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Barber CEH, Lethebe BC, Szostakiwskyj JH, Barnabe C, Barber MRW, Katz S, England BR, Hazlewood GS. A population-based analysis of rheumatology care patterns for inflammatory arthritis during COVID-19 in Alberta, Canada. Semin Arthritis Rheum 2024; 65:152364. [PMID: 38237230 DOI: 10.1016/j.semarthrit.2024.152364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of the study was to understand the impact of the COVID-19 pandemic on inflammatory arthritis (IA) rheumatology care in Alberta, Canada. METHODS We used linked provincial health administrative datasets to establish an incident cohort of individuals with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS) seen at least once by a rheumatologist. We examined incidence rates (IR) per 100,000 population, and patterns of follow-up care between 2011 and 2022. In a subset of individuals diagnosed five years prior to the pandemic, we report on those lost to follow-up during the pandemic, and those with virtual care visits followed by in-person visit within 30 days. Multivariable logistic regression was used to examine patient characteristics associated with these patterns of care. RESULTS The IR for RA in 2020 declined compared to previous years (44.6), but not for AS (9.2) or PsA (9.1). In 2021 IRs rose (RA 49.5; AS 11.8; PsA 11.8). Among those diagnosed within 5 years of the pandemic, 632 (6.0 %) were lost to follow-up, with characteristics of those lost to follow-up differing between IA types. 1444 individuals had at least one virtual visit followed within 30 days by an in-person follow-up. This was less common in males (OR 0.69-0.79) and more common for those with a higher frequency of physician visits prior to the pandemic (OR 1.27-1.32). CONCLUSION Impacts of patterns of care during the pandemic should be further explored for healthcare planning to uphold optimal care access and promote effective use of virtual care.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Brendan Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Steven Katz
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System & University of Nebraska Medical Center, Omaha, NE, USA
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
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Talotta R, Aiello MR, Restuccia R, Magaudda L. Non-Pharmacological Interventions for Treating Psoriatic Arthritis. Altern Ther Health Med 2024; 30:36-43. [PMID: 38581338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Background and Objective In this review, we discuss evidence concerning the management of psoriatic arthritis (PsA) patients with non-pharmacological interventions and additionally develop physical training protocols that could be prescribed to these patients. Methods We selected 110 articles, published on PubMed and Google Scholar databases from 1972 to date, investigating the effects of generic hygienic-dietary recommendations and training programs in PsA or psoriasis (PSO) individuals. Results Although data in support are limited, aerobic, endurance, and strength exercises as well as complementary techniques may all be useful in preserving or improving residual functional capacity, joint flexibility, and muscle strength. Exercise may reduce systemic inflammation, pain, and fatigue and additionally control PsA comorbidities, like dysmetabolism or obesity. Conclusions The polyhedral clinical expression of PsA underlines the need for a multidisciplinary approach combining the synergistic effects of pharmacological and non-pharmacological treatments. The latter range from preventive measures, like dietary modifications, weight loss, and cigarette smoking cessation, to personalized training protocols according to disease activity and phenotype, comorbidities, and individual tolerability. In these patients, we strongly encourage the regular practice of motor activity at progressively increasing intensity with combined supervised aerobic, strength, endurance, and stretching exercises.
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Asahina A, Minami Y, Kameda H. A cross-sectional questionnaire survey involving physicians for the clarification of the diagnosis and current status of therapeutic intervention of psoriatic arthritis in Japan. J Dermatol 2024; 51:261-270. [PMID: 38087804 DOI: 10.1111/1346-8138.17055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/06/2023] [Accepted: 11/09/2023] [Indexed: 02/04/2024]
Abstract
Patients with psoriatic arthritis (PsA) often experience comorbid, irreversible joint destruction, therefore early diagnosis and treatment of PsA are important. The diagnosis requires a comprehensive assessment, which includes an interview, a physical examination, a visual examination of the skin and nails, a blood test, and an imaging test. To clarify how patients with PsA are actually diagnosed and how physicians collaborate among clinical departments, we conducted a web-based questionnaire survey of 500 physicians (dermatologists, rheumatologists, and orthopedists) frequently involved in PsA treatment in Japan. The survey showed that those patients are rarely confirmed to have axial arthritis, peripheral arthritis, enthesitis, or dactylitis by general dermatology practitioners (GP dermatologists). Overall, <60% of patients suspected of having PsA underwent PsA examination by GP dermatologists more than once every 6 months; this percentage is lower than that of patients who underwent PsA examination by rheumatologists and orthopedists. The Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire is the most commonly used for PsA screening. However, users of PASE were only 11.0%, 25.3%, 14.8%, and 24.1% of GP dermatologists, attending dermatologists in hospitals (HP dermatologists), rheumatologists, and orthopedists, respectively. While >80% of HP dermatologists, rheumatologists, and orthopedists used imaging tests (ultrasound, X-ray, and magnetic resonance imaging) for PsA screening, only 40% of GP dermatologists performed imaging tests. Regarding the demands on the healthcare environment of PsA treatment, early diagnosis and treatment for PsA are crucial in every clinical department. The present study showed that GP dermatologists rarely perform imaging tests or confirm a PsA diagnosis, thus patients may miss out on appropriate treatment through collaboration among clinical departments and step-up therapy. Because patients with PsA present diverse comorbid clinical symptoms, early diagnosis, including routine imaging tests, and appropriate treatment in collaboration with other experts are necessary.
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Affiliation(s)
- Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukie Minami
- Medical Affairs Department, Maruho Co., Ltd., Osaka, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
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Madahar SS, Gideon A, Abdul-Sater AA. Nod-like receptors in inflammatory arthritis. Biomed J 2024; 47:100655. [PMID: 37598797 PMCID: PMC10825342 DOI: 10.1016/j.bj.2023.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023] Open
Abstract
Nod-like receptors (NLRs) are innate immune receptors that play a key role in sensing components from pathogens and from damaged cells or organelles. NLRs form signaling complexes that can lead to activation of transcription factors or effector caspases - by means of inflammasome activation -Inflammatory arthritis (IA) culminating in promoting inflammation. An increasing body of research supports the role of NLRs in driving pathogenesis of IA, a collection of diseases that include rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis, and pediatric arthritis. In this review, we briefly discuss the main drivers of IA diseases and dive into the evidence for - and against - various NLRs in driving these diseases. We also review the studies examining the use of NLR and inflammasome inhibitors as potential therapies for IA.
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Affiliation(s)
- Sahib Singh Madahar
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada; Department of Biology, York University, Toronto, Ontario, Canada
| | - Alita Gideon
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Ali A Abdul-Sater
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada.
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Kragsnaes MS, Jensen JRB, Nilsson AC, Malik MI, Munk HL, Pedersen JK, Horn HC, Kruhøffer M, Kristiansen K, Mullish BH, Marchesi JR, Kjeldsen J, Röttger R, Ellingsen T. Dynamics of inflammation-associated plasma proteins following faecal microbiota transplantation in patients with psoriatic arthritis and healthy controls: exploratory findings from the FLORA trial. RMD Open 2024; 10:e003750. [PMID: 38296309 PMCID: PMC10836383 DOI: 10.1136/rmdopen-2023-003750] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES The gut microbiota can mediate both pro and anti-inflammatory responses. In patients with psoriatic arthritis (PsA), we investigated the impact of faecal microbiota transplantation (FMT), relative to sham transplantation, on 92 inflammation-associated plasma proteins. METHODS This study relates to the FLORA trial cohort, where 31 patients with moderate-to-high peripheral PsA disease activity, despite at least 3 months of methotrexate treatment, were included in a 26-week, double-blind, randomised, sham-controlled trial. Participants were allocated to receive either one gastroscopic-guided healthy donor FMT (n=15) or sham (n=16). Patient plasma samples were collected at baseline, week 4, 12 and 26 while samples from 31 age-matched and sex-matched healthy controls (HC) were collected at baseline. Samples were analysed using proximity extension assay technology (Olink Target-96 Inflammation panel). RESULTS Levels of 26 proteins differed significantly between PsA and HC pre-FMT (adjusted p<0.05), of which 10 proteins were elevated in PsA: IL-6, CCL20, CCL19, CDCP1, FGF-21, HGF, interferon-γ (IFN-γ), IL-18R1, monocyte chemotactic protein 3, and IL-2. In the FMT group, levels of 12 proteins changed significantly across all timepoints (tumour necrosis factor (TNF), CDCP1, IFN-γ, TWEAK, signalling lymphocytic activation molecule (SLAMF1), CD8A, CD5, Flt3L, CCL25, FGF-23, CD6, caspase-8). Significant differences in protein levels between FMT and sham-treated patients were observed for TNF (p=0.002), IFN-γ (p=0.011), stem cell factor (p=0.024), matrix metalloproteinase-1 (p=0.038), and SLAMF1 (p=0.042). FMT had the largest positive effect on IFN-γ, Axin-1 and CCL25 and the largest negative effect on CCL19 and IL-6. CONCLUSIONS Patients with active PsA have a distinct immunological plasma protein signature compared with HC pre-FMT. FMT affects several of these disease markers, including sustained elevation of IFN-γ. TRIAL REGISTRATION NUMBER NCT03058900.
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Affiliation(s)
- Maja Skov Kragsnaes
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Muhammad Irfan Malik
- Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jens Kristian Pedersen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Karsten Kristiansen
- Department of Biology, Laboratory of Genomics and Molecular Biomedicine, University of Copenhagen, Copenhagen, Denmark
- Institute of Metagenomics, Qingdao-Europe Advanced Institute for Life Sciences, Qingdao, China
| | - Benjamin H Mullish
- Division of Digestive Diseases, Imperial College London Faculty of Medicine, London, UK
- Department of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Julian R Marchesi
- Division of Digestive Diseases, Imperial College London Faculty of Medicine, London, UK
| | - Jens Kjeldsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Richard Röttger
- Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Vestergaard SB, Esbensen BA, Klausen JM, Glintborg B, Lau L, Yilmaz Jantzen C, Aadahl M, Fevejle Cromhout P, de Thurah A. Prevalence of anxiety and depression and the association with self-management behaviour in >12 000 patients with inflammatory rheumatic disease: a cross-sectional nationwide study. RMD Open 2024; 10:e003412. [PMID: 38253596 PMCID: PMC10806500 DOI: 10.1136/rmdopen-2023-003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To investigate the prevalence of anxiety and depression among patients with inflammatory arthritis (IA) and evaluate the association of these mental health issues with self-management behaviour. METHODS In this nationwide cross-sectional study, we analysed data from 12 713 adult Danish patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or spondyloarthritis (SpA). Patients received an electronic questionnaire covering sociodemographics, self-management behaviour and mental health status. Questionnaire data were linked to clinical data from the Danish Rheumatology database (DANBIO) and the Danish National Patient Registry. The prevalence of anxiety and depression (by the Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D)) was estimated separately for RA/PsA/SpA. The association between mental health status and low self-management behaviour (adherence to treatment, health activation and physical activity) was estimated using multivariable logistic regression, adjusting for age, sex, educational level and comorbidity. RESULTS The prevalence of anxiety (HADS-A≥8) was highest for patients with SpA (34.5% (95% CI 32.4% to 36.6%)) and lowest for patients with RA (22.1% (95% CI 21.2% to 23.0%)), it was higher for women, younger (<55 years) and recently diagnosed (<3 years) patients and those with basic education. Similar prevalence estimates were found for depression. Across diagnoses, the clinically relevant symptoms of anxiety and depression (HADS≥8) were significantly associated with low self-management behaviour. CONCLUSION Patients with IA showed substantial levels of anxiety and depression. A statistically significant association between anxiety and depression and low self-management behaviour was identified. These findings call for a systematic approach to identifying mental health issues in patients with IA.
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Affiliation(s)
| | - Bente Appel Esbensen
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Julie Midtgaard Klausen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Lene Lau
- Patient Research Partner, Aarhus, Denmark
| | | | - Mette Aadahl
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital Center for Clinical Research and Prevention, Frederiksberg, Denmark
| | | | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus Faculty of Health, Aarhus, Denmark
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Silva DR, Meireles SM, Brumini C, Natour J. Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial. Adv Rheumatol 2023; 63:58. [PMID: 38093394 DOI: 10.1186/s42358-023-00342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients. METHODS Forty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise. RESULTS At baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the "emotional aspect" domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the "alternate biceps (bilateral)" exercise. CONCLUSION Functional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis. TRIAL REGISTRATION ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1 .
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Affiliation(s)
- Diego Roger Silva
- Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 740;, São Paulo, SP, CEP: 04023-900, Brazil
| | - Sandra Mara Meireles
- Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 740;, São Paulo, SP, CEP: 04023-900, Brazil
| | - Christine Brumini
- Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 740;, São Paulo, SP, CEP: 04023-900, Brazil
| | - Jamil Natour
- Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 740;, São Paulo, SP, CEP: 04023-900, Brazil.
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von Ahnen JA, Gross G, Lull C, Blauth M, Kraemer B, Olsavszky V, Leipe J, Schmieder A. The Effect of an Interdisciplinary Dermatological-Rheumatological Consultation on the Outcome of Patients with Psoriasis with Musculoskeletal Pain: A Prospective, Single-Center Cohort Study. Adv Ther 2023; 40:5243-5253. [PMID: 37768507 PMCID: PMC10611824 DOI: 10.1007/s12325-023-02667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA), a disease with complex inflammatory musculoskeletal manifestations, complicates psoriasis in up to 30% of patients. In this study, we aimed to determine the effect of an interdisciplinary dermatological-rheumatological consultation (IDRC) for patients with psoriasis with musculoskeletal symptoms. METHODS This prospective study enrolled 202 patients with psoriasis. Patients with musculoskeletal pain (MSP) (n = 115) participated in an IDRC 12 weeks after enrollment. The outcome was evaluated after 24 weeks. RESULTS In 12/79 (15.2%) patients seen in the IDRC, the prior diagnosis was changed: eight with a first diagnosis of PsA, four with a diagnosis of PsA rescinded. Treatment was modified in 28% of patients. Significant improvements in Psoriasis Area and Severity Index (PASI) (from 5.3 to 2.0; p < 0.001) and Dermatology Life Quality Index (DLQI) (from 6.7 to 4.5; p = 0.009) were observed. By comparing changes in PASI and DLQI over the study period, an improvement in PASI of 0.7 ± 1.4 points (p = 0.64) and in DLQI of 2.9 ± 1.5 points (p = 0.051) could be attributed to participation in the IDRC. CONCLUSION An IDRC of patients with psoriasis with MSP leads to a valid diagnosis of PsA and improvement in quality of life. Based on these results, an IDRC is a valuable and time efficient way for psoriasis patient with MSP to receive optimal care.
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Affiliation(s)
- Jan Alwin von Ahnen
- Department of Dermatology. Venerology, and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Georg Gross
- Fifth Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Lull
- Department of Dermatology. Venerology, and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Mara Blauth
- Department of Dermatology. Venerology, and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernhard Kraemer
- Fifth Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Victor Olsavszky
- Department of Dermatology. Venerology, and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan Leipe
- Fifth Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, Venereology and Allergology, University Medical Center Würzburg, University Hospital Würzburg, Josef-Schneider Strasse 2, 97080, Wurzburg, Germany.
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Hewitt RM, Urmston D, Mcateer H, Schofield J, Bundy C. A UK online survey exploring patient perspectives of remote consultations for managing psoriasis and psoriatic arthritis during the SARS-CoV-2 pandemic. PSYCHOL HEALTH MED 2023; 28:3163-3176. [PMID: 35941815 DOI: 10.1080/13548506.2022.2104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
The use of remote consultations via telephone or video can contribute to the management of people with psoriasis and has allowed continuity of patient care throughout the SARS-CoV-2 pandemic, though little is known about the patient experience. The present study aimed to provide insights into the views and experiences of people with psoriasis and psoriatic arthritis on their remote consultations during the SARS-CoV-2 pandemic and develop guidance for patients and healthcare professionals on how to optimise future remote consultations. We conducted a cross-sectional, on-line survey of people with psoriasis and psoriatic arthritis. Data were analysed using descriptive statistics and Thematic Analysis. Overall, 126 people reported experiences of telephone (92%) or video (8%) consultations. Most participants were satisfied with (78%), and were happy for, remote consultations to continue (21%); few were not (5%). Others did not always want remote consultations (39%) and preferred alternating with face-to-face consultations (18%). Some wanted remote care during the pandemic only (17%). Five themes were identified: (1) Advantages of Remote Consultations; (2) Disadvantages of Remote Consultations plus sub-themes (2.1) Practical Issues and (2.2) the Absence of Non-Verbal Cues and Emotions; (3) Serving a Purpose; and (4) A 'Good' Remote Consultation; and (5) Advice to Other Patients. Remote consultations form an important part of psoriatic disease management, mainly for routine follow-up appointments in patients with stable disease, and in addition to face-to-face consultations. Additional skills training for clinicians could improve the quality of remote consultations.
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Affiliation(s)
- Rachael M Hewitt
- School of Healthcare Sciences, College of Biomedical & Lifesciences, Cardiff University, Cardiff, UK
| | | | - Helen Mcateer
- The Psoriasis Association, Northampton, England, UKb
| | - Julia Schofield
- The Psoriasis Association, Northampton, England, UKb
- Postgraduate Medicine, University of Hertfordshire, College Lane, Hatfield, England
| | - Chris Bundy
- School of Healthcare Sciences, College of Biomedical & Lifesciences, Cardiff University, Cardiff, UK
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Schäfer J, Behning C, Brossart P, Bieber T, Wilsmann-Theis D, Schäfer VS. Psoriatic arthritis or osteoarthritis? Data from a specialized dermatological-rheumatological collaboration-the Psoriatic Arthrtis Center Bonn. J Eur Acad Dermatol Venereol 2023; 37:e1348-e1350. [PMID: 37422705 DOI: 10.1111/jdv.19320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Jana Schäfer
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | | | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
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Song K, Webb L, Eder L, FitzGerald O, Goel N, Helliwell PS, Katz A, Merola JF, Rosen CF, Coates LC, Poddubnyy D. Screening and Referral Strategies for the Early Recognition of Psoriatic Arthritis Among Patients With Psoriasis: Results of a GRAPPA Survey. J Rheumatol 2023; 50:1439-1445. [PMID: 37582554 DOI: 10.3899/jrheum.2023-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This study aimed to explore the experiences of dermatologists and rheumatologists in the early recognition of psoriatic arthritis (PsA) and to identify potential improvements to the current shared-care model. METHODS A 24-question survey addressing referral strategies was constructed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) project steering committee and sent to all members (n = 927). Questions addressed the use of screening tools, frequency of PsA in patients with psoriasis, therapeutic decision making, and suggestions for earlier PsA recognition and current unmet needs. RESULTS There were 149 respondents (16.1% response rate), which included 113 rheumatologists from 37 countries and 26 dermatologists from 16 countries. Of the dermatologists, 81% use PsA-specific screening instruments. Conversely, rheumatologists reported that only 26.8% of patients referred to them from all sources had been assessed with screening tools. Although dermatologists reported that a mean of 67% of suspected PsA cases were confirmed, rheumatologists reported a mean of 47.9% of confirmed cases. Both specialties reported similar views regarding optimization of the diagnostic process and indicated that the best approach involved combining patient-reported (ie, screening tools) and physician-confirmed findings. Moreover, both specialties identified the education of primary care physicians (PCPs) and dermatologists as the greatest priority to improve PsA screening. CONCLUSION The survey indicated the current unmet needs in the early recognition of PsA. Important areas to address include improving the use of screening instruments, increasing the education of community-based dermatologists and PCPs, and using a combination of patient-reported and physician-confirmed findings in the screening approach.
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Affiliation(s)
| | - Louisa Webb
- L. Webb, BA, L.C. Coates, PhD, MBChB, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Oliver FitzGerald
- O. FitzGerald, MD, School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Niti Goel
- N. Goel, MD, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philip S Helliwell
- P.S. Helliwell, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Chapel Allerton Hospital, Leeds, UK
| | - Arnon Katz
- A. Katz, BSc, MSc, Patient Research Partner, Haifa, Israel
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cheryl F Rosen
- C.F. Rosen, MD, Division of Dermatology, Toronto Western Hospital and University Health Network Hospitals, Toronto, Ontario, Canada
| | - Laura C Coates
- L. Webb, BA, L.C. Coates, PhD, MBChB, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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12
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König A, Hofmann M, Kaufmann R, Müller-Stahl J, Pinter A. Management of psoriatic arthritis by dermatologists - a German nationwide survey. J Dtsch Dermatol Ges 2023; 21:1351-1357. [PMID: 37814389 DOI: 10.1111/ddg.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/22/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Psoriatic arthritis (PsA) warrants early diagnosis and treatment for optimal results. This study aimed to elucidate routine monitoring activities for PsA with concurrent psoriasis (PsO) by dermatologists to gather data on how conditions for optimal treatment are ensured. PATIENTS AND METHODS This non-interventional, prospective, epidemiological, cross-sectional study (2016-2019) included patients with confirmed PsA from dermatologists. Descriptive statistics were conducted for center and patient characteristics as well as for data of PsA monitoring and treatment stratified by different center types. RESULTS 212 patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. The majority of the PsA patients were diagnosed by a rheumatologist (> 55% in each center type) at an early or intermediate stage (> 59%). Treatment was initiated most frequently by a dermatologist (office-based physicians: 69.6%, hospitals: 60.9%, university hospitals: 82.9%). Patients were treated with biologics more frequently in university hospitals (single therapy: 43.9%, in combination with systemic therapy: 26.8%) compared to private practices (single: 44.6%, combination: 13.5%) and non-university hospitals (single: 34.8%, combination: 8.7%). CONCLUSIONS As PsA diagnosis was performed most frequently by rheumatologists whereas treatment was primarily initiated by dermatologists, an optimal collaboration between these specialists is crucial.
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Affiliation(s)
- Anke König
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Matthias Hofmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
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13
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Coates LC, Eder L, Poddubnyy D, Rosen CF. Identification of Psoriatic Arthritis in Patients With Psoriasis. J Rheumatol 2023; 50:25-26. [PMID: 37419623 DOI: 10.3899/jrheum.2023-0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
People with psoriasis (PsO) are at increased risk of developing psoriatic arthritis (PsA). Screening patients with PsO for PsA may be helpful in diagnosing PsA early. Dermatologists play a role in assessing their patients with PsO for musculoskeletal symptoms and referring them to a rheumatologist for diagnosis and treatment.
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Affiliation(s)
- Laura C Coates
- L.C. Coates, MD, PhD, Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, and Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Denis Poddubnyy
- D. Poddubnyy, MD, PhD, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Cheryl F Rosen
- C.F. Rosen, MD, Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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14
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Leung YY, Tillett W, de Wit M, Orbai AM, Coates LC, FitzGerald O, Helliwell PS, Strand V, Mease PJ, Goel N, Christensen R, Merola JF, Lindsay CA, Ogdie A, Gossec L, Gladman DD. Initiating Evaluation of Composite Outcome Measures for Psoriatic Arthritis: 2022 Updates From the GRAPPA-OMERACT Working Group. J Rheumatol 2023; 50:53-57. [PMID: 37419621 DOI: 10.3899/jrheum.2023-0530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) working group-comprising rheumatologists, dermatologists, methodologists, and patient research partners-provided updates at the GRAPPA 2022 annual meeting on its work to evaluate composite outcome measures for PsA. Ten composite outcome measures were considered. Initial steps were to define the population, the purpose of use, and the proposed pros and cons of the 10 candidate composite instruments for PsA. Preliminary Delphi exercises within the working group and GRAPPA stakeholders confirmed high priority for evaluating minimal disease activity (MDA); moderate priority for Disease Activity in PsA (DAPSA), American College of Rheumatology (ACR) response criteria, Psoriatic Arthritis Disease Activity Score (PASDAS), Composite Psoriatic Disease Activity Index (CPDAI), 3 visual analog scale (VAS), and 4VAS; and low priority for Disease Activity Score in 28 joints (DAS28), Psoriatic Arthritis Responder Criteria (PsARC), and Routine Assessment of Patient Index Data 3 (RAPID3). Further appraisal of candidate composite instruments is ongoing.
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Affiliation(s)
- Ying-Ying Leung
- Y.Y. Leung, MB ChB, MD, Duke-NUS Medical School, Singapore, Department of Rheumatology and Immunology, Singapore General Hospital, Singapore;
| | - William Tillett
- W. Tillett, BSc, MB ChB, PhD, Royal National Hospital for Rheumatic Diseases, University of Bath, Bath, UK
| | - Maarten de Wit
- M. de Wit, PhD, GRAPPA Patient Research Partner, Amsterdam, the Netherlands
| | - Ana-Maria Orbai
- A.M. Orbai, MD, MHS, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura C Coates
- L.C. Coates, MB ChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver FitzGerald
- O. FitzGerald, MD, Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Philip S Helliwell
- P.S. Helliwell, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Vibeke Strand
- V. Strand, MD, Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Philip J Mease
- P.J. Mease, MD, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA
| | - Niti Goel
- N. Goel, MD, GRAPPA Patient Research Partner, and Therapeutic Area Head of Rheumatology, TrialSpark, and Duke University School of Medicine, Durham, North Carolina, USA
| | - Robin Christensen
- R. Christensen, MSc, PhD, Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christine A Lindsay
- C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Prosper, Texas, USA, employed by Arcutis Biotherapeutics Inc
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laure Gossec
- L. Gossec, MD, PhD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and AP-HP, Pitié-Salpêtrière Hospital, Rheumatology Department, Paris, France
| | - Dafna D Gladman
- D.D. Gladman, MD, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, and Psoriatic Arthritis Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
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15
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Eder L, James AJ, van der Horst-Bruinsma I, Coates LC, Goel N. Diversity, Equity, and Inclusion: Sex and Gender and Intersectionality With Race and Ethnicity in Psoriatic Disease. J Rheumatol 2023; 50:38-40. [PMID: 37527854 DOI: 10.3899/jrheum.2023-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
Sex (biological attributes associated with being male or female) and gender (sociocultural-driven traits and behaviors related to being a man or a woman) are emerging as important determinants of disease course and response to therapy in patients with psoriasis and psoriatic arthritis (PsA). Although psoriatic disease (PsD) is equally prevalent in men and women, the condition affects them in different and unique ways, giving rise to sex- and gender-related differences in clinical presentation, including baseline disease activity, disease course, and response to treatment. Better understanding of the roles sex and gender play in the development and evolution of PsD has the potential to improve patient care. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) continues its effort to highlight issues related to diversity, equity, and inclusion in people with PsD by dedicating a session during the annual meeting to sex and gender and their intersectionality with race and ethnicity in individuals with PsA.
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Affiliation(s)
- Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;
| | - Alaina J James
- A.J. James, MD, PhD, Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Irene van der Horst-Bruinsma
- I. van der Horst-Bruinsma, MD, Radboud University Medical Centre, Department of Rheumatology, Nijmegen, the Netherlands
| | - Laura C Coates
- L.C. Coates, MD, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Niti Goel
- N. Goel, MD, GRAPPA Patient Research Partner, Durham, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, and DurTrialSpark Inc., Durham, North Carolina, USA
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16
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Diaz AJ, Rosety MA, Armario JC, Bandez MJ, Garcia-Gomez N, Sanchez-Sanchez E, Diaz J, Castejon-Riber C, Bernardi M, Rosety-Rodriguez M M, Ordonez FJ, Rosety I. Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis. Nutrients 2023; 15:4563. [PMID: 37960216 PMCID: PMC10648681 DOI: 10.3390/nu15214563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Fatigue and musculoskeletal pain are also frequent in patients with psoriasis (PsO) without arthritis (PsA). The current study aimed to assess the impact of an intervention program based on aerobic training to reduce fatigue and musculoskeletal pain in patients with PsO without PsA. A total of 118 male patients with PsO volunteered in the current interventional study and were randomly allocated to the experimental (n = 59) or control group (n = 59). The intervention consisted of a 16-week aerobic training program on a treadmill, three sessions per week, consisting of a warm-up, 35-50 min treadmill exercise (increasing 5 min/4 weeks) at a work intensity of 50-65% of peak heart-rate (increasing 5%/4 weeks), and cooling-down. The functional assessment of chronic illness therapy fatigue scale (FACIT-Fatigue), health assessment questionnaire disability index (HAQ-DI), and visual analog scale (VAS) were compared pre and post intervention. Nutritional intake, maximal aerobic power, lipid profile, serum markers of muscle damage, and body composition were also assessed. When compared to baseline, FACIT-Fatigue, HAQ-DI, and VAS scores were significantly improved without increasing markers of muscle damage. Fat mass percentage, lipid profile, and maximal oxygen consumption were also improved. In conclusion, a 16-week aerobic training program at moderate intensity was safe, well tolerated, and effective in psoriatic patients without PsA. Long-term follow-up studies are required to examine whether these promising results may improve clinical outcomes.
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Affiliation(s)
- Antonio J. Diaz
- School of Nursing and Physiotherapy, University of Cadiz, Ana Viya Avenue, 52, 11009 Cadiz, Spain;
| | - Miguel A. Rosety
- School of Sports Sciences, University of Cadiz, Rep. Saharahui Avenue, 12, 11519 Cadiz, Spain;
| | - Jose C. Armario
- Dermatology Unit, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | - Manuel J. Bandez
- Biomedicine Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | - Natalia Garcia-Gomez
- Histology and Pathology Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
| | | | - Jara Diaz
- School of Sports Sciences, University of Cadiz, Rep. Saharahui Avenue, 12, 11519 Cadiz, Spain;
| | - Cristina Castejon-Riber
- School of Education Sciences, University of Cordoba, C/San Alberto Magno s/n, 14071 Cordoba, Spain;
| | - Marco Bernardi
- School of Sports Medicine, University La Sapienza, Ple. Aldo Moro 5, 00185 Rome, Italy;
| | - Manuel Rosety-Rodriguez M
- School of Sports Medicine, University of Cadiz, Virgen del Carmen s/n, 11100 Cadiz, Spain; (M.R.-R.M.); (F.J.O.)
| | - Francisco J. Ordonez
- School of Sports Medicine, University of Cadiz, Virgen del Carmen s/n, 11100 Cadiz, Spain; (M.R.-R.M.); (F.J.O.)
| | - Ignacio Rosety
- Human Anatomy Department, School of Medicine, University of Cadiz, Fragela Square s/n, 11003 Cadiz, Spain;
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Karmacharya P, Stull C, Stephens-Shields A, Husni ME, Scher JU, Craig E, Fitzsimmons R, Reddy SM, Magrey MN, Ogdie A, Walsh JA. Responsiveness and Minimum Clinically Important Difference in Patient-Reported Outcome Measures Among Patients With Psoriatic Arthritis: A Prospective Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:2182-2189. [PMID: 36913210 DOI: 10.1002/acr.25111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/31/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To determine the responsiveness to therapy and minimum clinically important improvement (MCII) for patient-reported outcome measures in psoriatic arthritis (PsA) and to examine the impact of baseline disease activity on the ability to demonstrate change. METHODS A longitudinal cohort study was performed within the PsA Research Consortium. Patients completed several patient-reported outcomes, including the Routine Assessment of Patient Index Data, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Psoriatic Arthritis Impact of Disease 12-item (PsAID12) questionnaire, and others. The mean change in the scores between visits and standardized response means (SRMs) were calculated. The MCII was calculated as the mean change in score among patients who reported minimal improvement. SRMs and MCIIs were compared among subgroups with moderate to highly active PsA and those with lower disease activity. RESULTS Among 171 patients, 266 therapy courses were included. The mean ± SD age was 51 ± 13.8 years, 53% were female, and the mean swollen and tender joint counts were 3 and 6, respectively, at baseline. SRMs and MCII for all measures were small to moderate, although greater among those with higher baseline disease activity. BASDAI had the best SRM overall and for less active PsA, and the clinical Disease Activity of PsA (cDAPSA) and PsAID12 were best for those with higher disease activity. CONCLUSION SRMs and MCII were relatively small in this real-world population, particularly among those with lower disease activity at baseline. BASDAI, cDAPSA, and PsAID12 had good sensitivity to change, but selection for use in trials should consider the baseline disease activity of patients to be enrolled.
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Affiliation(s)
| | - Courtney Stull
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Marina N Magrey
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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18
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Thomsen RS, Nilsen TIL, Haugeberg G, Sitter B, Kavanaugh A, Pedersen SJ, Hoff M. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:743. [PMID: 37726677 PMCID: PMC10508016 DOI: 10.1186/s12891-023-06871-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA) there is a theoretical risk of increased disease activity related to strenuous physical activity, including exercise. We evaluated the effect of high intensity interval training (HIIT) on objective measures of inflammation in PsA assessed by ultrasound (US) of peripheral joints and entheses, and by bone marrow edema (BME) on MRI of the sacroiliac joints (SIJ) and spine. METHODS We randomly assigned 67 PsA patients to an intervention group that performed structured HIIT for 11 weeks, or to a control group instructed not to change their physical exercise habits. Outcome measures included US evaluation of the total cohort and MRI in a subgroup of 41; both assessed at 3 months. We calculated the proportions with an increased US B-mode and power-doppler (PD) signal of joints and entheses and Spondyloarthritis-Research-Consortium-of-Canada (SPARCC)-BME score of the SIJ and spine for both groups. RESULTS Proportions with an increased US B-mode score of the joints were 32% and 28% in HIIT and control groups, respectively. Corresponding proportions of PD scores of the joints were 7% and 10% and PD scores of entheses were 32% and 31%. The proportions with increased MRI BME of the SIJ were 6% in the HIIT group and 10% in the control group. Corresponding proportions were 6% and 5% for the MRI BME of the spine. CONCLUSION In PsA patients with a low to moderate disease activity, there was no clear evidence of objectively measured increased inflammation after HIIT, as evaluated by US and MRI. TRIAL REGISTRATION ClinicalTrials.gov NCT02995460 (16/12/2016).
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Affiliation(s)
- Ruth Stoklund Thomsen
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway.
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Glenn Haugeberg
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Division of Rheumatology, Department of Internal Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Beathe Sitter
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, School of Medicine, University of California, San Diego, USA
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Denmark
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Puche-Larrubia MÁ, López-Medina C, Ziadé N. Peripheral spondyloarthritis: What have we learned? Best Pract Res Clin Rheumatol 2023; 37:101862. [PMID: 37599204 DOI: 10.1016/j.berh.2023.101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
The peripheral spondyloarthritis (pSpA) entity remains poorly defined in comparison with axial SpA and psoriatic arthritis, as the clinical symptoms have low specificity, the biological markers are virtually lacking, and dedicated randomized controlled trials in this specific indication remain scarce. In addition, clinical similarities between pSpA and psoriatic arthritis (PsA) have been described, partly explained by a resemblance in the pathophysiology of both entities. Thus, diagnosing pSpA can be challenging because of the overlap with other entities and the absence of a specific test or imaging study that can definitively diagnose the condition. The aim of this review is to summarize the current understanding of pSpA, its epidemiology, physiopathology, clinical diagnosis, and classification criteria. In addition, we present patient-reported outcomes used in pSpA clinical studies, available evidence on therapies, and future directions.
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Affiliation(s)
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Cordoba, Cordoba, Spain.
| | - Nelly Ziadé
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
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Lubrano E, Scriffignano S, de Vlam K, Ronga M, Perrotta FM, Lories R. Triple jump for the optimal management of psoriatic arthritis: diet, sleep and exercise - a review. RMD Open 2023; 9:e003339. [PMID: 37648398 PMCID: PMC10471880 DOI: 10.1136/rmdopen-2023-003339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterised by the association of arthritis and psoriasis combined with other related conditions and comorbidities. Treatment of PsA has rapidly evolved by the introduction of new biological drugs and small molecules which allow to achieve disease remission or low disease activity in most of the patients. However, unmet treatment needs still persist for those patients with persistent disease activity or symptoms, impaired function, reduced quality of life or comorbidities. In this context, non-pharmacological approaches, including diet modifications, an adequate sleep quality and physical activity could provide additional benefits. In recent years, diet modifications, improvement of sleep quality and physical activity became an area of interest for researchers and some studies showed how a holistic non-pharmacological approach may ameliorate the quality of life of patients with PsA.The aim of this manuscript was to review the current evidence on the intriguing link and potential effects of diet, sleep and exercise in PsA patients. In particular, we reviewed the literature focusing on the possible benefits of a holistic approach to PsA patients considering lifestyle modifications.
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Affiliation(s)
- Ennio Lubrano
- Dipartimento di Medicina, Università degli Studi del Molise, Campobasso, Italy
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Cente, KU Leuven, Leuven, Belgium
| | - Silvia Scriffignano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
| | - Kurt de Vlam
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Mario Ronga
- Department of Health Sciences, Università degli Studi del Piemonte Orientale Amedeo Avogadro Facoltà di Medicina e Chirurgia, Novara, Italy
| | - Fabio Massimo Perrotta
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Universita degli Studi del Molise, Campobasso, Italy
| | - Rik Lories
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Cente, KU Leuven, Leuven, Belgium
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Hailey L, Howells L, Bundy C, Kirtley S, Martin S, O'Sullivan D, Steinkoening I, Stepney M, Coates LC. Developing evidence-based patient-focused learning materials to support health behaviour change for people living with psoriatic arthritis. RMD Open 2023; 9:e003190. [PMID: 37652555 PMCID: PMC10476110 DOI: 10.1136/rmdopen-2023-003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/24/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES In psoriatic arthritis (PsA), self-management is important for patient function and quality of life. Behaviour change can be difficult, patients could benefit from high-quality support to initiate change. Our aim was to codesign the project as theory-informed, evidence-based, patient-focused, materials supporting healthy lifestyle changes for patients diagnosed with PsA. METHODS Development of the materials was overseen by a steering group of patients with PsA, psychologists, rheumatologists, a design team and researchers. First, a literature review was performed to establish the evidence base for behaviours and potential interventions in PsA, including diet, weight, alcohol, smoking, exercise, anxiety, depression and stress. An initial roundtable of patients with PsA prioritised areas and content ideas. Draft materials including a website and downloadable materials were produced. A second roundtable of patients with PsA collected feedback on the draft content and design. A third roundtable was held with patients with PsA and a fourth with clinicians to refine the materials and ensuring that they were evidence based, accessible, interesting, and helpful to initiate and maintain change. A final evaluation survey was performed to review the draft website before launching the final materials. RESULTS 15 candidate topics were prioritised. A website and set of postcards summarising the topics were developed by the design team and refined following feedback from the roundtable groups. CONCLUSION This project created patient-focused resources to support behaviour change. It addresses common concerns of patients with PsA about how they may optimise their health by providing practical and brief interventions to challenge and support them to make changes.
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Affiliation(s)
- Louise Hailey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura Howells
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Christine Bundy
- Behavioural Medicine/ Health Psychology School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Samantha Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | | | | | - Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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22
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Abstract
INTRODUCTION Nail psoriasis is an inflammatory disorder without a potential scarring outcome, but the nail signs, even the milder ones, can cause discomfort to patients and severely affect their quality of life. Nail psoriasis may be associated with psoriatic arthritis and when it starts during infancy, it may be a predictor of a more severe disease course in adulthood. All these issues contribute to the high economic burden of psoriasis. AREAS COVERED Nail psoriasis is notoriously difficult to treat, even though new treatments are in continuous development. This paper provides an update on new treatments and address the current gaps in care of nail psoriasis. EXPERT OPINION A better understanding of the disease pathogenesis and more 'real-life' studies will definitely be helpful to improve treatment results. A lower level of heterogeneity should be advisable among trials when evaluating nail psoriasis. Moreover, the relationship between nail psoriasis and psoriatic arthritis should be the focus of unbiased studies in order to better define the real risk that nail psoriasis patients have to develop arthritis.
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Affiliation(s)
- Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Antonella Tosti
- Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
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23
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Su Y, Wang CH, Gao JF, Zhang FX, Lin JY, Zhang LY, Zhao Y. [Recommendations for diagnosis and treatment of psoriatic arthritis in China]. Zhonghua Nei Ke Za Zhi 2022; 61:883-892. [PMID: 35922212 DOI: 10.3760/cma.j.cn112138-20220103-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriatic arthritis is a chronic systemic autoimmune disease, characterized by psoriasis skin lesions and inflammation of the spine and joint. It has complicated clinical manifestations and individual variations. Nearly half of the patients will have joints erosion in two years, which is crippling. The severity of the skin and joint disease frequently do not correlate with each other. Currently, the understanding of the disease is insufficient in China with the lack of standardized diagnosis and treatment. Therefore, researchers from the Chinese Rheumatology Association formulated this specification based on the diagnosis and management experience together with guidelines at home and abroad. The specification summarizes the present situation of domestic diagnosis and treatment, aiming to standardize the diagnosis process and treatment protocols of psoriatic arthritis. Furthermore, it can reduce misdiagnosis and missed diagnosis, as well as improve the prognosis.
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Affiliation(s)
- Y Su
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - C H Wang
- Department of Rheumatology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - J F Gao
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - F X Zhang
- Department of Rheumatology and Clinical Immunology, Hebei Provincal People's Hospital, Shijiazhuang 050051, China
| | - J Y Lin
- Department of Rheumatology and Immunology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - L Y Zhang
- Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinial Immunology, Ministry of Education, Beijing 100730, China
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Abstract
There is increasing evidence of racial and ethnic disparities in the evaluation and treatment of people with psoriasis (PsO) and psoriatic arthritis, and inadequate racial/ethnic diversity in psoriatic disease (PsD) research. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2021 annual meeting, a program focusing on diversity, equity, and inclusion (DEI) was presented to highlight known health and healthcare disparities in PsD. There is limited understanding of the prevalence and severity of PsD and how it affects quality of life among racial/ethnic minorities with PsD. Educational gaps and lack of diversity in our dermatology workforce may be contributing to challenges in appropriately diagnosing and treating PsO in darker skin types. Racial/ethnic minorities are also inadequately represented in clinical research, including trial recruitment and participation, for PsD. A panel of patient research partners, researchers, and clinicians ended the session with a broad discussion on how GRAPPA can better ensure racial/ethnic DEI in their educational, research, and clinical missions.
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Affiliation(s)
- Junko Takeshita
- J. Takeshita, MD, PhD, MSCE, Department of Dermatology, Department of Biostatistics, and Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Chau
- J. Chau, MCS, Patient Research Partner, Hong Kong Psoriatic Arthritis Association, Hong Kong, China
| | - Kristina Callis Duffin
- K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah, Salt Lake City, Utah, USA;
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, Chief Medical Officer, Abcuro Inc., and Adjunct Assistant Professor, Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
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25
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Schläpfer-Pessina A, Dumusc A. [Use of clinical scores for rheumatoid arthritis and inflammatory rheumatic diseases in routine care]. Rev Med Suisse 2022; 18:462-466. [PMID: 35306765 DOI: 10.53738/revmed.2022.18.773.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many clinical scores have been developed in research to measure rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) activity. In routine care, they may be used as part of a treat to target (T2T) strategy consisting of a systematic evaluation of disease activity followed by an adaptation of the treatment in order to reach a predefined therapeutic target, generally remission. The benefits of this strategy have been showed in RA and its use is recommended for this condition. The added value of the T2T strategy for SpA and PsA remains debated, requiring further studies. Scores may be used for the follow-up of patients, but their limitations should be taken in consideration.
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Affiliation(s)
- Aline Schläpfer-Pessina
- Service de rhumatologie, Département de l'appareil locomoteur, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Alexandre Dumusc
- Service de rhumatologie, Département de l'appareil locomoteur, Centre hospitalier universitaire vaudois, 1011 Lausanne
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26
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Akhlaq A, Ali HF, Sheikh AB, Muhammad H, Ijaz SH, Sattar MH, Nazir S, Ud Din MT, Nasir U, Khan MZ, Muslim MO, Wazir MHK, Dani SS, Fudim M, Minhas AMK. Cardiovascular Diseases in the Patients with Psoriatic Arthritis. Curr Probl Cardiol 2022; 48:101131. [PMID: 35124075 DOI: 10.1016/j.cpcardiol.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
There are limited data regarding the burden and trend of cardiovascular diseases (CVD) in psoriatic arthritis (PsA). We analyzed the National Inpatient Sample database from January 2005 to December 2018 to examine the hospitalization trends amongst adults with PsA primarily for heart failure (HF), acute myocardial infarction (AMI), and stroke. The primary outcomes of interest included in-hospital mortality, length of stay (LOS), and inflation-adjusted cost. The age-adjusted percentage of HF hospitalizations among PsA patients decreased from 2.5% (2005/06) to 1.4% (2011/12; P-trend 0.013) and subsequently increased to 2.0% (2017/18; P-trend 0.044). The age-adjusted percentage of AMI hospitalizations among PsA patients showed a non-statistically significant decreasing trend from 2.1% (2005/06) to 1.7% (2011/12; P-trend 0.248) and showed a non-statistically significant increase to 2.3% (2017/18; P-trend 0.056). The age-adjusted stroke hospitalizations increased from 1.1% (2005/06) to 1.3% (2017/18; P-trend 0.036). Apart from a decrease in adjusted inflation-adjusted cost among heart failure hospitalizations, there was no significant change in inpatient mortality, length of stay or hospital cost, during the study period. We found an increasing trend of cardiovascular hospitalizations in patients with PsA. These findings will raise awareness and inform further research and clinical practice for PSA patients with CVD.
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Affiliation(s)
- Anum Akhlaq
- Department of Internal Medicine, University of Mississippi Medical Center, MS, USA
| | | | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Hafiz Muhammad
- Department of Internal Medicine, Agha Khan University Hospital, Karachi, Pakistan
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | | | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Mian Tanveer Ud Din
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Usama Nasir
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | | | | | | | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
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27
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Gottlieb AB, Wells AF, Merola JF. Telemedicine and psoriatic arthritis: best practices and considerations for dermatologists and rheumatologists. Clin Rheumatol 2022; 41:1271-1283. [PMID: 35083564 PMCID: PMC8791553 DOI: 10.1007/s10067-022-06077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
Telemedicine encompasses a variety of modalities that allow for the remote assessment and treatment of patients. The technologies, services, and tools available for telemedicine in the USA are increasingly becoming an integral part of the healthcare system to bridge the gaps in care that can arise from geographic and/or socioeconomic obstacles and provider shortages. Telemedicine can be applied to a spectrum of clinical areas, including rheumatic diseases. Psoriatic arthritis (PsA) is a chronic, inflammatory, multisystem disease with predominately skin and joint manifestations. PsA is often misdiagnosed and/or undiagnosed, which can lead to worse patient outcomes, including irreversible joint erosion and damage. The difficulties in diagnosing and managing PsA are confounded by the emergence and increased use of telemedicine because of the COVID-19 pandemic. Telemedicine presents the opportunity to increase access to healthcare by rheumatologists and dermatologists to improve training and education regarding PsA and to decrease time attributed to office visits associated with PsA. However, challenges in diagnosing PsA without a thorough in-person physical examination by a trained rheumatologist or dermatologist exist. We provide an overview of the ways telemedicine can be incorporated into clinical care and optimized for patients with PsA; characteristic clinical features of PsA, with a focus on skin and joint signs and symptoms; screening tools to be used in routine clinical care; assessments that can be used to evaluate quality of life, functional ability, and disease activity in PsA; and resources and recommendations for the development of future telemedicine use in rheumatology and dermatology.Key Points • Patients with psoriatic arthritis (PsA) are often misdiagnosed and/or undiagnosed. • Telemedicine can improve access to healthcare by rheumatologists and dermatologists. • Telemedicine can be incorporated into clinical care and optimized for managing PsA. |
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Affiliation(s)
- Alice B. Gottlieb
- Icahn School of Medicine at Mount Sinai, 10 Union Square East, New York, NY USA
| | - Alvin F. Wells
- Aurora Rheumatology and Immunotherapy Center, Franklin, WI USA
| | - Joseph F. Merola
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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28
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Valero C, Baldivieso JP, Gonzalez-Alvaro I, Tomero E, Castañeda S, García-Vicuña R. Effectiveness and safety of combined biological therapy in patients with refractory multidomain spondyloarthritis. Ann Rheum Dis 2022; 81:899-901. [PMID: 35086814 DOI: 10.1136/annrheumdis-2021-221812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Cristina Valero
- Rheumatology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | | | | | - Eva Tomero
- Rheumatology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - Santos Castañeda
- Rheumatology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
- Department of Medicine. Cátedra UAM-ROCHE, EPID-Future, Universidad Autonoma de Madrid, Madrid, Spain
| | - Rosario García-Vicuña
- Rheumatology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
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29
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Glintborg B, Jensen DV, Terslev L, Pfeiffer Jensen M, Hendricks O, Østergaard M, Engel S, Horskjær Rasmussen S, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Nørgaard Agerbo J, Ziegler C, Hetland ML. Impact of the COVID-19 pandemic on treat-to-target strategies and physical consultations in >7000 patients with inflammatory arthritis. Rheumatology (Oxford) 2021; 60:SI3-SI12. [PMID: 34146099 PMCID: PMC8344418 DOI: 10.1093/rheumatology/keab500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore the impact of the COVID-19 pandemic on treat-to-target strategies (disease activity, remission rates) and access to physical consultations in patients with inflammatory rheumatic disease, as well as to explore characteristics of patients with/without physical consultations in the clinic and the impact of early vs established disease. METHODS Patients with RA, PsA or axial SpA (axSpA) prospectively followed in the nationwide DANBIO registry answered online questionnaires and reported patient-reported outcomes (PROs) in June and November 2020. Patient characteristics, disease activity and physical consultations in the clinic before and during the pandemic were identified in DANBIO [all patients and subgroups with early disease (disease duration ≤2 years)]. In individual patients, changes in PROs before and during the pandemic were calculated. Characteristics of patients with/without physical consultations were described (age, gender, education level, comorbidities, disease duration, treatment). RESULTS We included 7836 patients (22% of eligible patients), 12% of which had early disease. PROs were stable before and during the pandemic, with median changes approximating zero, as well as in patients with early disease. Remission rates were stable. The relative decrease in the number of patients with physical consultations was 21-72%, which was highest in axSpA. Characteristics of patients with/without physical consultations were similar. Self-reported satisfaction with treatment options and access was >70%; the preferred contact form was physical consultation (66%). CONCLUSION In this nationwide study performed during the first 8 months of the pandemic, patient satisfaction was high and the PROs and remission rates remained stable despite the remarkable reduction in physical consultations, as well as in patients with early disease. Characteristics of patients with/without physical consultations appeared similar.
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Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Dorte Vendelbo Jensen
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte and Herlev Hospital
| | - Lene Terslev
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg
- Department of Regional Health Research, University of Southern Denmark, Odense
| | - Mikkel Østergaard
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Sara Engel
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Thomas Adelsten
- Department of Rheumatology, Zealand University Hospital, Køge
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital, Køge
| | - Kamilla Danebod
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense
- Department of Clinical Research, University of Southern Denmark, Odense
| | - Jens Kristian Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense
- Rheumatology Section, Department of Medicine M, Odense University Hospital and Svendborg Hospital, Svendborg
| | - René Drage Østgård
- Rheumatology Section, Department of Medicine M, Odense University Hospital and Svendborg Hospital, Svendborg
- Diagnostic Center, Silkeborg Regional Hospital, Silkeborg
| | | | | | | | | | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
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30
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Mendes-Bastos P, Nero P, Ferreira P, Bernardo A, Barcelos A, Pimentel Dos Santos FM, Sousa J, Loureiro MM, Magina S, Alpalhão M, Antunes J, Vieira-Sousa E. A multidisciplinary approach in psoriatic disease: the different models of dermatology-rheumatology collaborations in Portugal. Acta Reumatol Port 2021; 46:333-341. [PMID: 34962248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Psoriatic disease (Psoriasis and Psoriatic Arthritis, PsD) is a condition that affects the skin, the musculoskeletal system, and beyond, impairing patients' quality of life. A multidisciplinary approach of combined dermatology-rheumatology clinics is recommended and valuable to respond to PsD diagnosis, management, and treatment challenges. In Portugal, five Hospitals have implemented a multidisciplinary clinic for PsD assessment. This report aims to describe how these multidisciplinary clinics were developed, their characteristics, and the main obstacles to their implementation. Although the different hospitals adopted distinct functional models, a consensus respecting the minimal core set assessment for PsD in Multidisciplinary Dermatology/Rheumatology Clinics should comprise all disease manifestations and, if possible, quality of life. The main objective of these clinics is to achieve remission/minimal disease activity. Limitations to these multidisciplinary approaches are discussed, namely financial, time management, and human resources obstacles that can be a handicap in their implementation, despite the benefits of PsD integrated care.
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Affiliation(s)
| | - Patrícia Nero
- Serviço de Reumatologia, Hospital CUF Descobertas, Lisboa, Portugal
| | - Paulo Ferreira
- Centro de Dermatologia, Hospital CUF Descobertas, Lisboa, Portugal
| | - Alexandra Bernardo
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João, Porto
| | - Anabela Barcelos
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC)
| | - Fernando M Pimentel Dos Santos
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Portugal
| | - João Sousa
- Serviço de Dermatologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal
| | | | - Sofia Magina
- Serviço de Dermatologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Departamento de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Miguel Alpalhão
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Joana Antunes
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Unidade de Investigação Reumatologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade Medicina Universidade de Lisboa
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31
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Hjuler KF, Dige A, Agnholt J, Laurberg TB, Loft AG, Møller LF, Christensen R, Iversen L. Effectiveness of interdisciplinary combined dermatology-gastroenterology-rheumatology clinical care compared to usual care in patients with immune-mediated inflammatory diseases: a parallel group, non-blinded, pragmatic randomised trial. BMJ Open 2021; 11:e041871. [PMID: 33910945 PMCID: PMC8094387 DOI: 10.1136/bmjopen-2020-041871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Immune-mediated inflammatory diseases (IMIDs) are associated with reduced health-related quality of life (HRQol), increased risk of somatic and psychiatric comorbidities and reduced socioeconomic status. Individuals with one IMID have an increased risk for developing other IMIDs. The unmet needs in the care of patients with IMIDs may result from a lack of patient-centricity in the usual monodisciplinary siloed approach to these diseases. The advantages of novel interdisciplinary clinics towards the traditional therapeutic approach have not been investigated. The overall aim of this study is to determine the effectiveness of an interdisciplinary combined clinic intervention compared with usual care in a population of patients with the IMIDs: psoriasis, hidradenitis suppurativa, psoriatic arthritis, axial spondyloarthritis and inflammatory bowel disease. Our hypothesis is that an interdisciplinary combined clinic intervention will be more effective than usual care in improving clinical and patient-reported outcomes, and that a more effective screening and management of other IMIDs and comorbidities can be performed. METHODS AND ANALYSIS This is a randomised, usual care controlled, parallel-group pragmatic clinical trial. 300 consecutively enrolled participants with co-occurrence of at least two IMIDs are randomly assigned in a 2:1 ratio to either treatment in the interdisciplinary combined clinic or usual care. The study will consist of a 6-month active intervention period and a 6-month follow-up period where no intervention or incentives will be provided by the trial. The primary outcome is the change from baseline to 24 weeks on the Short-Form Health Survey (SF-36) Physical Component Summary. Additional patient-reported outcome measures and clinical measures are assessed as secondary outcomes. ETHICS AND DISSEMINATION Ethical approval of this study protocol was established by the institutional review board of the study site. The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with patient organisations. TRIAL REGISTRATION NUMBER NCT04200690.
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Affiliation(s)
- Kasper Fjellhaugen Hjuler
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Dige
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Agnholt
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Bay Laurberg
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gitte Loft
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Faurskov Møller
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
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Kragsnaes MS, Sødergren ST, Kjeldsen J, Horn HC, Munk HL, Pedersen JK, Klinkby CS, de Wit M, Ahlmark NG, Tjørnhøj-Thomsen T, Ellingsen T. Experiences and perceptions of patients with psoriatic arthritis participating in a trial of faecal microbiota transplantation: a nested qualitative study. BMJ Open 2021; 11:e039471. [PMID: 34006020 PMCID: PMC7942243 DOI: 10.1136/bmjopen-2020-039471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Patients' first-hand experiences of faecal microbiota transplantation (FMT) performed in a rheumatological care setting have yet to be elucidated. The objectives were to explore participants' perceptions of being part of an FMT trial thereby identifying potential trial participation effects and enlightening the patient perspective on the outlook for future FMT trials in rheumatic diseases. DESIGN In a qualitative study nested within a double-blind, randomised, placebo-controlled trial (RCT) testing FMT as a potential new antirheumatic treatment, semistructured telephone interviews were conducted following the trial participants' final 26-week visit. Qualitative researchers, who did not take part in the main trial, performed the interviews and the primary analysis. The experiences explored related to the conduct of the RCT and changes in the participants' everyday life. The analysis was carried out using a thematic approach. SETTING A Danish rheumatology university outpatient clinic with nationwide inclusion. PARTICIPANTS The study included 10 patients with psoriatic arthritis (PsA) who were unaware of their treatment allocation (FMT/sham transplantation) and completed the final 26-week trial visit. RESULTS Participation in the RCT influenced the patients' understanding of PsA and induced positive changes in their everyday life. Renewed hopes for the future in addition to a feeling of enhanced care contributed to significant trial participation effects. FMT was deemed a tolerable and safe treatment. CONCLUSIONS Discrepancies between the clinical and the research setting should be considered when discussing the clinical relevance of the results of the RCT. Overall, patients with PsA who have participated in an RCT testing FMT find the treatment acceptable and safe encouraging more research into the field of microbiota-targeted interventions in rheumatic diseases. TRIAL REGISTRATION NUMBER NCT03058900; Pre-results.
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Affiliation(s)
| | - Shaun Theodor Sødergren
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | | | | | - Jens Kristian Pedersen
- Department of Medicine, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | | | | | - Nanna Gram Ahlmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Ellison A, Kranz D, Mesinkovska NA, Christiano AM, Shapiro J, Norris DA. Forging the Future: 2018 Alopecia Areata Research Summit Summary Report. J Investig Dermatol Symp Proc 2020; 20:S1-S5. [PMID: 33099376 DOI: 10.1016/j.jisp.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Alopecia areata (AA) is a common autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body that affects over 146 million people worldwide at some point in their lives. Founded in 1981, the National AA Foundation (NAAF) is a nonprofit organization that supports research to find a cure or acceptable treatment for AA, supports those with the disease, and educates the public about AA. NAAF conducts research summits every two years to review progress and create new directions in its funded and promoted research. This report from the seventh AA Research Summit, Forging the Future, held December 4-5, 2018 in New York City provides highlights of the research presented and future research priorities identified during targeted discussion sessions.
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Affiliation(s)
- Abby Ellison
- National Alopecia Areata Foundation, San Rafael, California, USA.
| | - Dory Kranz
- National Alopecia Areata Foundation, San Rafael, California, USA
| | - Natasha A Mesinkovska
- National Alopecia Areata Foundation, San Rafael, California, USA; Department of Dermatology, University of California, Irvine, California, USA
| | - Angela M Christiano
- Departments of Dermatology and Genetics & Development, Columbia University, New York, New York, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - David A Norris
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Droz N, Hanaway P, Hyman M, Jin Y, Beidelschies M, Husni ME. The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: A retrospective study. PLoS One 2020; 15:e0240416. [PMID: 33031458 PMCID: PMC7544031 DOI: 10.1371/journal.pone.0240416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite treatment advances for inflammatory arthritis, a significant amount of patients fail to achieve remission. Other modifiable factors such as diet, physical activity and environmental exposures may be an important area of focus to help patients achieve disease remission and greater overall health. Functional medicine focuses on these lifestyle factors and may be an important adjunctive therapy. In this study, we examined the impact of functional medicine on patient-reported outcomes in patients with inflammatory arthritis. MATERIALS AND METHODS In this 12-week, retrospective study, patients with confirmed diagnoses of rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were treated according to guidelines from the American College of Rheumatology for RA or PSA respectively. Those in the functional medicine group underwent a functional medicine program adjunctive to the standard of care. Patient reported outcomes, such as PROMIS (Patient Reported Outcomes Measurement Information System) global physical health, mental health and pain scores were collected at baseline and 12 weeks. Multivariable statistical modeling was used to identify the impact of functional medicine on patient-reported outcomes. RESULTS 318 patients were screened and 54 patients (mean age 52.9±11.3 years, females 74(67.9%)), were included. Baseline characteristics were similar in both patient groups with the exception of PROMIS global physical health and pain (PROMIS global physical health score 43·2 ± 6·6 and 39·7 ± 8·7 and pain scores of 3·5 ± 1·9 and 5·2 ± 2·7 in the functional medicine group vs. standard of care group respectively). Using multivariable model to account for these differences, patients in the functional medicine group had a statistically significant reduction in pain (0.92, p-value = 0.007) and change in PROMIS physical health score (2·84, p-value = 0.001) as compared to the standard of care. Changes in PROMIS global mental health scores were also significant and were dependent on age and were greatest in those older than 55. LIMITATIONS Retrospective design, baseline difference in patient reported outcomes. CONCLUSIONS Functional medicine may have an important role as adjunctive therapy to improve patients' pain, physical and mental health in those who do not see improvement with conventional therapy alone.
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Affiliation(s)
- Nicole Droz
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Patrick Hanaway
- Center for Functional Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Mark Hyman
- Center for Functional Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Yuxuan Jin
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States of America
| | - Michelle Beidelschies
- Center for Functional Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - M. Elaine Husni
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, United States of America
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Strickler AL, Cifuentes D, Mihovilovic K, Vergara F, Grez M, Rivera V. [Change of diagnosis and diagnostic category in patients with juvenile idiopathic arthritis within 7 years of follow-up]. Rev Chil Pediatr 2020; 91:521-528. [PMID: 33399728 DOI: 10.32641/rchped.v91i4.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. OBJECTIVE To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. PATIENTS AND METHOD Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. RESULTS We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. CONCLUSIONS Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.
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MESH Headings
- Adolescent
- Aftercare
- Arthritis, Juvenile/classification
- Arthritis, Juvenile/complications
- Arthritis, Juvenile/diagnosis
- Arthritis, Juvenile/therapy
- Arthritis, Psoriatic/complications
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/therapy
- Arthritis, Rheumatoid/classification
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/therapy
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/therapy
- Male
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Retrospective Studies
- Transition to Adult Care
- Young Adult
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Affiliation(s)
- Alexis L Strickler
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Daniela Cifuentes
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Krasna Mihovilovic
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Francisca Vergara
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Mónica Grez
- Hospital Dr. Eduardo Schütz Schroeder, Puerto Montt, Chile
| | - Viviana Rivera
- Escuela de Medicina, Departamento de Salud Pública, Universidad San Sebastián, Puerto Montt, Chile
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Zarco Montejo P, Almodóvar González R, De Higes-Martínez E, Gorgojo-Martínez JJ, Guijarro Herraiz C, López Navas MJ, Palacios D, Peláez Álvarez JC, Ruíz Genao D, Piedrafita B, Gómez S, Falkenbach E, Rebollo Laserna FJ, López Estebaranz JL. Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis. Rheumatol Int 2020; 40:969-981. [PMID: 32274527 DOI: 10.1007/s00296-020-04573-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to generate practical recommendations to assist rheumatologists and dermatologists in the management of cardiovascular (CV) comorbidities in patients with moderate-to-severe psoriasis (MS-PSO) and psoriatic arthritis (PsA). A two-round Delphi study was conducted. A panel of experts rated their agreement with a set of statements (n = 52) on a nine-point Likert scale (1 = totally disagree; 9 = totally agree). Statements were classified as inappropriate (median 1-3), irrelevant (median 4-6) or appropriate (median 7-9). Consensus was established when at least two-thirds of the panel responded with a score within any one range. A total of 25 experts, 60% rheumatologists and 40% dermatologists, participated in two consultation rounds. There was overall unanimity on the appropriateness of an initial assessment for CV risk factors in all patients with MS-PSO and PsA. Most panelists (88.0%) also supported the evaluation of patients' psychological and physical status. Additionally, most panelists (72.2%) agreed on a novel sequential approach for the management of CV comorbidities. This sequence starts with the assessment of hypertension, diabetes and dyslipidemia along with the identification of depression and anxiety disorders. Once these factors are under control, smoking cessation programs might be initiated. Finally, if patients have not met weight loss goals with lifestyle modifications, they should receive specialized treatment for obesity. This study has drawn up a set of practical recommendations that will facilitate the management of CV comorbidities in patients with MS-PSO and PsA.
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Affiliation(s)
- Pedro Zarco Montejo
- Rheumatology Unit, Hospital Universitario Fundación de Alcorcón, C/Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Raquel Almodóvar González
- Rheumatology Unit, Hospital Universitario Fundación de Alcorcón, C/Budapest 1, 28922, Alcorcón, Madrid, Spain.
| | - Eva De Higes-Martínez
- Respiratory Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | | | - Carlos Guijarro Herraiz
- Internal Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
- Rey Juan Carlos University, Madrid, Spain
| | | | - David Palacios
- Primary Care, National Coordinator for Dermatology at SEMERGEN, Madrid, Spain
| | | | - Diana Ruíz Genao
- Dermatology Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
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Queiro R, Pardo E, Charca L. Distribution of the components of the MDA response among patients with psoriatic arthritis with and without an acceptable symptomatic state. Clin Exp Rheumatol 2020; 38:575-576. [PMID: 31994485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
| | - Estefanía Pardo
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Lilyan Charca
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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38
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Batu ED, Sonmez HE, Kösemehmetoğlu K, Özer H, Aydingöz Ü. Lipoma Arborescens Associated With Psoriatic Arthritis in an Adolescent Boy: A Case Report and Review of the Literature. J Clin Rheumatol 2020; 26:e47-e49. [PMID: 32073533 DOI: 10.1097/rhu.0000000000000833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Queiro R, Cañete JD. Good clinimetric alignment between remission and a low impact of disease in patients with axial psoriatic arthritis. Clin Exp Rheumatol 2020; 38:136-139. [PMID: 31376259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The concept of axial disease in psoriatic arthritis (PsA) is not well established. It is also unclear how this disease domain should be evaluated. We aimed to test whether the remission is aligned with a low impact state of the disease in patients with axial PsA. METHODS Post hoc analysis of a multicentre study conducted in 223 patients with PsA under treatment with systemic biological and non-biological therapies. To define axial disease, ASAS criteria were used. Remission corresponded to a BASDAI less than or equal to 2. The impact of the disease was evaluated according to the PsAID. The Cohen's kappa agreement between remission and patient-acceptable symptoms state (PASS) was analysed. RESULTS Thirty-seven of the 223 patients (16.6%) met ASAS criteria for axial disease. Fifteen of the 122 (12.3%) patients in PASS situation had axial disease compared to 22 of 101 (21.8%) who did not reach this state, p<0.05. All items, as well as the total score of the BASDAI (4.48±2.03 vs. 1.14±1.02) were significantly higher in the patients who did not achieve a PASS, p<0.001. The kappa agreement between BASDAI remission and PASS was high [κ: 0.73 (95%CI: 0.64-0.83) p<0.0001]. CONCLUSIONS BASDAI remission and a low impact of the disease show good clinimetric alignment. Both measures could be useful for a more comprehensive assessment of axial disease in PsA.
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Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Juan D Cañete
- Arthritis Unit, Rheumatology Division, Hospital Clinic, Barcelona, Spain
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Laires PA, Carrilho M, Tavares-Costa J, Lucas P, Machado P, Cunha-Miranda L, Pimentel-Santos F, Santos H, Vieira-Sousa E, Santos MJ. Development and validation of psoriatic arthritis switch quality assessment tool (PASQAL) - an outcomes measurement tool to assess the quality of biologic switch decisions in psoriatic arthritis. Acta Reumatol Port 2020; 45:46-57. [PMID: 32578579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Switching between biologic therapies is a recommended strategy for Psoriatic Arthritis (PsA) patients that show an insufficient response or adverse events. Although the choice of the subsequent biologic may be dependent on many factors, assessing the quality of the switch decision is of utmost relevance. OBJECTIVES To develop and validate two outcomes measurement tools (for patients with peripheral and axial PsA phenotypes) that address the quality of treatment decisions in PsA regarding the switch of biologic therapies in clinical practice. METHODS A Task Force and an Expert Panel were specifically assembled for this purpose. The Psoriatic Arthritis Switch Quality Assessment tool (PASQAL) development comprised a modified-Delphi method in a four-step procedure: 1) literature search and experts' opinion collection about quality indicators for PsA management; 2) Delphi design to address the development of the measurement tool; 3) three Delphi questionnaire rounds; 4) final consensus meeting. This phase resulted in the definition of two measurement tools, one to evaluate the quality of biologic switch in peripheral (pPASQAL) and another one in axial PsA (axPASQAL). For the validation of PASQAL, 12 experienced rheumatologists were asked to evaluate and classify the biologic switch of 80 clinical cases (40 with predominant peripheral and 40 with predominant axial PsA). Clinical judgement was defined to be the "gold standard" against which the performance of PASQAL was assessed. The results were used to assess tools' performance (sensitivity/specificity analysis) and the agreement between the tools and the gold standard (Cohen's kappa). RESULTS PASQAL consists of 6 domains (joint disease activity, dactylitis, enthesis, physical function, quality of life, and skin and nail manifestations), respective instruments and thresholds. The classification of the biologic switch was divided into three quality levels: "Good", based on treat-to-target thresholds; "Moderate", based on improvement from baseline; and the remaining as "Insufficient". pPASQAL was found to be highly sensitive (92%) with the "Good" quality level and specific (97%) with the "Insufficient" quality level. Whilst axPASQAL showed overall higher sensitivity and specificity for all quality levels, as well as a higher level of agreement between the tool and the gold standard than pPASQAL (k=0.87 vs k=0.71). CONCLUSION PASQAL was developed and showed good criterion validity for the evaluation of the quality of switch in both peripheral and axial PsA phenotypes. These tools may be used in research as well as in clinical practice, to support rheumatologists in making more informed therapeutic decisions.
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Affiliation(s)
- Pedro Almeida Laires
- Health Economics and Outcomes Research - Novartis Farma, Oeiras, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | | | | | | | - Pedro Machado
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital
| | | | - Fernando Pimentel-Santos
- Chronic Diseases Research Centre, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon and Rheumatology Department, Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Helena Santos
- Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHLN Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Por
| | - Maria José Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada and Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Mai A, Braun J, Reese JP, Westerhoff B, Trampisch U, Klaassen-Mielke R, Timmesfeld N, Trampisch HJ, Krause D. Nurse-led care versus physician-led care in the management of rheumatoid arthritis and psoriatic arthritis (StaerkeR): study protocol for a multi-center randomized controlled trial. Trials 2019; 20:793. [PMID: 31888706 PMCID: PMC6937804 DOI: 10.1186/s13063-019-3808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In Germany, the care of patients with inflammatory arthritis could be improved. Although specialized rheumatology nurses could take over substantial aspects of patient care, this hardly occurs in Germany. Thus, the aim of the study is to examine structured nursing consultation in rheumatology practices. METHODS/DESIGN In total, 800 patients with a stable course of rheumatoid arthritis or psoriatic arthritis in 20 centers in North Rhine-Westphalia and Lower Saxony will be randomized to either nurse-led care or standard care. Participating nurses will study for a special qualification in rheumatology and trial-specific issues. It is hypothesized that nurse-led care is non-inferior to standard care provided by rheumatologists with regard to a reduction of disease activity (DAS28) while it is hypothesized to be superior regarding changes in health-related quality of life (EQ-5D-5L) after 1 year. Secondary outcomes include functional capacity, patient satisfaction with treatment, and resource consumption. DISCUSSION Since there is insufficient care of rheumatology patients in Germany, the study may be able to suggest improvements. Nurse-led care has the potential to provide more efficient and effective patient care. This includes a more stringent implementation of the treat-to-target concept, which may lead to a higher percentage of patients reaching their treatment targets, thereby improving patient-related outcomes, such as quality of life, functional capacity, and participation. Additionally, nurse-led care may be highly cost-effective. Finally, this project may form the basis for a sustainable implementation of nurse-led care in standard rheumatology care in Germany. TRIAL REGISTRATION German Clinical Trials Register, DRKS00015526. Registered on 11 January 2019.
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Affiliation(s)
- Anna Mai
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | | | - Jens-Peter Reese
- Coordinating Center for Clinical Trials of the Philipps-University of Marburg, 35043 Marburg, Germany
| | | | | | - Renate Klaassen-Mielke
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Hans J. Trampisch
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Dietmar Krause
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
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Pouw JN, Leijten EFA, Tekstra J, Balak DMW, Radstake TRDJ. [Spectrum of psoriatic conditions]. Ned Tijdschr Geneeskd 2019; 163:D3936. [PMID: 31361418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Psoriasis is a common immune-mediated inflammatory condition that primarily affects skin and nails. 6-41% of psoriasis patients develop psoriatic arthritis (PsA). The ways in which PsA can manifest itself include peripheral arthritis, axial spondyloarthritis, dactylitis and enthesitis. This heterogeneous clinical picture makes it sometimes difficult to recognise PsA,potentially resulting in permanent joint damage and functional impairments. Some people see psoriasis and PsA as 2 manifestations of a single disease because the multifactorial origins of psoriasis and PsA are largely overlapping. Psoriatic conditions are associated with a high burden of disease, reduced quality of life and comorbidities, including psychiatric and cardiovascular conditions. In recent years, several immunological pathways, immune cells and cytokines have been identified as important factors in pathophysiology and as new therapeutic targets. For many PsA patients treatment with disease modifying anti-rheumatic drugs leads to significant improvement of symptoms and quality of life.
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Affiliation(s)
- Juliëtte N Pouw
- UMC Utrecht, afd. Reumatologie en Klinische Immunologie, Utrecht
- Contact: J.N. Pouw
| | | | - Janneke Tekstra
- UMC Utrecht, afd. Reumatologie en Klinische Immunologie, Utrecht
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Abstract
Obesity is a common cardiovascular risk factor in psoriatic disease. Although the prevalence of obesity is high, the factors associated with it in patients with psoriatic arthritis (PsA) are poorly understood. We aimed to analyze the frequency and obesity-associated factors in a cohort of PsA.This retrospective cross-sectional study included 290 consecutive patients with PsA according to CASPAR criteria. Three-hundred ten psoriatic patients without arthritis and 600 outpatients without inflammatory conditions were used as comparison populations. The factors associated with obesity were analyzed first using conditional logistic regression. The significant factors in this first model were introduced in a multivariate model using a backward step approach.This series included 159 men (54.8%) and 131 women (45.2%), with an average age of 54 ± 12 years. Obesity was more common both in psoriasis (36.5% vs 22%, OR 2.1 [95%CI: 1.5-2.8), P < .01]) and PsA (27.6% vs 22%, OR 1.4 [95%CI: 1.0-1.9], P < .05) than in the non-inflammatory population. Obesity was more frequent in psoriasis (36.5%) than in PsA (27.6%), OR 1.5 95% CI: 1.1 to 2.1, P < .05. After correcting for age, sex, disease duration, and other confounders, independent associations with obesity (P < .05) were: PsA family history (OR 3.6, 95%CI: 1.1-12.4), evolution as axial disease (OR 4.4, 95%CI: 1.0-15.4), and dyslipidemia (OR 3.5, 95%CI: 1.5-8.6).Obesity is common in psoriatic disease, but much more frequent among patients with cutaneous than joint disease. Patients who present with spondylitis during evolution are more prone to this comorbidity, and therefore, should be closely monitored to correct this eventuality in a timely manner.
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Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA) Oviedo
| | - Andrés Lorenzo
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA) Oviedo
| | - Patricia Tejón
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA) Oviedo
| | - Pablo Coto
- Dermatology Division, Hospital Alvarez Buylla, Mieres-Asturias, Spain
| | - Estefanía Pardo
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA) Oviedo
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Selvanderan SP, Goldblatt F, Nguyen NQ, Costello SP. Faecal microbiota transplantation for Clostridium difficile infection resulting in a decrease in psoriatic arthritis disease activity. Clin Exp Rheumatol 2019; 37:514-515. [PMID: 30943129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Shane P Selvanderan
- Centre for Nutrition and Gastrointestinal Disease Research, The University of Adelaide and South Australian Health and Medical Research Institute, South Australia, Australia.
| | - Fiona Goldblatt
- Department of Rheumatology, Flinders Medical Centre, South Australia, Australia
| | - N Q Nguyen
- Centre for Nutrition and Gastrointestinal Disease Research, The University of Adelaide and South Australian Health and Medical Research Institute, and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, South Australia, Australia
| | - Sam P Costello
- Centre for Nutrition and Gastrointestinal Disease Research, The University of Adelaide and South Australian Health and Medical Research Institute, and Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Felbo SK, Terslev L, Østergaard M. Imaging in peripheral and axial psoriatic arthritis: contributions to diagnosis, follow-up, prognosis and knowledge of pathogenesis. Clin Exp Rheumatol 2018; 36 Suppl 114:24-34. [PMID: 30296988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
Imaging in psoriatic arthritis (PsA) is rapidly evolving, and the use of sensitive modalities both in clinical research and routine care is increasing. This article provides an overview of current knowledge of different imaging methods in PsA, including current and possible future use in diagnosis, prognosis and clinical management, value in understanding pathogenesis, and latest activities to establish responsive imaging outcome measures. Much research remains to be performed concerning imaging in PsA, particularly on its optimal use in routine clinical care, the clinical consequences of imaging-detected subclinical disease, and specific and sensitive PsA imaging outcome measures.
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Affiliation(s)
- Sara K Felbo
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; and Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, Univ. of Copenhagen, Copenhagen, Denmark.
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; and Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, Univ. of Copenhagen, Copenhagen, Denmark
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D'Agostino MA. Enthesitis detection by ultrasound: where are we now? Clin Exp Rheumatol 2018; 36 Suppl 114:127-130. [PMID: 30296977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
Over the last 25 years, ultrasound has been used to evaluate involvement at the entheses in spondyloarthritis (SpA) and psoriatic arthritis (PsA). Several studies have been reported indicating its value in detecting active inflammation at entheseal sites using both gray scale and Doppler findings. This review explores the recent literature and appraises the current knowledge and the unmet needs of enthesitis detection by ultrasound in the management of both SpA and PsA.
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Affiliation(s)
- Maria-Antonietta D'Agostino
- Rheumatology Department, APHP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France.
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Zabotti A, Mandl P, Zampogna G, Dejaco C, Iagnocco A. One year in review 2018: ultrasonography in rheumatoid arthritis and psoriatic arthritis. Clin Exp Rheumatol 2018; 36:519-525. [PMID: 30058527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound is playing an increasingly important role in the differential diagnosis and monitoring of rheumatoid arthritis (RA) and psoriatic arthritis (PsA). This technique is more sensitive and specific than clinical examination to detect active synovitis, and the identification of specific synovitis patterns enable differentiation of PsA from RA and other entities. Ultrasound verified inflammation changes along with clinical improvement during therapy, and ultrasound was shown to predict future clinical and structural outcomes thus complementing the clinical risk assessment of patients. In the present review, we summarised the scientific evidence published in 2017 focussing on the use of ultrasonography for clinically relevant and pragmatic aspects of diagnosis and management of RA and PsA.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Austria
| | | | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck, Italy; and Department of Rheumatology and Immunology, Medical University Graz, Austria
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Almodóvar R, Zarco P, Otón T, Carmona L. Effect of weight loss on activity in psoriatic arthritis: A systematic review. Reumatol Clin (Engl Ed) 2018; 14:207-210. [PMID: 28262478 DOI: 10.1016/j.reuma.2017.01.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 12/16/2016] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the association between weight loss and changes in disease activity in patients with psoriatic arthritis (PsA). METHODS We performed a systematic review of the literature, with searches in Medline, Embase and Cochrane Central Library from inception until April 2015. INCLUSION CRITERIA 1) randomized controlled trials (RCT); 2) PsA patients; 3) interventions were any intervention aimed at weight control; and 4) a PsA activity-related outcome measure was evaluated. Risks of bias were assessed by the Cochrane Collaboration scale. RESULTS Of the 215 articles identified, only 2 RCT met the inclusion criteria, 1 in abstract format. Both showed moderate risk of bias. Patients who managed to lose weight-by any method-had better results in terms of activity and inflammation. The percentage of weight loss correlated moderately with changes in inflammatory outcomes. CONCLUSION Weight loss in PsA could be associated with less inflammation; however, the evidence to support this is limited.
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Affiliation(s)
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, InMusc, Madrid, España
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética, InMusc, Madrid, España
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Abstract
Psoriatic arthritis is a chronic, immune-mediated, inflammatory arthropathy that presents with inflammation of the joints and entheses, including those of the axial skeleton, and is associated with increased mortality from cardiovascular disease. Diagnosis is primarily based on clinical phenotype because of the diversity of the associated features, which can include skin and nail disease, dactylitis, uveitis, and osteitis. Improved understanding of the pathogenesis of psoriatic arthritis has led to the development of effective biologics and small-molecular drugs targeting specific cytokines and signalling pathways, which can prevent disease progression and improve quality of life. However, at least 40% of patients with psoriatic arthritis have only a partial response or fail to respond to such treatments. Cytokine inhibitors, mainly those specific for tumour necrosis factor and, more recently, the interleukin 23-T-helper-17 cell pathway, have been highly successful in the treatment of disease manifestations in several different tissues, although targeting the interleukin 23-T-helper-17 cell pathway might be more effective in psoriasis than in arthritis. However, the precise mechanisms underlying the pathogenesis of psoriatic arthritis-which include genetics, environmental factors, and immune-mediated inflammation-are complex, and the relationship between disease of the joint and that of other domains is poorly understood. Improving our understanding of psoriatic arthritis pathogenesis could help to establish validated biomarkers for diagnosis, predict therapeutic response and remission, develop precision medicines, and predict which patients will respond to which therapy. We discuss advances in pathogenetic translational research that could inform these issues.
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Affiliation(s)
- Douglas J Veale
- Rheumatology EULAR Centre of Excellence, St Vincent's University Hospital and University College Dublin, Dublin, Ireland.
| | - Ursula Fearon
- Rheumatology EULAR Centre of Excellence, St Vincent's University Hospital and University College Dublin, Dublin, Ireland; Department of Molecular Rheumatology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
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Kragsnaes MS, Kjeldsen J, Horn HC, Munk HL, Pedersen FM, Holt HM, Pedersen JK, Holm DK, Glerup H, Andersen V, Fredberg U, Kristiansen K, Christensen R, Ellingsen T. Efficacy and safety of faecal microbiota transplantation in patients with psoriatic arthritis: protocol for a 6-month, double-blind, randomised, placebo-controlled trial. BMJ Open 2018; 8:e019231. [PMID: 29703851 PMCID: PMC5922473 DOI: 10.1136/bmjopen-2017-019231] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION An unbalanced intestinal microbiota may mediate activation of the inflammatory pathways seen in psoriatic arthritis (PsA). A randomised, placebo-controlled trial of faecal microbiota transplantation (FMT) infused into the small intestine of patients with PsA with active peripheral disease who are non-responsive to methotrexate (MTX) treatment will be conducted. The objective is to explore clinical aspects associated with FMT performed in patients with PsA. METHODS AND ANALYSIS This trial is a randomised, two-centre stratified, double-blind (patient, care provider and outcome assessor), placebo-controlled, parallel-group study. Eighty patients will be included and randomised (1:1) to either placebo (saline) or FMT provided from an anonymous healthy donor. Throughout the study, both groups will continue the weekly self-administered subcutaneous MTX treatment, remaining on the preinclusion dosage (15-25 mg/week). The clinical measures of psoriasis and PsA disease activity used include the Short (2-page) Health Assessment Questionnaire, the Dermatology Quality of Life Index, the Spondyloarthritis Research Consortium of Canada Enthesitis Index, the Psoriasis Area Severity Index, a dactylitis digit count, a swollen/tender joint count (66/68), plasma C reactive protein as well as visual analogue scales for pain, fatigue and patient and physician global assessments. The primary end point is the proportion of patients who experience treatment failure during the 6-month trial period. The number of adverse events will be registered throughout the study. ETHICS AND DISSEMINATION This is a proof-of-concept clinical trial and will be performed in agreement with Good Clinical Practice standards. Approvals have been obtained from the local Ethics Committee (DK-S-20150080) and the Danish Data Protection Agency (15/41684). The study has commenced in May 2017. Dissemination will be through presentations at national and international conferences and through publications in international peer-reviewed journal(s). TRIAL REGISTRATION NUMBER NCT03058900; Pre-results.
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Affiliation(s)
- Maja Skov Kragsnaes
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Department of Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jens Kjeldsen
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | | | | | | | - Hanne Marie Holt
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | | | | | - Henning Glerup
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Vibeke Andersen
- IRS-Centre Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
- Institute of Metagenomics, BGI-Shenzhen, Shenzhen, China
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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