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Krijbolder DI, Matthijssen XME, van Dijk BT, van Steenbergen HW, Boeters DM, Willemze A, Schouffoer AA, van der Helm-van Mil AHM. The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial MRIs in the TREAT EARLIER Trial. Arthritis Rheumatol 2023; 75:1512-1521. [PMID: 37094363 PMCID: PMC7615887 DOI: 10.1002/art.42527] [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: 03/23/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The natural trajectory of clinical arthritis progression at the tissue level remains elusive. We hypothesized that subclinical inflammation in different joint tissues (synovitis, tenosynovitis, osteitis) increases in a distinct temporal order in patients with clinically suspect arthralgia (CSA) who develop rheumatoid arthritis (RA) and subsides in a different sequence when CSA spontaneously resolves. METHODS We studied 185 serial magnetic resonance images (MRIs) from CSA patients with subclinical joint inflammation from the placebo arm of the TREAT EARLIER trial: 52 MRIs from 21 RA progressors (MRIs conducted at 1 year before, at 4 months before, and upon RA development), and 133 MRIs from 35 patients with spontaneous resolution of pain (MRIs conducted at baseline and at 4, 12, and 24 months). MRIs were scored for osteitis, synovitis, and tenosynovitis. We used cross-lagged models to evaluate 2 types of time patterns between pairs of inflamed tissues: a simultaneous pattern (coinciding changes) and a subsequent pattern (inflammatory changes in 1 tissue preceding changes in another tissue). RESULTS In patients who developed RA, synovitis, tenosynovitis, and osteitis increased simultaneously. Increasing osteitis occurred in the final 4 months before RA diagnosis, following incremental tenosynovitis and synovitis changes during the 1 year to 4 months before diagnosis (P < 0.01). In anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative patients who progressed to RA, osteitis increased just before RA development. In patients with pain resolution, simultaneous decreases in synovitis, tenosynovitis, and osteitis occurred, with tenosynovitis decreasing in the first 4 months after CSA onset preceding decreasing synovitis and osteitis during 4-12 months (P = 0.02 and P < 0.01). CONCLUSION We identified natural sequences of subclinical inflammation in different joint tissues, which deepens our understanding of clinical arthritis and RA development. During RA progression, increasing osteitis followed previous increases in tenosynovitis and synovitis. During pain resolution, tenosynovitis decreased first, followed by decreasing synovitis and osteitis.
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Affiliation(s)
- Doortje I. Krijbolder
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bastiaan T. van Dijk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Debbie M. Boeters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemiek Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Anne A. Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
| | - Annette H. M. van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Liem SIE, Ciaffi J, van Leeuwen NM, Boonstra M, Ahmed S, Beaart-van de Voorde LJJ, Corsel A, Dhondai T, Ninaber MK, Geelhoed-Veltman JJM, Heuvers ME, Tushuizen ME, Ajmone Marsan N, Kiès P, Schouffoer AA, Huizinga TWJ, Allaart CF, De Vries-Bouwstra J. Step forward in early recognition of systemic sclerosis: data from the Leiden CCISS cohort. RMD Open 2023; 9:rmdopen-2022-002971. [PMID: 37028816 PMCID: PMC10083842 DOI: 10.1136/rmdopen-2022-002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Since 2009, Dutch patients with a confirmed diagnosis/suspicion of systemic sclerosis (SSc) can be referred to the Leiden Combined Care in Systemic Sclerosis (CCISS) cohort. This study evaluated whether early recognition of SSc has improved over time and whether disease characteristics and survival has changed over time. METHODS 643 SSc patients fulfilling American College of Rheumatology/European Alliance of Associations for Rheumatology 2013 SSc criteria were included and categorised into three groups based on cohort-entry year: (1) 2010-2013 (n=229 (36%)), (2) 2014-2017 (n=207 (32%)) and (3) 2018-2021 (n=207 (32%)). Variables including disease duration, interstitial lung disease (ILD), digital ulcers (DU), diffuse cutaneous SSc (dcSSc), antitopoisomerase (ATA) and anticentromere (ACA) antibodies, and survival from disease onset were compared between cohort-entry groups, including analyses stratified for sex and autoantibodies. RESULTS Over time, duration between onset of disease symptoms and cohort entry decreased in males and females, but was always longer in females than in males.The proportion of patients presenting with DU decreased, especially in ACA+SSc patients. Almost no ACA+ patients presented with ILD, while in ATA+ patients this proportion was 25% in 2010-2013 and decreased to 19% in 2018-2021. A reduction in patients presenting with clinically meaningful ILD and dcSSc was observed.Overall 8-year survival for males was 59% (95% CI 40% to 73%) and for females 89% (95% CI 82% to 93%). Eight-year survival showed a trend for improvement over time, and was always worse in males. CONCLUSION We observed a decrease in disease duration in Leiden CCISS cohort at cohort entry, possibly indicating more timely diagnosis of SSc. This could provide opportunities for early interventions. While symptom duration at presentation is longer in females, mortality is consistently higher in males, underlining the urge for sex-specific treatment and follow-up.
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Affiliation(s)
- Sophie I E Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Maaike Boonstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saad Ahmed
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anja Corsel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Talitha Dhondai
- Patient Advisory Board, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marlies E Heuvers
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Kwakkenbos L, Carrier ME, Welling J, Turner KA, Cumin J, Pépin M, van den Ende C, Schouffoer AA, Hudson M, van Breda W, Sauve M, Mayes MD, Malcarne VL, Nielson WR, Nguyen C, Boutron I, Rannou F, Thombs BD, Mouthon L. Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network hand exercise program (SPIN-HAND). PeerJ 2022; 10:e13471. [PMID: 35945943 PMCID: PMC9357372 DOI: 10.7717/peerj.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/29/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose The Scleroderma Patient-centered Intervention Network (SPIN) online hand exercise program (SPIN-HAND), is an online self-help program of hand exercises designed to improve hand function for people with scleroderma. The objective of this feasibility trial was to evaluate aspects of feasibility for conducting a full-scale randomized controlled trial of the SPIN-HAND program. Materials and Methods The feasibility trial was embedded in the SPIN cohort and utilized the cohort multiple randomized controlled trial (cmRCT) design. In the cmRCT design, at the time of cohort enrollment, cohort participants consent to be assessed for trial eligibility and randomized prior to being informed about trials conducted using the cohort. When trials were conducted in the cohort, participants randomized to the intervention were informed and consented to access the intervention. Participants randomized to control were not informed that they have not received an intervention. All participants eligible and randomized to participate in the trial were included in analyses on an intent-to-treat basis. Cohort participants with a Cochin Hand Function Scale score ≥ 3/90 and an interest in using an online hand-exercise intervention were randomized (1:1 ratio) to be offered as usual care plus the SPIN-HAND Program or usual care for 3 months. User satisfaction was assessed with semi-structured interviews. Results Of the 40 randomized participants, 24 were allocated to SPIN-HAND and 16 to usual care. Of 24 participants randomized to be offered SPIN-HAND, 15 (63%) consented to use the program. Usage of SPIN-HAND content among the 15 participants who consented to use the program was low; only five (33%) logged in more than twice. Participants found the content relevant and easy to understand (satisfaction rating 8.5/10, N = 6). Automated eligibility and randomization procedures via the SPIN Cohort platform functioned properly. The required technical support was minimal. Conclusions Trial methodology functioned as designed, and the SPIN-HAND Program was feasibly delivered; however, the acceptance of the offer and use of program content among accepters were low. Adjustments to information provided to potential participants will be implemented in the full-scale SPIN-HAND trial to attempt to increase offer acceptance.
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Affiliation(s)
| | - Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands
| | | | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Mia Pépin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | | | - Anne A. Schouffoer
- Leiden University Medical Center, Leiden, The Netherlands,Haga Teaching Hospital, The Hague, The Netherlands
| | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ward van Breda
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada,Scleroderma Canada, Ottawa, Ontario, Canada
| | - Maureen D. Mayes
- University of Texas McGovern School of Medicine, Houston, Texas, United States of America
| | | | | | | | - Isabelle Boutron
- Centre d’Épidémiologie Clinique, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France,Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Université de Paris, Paris, France
| | - François Rannou
- Université de Paris, Paris, France,Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada,Department of Psychology, McGill University, Montreal, Quebec, Canada,Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France,APHP-CUP, Hôpital Cochin, Paris, France
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Stöcker JK, Schouffoer AA, Spierings J, Schriemer MR, Potjewijd J, de Pundert L, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Staal JB, Satink T, Vonk MC, van den Ende CHM. Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud's phenomenon, and digital ulcers in patients with systemic sclerosis. Rheumatology (Oxford) 2021; 61:1476-1486. [PMID: 34260723 PMCID: PMC8996778 DOI: 10.1093/rheumatology/keab537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic sclerosis is a complex connective tissue disease affecting mental and physical health. Fatigue, hand function loss, and Raynaud's phenomenon are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. METHODS A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding Raynaud's phenomenon and digital ulcers. For each recommendation the level of evidence and the level of agreement was determined. RESULTS Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue (12), hand function loss (8), and Raynaud's phenomenon/digital ulcers-related problems (14), were approved by the task force. CONCLUSIONS These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings.
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Affiliation(s)
- Juliane K Stöcker
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Anne A Schouffoer
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands.,Haga Teaching Hospital, Department of Rheumatology, The Hague, The Netherlands
| | - Julia Spierings
- University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands.,Royal Free and University College London, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - Marisca R Schriemer
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,National Association for people with Lupus, Systemic Sclerosis, Antiphospholipid syndrome, and Mixed Connective Tissue Disease, Utrecht, The Netherlands
| | - Judith Potjewijd
- Maastricht University Medical Center, Department of Clinical immunology, Maastricht, The Netherlands
| | - Lian de Pundert
- Haga Teaching Hospital, Department of physical therapy, The Hague, The Netherlands.,University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Frank H J van den Hoogen
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | | | - J Bart Staal
- HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Research group Neuro Rehabilitation, Nijmegen, The Netherlands.,European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Madelon C Vonk
- Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
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5
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Ciaffi J, van Leeuwen NM, Boonstra M, Kroft LJM, Schouffoer AA, Ninaber MK, Huizinga TWJ, de Vries-Bouwstra JK. Evolution of interstitial lung disease one year after hematopoietic stem cell transplantation or cyclophosphamide for systemic sclerosis. Arthritis Care Res (Hoboken) 2020; 74:433-441. [PMID: 32961038 PMCID: PMC9303567 DOI: 10.1002/acr.24451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
Objective Hematopoietic stem cell transplantation (HSCT) and cyclophosphamide (CYC) are treatment options for progressive systemic sclerosis associated with interstitial lung disease (SSc‐ILD). The aims of our retrospective observational study were to evaluate: 1) the evolution of SSc‐ILD in SSc patients treated with HSCT (assessed by high‐resolution computed tomography [HRCT]; a group of patients treated with CYC was included as frame of reference); 2) how results of pulmonary function tests (PFTs) are associated with HRCT findings; and 3) which factors predict ILD reduction. Methods We semiquantitatively scored total ILD extent, reticulations, and ground‐glass opacities (GGO) scores at baseline and at the 1‐year HRCTs of SSc patients treated with HSCT or CYC. Linear association between changes in HRCT scores and PFT results and predictors of ILD improvement were studied. Results We included 51 patients (those treated with HSCT [n = 20] and those treated with CYC [n = 31]). The mean change in total ILD score was –5.1% (95% confidence interval [95% CI] –10.2, 0.0) in the HSCT treatment group (P = 0.050), and –1.0% (95% CI –4.3, 2.3) in the CYC treatment group (P = 0.535). For all patients, the evolution of HRCT scores was weakly associated with relative changes in PFT results. In univariate logistic regression, higher ground‐glass opacities, higher total ILD, and lower single‐breath diffusing capacity for carbon monoxide scores at baseline predicted improvement of ILD extent after treatment, but a multivariable model could not be built to assess independency of predictors. Conclusion One year after treatment with HSCT, a nonsignificant but clear reduction of SSc‐ILD extent was observed. Changes in PFT results were associated with changes in HRCT scores but the correlation was weak and cannot be considered conclusive.
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Affiliation(s)
- Jacopo Ciaffi
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Rheumatology Unit, Azienda Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.,Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nina M van Leeuwen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike Boonstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Spierings J, van den Ende CHM, Schriemer RM, Bernelot Moens HJ, van der Bijl EA, Bonte-Mineur F, de Buck MPD, de Kanter MAE, Knaapen-Hans HKA, van Laar JM, Mulder UDJ, Potjewijd J, de Pundert LAJ, Schoonbrood THM, Schouffoer AA, Stel AJ, Vercoutere W, Voskuyl AE, de Vries-Bouwstra JK, Vonk MC. How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality? Rheumatology (Oxford) 2020; 59:1226-1232. [PMID: 31539063 PMCID: PMC7244783 DOI: 10.1093/rheumatology/kez417] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek.,Department of Rheumatology, Radboud University Medical Center, Nijmegen
| | - Rita M Schriemer
- NVLE, Dutch patient organization for systemic autoimmune diseases, Utrecht
| | | | | | | | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Udo D J Mulder
- Department of Internal Medicine, division Vascular Medicine, University of Groningen, Groningen
| | - Judith Potjewijd
- Department of Clinical immunology, Maastricht University Medical Center+, Maastricht
| | | | | | | | - Alja J Stel
- Department of Rheumatology, University Medical Center Groningen, Groningen
| | - Ward Vercoutere
- Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, loc. VUMC, Amsterdam
| | | | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen
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Fox RS, Kwakkenbos L, Carrier M, Mills SD, Gholizadeh S, Jewett LR, Roesch SC, Merz EL, Assassi S, Furst DE, Gottesman K, Mayes MD, Thombs BD, Malcarne VL, Baron M, Bartlett SJ, Ells C, Hudson M, Jang Y, Körner A, Kafaja S, Hoogen F, Mouthon L, Nielson WR, Riggs R, Nielsen K, Wigley F, Boutron I, Maia AC, Leite C, El‐Baalbaki G, Ende C, Fligelstone K, Frech T, Godard D, Harel D, Impens A, Johnson SR, Kennedy AT, Khalidi N, Marra C, Pope J, Portales A, Luna D, Schouffoer AA, Levis B, Suarez‐Almazor ME, Welling J, Wong‐Rieger D, Agard C, Ikic A, Smets P, Roux S, Terrier B, Hij A, Berthier S, Rodriguez E, Chung L, Gill A, Domsic R, Wilcox P, Fortin PR, Spiera R, Granel‐Rey B, Grange C, Sobanski V, Herrick AL, Varga J, Jones N, Manning J, Martin T, Maurier F, Rivière S, Robinson D, Smith D, Steen V, Sutton E, Thorne C, Turner K. Reliability and Validity of Three Versions of the Brief Fear of Negative Evaluation Scale in Patients With Systemic Sclerosis: A Scleroderma Patient‐Centered Intervention Network Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:1646-1652. [DOI: 10.1002/acr.23532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/30/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Rina S. Fox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada and Radboud University Nijmegen The Netherlands
| | - Marie‐Eve Carrier
- Lady Davis Institute for Medical Research Jewish General Hospital Montreal Quebec Canada
| | - Sarah D. Mills
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Shadi Gholizadeh
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego
| | - Lisa R. Jewett
- Lady Davis Institute for Medical Research, Jewish General Hospital and McGill University Montreal Quebec Canada
| | - Scott C. Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University San Diego
| | - Erin L. Merz
- California State University Dominguez Hills Carson
| | | | - Daniel E. Furst
- Geffen School of Medicine at the University of California Los Angeles
| | | | | | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital and McGill UniversityMontreal Quebec Canada
| | - Vanessa L. Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology and San Diego State University San Diego
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Kwakkenbos L, Sanchez TA, Turner KA, Mouthon L, Carrier ME, Hudson M, van den Ende CHM, Schouffoer AA, Welling JJKC, Sauvé M, Thombs BD. The association of sociodemographic and disease variables with hand function: a Scleroderma Patient-centered Intervention Network cohort study. Clin Exp Rheumatol 2018; 36 Suppl 113:88-94. [PMID: 30277865] [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: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Impaired hand function in systemic sclerosis (SSc) is a primary cause of disability and contributes diminished health-related quality of life. The objective of the present study was to evaluate sociodemographic, lifestyle, and disease-related factors independently associated with hand function in SSc. METHODS Patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed baseline study questionnaires between March 2014 and September 2017 were included. Hand function was measured using the Cochin Hand Function Scale (CHFS). Multiple linear regression analysis was used to identify independent correlates of impaired hand function. RESULTS Among 1193 participants (88% female), the mean CHFS score was 13.3 (SD=16.1). Female sex (standardised regression coefficient, beta (β)=.05), current smoking (β=.07), higher BMI (β=.06), diffuse SSc (β=0.14), more severe Raynaud's scores (β=.23), more severe finger ulcer scores (β=.23), moderate (β=0.19) or severe small joint contractures (β=.20), rheumatoid arthritis (β=0.07), and idiopathic inflammatory myositis (β=0.06) were significantly associated with higher CHFS scores (more impaired hand function). Consumption of 1-7 alcoholic drinks per week (β=-0.07) was associated with lower CHFS scores (less impaired hand function) compared to no drinking. CONCLUSIONS Multiple factors are associated with hand function in SSc. The presence of moderate or severe small joint contractures, the presence of digital ulcers, and severity of Raynaud's phenomenon had the largest associations. Effective interventions are needed to improve the management of hand function in patients with SSc.
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Affiliation(s)
- Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Psychiatry, McGill University, Montreal, Canada
| | - Tatiana A Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hopitaux de Paris; Service de Medicine Interne, Centre de Reference Maladies Systémiques Autoimmunes Rares, vascularites nécrosantes et sclérodermie systémique, Hopital Cochin, Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Medicine, McGill University, Montreal, Canada
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden; Haga Teaching Hospital, The Hague, the Netherlands
| | - Joep J K C Welling
- NVLE Dutch patient organisation for systemic autoimmune diseases, Utrecht, the Netherlands; and Federation of European Scleroderma Associations, Brussels, Belgium
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton; and Scleroderma Society of Canada, Ottawa, Canada
| | - Brett D Thombs
- Lady Davis Inst. Med. Res., Jewish General Hosp., Montreal; Dept.of Psychiatry, Dept.of Medicine, Dept.of Epidemiology, Biostatistics and Occupational Health, Dept.of Educational & Counselling Psychology, Dept.of Psychology , McGill Univ., Montreal, Canada
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9
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Markusse IM, Meijs J, de Boer B, Bakker JA, Schippers HPC, Schouffoer AA, Ajmone Marsan N, Kroft LJM, Ninaber MK, Huizinga TWJ, de Vries-Bouwstra JK. Predicting cardiopulmonary involvement in patients with systemic sclerosis: complementary value of nailfold videocapillaroscopy patterns and disease-specific autoantibodies. Rheumatology (Oxford) 2017; 56:1081-1088. [PMID: 27940596 DOI: 10.1093/rheumatology/kew402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the prevalence of anti-extractable nuclear antigen (anti-ENA) antibodies in Dutch SSc patients and the predictive power of the combination of specific anti-ENA antibodies and nailfold videocapillaroscopy (NVC) patterns to improve identification of patients with high risk for cardiopulmonary involvement. Methods A total of 287 patients (79%) from the Leiden SSc-Cohort had data available on NVC-pattern (no SSc-specific, early, active, late) and anti-ENA antibodies. Associations between anti-ENA/NVC combinations with cardiopulmonary parameters were explored using logistic regression. Results Prevalence of ACA was 37%, anti-Scl-70 24%, anti-RNP 9%, anti-RNAPIII 5%, anti-fibrillarin 4%, anti-Pm/Scl 3%, anti-Th/To 0.3% and anti-Ku 1.4%. NVC showed a SSc-specific pattern in 88%: 10% early, 42% active and 36% late. The prevalence of different NVC patterns was equally distributed among specific anti-ENA antibodies, except for the absence of early pattern in anti-RNP positive patients. Fifty-one percent had interstitial lung disease (ILD), 59% had decreased diffusion capacity for carbon monoxide and 16% systolic pulmonary artery pressure >35 mmHg (sPAP↑). Regardless of ENA-subtype, NVC-pattern showed a stable association with presence of ILD or sPAP↑. For ILD, the odds ratios (ORs) were 1.3-1.4 ( P < 0.05 for analyses with anti-RNAPIII, anti-RNP). For diffusion capacity for carbon monoxide, the OR was 1.5 ( P < 0.05 for analyses with ACA, anti-Scl-70, anti-RNAPIII, anti-RNP). For sPAP↑, the ORs were 2.2-2.4 ( P < 0.05 for analyses with anti-RNAPIII, anti-RNP). Conclusion In Dutch SSc patients, all SSc-specific auto-antibodies were found, with ACA and anti-Scl-70 being the most prevalent. Strikingly, the association between NVC-pattern and heart/lung involvement was independent of specific anti-ENA antibodies, which might indicate microangiopathy is an important cause of organ involvement.
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Affiliation(s)
| | | | | | - Jaap A Bakker
- Department of Clinical Chemistry and Laboratory Medicine
| | | | | | | | | | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
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10
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Azar M, Rice DB, Kwakkenbos L, Carrier ME, Shrier I, Bartlett SJ, Hudson M, Mouthon L, Poiraudeau S, van den Ende CHM, Johnson SR, Rodriguez Reyna TS, Schouffoer AA, Welling J, Thombs BD. Exercise habits and factors associated with exercise in systemic sclerosis: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study. Disabil Rehabil 2017; 40:1997-2003. [DOI: 10.1080/09638288.2017.1323023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | | | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Luc Mouthon
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Serge Poiraudeau
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Service de Médecine Physique et Réadaptation, Hôpital Cochin, Paris, France
- IFR Handicap INSERM, Paris, France
| | | | - Sindhu R. Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | | | - Anne A. Schouffoer
- Leiden University Medical Center, Leiden, the Netherlands
- Haga Teaching Hospital, the Hague, the Netherlands
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, the Netherlands
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
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11
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Levis AW, Harel D, Kwakkenbos L, Carrier ME, Mouthon L, Poiraudeau S, Bartlett SJ, Khanna D, Malcarne VL, Sauve M, van den Ende CHM, Poole JL, Schouffoer AA, Welling J, Thombs BD. Using Optimal Test Assembly Methods for Shortening Patient-Reported Outcome Measures: Development and Validation of the Cochin Hand Function Scale-6: A Scleroderma Patient-Centered Intervention Network Cohort Study. Arthritis Care Res (Hoboken) 2016; 68:1704-1713. [PMID: 27015290 DOI: 10.1002/acr.22893] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop and validate a short form of the Cochin Hand Function Scale (CHFS), which measures hand disability, for use in systemic sclerosis, using objective criteria and reproducible techniques. METHODS Responses on the 18-item CHFS were obtained from English-speaking patients enrolled in the Scleroderma Patient-Centered Intervention Network Cohort. CHFS unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit to CHFS items. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible form length between 1 and 17 items. The final short form selected was the form with the least number of items that maintained statistically equivalent convergent validity, compared to the full-length CHFS, with the Health Assessment Questionnaire (HAQ) disability index (DI) and the physical function domain of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29). RESULTS There were 601 patients included. A 6-item short form of the CHFS (CHFS-6) was selected. The CHFS-6 had a Cronbach's alpha of 0.93. Correlations of the CHFS-6 summed score with HAQ DI (r = 0.79) and PROMIS-29 physical function (r = -0.54) were statistically equivalent to the CHFS (r = 0.81 and r = -0.56). The correlation with the full CHFS was high (r = 0.98). CONCLUSION The OTA procedure generated a valid short form of the CHFS with minimal loss of information compared to the full-length form. The OTA method used was based on objective, prespecified criteria, but should be further studied for viability as a general procedure for shortening patient-reported outcome measures in health research.
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Affiliation(s)
- Alexander W Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | | | - Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada, and Radboud University, Nijmegen, The Netherlands
| | | | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, and Hôpital Cochin, Paris, France
| | - Serge Poiraudeau
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, and IFR Handicap INSERM, Paris, France
| | | | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor
| | - Vanessa L Malcarne
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, and Scleroderma Society of Canada, Ottawa, Ontario, Canada
| | | | | | | | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
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12
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Schouffoer AA, van der Giesen FJ, Beaart-van de Voorde LJJ, Wolterbeek R, Huizinga TWJ, Vliet Vlieland TPM. Validity and responsiveness of the Michigan Hand Questionnaire in patients with systemic sclerosis. Rheumatology (Oxford) 2016; 55:1386-93. [PMID: 27074806 DOI: 10.1093/rheumatology/kew016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim was to assess the validity and responsiveness of the Michigan Hand Questionnaire (MHQ) in patients with SSc. METHODS Data were gathered in connection with a randomized, controlled trial comparing the effectiveness of a 12-week multidisciplinary team care programme, including a hand function treatment module, with regular care. Hand function was evaluated by the MHQ (37 items, six domains: Function, Daily activities, Pain, Work, Aesthetics and Satisfaction) and other measurements, including the HAQ, Hand Mobility in Scleroderma, Sequential Occupational Dexterity Assessment (SODA), grip strength, pinch grip and modified Rodnan Skin Score. Fifty-three patients (28 intervention group and 25 control group) completed evaluation at baseline and after 12 weeks. Validity was determined by computing Spearman correlation coefficients between the baseline MHQ total score and subscales and other measures of (hand) disability. Responsiveness in the intervention group was evaluated by the standardized response mean and effect size (ES). In addition, the pooled ES for the difference between the two groups was computed. RESULTS Significant correlations were seen between the MHQ total score and the HAQ (r = -0.62), Hand Mobility in Scleroderma (r = -0.54), SODA (r = 0.47), SODA Pain (r = 0.32) and modified Rodnan Skin Score (r = 0.46). The ES of the MHQ total score within the intervention group was 0.49, which was larger than that of all other outcome measures. Similar results were obtained for the standardized response mean. The pooled ES of the difference between intervention and control groups for the MHQ total score was 0.86. CONCLUSION The MHQ demonstrated adequate validity and responsiveness in patients with SSc.
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Affiliation(s)
- Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Department of Rheumatology, Haga Teaching Hospital, The Hague,
| | | | | | | | | | - Theodora P M Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Department of Orthopaedics, Leiden University Medical Center, The Netherlands
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13
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Meijs J, Schouffoer AA, Ajmone Marsan N, Kroft LJM, Stijnen T, Ninaber MK, Huizinga TWJ, Vliet Vlieland TPM, de Vries-Bouwstra JK. Therapeutic and diagnostic outcomes of a standardised, comprehensive care pathway for patients with systemic sclerosis. RMD Open 2016; 2:e000159. [PMID: 27042333 PMCID: PMC4800807 DOI: 10.1136/rmdopen-2015-000159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/17/2016] [Accepted: 02/20/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives To determine the outcomes, including number of medical interventions and initiation of immunosuppressive treatment of a standardised, comprehensive, diagnostic care pathway for patients with systemic sclerosis (SSc). Patient characteristics associated with need for medical interventions and with need for immunosuppressive treatment were determined. Methods Data were routinely gathered in connection with a 2-day care pathway combining multidisciplinary care and complete diagnostic work-up of organ involvement in SSc. The number of patients in whom the pathway resulted in medical interventions, and/or initiation of immunosuppressives was recorded. Patient characteristics and diagnostic tests results were compared between patients with and without medical interventions, and patients with and without initiation of immunosuppressives by means of multivariable logistic regression analyses. Results During a period of 44 months, 226 patients with SSc were referred to the care pathway. They included 186 (82%) women with mean age of 54 (SD 14.5) years, and median disease duration of 4 years (range 1–11); 73 (32%) of them had diffuse cutaneous SSc. Medical interventions were initiated in 191 (85%) patients, including initiation of immunosuppressive treatment in n=49 (22%). Presence of telangiectasias and higher erythrocyte sedimentation rate were associated with any medical intervention. Of commonly available variables, lower age, higher skin score and absence of anticentromere antibody were associated with initiation of immunosuppressives. Conclusions A standardised comprehensive 2-day care pathway for patients with SSc resulted in additional diagnostic or therapeutic interventions in 85% of the patients, regardless of SSc subtype and disease duration. In 22% of the patients, immunosuppressive treatment was initiated.
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Affiliation(s)
- Jessica Meijs
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Haga Hospital, The Hague, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Lucia J M Kroft
- Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics , Leiden University Medical Center , Leiden , The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology , Leiden University Medical Center , Leiden , The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
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14
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Willems LM, Vriezekolk JE, Schouffoer AA, Poole JL, Stamm TA, Boström C, Kwakkenbos L, Vliet Vlieland TPM, van den Ende CHM. Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review. Arthritis Care Res (Hoboken) 2015; 67:1426-39. [PMID: 25832447 DOI: 10.1002/acr.22595] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/24/2015] [Accepted: 03/24/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). METHODS Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. RESULTS Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. CONCLUSION The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.
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Affiliation(s)
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden, and Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Linda Kwakkenbos
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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15
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Meijs J, Schouffoer AA, Ajmone Marsan N, Stijnen T, Putter H, Ninaber MK, Huizinga TWJ, de Vries-Bouwstra JK. A prediction model for progressive disease in systemic sclerosis. RMD Open 2015; 1:e000113. [PMID: 26688749 PMCID: PMC4680735 DOI: 10.1136/rmdopen-2015-000113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 10/03/2015] [Indexed: 12/02/2022] Open
Abstract
Objective To develop a model that assesses the risk for progressive disease in patients with systemic sclerosis (SSc) over the short term, in order to guide clinical management. Methods Baseline characteristics and 1 year follow-up results of 163 patients with SSc referred to a multidisciplinary healthcare programme were evaluated. Progressive disease was defined as: death, ≥10% decrease in forced vital capacity, ≥15% decrease in diffusing capacity for carbon monoxide, ≥10% decrease in body weight, ≥30% decrease in estimated-glomerular filtration rate, ≥30% increase in modified Rodnan Skin Score (with Δ≥5) or ≥0.25 increase in Scleroderma Health Assessment Questionnaire. The number of patients with progressive disease was determined. Univariable and multivariable logistic regression analyses were used to assess the probability of progressive disease for each individual patient. Performance of the prediction model was evaluated using a calibration plot and area under the receiver operating characteristic curve. Results 63 patients had progressive disease, including 8 patients who died ≤18 months after first evaluation. Multivariable analysis showed that friction rubs, proximal muscular weakness and decreased maximum oxygen uptake as % predicted, adjusted for age, gender and use of immunosuppressive therapy at baseline, were significantly associated with progressive disease. Using the prediction model, the predicted chance for progressive disease increased from a pretest chance of 37% to 67–89%. Conclusions Using the prediction model, the chance for progressive disease for individual patients could be doubled. Friction rubs, proximal muscular weakness and maximum oxygen uptake as % predicted were identified as relevant parameters.
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Affiliation(s)
- Jessica Meijs
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Haga Hospital, The Hague, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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16
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Couperus LE, Vliegen HW, Henkens IR, Maan AC, Treskes RW, de Vries JK, Schouffoer AA, Swenne CA, Schalij MJ, Scherptong RWC. Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient. J Electrocardiol 2015; 49:60-8. [PMID: 26489821 DOI: 10.1016/j.jelectrocard.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a leading cause of death in systemic sclerosis (SSc) patients. The current study assessed the ability of the ECG-derived ventricular gradient (VG-RVPO) to detect PH and predict all-cause mortality in PH patients with subtypes of SSc differing in the extent of multi-organ involvement. METHODS ECGs were obtained from 196 patients with limited and 77 patients with diffuse SSc included from our screening programme on cardiac complications. The association of the VG-RVPO with (1) the presence of PH, (2) conventional screening parameters and (3) survival in PH patients was assessed. RESULTS In limited SSc patients an elevated VG-RVPO corresponded with the presence of PH (-5±12 mV.ms vs -22±16 mV.ms, P<0.01), correlated significantly with conventional screening parameters and had a better diagnostic performance than the presence of a right heart axis (AUC 0.81 vs 0.60; P=0.04). These differences were not observed in patients with diffuse SSc. An elevated VG-RVPO was associated with decreased survival in all SSc patients with PH (3 year survival 30% vs 64%, P=0.02). CONCLUSION An elevated VG-RVPO is associated with PH in limited SSc patients and with decreased survival in all SSc patients with PH.
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Affiliation(s)
- L E Couperus
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - H W Vliegen
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - I R Henkens
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - A C Maan
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - R W Treskes
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - J K de Vries
- Department of Rheumatology, Leiden University Medical Center, the Netherlands
| | - A A Schouffoer
- Department of Rheumatology, Leiden University Medical Center, the Netherlands
| | - C A Swenne
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - R W C Scherptong
- Department of Cardiology, Leiden University Medical Center, the Netherlands.
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17
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Yiu KH, Ninaber MK, Kroft LJ, Schouffoer AA, Stolk J, Scherer HU, Meijs J, de Vries-Bouwstra J, Tse HF, Delgado V, Bax JJ, Huizinga TWJ, Marsan NA. Impact of pulmonary fibrosis and elevated pulmonary pressures on right ventricular function in patients with systemic sclerosis. Rheumatology (Oxford) 2015; 55:504-12. [DOI: 10.1093/rheumatology/kev342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Indexed: 11/12/2022] Open
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18
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Ninaber MK, Stolk J, Smit J, Le Roy EJ, Kroft LJ, Els Bakker M, de Vries Bouwstra JK, Schouffoer AA, Staring M, Stoel BC. Lung structure and function relation in systemic sclerosis: Application of lung densitometry. Eur J Radiol 2015; 84:975-9. [DOI: 10.1016/j.ejrad.2015.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/03/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
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Wevers-de Boer KVC, Heimans L, Visser K, Schouffoer AA, Molenaar ETH, van Groenendael JHLM, Peeters AJ, Speyer I, Collée G, Huizinga TWJ, Allaart CF. Determinants of reaching drug-free remission in patients with early rheumatoid or undifferentiated arthritis after one year of remission-steered treatment. Rheumatology (Oxford) 2015; 54:1380-4. [PMID: 25687553 DOI: 10.1093/rheumatology/keu477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess whether baseline characteristics in patients with undifferentiated arthritis or early RA affect the possibility of achieving drug-free remission after 1 year (DFR1 year) of early remission induction therapy. METHODS We included 375 patients participating in the IMPROVED study who achieved remission (DAS < 1.6) after 4 months (early remission) and were by protocol able to achieve DFR1 year. Having started with MTX plus prednisone, patients tapered prednisone to zero; after 8 months, those still in remission tapered MTX to zero, while those not in remission restarted prednisone. Characteristics of patients achieving and not achieving DFR1 year were compared. Logistic regression was performed to identify predictors of DFR1 year. RESULTS After 1 year, 119 patients (32%) were in DFR. Presence of RF, fulfilling the 2010 criteria for RA, and a low tender joint count were associated with achieving DFR1 year, whereas presence of ACPA was not. None of the baseline characteristics was independently associated with DFR1 year. DFR1 year was sustained for 4 months in 65% of the patients. ACPA-positive patients less often had sustained DFR than ACPA-negative patients (58% vs 80%, P = 0.013). CONCLUSION After 1 year of remission-steered treatment, 32% of the patients who had achieved early remission after 4 months were able to taper medication and achieved DFR. Neither the presence of ACPA nor any other baseline characteristics were independently associated with achieving DFR1 year, but in ACPA-positive patients DFR was less often sustained.
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Affiliation(s)
| | - Lotte Heimans
- Department of Rheumatology, Leiden University Medical Centre, Leiden
| | - Karen Visser
- Department of Rheumatology, Leiden University Medical Centre, Leiden
| | | | | | | | - André J Peeters
- Department of Rheumatology, Reinier de Graaf Gasthuis, Delft
| | - Irene Speyer
- Department of Rheumatology, Bronovo Hospital, The Hague and
| | - Gerard Collée
- Department of Rheumatology, Medical Center Haaglanden, The Hague, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Leiden
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Ninaber MK, Hamersma WBGJ, Schouffoer AA, van 't Wout EFA, Stolk J. The global peripheral chemoreflex drive in patients with systemic sclerosis: a rebreathing and exercise study. QJM 2015; 108:33-8. [PMID: 25024353 DOI: 10.1093/qjmed/hcu150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exercise intolerance (EI) in systemic sclerosis (SSc) is difficult to manage by the clinician. The peripheral chemoreflex drive compensates for metabolic acidosis during exercise and may be related to EI. AIM To assess the global peripheral chemoreflex drive (GPCD) in patients with SSc at rest and during exercise. METHODS Consecutively tested SSc patients (n = 49) were evaluated by pulmonary function tests, carbon dioxide (CO2) rebreathing studies and non-invasive cardiopulmonary exercise testing (CPET). Results of their CO2 rebreathing tests were compared with those of controls (n = 32). Respiratory compensation for metabolic acidosis during CPET was defined by the occurrence of a sharp increase in minute ventilation (VdotE) and the ventilatory equivalent for CO2 (V'E and V'CO2) at the end of the isocapnic buffer phase. Euoxic (eVHR) and hyperoxic (hVHR) ventilatory responses to hypercapnia were measured and its difference (eVHR - hVHR) was considered to reflect the GPCD. RESULTS In 45 patients with SSc, CPET results showed respiratory compensation at the occurrence of metabolic acidosis. eVHR - hVHR in patients with diffuse cutaneous SSc (dcSSc) differed significantly from that in patients with limited cutaneous SSc (lcSSc) and from that in controls (0.47 ± 0.38 (dcSSc) vs. 0.90 ± 0.77 (lcSSc) and 0.90 ± 0.49 (controls) l/min/mmHg; P = 0.04 and P = 0.03, respectively). CONCLUSIONS Respiratory compensation for metabolic acidosis occurred in all patients. However, the GPCD was diminished in dcSSc patients, suggesting an altered control of breathing. Its assessment may help the clinician to better understand reported EI and exertional dyspnea in dcSSc patients.
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Affiliation(s)
- M K Ninaber
- From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands
| | - W B G J Hamersma
- From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands
| | - A A Schouffoer
- From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands
| | - E F A van 't Wout
- From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands
| | - J Stolk
- From the Department of Pulmonology, Department of Rheumatology, Leiden University Medical Center, Leiden and Department of Rheumatology, HAGA Hospital The Hague, The Netherlands
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Meijs J, Pors D, Vliet Vlieland TPM, Huizinga TWJ, Schouffoer AA. Translation, cross-cultural adaptation, and validation of the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (SCTC GIT) 2.0 into Dutch. Clin Exp Rheumatol 2014; 32:S-41-8. [PMID: 24984228] [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: 10/23/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To translate and adapt the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA SCTC GIT 2.0) into Dutch and validate it among Dutch systemic sclerosis (SSc) patients. METHODS First, the UCLA SCTC GIT 2.0 questionnaire was translated and adapted according to international guidelines. The resulting Dutch GIT 2.0 was, in combination with the SSc Health Assessment Questionnaire (SHAQ) and Short Form-36 (SF-36) administered to SSc patients participating in a standardised medical assessment. Moreover, all previous clinical examinations and confirmed medical diagnoses related to GIT were extracted from the medical records. Internal consistency was determined by calculating Cronbach's alpha. To determine the reliability, the questionnaire was re-administered with an interval of two weeks to a subgroup of patients and the intraclass-correlation coefficient (ICC) was computed. Spearman correlation coefficients between GIT scores, SF-36 and SHAQ were computed. GIT scores were compared among patients with and without previous gastrointestinal examinations and/or diagnoses. RESULTS Eighty-nine patients with a mean age of 53.6 (SD 12) years, and predominantly female (76%) were included. The median total GIT score was 0.17 (Cronbach's alpha 0.921). The test-retest reliability of the total GIT score was good (n=27; ICC 0.749). Overall, the GIT total scores correlated significantly with the SHAQ visual analogue scale intestinal complaints and the SF-36. Significant differences between GIT total and subscale scores of patients with and without previous gastrointestinal examinations and diagnoses were present. CONCLUSIONS The Dutch GIT 2.0 questionnaire showed good internal consistency, construct validity and test-retest reliability.
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Affiliation(s)
- J Meijs
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
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Ninaber MK, Hamersma WBGJ, Schouffoer AA, Kovacs G, Olschewski H, Holman ER, Ajmone Marsan N, Stolk J. Detection of pulmonary vasculopathy by novel analysis of oxygen uptake in patients with systemic sclerosis: association with pulmonary arterial pressures. Clin Exp Rheumatol 2014; 32:S-60-7. [PMID: 25068203] [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: 10/28/2013] [Accepted: 03/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES During cardiopulmonary exercise testing (CPET) compromised pulmonary vasculature in patients with systemic sclerosis (SSc) may lead to increases in pulmonary arterial pressures (PAP) and decreased oxygen uptake. We hypothesised that this may lead into a disproportional heart rate (HR) increase with a corresponding V'O₂/HR breakpoint and relates to systolic PAP at rest. METHODS In a prospective design we evaluated V'O₂/HR slopes for breakpoints. To understand its physiological meaning, we evaluated V'O₂/HR and V'O₂/mPAP slopes for breakpoints in a historic data set of SSc patients, in which CPET and right heart catheterisation was performed simultaneously. V'O₂/HR slopes with a peak oxygen uptake outside the normal range were defined as pathologic. RESULTS A breakpoint occurred in both V'O₂/mPAP and V'O₂/HR slope in 16/34 patients in the historic dataset and occurred in the V'O₂/mPAP slope at a lower V'O₂in 15 patients. In the prospective dataset, 73/121 patients showed a V'O₂/HR breakpoint and achieved a significantly lower peak oxygen uptake compared to 48/121 patients without a V'O2/HR breakpoint (p=0.036). Mean systolic PAP in 41/121 patients with a pathologic V'O₂/HR slope differed significantly from patients without a pathologic V'O₂/HR slope (p=0.027). In 27/121 patients with a systolic PAP < 35 mmHg a pathologic V'O₂/HR slope was observed. CONCLUSIONS SSc patients with a V'O₂/HR breakpoint are characterised by a decreased oxygen uptake, likely caused by sudden PAP increases during exercise. Importantly, in patients with normal resting SPAP pathologic V'O₂/HR slopes were observed. This suggests that these patients are at risk for developing pulmonary hypertension.
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Affiliation(s)
- M K Ninaber
- Leiden University Medical Center, Department of Pulmonology, Leiden, The Netherlands.
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Markusse IM, de Vries-Bouwstra JK, Han KH, van der Lubbe PAHM, Schouffoer AA, Kerstens PJSM, Lems WF, Huizinga TWJ, Allaart CF. Feasibility of tailored treatment based on risk stratification in patients with early rheumatoid arthritis. Arthritis Res Ther 2014; 16:430. [PMID: 25253199 PMCID: PMC4203912 DOI: 10.1186/s13075-014-0430-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/18/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Personalized medicine is the holy grail of medicine. The EULAR recommendations for the management of rheumatoid arthritis (RA) support differential treatment between patients with baseline characteristics suggestive of a non-poor prognosis (non-PP) or poor prognosis (PP) (presence of autoantibodies, a high inflammatory activity and damage on radiographs). We aimed to determine which prognostic risk groups benefit more from initial monotherapy or initial combination therapy. METHODS 508 patients were randomized to initial monotherapy (iMono) or initial combination therapy (iCombo). Disease outcomes of iMono and iCombo were compared within non-PP or PP groups as determined on baseline characteristics RESULTS PP patients treated with iCombo after three months more often achieved ACR20 (70% vs 38%, P <0.001), ACR50 (48% vs 13%, P <0.001) and ACR70 response (24% vs 4%, P <0.001) than those treated with iMono, and had more improvement in HAQ (median decrease 0.75 vs 0.38, P <0.001). After 1 year, differences in ACR20 response and DAS-remission remained; PP patients treated with iCombo (vs iMono) had less radiographic progression (median 0.0 vs 1.5, P =0.001). CONCLUSIONS Since PP and non-PP patients benefit equally from iCombo through earlier clinical response and functional improvement than with iMono, we conclude that personalized medicine as suggested in the guidelines is not yet feasible. The choice of treatment strategy should depend more on rapid relief of symptoms than on prognostic factors. TRIAL REGISTRATION Netherlands Trial Register NTR262 (registered 7 September 2005) and NTR265 (8 September 2005).
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Meijs J, Zirkzee EJM, Schouffoer AA, Henquet SM, Caljouw MAA, Stijnen T, Huizinga TWJ, Schuerwegh AJM, Vliet Vlieland TPM. Health-care utilization in Dutch systemic sclerosis patients. Clin Rheumatol 2013; 33:825-32. [DOI: 10.1007/s10067-013-2373-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/16/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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Yiu KH, Schouffoer AA, Marsan NA, Ninaber MK, Stolk J, Vlieland TV, Scherptong RW, Delgado V, Holman ER, Tse HF, Huizinga TWJ, Bax JJ, Schuerwegh AJM. Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: Relationship to functional capacity and ventricular arrhythmias. ACTA ACUST UNITED AC 2011; 63:3969-78. [DOI: 10.1002/art.30614] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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van Wyk L, van der Marel J, Schuerwegh AJM, Schouffoer AA, Voskuyl AE, Huizinga TWJ, Bianchi DW, Scherjon SA. Increased incidence of pregnancy complications in women who later develop scleroderma: a case control study. Arthritis Res Ther 2011; 13:R183. [PMID: 22053948 PMCID: PMC3334631 DOI: 10.1186/ar3510] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 09/01/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022] Open
Abstract
Introduction Studies have shown that fetal progenitor cells persist in maternal blood or bone marrow for more than 30 years after delivery. Increased trafficking of fetal cells occurs during pregnancy complications, such as hypertension, preeclampsia, miscarriage and intra-uterine growth restriction (IUGR). Women with these pregnancy complications are significantly more often HLA-class II compatible with their spouses. Women who later develop scleroderma also give birth to an HLA-class II child more often. From these prior studies we hypothesized that preeclampsia and other pregnancy complications could be associated with increased levels of fetal cell trafficking, and later be involved in the development of scleroderma. Methods This study was a retrospective multi-centre matched case-control study. One-hundred-and-three women with systemic sclerosis (SSc) and 103 women with no history of SSc or other autoimmune disease were given a questionnaire regarding complications during pregnancy, such as hypertension, intra-uterine growth restriction (IUGR) and miscarriage. Conditional logistic regression analysis was used to assess associations. Results We found a statistically significantly increased incidence of having had a pregnancy history of hypertension or a fetus with IUGR in women who subsequently developed SSc compared to healthy controls. We found an odds ratio of 2.6 (95% confidence interval (CI): 1.1 to 4.6) for hypertensive complications during pregnancy and an odds ratio of 3.9 (95% CI: 1.2 to 12.3) for intra-uterine growth restriction for women with SSc compared to healthy controls. Conclusions This is the first study to show an association between hypertensive complications during pregnancy or IUGR and the development of SSc at a later age. We speculate that the pregnancy abnormalities may have resulted in increased fetomaternal trafficking, which may have played a role in the increased incidence of SSc. Further studies are indicated to examine this putative relationship.
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Affiliation(s)
- Linda van Wyk
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, PO BOX 9600, 2300 RC Leiden, The Netherlands.
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Zirkzee EJM, Steup-Beekman GM, Schouffoer AA, Henquet SM, Caljouw MAA, Huizinga TWJ, Vlieland TPMV. Health care usage in Dutch systemic lupus erythematosus patients. Lupus 2011; 20:1147-54. [DOI: 10.1177/0961203311405372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a first step in the improvement of the organization of care for patients with systemic lupus erythematosus (SLE) we studied their health care usage and its determinants. A questionnaire was sent to 161 outpatients of the rheumatology clinic of a Dutch university hospital. The questionnaire comprised questions on health care usage, quality of life and sociodemographic characteristics. Disease characteristics were extracted from the medical record. Among the 102 responders (63% response rate) the proportions of patients reporting contacts with a rheumatologist because of SLE since onset of the disease and over the past 12 months were 100% and 83%, respectively. These proportions were 93% and 68% for all other medical specialists, 88% and 44% for the general practitioner, 78% and 44% for any health professional, 29% and 9% for care at home, 48% and 17% for hospital admissions and 29% and 2% for day-patient care. Younger age, major organ involvement, the use of immunosuppressants and worse physical functioning were found to be significantly associated with greater health care use. This study demonstrated that health care usage by SLE patients is substantial and involves a variety of health care services. Further research should be directed at patients’ satisfaction and patients’ needs regarding the optimal organization of integrated, multidisciplinary services that are accessible for SLE patients of all ages.
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Affiliation(s)
- EJM Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - GM Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - AA Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - SM Henquet
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - MAA Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - TWJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - TPM Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Schouffoer AA, Zirkzee EJM, Henquet SM, Caljouw MAA, Steup-Beekman GM, van Laar JM, Vlieland TPMV. Needs and preferences regarding health care delivery as perceived by patients with systemic sclerosis. Clin Rheumatol 2011; 30:815-24. [PMID: 21243390 PMCID: PMC3101347 DOI: 10.1007/s10067-010-1645-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 11/09/2010] [Accepted: 11/30/2010] [Indexed: 11/16/2022]
Abstract
This study aims to examine the needs and preferences regarding the delivery of health care services and information provision and their determinants in patients with systemic sclerosis (SSc). A questionnaire was sent to 77 SSc outpatients, comprising 27 items on health care needs within the domains physical, psychological, social support, employment/daily activities, or other health problems and 13 items on information needs. Moreover, the patients’ preferences regarding the provision of health care services and information were listed. Additional assessments included sociodemographic characteristics, physical functioning (SSc Health Assessment Questionnaire), and quality of life (SF-36). Sixty-four patients (83%) returned the questionnaire. Twenty-six patients (41%) reported one or more unmet health care needs, with the highest proportions of patients with unmet needs seen in the physical (28%) and psychological (20%) domain. The highest percentages of patients with information needs were observed for medical subjects (20–28%). A lower mental component summary scale score and younger age were associated with the presence of at least one health care need in the psychological domain. Worse physical functioning, a diagnosis of diffuse SSc and having a partner were associated with higher information need score. A yearly, standardized multidisciplinary assessment program was most frequently mentioned as a preferred, but not yet existing health care model (59%) and the rheumatologist as a preferred source of information supply (75%). Unmet health care and information needs are common among SSc patients. To improve SSc health care, more attention should be paid to health care services for specific physical and psychological problems and medical information supply by the rheumatologist. In addition, the development of new models of care, such as a yearly, standardized multidisciplinary diagnostic program seems warranted.
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Affiliation(s)
- Anne A Schouffoer
- Department of Rheumatology, C-01-Q, Leiden University Medical Center, 2300, RC, Leiden, The Netherlands.
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Schouffoer AA, Siegert CE, Arend SM, Thompson J, van Oostaijen JA. Embolization of a ruptured aneurysm in classic polyarteritis nodosa presenting as perirenal hematoma. Arch Intern Med 1998; 158:1466-8. [PMID: 9665358 DOI: 10.1001/archinte.158.13.1466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 26-year-old man was admitted with abdominal pain, anemia, and hypertension. Ultrasonography and computed tomography revealed a perirenal hematoma. Soon after admission, the patient went into shock, and emergency angiography was performed. Two active bleeding sites were found in the left kidney and were successfully embolized. Also, multiple aneurysms, consistent with the diagnosis of classic polyarteritis nodosa, were seen. After treatment was initiated, the patient recovered fully. When a spontaneous perirenal hematoma is a presenting symptom of classic polyarteritis nodosa, a delay in making the right diagnosis is likely to occur. Angiography not only may provide a quick diagnosis, but it can also be used to perform therapeutic embolization. In patients with classic polyarteritis nodosa and hemorrhage from a ruptured aneurysm, angiography may be a therapeutic alternative to surgery.
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Affiliation(s)
- A A Schouffoer
- Department of Nephrology, Leiden University Medical Centre, The Netherlands
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