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Lendrem D, Mitchell S, McMeekin P, Gompels L, Hackett K, Bowman S, Price E, Pease CT, Emery P, Andrews J, Lanyon P, Hunter J, Gupta M, Bombardieri M, Sutcliffe N, Pitzalis C, McLaren J, Cooper A, Regan M, Giles I, Isenberg D, Saravanan V, Coady D, Dasgupta B, McHugh N, Young-Min S, Moots R, Gendi N, Akil M, Griffiths B, Ng WF. Do the EULAR Sjögren's syndrome outcome measures correlate with health status in primary Sjögren's syndrome? Rheumatology (Oxford) 2015; 54:655-9. [PMID: 25240612 DOI: 10.1093/rheumatology/keu361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 11/08/2023] Open
Abstract
OBJECTIVE This study sets out to investigate the relationship between health status [EuroQol five-dimensions questionnaire (EQ-5D)] in primary SS and three of the European League Against Rheumatism (EULAR) SS outcome measures-the disease activity index (ESSDAI), the patient reported index (ESSPRI) and the sicca score. In particular, the goal was to establish whether there is a relationship between the EULAR outcome measures and quality of life. METHODS Health status was evaluated using a standardized measure developed by the EuroQol Group-the EQ5D. This permits calculation of two measures of health status: time trade-off (TTO) values and the EQ-5D visual analogue scale (VAS) scores. We used Spearman's rank correlation analysis to investigate the strength of association between health status and three EULAR measures of physician- and patient-reported disease activity in 639 patients from the UK primary SS registry (UKPSSR) cohort. RESULTS This study demonstrates that the EULAR SS disease-specific outcome measures are significantly correlated with health outcome values (P < 0.001). Higher scores on the ESSDAI, EULAR sicca score and ESSPRI are associated with poorer health states-i.e. lower TTO values and lower VAS scores. While all three are significantly correlated with TTO values and EQ-5D VAS scores, the effect is strongest for the ESSPRI. CONCLUSION This study provides further evidence supporting the use of ESSDAI, EULAR sicca score and ESSPRI measures in the clinic. We also discuss the need for disease-specific measures of health status and their comparison with standardized health outcome measures.
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Affiliation(s)
- Dennis Lendrem
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK. Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the
| | - Sheryl Mitchell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Peter McMeekin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Luke Gompels
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Katie Hackett
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK. Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the
| | - Simon Bowman
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Elizabeth Price
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Colin T Pease
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Emery
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Jacqueline Andrews
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Peter Lanyon
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - John Hunter
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Monica Gupta
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Michele Bombardieri
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Nurhan Sutcliffe
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Costantino Pitzalis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - John McLaren
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Annie Cooper
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Marian Regan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Ian Giles
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - David Isenberg
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Vadivelu Saravanan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - David Coady
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Bhaskar Dasgupta
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Neil McHugh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Steven Young-Min
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Robert Moots
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Nagui Gendi
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Mohammed Akil
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK
| | - Wan-Fai Ng
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the London NHS Trust & Barts and the London School of Medicine and Dentistry, NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, Royal Hampshire County Hospital, Winchester, Royal Derby Hospital, Derby, University College London Hospitals NHS Foundation Trust, London, Queen Elizabeth Hospital, Gateshead, Sunderland Royal Hospital, Sunderland, Southend University Hospital, Royal National Hospital for Rheumatic Diseases, Bath, Portsmouth Hospitals NHS Trust, Aintree University Hospitals, Liverpool, Basildon Hospital, Basildon, Royal Hallamshire Hospital, Sheffield, UK. Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Birmingham, Birmingham, Great Western Hospitals NHS Foundation Trust, Swindon, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, Nottingham University Hospital, Nottingham, Gartnavel General Hospital, Glasgow, Barts and the
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