressed circulating 1,25(OH)2 D, corrected the hypercalcemia, and improved her renal function, joint pain and swelling, and gait. Mutation analysis excluded idiopathic infantile hypercalcemia, type 1, and known forms of OPT, and identified a heterozygous germline missense mutation in NOD2 common in PGA (c.1001G>A, p.Arg334Gln). Thus, radiological and histological findings of OPT and severe hypercalcemia from apparent extrarenal production of 1,25(OH)2 D can complicate NOD2-associated PGA. Although the skeletal findings seem inconsequential, treatment of the hypercalcemia is crucial to protect the kidneys. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA.,Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Emilina Lim
- Pediatrics/Rheumatology, CHOC Children's Hospital, Orange, CA, USA
| | - William H McAlister
- Mallinckrodt Institute of Radiology, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, MO, USA
| | - Gary S Gottesman
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
| | - Lien Trinh
- Pediatrics/Endocrinology, CHOC Children's Hospital, Orange, CA, USA
| | - Deborah J Veis
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Vinieth N Bijanki
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
| | - Matthew G Boden
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
| | - Angela Nenninger
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA.,Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
| | - David Buchbinder
- Pediatrics/Hematology, CHOC Children's Hospital - UC Irvine, Orange, CA, USA
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10
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Balasubramanian A, Wade SW, Adler RA, Saag K, Pannacciulli N, Curtis JR. Glucocorticoid Exposure and Fracture Risk in a Cohort of US Patients With Selected Conditions. J Bone Miner Res 2018; 33:1881-1888. [PMID: 29924418 DOI: 10.1002/jbmr.3523] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/07/2022]
Abstract
The purpose of this work was to evaluate systemic glucocorticoid exposure and fracture among patients with newly-diagnosed inflammatory and immune-modulated conditions. Using administrative data, inception cohorts of rheumatoid arthritis (RA), asthma/chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), multiple sclerosis (MS), lupus, and sarcoidosis patients age 18 to 64 years with benefits coverage ≥12 months before diagnosis (January 1, 2005 to December 31, 2012) were followed to clinical fracture, cancer diagnosis, or December 31, 2012. Glucocorticoid users were new to therapy. Fracture incidence rates (IRs) per 1000 person-years were stratified by prednisone equivalent doses. Cox's proportional hazards models assessed risk by daily and cumulative dose, and by time since discontinuation, adjusted for baseline characteristics. Most patients (72% of 403,337) had glucocorticoid exposure; 52% were under age 50. IR (95% confidence interval [CI]) of any osteoporotic fracture was elevated at doses <5 mg/day (IR 9.33; 95% CI, 7.29 to 11.77) versus 0 mg/day (IR 4.87 (95% CI, 4.72 to 5.02). Fracture rates were elevated at doses <5 mg/day in patients <50 years and those ≥50 years. In both age groups, fracture risk increased with increasing cumulative exposure, being approximately 2.5-fold higher at cumulative dose ≥5400 mg compared to <675 mg. At ≥5400 mg, IR values were 5.69 (95% CI, 4.32 to 7.35) in patients <50 years and 17.10 (95% CI, 14.97 to 19.46) in older patients. Fracture risk decreased significantly within months following glucocorticoid discontinuation. In patients with a variety of inflammatory conditions, fracture risk increased at doses as low as <5 mg/day. Risk increased with increasing cumulative exposure and decreased soon following glucocorticoid discontinuation. Trends were similar between patients older and younger than 50 years. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT, USA
| | - Robert A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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George MD, Sauer BC, Teng CC, Cannon GW, England BR, Kerr GS, Mikuls TR, Baker JF. Biologic and Glucocorticoid Use after Methotrexate Initiation in Patients with Rheumatoid Arthritis. J Rheumatol 2018; 46:343-350. [PMID: 30275262 DOI: 10.3899/jrheum.180178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Biologic therapies can improve disease control for patients with rheumatoid arthritis (RA) but may be both overused and underused. We aimed to identify predictors of greater use of biologic therapies and to identify factors associated with persistent glucocorticoid use. METHODS Using national US Veteran's Affairs databases 2005-2016, we identified patients with RA receiving a first-ever prescription of methotrexate (MTX), requiring ≥ 6 months of baseline data. We evaluated predictors of biologic therapy initiation within 2 years of starting MTX and factors associated with baseline and persistent glucocorticoid use at 6-12 months using multivariable models. RESULTS Among 17,415 patients starting MTX, 3263 patients received biologic therapy within 2 years (20.6% 2-yr incidence). In adjusted analyses, biologic use was substantially lower in older patients [e.g., aHR 0.20 (95% CI 0.16, 0.26) for patients ≥ 80 vs < 50] and patients with more comorbidities [aHR 0.79 (95% CI 0.72, 0.87) for Charlson score ≥ 3 vs < 3]. Patients with heart failure [aHR 0.68 (95% CI 0.54, 0.84)], cancer [aHR 0.78 (95% CI 0.66, 0.92)], or who were nonwhite [aHR 0.79 (95% CI 0.72, 0.87)] were also less likely to receive a biologic. In contrast, baseline and persistent glucocorticoid use was similar across age groups and more common in patients with greater comorbidity. CONCLUSION Biologic therapy is initiated less frequently in patients with RA who are older, have more comorbidities, and who are nonwhite. While biologics may be avoided in older and sicker patients because of safety concerns, glucocorticoid use is similar regardless of age and is more frequent in patients with comorbidities, with implications for patient outcomes.
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Affiliation(s)
- Michael D George
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA. .,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania.
| | - Brian C Sauer
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Chia-Chen Teng
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Grant W Cannon
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Bryant R England
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Gail S Kerr
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Ted R Mikuls
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
| | - Joshua F Baker
- From the Philadelphia Veterans Affairs (VA) Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center (UNMC), Omaha, Nebraska; DC VA Medical Center, Georgetown and Howard University, Washington, D.C., USA.,M.D. George, MD, MSCE, University of Pennsylvania, VA Medical Center; B.C. Sauer, PhD, VA Medical Center, University of Utah; C.C. Teng, MS, VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; G.W. Cannon, MD, VA Medical Center, University of Utah; B.R. England, MD, VA Medical Center, University of Nebraska Medical Center; G.S. Kerr, MD, VA Medical Center, Georgetown and Howard Universities; T.R. Mikuls, MD, MSPH, VA Medical Center, University of Nebraska Medical Center; J.F. Baker, MD, MSCE, VA Medical Center, University of Pennsylvania
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Mitander A, Fei Y, Trysberg E, Mohammad M, Hu Z, Sakiniene E, Pullerits R, Jin T. Complement Consumption in Systemic Lupus Erythematosus Leads to Decreased Opsonophagocytosis In Vitro. J Rheumatol 2018; 45:1557-1564. [PMID: 30173146 DOI: 10.3899/jrheum.171325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Infections remain a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The high prevalence of infections in SLE is attributed to both the disease and its treatments. The complement system plays an important role in host immune responses against invading microorganisms. We sought to provide the experimental and clinical evidence supporting the hypothesis that low levels of complement factors cause defective complement-mediated opsonization in patients with SLE. METHODS Staphylococcus aureus was opsonized with sera from healthy individuals (n = 16), SLE patients with normal (n = 5) or low complement (n = 8) levels. Phagocytosis of S. aureus by healthy human neutrophils was analyzed by an imaging flow cytometry-based method. We retrospectively examined the infection incidence in relation to complement levels in a cohort of 165 patients with SLE during a 1.5-year period. The association was analyzed for infection incidence and disease-related variables. RESULTS Uptake of S. aureus by neutrophils was decreased when S. aureus was opsonized with sera from SLE patients with low complement levels compared to sera from healthy individuals and SLE patients with normal complement. In our SLE cohort, 44% of patients had at least 1 infection during the 1.5 years. No significant association was observed between complement levels and infection risk. Importantly, high-dose glucocorticoids (GC; prednisone ≥ 10 mg/day) were the most important predictive factor for infections in patients with SLE. CONCLUSION Low complement levels affect bacterial opsonization in SLE blood and lead to downregulated phagocytosis by neutrophils. High-dose GC increase the infection risk in patients with SLE.
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Affiliation(s)
- Amanda Mitander
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Ying Fei
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Estelle Trysberg
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Majd Mohammad
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Zhicheng Hu
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Egidija Sakiniene
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Rille Pullerits
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Tao Jin
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. .,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital.
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Kim D, Cho SK, Park B, Jang EJ, Bae SC, Sung YK. Glucocorticoids Are Associated with an Increased Risk for Vertebral Fracture in Patients with Rheumatoid Arthritis. J Rheumatol 2018; 45:612-620. [PMID: 29545455 DOI: 10.3899/jrheum.170054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify the effects of glucocorticoids (GC) on various types of fractures in patients with rheumatoid arthritis (RA). METHODS We used the Korean National Healthcare Claims database from 2010 to establish a retrospective cohort of patients with RA ≥ 19 years old. We then followed those patients through December 2013. The incidence rates of total and major fractures were calculated. We evaluated the effects of GC dose and duration on fractures using multivariable logistic regression analyses. We also examined the influence of GC on fractures in RA patients without a history of osteoporosis. RESULTS A total of 11,599 fractures was observed in 9964 out of 138,240 patients with RA. During followup, 68.2% of patients used oral GC for > 3 months. Adjusted analysis showed the risk of vertebral fractures was increased by the following characteristics: duration of GC ≥ 6 months (OR 1.76, p < 0.01); mean dose of GC ≥ 2.5 mg (OR range = 1.37-1.71, p < 0.01); and highest daily dose of GC ≥ 10 mg (OR range = 1.23-1.75, p < 0.03). However, neither the duration nor the dose of oral GC increased the risk of hip and nonvertebral/nonhip fractures in patients with RA. Consistent results were observed in RA patients without osteoporosis. CONCLUSION Longer duration and higher dose of oral GC in patients with RA increased the risk of vertebral fractures. However, the dose and duration of GC did not influence the risk of hip and nonvertebral/nonhip fractures.
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Affiliation(s)
- Dam Kim
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
| | - Soo-Kyung Cho
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
| | - Byeongju Park
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
| | - Eun Jin Jang
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
| | - Sang-Cheol Bae
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
| | - Yoon-Kyoung Sung
- From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea. .,D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases.
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Best JH, Kong AM, Lenhart GM, Sarsour K, Stott-Miller M, Hwang Y. Association Between Glucocorticoid Exposure and Healthcare Expenditures for Potential Glucocorticoid-related Adverse Events in Patients with Rheumatoid Arthritis. J Rheumatol 2018; 45:320-328. [PMID: 29335343 DOI: 10.3899/jrheum.170418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Oral glucocorticoid (OGC) use for rheumatoid arthritis (RA) is debated because of the adverse event (AE) profile of OGC. We evaluated the associations between cumulative doses of OGC and potential OGC-related AE, and quantified the associated healthcare expenditures. METHODS Using the MarketScan databases, patients ≥ 18 years old who have RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from January 1 to December 31, 2013 (evaluation period), were identified. Cumulative OGC dose was measured using prescription claims during the baseline period. Potential OGC-related AE (osteoporosis, fracture, aseptic necrosis of the bone, type 2 diabetes, ulcer/gastrointestinal bleeding, cataract, hospitalization for opportunistic infection, myocardial infarction, or stroke) and AE-related expenditures (2013 US$) were gathered during the evaluation period. Multivariable regression models were fitted to estimate OR of AE and incremental costs for patients with AE. RESULTS There were 84,357 patients analyzed, of whom 48% used OGC during the baseline period and 26% had an AE during the evaluation period. A cumulative OGC dose > 1800 mg was associated with an increased risk of any AE compared with no OGC exposure (OR 1.19, 99.65% CI 1.09-1.30). Incremental costs per patient with any AE were significantly greater for cumulative OGC dose > 1800 mg compared with no OGC exposure (incremental cost = $3528, 99.65% CI $2402-$4793). CONCLUSION Chronic exposure to low to medium doses of OGC was associated with significantly increased risk of potential OGC-related AE in patients with RA, and greater cumulative OGC dose was associated with substantially higher AE-related healthcare expenditures among patients with AE.
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Affiliation(s)
- Jennie H Best
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted.,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh
| | - Amanda M Kong
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA. .,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted. .,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh.
| | - Gregory M Lenhart
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted.,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh
| | - Khaled Sarsour
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted.,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh
| | - Marni Stott-Miller
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted.,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh
| | - Yong Hwang
- From Genentech Inc., South San Francisco, California; Truven Health Analytics, an IBM Company; Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Jennie Best and Khaled Sarsour are employees of Genentech Inc. Amanda Kong and Gregory Lenhart are employees of Truven Health Analytics, which received funding from Genentech Inc. Marni Stott-Miller was an employee of Truven Health Analytics at the time this research was conducted.,J.H. Best, PhD, Genentech Inc.; A.M. Kong, MPH, Truven Health Analytics; G.M. Lenhart, MS, Truven Health Analytics; K. Sarsour, PhD, MPH, Genentech Inc.; M. Stott-Miller, PhD, MS, Truven Health Analytics; Y. Hwang, MD, University of Pittsburgh
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Chen HL, Shen LJ, Hsu PN, Shen CY, Hall SA, Hsiao FY. Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study. J Rheumatol 2017; 45:83-89. [PMID: 29142034 DOI: 10.3899/jrheum.160214] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this population-based study is to examine the adverse events (AE) associated with longitudinal systemic glucocorticoid (GC) use among an ethnic Chinese systemic lupus erythematosus (SLE) cohort. METHODS Our study subjects were patients with newly diagnosed SLE aged 18 and older who received at least 1 prescription of systemic GC between 2001 and 2012 from Taiwan's National Health Insurance Research Database (NHIRD). The earliest prescription date of systemic GC for each subject was defined as the index date. For each subject, we calculated the average prednisolone-equivalent dose and the medication possession ratio (MPR) of GC use every 90 days for each patient after the index date. Patients with a diagnosis of AE (defined by the International Classification of Diseases-9-Clinical Modification diagnosis code) during the followup were also identified from the NHIRD. Generalized estimating equations adjusted for propensity score were applied to examine the association between longitudinal GC use and risks of prespecified AE (musculoskeletal, gastrointestinal, ophthalmologic, infectious, cardiovascular, neuropsychiatric, metabolic, and dermatologic diseases). RESULTS We identified 11,288 patients with SLE (mean followup: 6.28 yrs). Higher doses and higher MPR of GC were associated with increased risk of osteonecrosis [adjusted OR (aOR) 2.87-9.09]. Similar results were found regarding the risk of osteoporosis (aOR 1.71-3.67), bacterial infection (aOR 2.12-3.89), Cushingoid syndrome (aOR 6.51-62.03), and sleep disorder (aOR 1.42-3.59). CONCLUSION To our knowledge, this is the first study to show that the dose and intensity of longitudinal use of GC were both associated with risk of AE among a nationwide Asian SLE cohort.
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Affiliation(s)
- Hung-Lin Chen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Li-Jiuan Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Ping-Ning Hsu
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Chieh-Yu Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Susan A Hall
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Fei-Yuan Hsiao
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA. .,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors.
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16
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Black RJ, Robson JC, Goodman SM, Hoon E, Lai LYH, Simon LS, Harrison E, Neill L, Richards P, Nelsen LM, Nebesky JM, Mackie SL, Hill CL. A Patient-reported Outcome Measure for Effect of Glucocorticoid Therapy in Adults with Inflammatory Diseases Is Needed: Report from the OMERACT 2016 Special Interest Group. J Rheumatol 2017; 44:1754-1758. [PMID: 28365575 DOI: 10.3899/jrheum.161083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Accepted: 02/14/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The need for a standardized instrument to measure the effect of glucocorticoid (GC) therapy has been well documented in the literature. The aim of the first GC Special Interest Group was to define a research agenda around the development of a patient-reported outcome measure (PROM) in this area. METHODS The results of a background literature search and the preliminary results of a pilot survey and 2 qualitative studies were presented to facilitate the development of a research agenda. RESULTS It was agreed that there was a need for a data-driven PROM that identified both positive and negative effects of GC therapy to be used across all inflammatory indications for systemic GC use in adults. A research agenda was developed, consisting of further qualitative work to assess the effect of GC across different groups including various indications for GC use, different age groups, different dosages, and duration of treatment. CONCLUSION There was agreement on the need for a PROM in this area and a research agenda was set.
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Affiliation(s)
- Rachel J Black
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland.
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital.
| | - Joanna C Robson
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Susan M Goodman
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Elizabeth Hoon
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Lana Y H Lai
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Lee S Simon
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Eileen Harrison
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Lorna Neill
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Pam Richards
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Linda M Nelsen
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - J Michael Nebesky
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Sarah L Mackie
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
| | - Catherine L Hill
- From the Discipline of Medicine, School of Public Health, The University of Adelaide; Rheumatology Unit, The Royal Adelaide Hospital, Adelaide; Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia; Faculty of Health and Applied Sciences, University of the West of England; University of Bristol, Bristol; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; PMR & GCA UK North East, Kibblesworth; PMR and GCA Scotland, Berwickshire, Foulden, UK; Hospital for Special Surgery, New York, New York; SDG LLC, Cambridge, Massachusetts; Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA; F. Hoffmann-Roche Ltd., Basel, Switzerland
- R.J. Black, MBBS, PhD Candidate, Consultant Rheumatologist, Clinical Lecturer, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital; J.C. Robson, MRCP, PhD, Consultant Senior Lecturer in Rheumatology, University of the West of England, and Honorary Senior Lecturer, University of Bristol, and Honorary Consultant, University Hospitals Bristol UK National Health Service Trust, and Faculty of Health and Applied Sciences, University of the West of England; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Hospital for Special Surgery; E. Hoon, PhD, Arthritis SA Florey Research Fellow, School of Public Health, The University of Adelaide; L.Y. Lai, MSc, PhD Candidate, Board Certified Pharmacotherapy Specialist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; L.S. Simon, MD, Principal, SDG LLC; E. Harrison, BSc (Hons Physiology), OMERACT Patient Research Partner, PMR and GCA UK North East; L. Neill, BSc (Hons Nat Phil), OMERACT Patient Research Partner, PMR and GCA Scotland; P. Richards, HNC (Business Studies), OMERACT Patient Research Partner, University of Bristol; L.M. Nelsen, MHS, Director, Patient Focused Outcomes, Value Evidence and Outcomes, GlaxoSmithKline; J.M. Nebesky, MD, Senior Medical Director, F. Hoffmann-La Roche Ltd.; S.L. Mackie, PhD, Associate Clinical Professor, Honorary Consultant Rheumatologist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; C.L. Hill, MD, Clinical Professor, Consultant Rheumatologist, Discipline of Medicine, The University of Adelaide, and Rheumatology Unit, The Royal Adelaide Hospital, and Rheumatology Unit, The Queen Elizabeth Hospital
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Boers M, Aletaha D, Mela CM, Baker DG, Smolen JS. Glucocorticoid Effect on Radiographic Progression in Placebo Arms of Rheumatoid Arthritis Biologics Trials. J Rheumatol 2016; 43:1024-6. [PMID: 27036379 DOI: 10.3899/jrheum.150932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of glucocorticoids (GC) on damage progression in placebo-biologic arms of rheumatoid arthritis (RA) biologics trials. METHODS Posthoc metaanalysis of 2 infliximab (IFX) trials (established and early RA) and 1 tocilizumab (TCZ) trial (established RA). RESULTS The proportion of patients receiving GC was 38%-64%, baseline damage was 11-82 Sharp/van der Heijde points, and progression in the placebo groups was 0.5-4.8 points in 6 months. In the pooled IFX studies, GC cotreatment reduced 6-month progression by 2.6 points (95% CI 0.6-4.5). In the TCZ study (progression rate 0.5 Genant points), no such difference was seen. CONCLUSION GC cotreatment may affect results in RA trials.
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Affiliation(s)
- Maarten Boers
- From the Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; Roche Products Ltd., Welwyn Garden City, UK; Janssen Research and Development, Spring House, Pennsylvania, USA.M. Boers, MD, PhD, MSc, Professor of Clinical Epidemiology, Department of Epidemiology and Biostatistics, VU University Medical Center; D. Aletaha, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna; C.M. Mela, PhD, MSc, BSc, Clinical Development Scientist, Roche Products Ltd.; D.G. Baker, MD, Vice President Immunology, Janssen Research and Development; J.S. Smolen, MD, Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna.
| | - Daniel Aletaha
- From the Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; Roche Products Ltd., Welwyn Garden City, UK; Janssen Research and Development, Spring House, Pennsylvania, USA.M. Boers, MD, PhD, MSc, Professor of Clinical Epidemiology, Department of Epidemiology and Biostatistics, VU University Medical Center; D. Aletaha, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna; C.M. Mela, PhD, MSc, BSc, Clinical Development Scientist, Roche Products Ltd.; D.G. Baker, MD, Vice President Immunology, Janssen Research and Development; J.S. Smolen, MD, Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna
| | - Christopher M Mela
- From the Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; Roche Products Ltd., Welwyn Garden City, UK; Janssen Research and Development, Spring House, Pennsylvania, USA.M. Boers, MD, PhD, MSc, Professor of Clinical Epidemiology, Department of Epidemiology and Biostatistics, VU University Medical Center; D. Aletaha, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna; C.M. Mela, PhD, MSc, BSc, Clinical Development Scientist, Roche Products Ltd.; D.G. Baker, MD, Vice President Immunology, Janssen Research and Development; J.S. Smolen, MD, Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna
| | - Daniel G Baker
- From the Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; Roche Products Ltd., Welwyn Garden City, UK; Janssen Research and Development, Spring House, Pennsylvania, USA.M. Boers, MD, PhD, MSc, Professor of Clinical Epidemiology, Department of Epidemiology and Biostatistics, VU University Medical Center; D. Aletaha, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna; C.M. Mela, PhD, MSc, BSc, Clinical Development Scientist, Roche Products Ltd.; D.G. Baker, MD, Vice President Immunology, Janssen Research and Development; J.S. Smolen, MD, Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna
| | - Josef S Smolen
- From the Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands; Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; Roche Products Ltd., Welwyn Garden City, UK; Janssen Research and Development, Spring House, Pennsylvania, USA.M. Boers, MD, PhD, MSc, Professor of Clinical Epidemiology, Department of Epidemiology and Biostatistics, VU University Medical Center; D. Aletaha, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna; C.M. Mela, PhD, MSc, BSc, Clinical Development Scientist, Roche Products Ltd.; D.G. Baker, MD, Vice President Immunology, Janssen Research and Development; J.S. Smolen, MD, Professor of Medicine, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna
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18
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LeBlanc CMA, Ma J, Taljaard M, Roth J, Scuccimarri R, Miettunen P, Lang B, Huber AM, Houghton K, Jaremko JL, Ho J, Shenouda N, Matzinger MA, Lentle B, Stein R, Sbrocchi AM, Oen K, Rodd C, Jurencak R, Cummings EA, Couch R, Cabral DA, Atkinson S, Alos N, Rauch F, Siminoski K, Ward LM. Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders. J Bone Miner Res 2015; 30:1667-75. [PMID: 25801315 PMCID: PMC4556451 DOI: 10.1002/jbmr.2511] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 12/21/2022]
Abstract
Vertebral fractures are an important yet underrecognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the 3 years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semiquantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9 ± 4.4 years; 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a 3-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%; 95% confidence interval (CI) 2.9% to 11.7%). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a twofold increased fracture risk (hazard ratio (HR) 2.0; 95% CI 1.1 to 3.5). Other predictors of increased vertebral fracture risk included: (1) increases in disease severity scores between baseline and 12 months; (2) increases in body mass index Z-scores in the first 6 months of each 12-month period preceding the annual fracture assessment; and (3) decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the 3 years following glucocorticoid initiation. Almost one-half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete clinical predictors of incident vertebral fractures were evident early in the course of glucocorticoid therapy.
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Affiliation(s)
| | - Jinhui Ma
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Johannes Roth
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Paivi Miettunen
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | | | - Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Robert Stein
- Department of Pediatrics, University of Western Ontario, London, ON, Canada
| | | | - Kiem Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Celia Rodd
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Roman Jurencak
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Robert Couch
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - David A Cabral
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Nathalie Alos
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
| | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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19
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Hara ES, Ono M, Pham HT, Sonoyama W, Kubota S, Takigawa M, Matsumoto T, Young MF, Olsen BR, Kuboki T. Fluocinolone Acetonide Is a Potent Synergistic Factor of TGF-β3-Associated Chondrogenesis of Bone Marrow-Derived Mesenchymal Stem Cells for Articular Surface Regeneration. J Bone Miner Res 2015; 30:1585-96. [PMID: 25753754 PMCID: PMC5569386 DOI: 10.1002/jbmr.2502] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/09/2015] [Accepted: 03/04/2015] [Indexed: 12/18/2022]
Abstract
Articular cartilage repair remains a challenging problem. Based on a high-throughput screening and functional analysis, we found that fluocinolone acetonide (FA) in combination with transforming growth factor beta 3 (TGF-β3) strongly potentiated chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs). In an in vivo cartilage defect model in knee joints of immunocompromised mice, transplantation of FA/TGF-β3-treated hBMSCs could completely repair the articular surface. Analysis of the intracellular pathways revealed that FA enhanced TGF-β3-induced phosphorylation of Smad2 and Smad3. Additionally, we performed a pathway array and found that FA activates the mTORC1/AKT pathway. Chemical inhibition of mTORC1 with rapamycin substantially suppressed FA effect, and inhibition of AKT completely repressed chondrogenesis of hBMSCs. Inhibition of glucocorticoid receptor with mifepristone also suppressed FA effect, suggesting that FA involves binding to the glucocorticoid receptor. Comparative analysis with other glucocorticoids (triamcinolone acetonide [TA] and dexamethasone [DEX]) revealed the unique ability of FA to repair articular cartilage surgical defects. Analysis of intracellular pathways showed that the mTORC1/AKT pathway and the glucocorticoid receptor was highly activated with FA and TA, but to a lesser extent with DEX. Collectively, these results show a unique ability of FA to enhance TGF-β3-associated chondrogenesis, and suggest that the FA/TGF-β3 combination may be used as major inducer of chondrogenesis in vitro. Additionally, FA/TGF-β3 could be potentially applied in a clinical setting to increase the efficiency of regenerative approaches based on chondrogenic differentiation of stem cells.
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Affiliation(s)
- Emilio Satoshi Hara
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Ono
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hai Thanh Pham
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Wataru Sonoyama
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Kubota
- Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masaharu Takigawa
- Advanced Research Center for Oral and Craniofacial Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Matsumoto
- Department of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Marian F Young
- Craniofacial and Skeletal Diseases Branch, National Institutes of Craniofacial and Dental Research, National Institutes of Health, Bethesda, MD,, USA
| | - Bjorn R Olsen
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA,, USA
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Wechalekar MD, Vinik O, Moi JHY, Sivera F, van Echteld IAAM, van Durme C, Falzon L, Bombardier C, Carmona L, Aletaha D, Landewé RB, van der Heijde DMFM, Buchbinder R. The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. J Rheumatol Suppl 2015; 92:15-25. [PMID: 25180124 DOI: 10.3899/jrheum.140458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of glucocorticoids (GC), colchicine, nonsteroidal antiinflammatory drugs (NSAID), interleukin-1 (IL-1) inhibitors, and paracetamol to treat acute gout. METHODS We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to September 2011. Randomized controlled trials (RCT) or quasi-RCT in adults with acute gout that compared GC, colchicine, NSAID, IL-1 inhibitors, and paracetamol to no treatment, placebo, another intervention, or combination therapy were included. Two authors independently extracted data and assessed risk of bias. Primary endpoints were pain and adverse events. Data were pooled where appropriate. RESULTS Twenty-six trials evaluating GC (N = 5), NSAID (N = 21), colchicine (N = 2), and canakinumab (N = 1) were included. No RCT assessed paracetamol or intraarticular (IA) GC. No RCT compared systemic GC with placebo. Moderate quality evidence (3 trials) concluded that systemic GC were as effective as NSAID but safer. Low quality evidence (1 trial) showed that both high- and low-dose colchicine were more effective than placebo, and low-dose colchicine was no different to placebo with respect to safety but safer than high-dose colchicine. Low quality evidence (1 trial) showed no difference between NSAID and placebo with regard to pain or inflammation. No NSAID was superior to another. Moderate quality evidence (1 trial) found that 150 mg canakinumab was more effective than a single dose of intramuscular GC (40 mg triamcinolone) and equally safe. CONCLUSION GC, NSAID, low-dose colchicine, and canakinumab all effectively treat acute gout. There was insufficient evidence to rank them. Systemic GC appeared safer than NSAID and lower-dose colchicine was safer than higher-dose colchicine.
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Affiliation(s)
- Mihir D Wechalekar
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Ophir Vinik
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - John H Y Moi
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Francisca Sivera
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Irene A A M van Echteld
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Caroline van Durme
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Louise Falzon
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Claire Bombardier
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Loreto Carmona
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Daniel Aletaha
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Robert B Landewé
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Désirée M F M van der Heijde
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
| | - Rachelle Buchbinder
- From the Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia; and Flinders University, Bedford Park, South Australia, Australia; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Rheumatology, Hospital General Universitario Elda, Alicante, Spain; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Division of Rheumatology and Institute of Health Policy, Management, and Evaluation, University of Toronto; and Toronto General Research Institute, University Health Network; Institute for Work and Health, Mount Sinai Hospital, Toronto, Ontario, Canada; Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands; and Atrium Medical Center; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Victoria, Australia; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Victoria, Australia.M.D. Wechalekar, MD, FRACP, Rheumatology Unit, Repatriation General Hospital, Daw Park, South Australia, Australia; and Flinders University; O. Vinik, MD, FRCPC, Division of Rheumatology, University of Toronto; J.H.Y. Moi, BPhysio (Hons), MBBS (Hons), FRACP, Rheumatologist, Department of Rheumatology, The Royal Melbourne Hospital, Melbourne, Australia; F. Sivera, MD
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Lee DY, Wetzsteon RJ, Zemel BS, Shults J, Organ JM, Foster BJ, Herskovitz RM, Foerster DL, Leonard MB. Muscle torque relative to cross-sectional area and the functional muscle-bone unit in children and adolescents with chronic disease. J Bone Miner Res 2015; 30:575-83. [PMID: 25264231 PMCID: PMC4532328 DOI: 10.1002/jbmr.2375] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 12/14/2022]
Abstract
Measures of muscle mass or size are often used as surrogates of forces acting on bone. However, chronic diseases may be associated with abnormal muscle force relative to muscle size. The muscle-bone unit was examined in 64 children and adolescents with new-onset Crohn's disease (CD), 54 with chronic kidney disease (CKD), 51 treated with glucocorticoids for nephrotic syndrome (NS), and 264 healthy controls. Muscle torque was assessed by isometric ankle dynamometry. Calf muscle cross-sectional area (CSA) and tibia cortical section modulus (Zp) were assessed by quantitative CT. Log-linear regression was used to determine the relations among muscle CSA, muscle torque, and Zp, adjusted for tibia length, age, Tanner stage, sex, and race. Muscle CSA and muscle torque-relative-to-muscle CSA were significantly lower than controls in advanced CKD (CSA -8.7%, p = 0.01; torque -22.9%, p < 0.001) and moderate-to-severe CD (CSA -14.1%, p < 0.001; torque -7.6%, p = 0.05), but not in NS. Zp was 11.5% lower in advanced CKD (p = 0.005) compared to controls, and this deficit was attenuated to 6.7% (p = 0.05) with adjustment for muscle CSA. With additional adjustment for muscle torque and body weight, Zp was 5.9% lower and the difference with controls was no longer significant (p = 0.09). In participants with moderate-to-severe CD, Zp was 6.8% greater than predicted (p = 0.01) given muscle CSA and torque deficits (R(2) = 0.92), likely due to acute muscle loss in newly-diagnosed patients. Zp did not differ in NS, compared with controls. In conclusion, muscle torque relative to muscle CSA was significantly lower in CKD and CD, compared with controls, and was independently associated with Zp. Future studies are needed to determine if abnormal muscle strength contributes to progressive bone deficits in chronic disease, independent of muscle area. © 2014 American Society for Bone and Mineral Research.
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Affiliation(s)
- Dale Y Lee
- Department of Pediatrics, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
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22
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Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Esche J, Wudy SA, Remer T. Higher glucocorticoid secretion in the physiological range is associated with lower bone strength at the proximal radius in healthy children: importance of protein intake adjustment. J Bone Miner Res 2015; 30:240-8. [PMID: 25196629 DOI: 10.1002/jbmr.2347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 01/18/2023]
Abstract
Whether higher production of glucocorticoids (GCs) within the physiological range may already be affecting bone status in healthy children is unknown. Because dietary protein intake affects both bone and GCs, we examined the association of urinary measures of glucocorticoid status and cortical bone in healthy non-obese children, after particularly controlling for protein intake. Proximal forearm bone parameters were measured by peripheral quantitative computed tomography (pQCT). Subjects studied (n = 175, 87 males, aged 6 to 18 years) had two 24-hour urine samples collected: the first sample at 1 year before bone measurement, and the second sample at the time of bone measurement. Major urinary GC metabolites were measured by mass spectrometry and summed to assess daily adrenal GC secretion (∑C21). Urinary free cortisol (UFF) and cortisone (UFE) were summed to assess potentially bioactive free GCs (UFF + UFE). After controlling for several covariates and especially urinary nitrogen (the biomarker of protein intake) cortisol secretion ∑C21 was inversely associated with all analyzed pQCT measures of bone quality. ∑C21 also predicted a higher endosteal and lower periosteal circumference, explaining both a smaller cortical area and (together with lower BMD) a lower strength-strain-index (SSI). UFF + UFE, UFE itself, and a urinary metabolite-estimate of 11beta-hydroxysteroid dehydrogenase type1 (11beta-HSD1) activity showed corresponding reciprocal associations (p < 0.05) with BMD and bone mineral content, but not with SSI and bone geometry variables. In conclusion, higher GC levels, even within the physiological range, appear to exert negative influences on bone modeling and remodeling already during growth. Our physiological data also suggest a relevant role of cortisone as the direct source for intracrine-generated cortisol by bone cell 11beta-HSD1.
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Affiliation(s)
- Lijie Shi
- Institute of Nutritional and Food Sciences-Nutritional Epidemiology, University of Bonn, Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study Center at the Research Institute of Child Nutrition Dortmund, Germany
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Koumakis E, Avouac J, Winzenrieth R, Toth E, Payet J, Kahan A, Allanore Y, Cormier C. Trabecular bone score in female patients with systemic sclerosis: comparison with rheumatoid arthritis and influence of glucocorticoid exposure. J Rheumatol 2014; 42:228-35. [PMID: 25448793 DOI: 10.3899/jrheum.140752] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a "high-risk" population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS. METHODS This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD. RESULTS TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7-19.2) and a T score ≤ -2.5 SD (OR 5.0, 95% CI 1.5-7.0) in SSc. No association between GC and TBS was found in RA. CONCLUSION Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.
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Affiliation(s)
- Eugénie Koumakis
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Jérôme Avouac
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Renaud Winzenrieth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Emese Toth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Judith Payet
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - André Kahan
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Yannick Allanore
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Catherine Cormier
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
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Zhu TY, Griffith JF, Au SK, Tang XL, Kwok AW, Leung PC, Li EK, Tam LS. Bone mineral density change in systemic lupus erythematosus: a 5-year followup study. J Rheumatol 2014; 41:1990-7. [PMID: 24986848 DOI: 10.3899/jrheum.131190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine changes of bone mineral density (BMD) over a 5-year period in a cohort of female patients with systemic lupus erythematosus (SLE) and to identify factors predictive of BMD loss. METHODS Our longitudinal study involved 125 female patients with SLE with a mean (SD) age of 46.5 years (10.1) and a median disease duration of 10.4 years. Demographics and clinical data were collected and BMD at the femoral neck, total hip, and lumbar spine (L1-4) was performed by using dual-energy x-ray absorptiometry at baseline and followup. RESULTS Average percentage changes of BMD over a mean followup of 5 years were -2.41% at the femoral neck, -1.63% at the total hip, and -0.62% at the lumbar spine, with significant changes at both the femoral neck (p < 0.0001) and total hip (p < 0.0005), but not at the lumbar spine (p = 0.128). Disease flare, new organ damage, and use of glucocorticoids during followup were significantly associated with larger decreases in BMD. BMD loss was arrested at the femoral neck and BMD increased at the total hip and lumbar spine in patients receiving antiosteoporosis therapy. In multivariate analyses, use of antiosteoporosis therapy was independently associated with increased BMD at any site and new organ damage was an independent predictor of BMD loss at the femoral neck. CONCLUSION Significant BMD loss at the hip over a period of 5 years was found in patients with SLE. Disease activity, disease damage, and use of glucocorticoids are the disease-specific variables that contribute to bone loss in SLE.
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Affiliation(s)
- Tracy Y Zhu
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - James F Griffith
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Sze-Ki Au
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Xiao-Lin Tang
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Anthony W Kwok
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Ping-Chung Leung
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Edmund K Li
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Lai-Shan Tam
- From the Department of Medicine and Therapeutics; Department of Imaging and Interventional Radiology; and The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.T.Y. Zhu, PhD, Department of Medicine and Therapeutics; J.F. Griffith, MD, Department of Imaging and Interventional Radiology; S-K. Au, MPhil, The Jockey Club Centre for Osteoporosis Care and Control; X-L. Tang, PhD, Department of Medicine and Therapeutics; A.W. Kwok, MPhil; P-C. Leung, DSc, The Jockey Club Centre for Osteoporosis Care and Control; E.K. Li, FRCP; L-S. Tam, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong.
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Barrera-Vargas A, Gómez-Martín D, Merayo-Chalico J, Ponce-de-León A, Alcocer-Varela J. Risk factors for drug-resistant bloodstream infections in patients with systemic lupus erythematosus. J Rheumatol 2014; 41:1311-6. [PMID: 24882843 DOI: 10.3899/jrheum.131261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify risk factors for developing drug-resistant bacterial infections in patients with systemic lupus erythematosus (SLE). METHODS A retrospective, case-control study was performed. Patients fulfilled American College of Rheumatology criteria for SLE and had an episode of bloodstream infection between 2001 and 2012. Cases were defined as those with bloodstream infection caused by drug-resistant bacteria (Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, or extended-spectrum-β-lactalamase-producing Escherichia coli); while controls had susceptible strains of S. aureus or E. coli. Differences between groups were analyzed by Student t test or Mann-Whitney U test. Association between variables was assessed by OR (CI 95%). Multivariate analysis was performed by binary logistic regression model. RESULTS Forty-four patients were included in each group. Variables associated with drug-resistant bloodstream infection were history of central nervous system activity; hematological activity, immunosuppressive treatment and prednisone dose at the time of the infection; and low C3 levels, antibiotic use, or hospitalization in the previous 3 months. In multivariate analysis, variables that remained significant were low C3 previous to infection (OR 3.12, CI 95% 1.91-8.22), previous hospitalization (OR 2.22, CI 95% 1.42-4.10), and prednisone dose at the time of infection (OR 1.10, CI 95% 1.04-1.22). CONCLUSION Low C3 levels, recent hospitalization, and prednisone dose at time of infection are independent risk factors for acquiring drug-resistant bacteria in patients with SLE. Although the present data do not fully support a change in initial treatment-decision strategies, this information could lead to prospective studies designed to address this issue, which could determine the best approach in clinical practice.
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Affiliation(s)
- Ana Barrera-Vargas
- From the Department of Immunology and Rheumatology and Department of Infectology and Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.A. Barrera-Vargas, MD, Department of Immunology and Rheumatology; D. Gómez-Martín, MD, PhD, Research Associate, Department of Immunology and Rheumatology; J. Merayo-Chalico, MD, Fellow in Rheumatology, Department of Immunology and Rheumatology; A. Ponce-de-León, MD, Attending Physician, Department of Infectology and Microbiology; J. Alcocer-Varela, MD, PhD, Professor and Chairman, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Diana Gómez-Martín
- From the Department of Immunology and Rheumatology and Department of Infectology and Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.A. Barrera-Vargas, MD, Department of Immunology and Rheumatology; D. Gómez-Martín, MD, PhD, Research Associate, Department of Immunology and Rheumatology; J. Merayo-Chalico, MD, Fellow in Rheumatology, Department of Immunology and Rheumatology; A. Ponce-de-León, MD, Attending Physician, Department of Infectology and Microbiology; J. Alcocer-Varela, MD, PhD, Professor and Chairman, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Javier Merayo-Chalico
- From the Department of Immunology and Rheumatology and Department of Infectology and Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.A. Barrera-Vargas, MD, Department of Immunology and Rheumatology; D. Gómez-Martín, MD, PhD, Research Associate, Department of Immunology and Rheumatology; J. Merayo-Chalico, MD, Fellow in Rheumatology, Department of Immunology and Rheumatology; A. Ponce-de-León, MD, Attending Physician, Department of Infectology and Microbiology; J. Alcocer-Varela, MD, PhD, Professor and Chairman, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Alfredo Ponce-de-León
- From the Department of Immunology and Rheumatology and Department of Infectology and Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.A. Barrera-Vargas, MD, Department of Immunology and Rheumatology; D. Gómez-Martín, MD, PhD, Research Associate, Department of Immunology and Rheumatology; J. Merayo-Chalico, MD, Fellow in Rheumatology, Department of Immunology and Rheumatology; A. Ponce-de-León, MD, Attending Physician, Department of Infectology and Microbiology; J. Alcocer-Varela, MD, PhD, Professor and Chairman, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Jorge Alcocer-Varela
- From the Department of Immunology and Rheumatology and Department of Infectology and Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.A. Barrera-Vargas, MD, Department of Immunology and Rheumatology; D. Gómez-Martín, MD, PhD, Research Associate, Department of Immunology and Rheumatology; J. Merayo-Chalico, MD, Fellow in Rheumatology, Department of Immunology and Rheumatology; A. Ponce-de-León, MD, Attending Physician, Department of Infectology and Microbiology; J. Alcocer-Varela, MD, PhD, Professor and Chairman, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
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