1
|
Andréasson K, Olofsson T, Lagishetty V, Alrawi Z, Klaassens E, Holster S, Hesselstrand R, Jacobs JP, Wallman JK, Volkmann ER. Treatment for Rheumatoid Arthritis Associated With Alterations in the Gastrointestinal Microbiota. ACR Open Rheumatol 2024. [PMID: 38653503 DOI: 10.1002/acr2.11673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Emerging research suggests that rheumatoid arthritis (RA) is associated with intestinal dysbiosis. This prospective pilot study evaluates changes in intestinal microbial composition in patients with RA initiating treatment with either methotrexate (MTX) or a tumor necrosis factor inhibitor (TNFi). METHODS Consecutive patients, fulfilling the 2010 American College of Rheumatology/EULAR classification criteria for RA, who started treatment with either MTX or TNFi delivered a stool sample upon initiation of immunosuppression and 3 months later. A 16S ribosomal RNA gene-based validated microbiota test (GA-map Dysbiosis Index Score [DIS], Genetic Analysis, Oslo, Norway) was used to evaluate for the presence and degree of dysbiosis. Fecal levels of Prevotella copri (P. copri) were analyzed by custom-made quantitative polymerase chain reaction. Changes in microbial composition were analyzed in relation to changes in disease activity, as measured by the disease activity score based on 28-joint counts, using C-reactive protein. RESULTS At baseline, dysbiosis was present in 33 of 50 (66%) participants and more common in participants with more than 2 years of disease duration (P = 0.019). At the 3-month follow-up, 27 of 50 (54%) were good treatment responders and the DIS had improved in 14 of 50 (28%). Participants initiating TNFi more often exhibited improvement in the DIS compared with those initiating MTX (P = 0.031). P. copri was identified in 32 of 50 (64%) at baseline. An improvement in disease activity score based on 28-joint counts, using C-reactive protein was associated with a simultaneous decrease in P. copri abundance (rs = 0.30, P = 0.036). CONCLUSION This study affirms that dysbiosis is a feature of RA. Although patients were not randomized to MTX or TNFi, the findings suggest that specific therapies may differentially modulate the gastrointestinal microbiota in RA. The association between P. copri and treatment response requires further study.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jonathan P Jacobs
- University of California, Los Angeles and VA Greater Los Angeles Healthcare System
| | | | | |
Collapse
|
2
|
Georgiadis S, Ørnbjerg LM, Michelsen B, Kvien TK, Di Giuseppe D, Wallman JK, Závada J, Provan SA, Kristianslund EK, Rodrigues AM, Santos MJ, Rotar Ž, Pirkmajer KP, Nordström D, Macfarlane GJ, Jones GT, van der Horst-Bruinsma I, Hellamand P, Østergaard M, Hetland ML. ASDAS-CRP and ASDAS-ESR cut-offs for disease activity states in axial spondyloarthritis - Are they interchangeable? J Rheumatol 2024:jrheum.2023-1217. [PMID: 38621792 DOI: 10.3899/jrheum.2023-1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) is recommended over erythrocyte sedimentation rate (ASDAS-ESR) to assess disease activity in axial spondyloarthritis (axSpA). Although ASDAS-CRP and ASDAS-ESR are not interchangeable, the same disease activity cut-offs are used for both. We aimed to estimate optimal ASDAS-ESR values corresponding to the established ASDAS-CRP cut-offs (1.3, 2.1 and 3.5) and investigate the potential improvement of level of agreement between ASDAS-ESR and ASDAS-CRP disease activity states when applying these estimated cut-offs. METHODS We used data from axSpA patients initiating a tumour necrosis factor inhibitor from nine European registries. ASDAS-ESR cut-offs were estimated using the Youden index. Level of agreement between ASDAS-ESR and ASDAS-CRP disease activity states was compared against each other. RESULTS In 3,664 patients, mean ASDAS-CRP was higher than ASDAS-ESR at both baseline (3.6 and 3.4, respectively) and aggregated follow-up at 6, 12, or 24 months (1.9 and 1.8, respectively). The estimated ASDAS-ESR values corresponding to the established ASDAS-CRP cut-offs were 1.4, 1.9 and 3.3. By applying these cut-offs, the proportion of discordance between disease activity states according to ASDAS-ESR and ASDAS-CRP decreased from 22.93% to 19.81% in baseline data but increased from 27.17% to 28.94% in follow-up data. CONCLUSION We estimated the optimal ASDAS-ESR values corresponding to the established ASDAS-CRP cut-off values. However, applying the estimated cut-offs did not increase the level of agreement between ASDAS-ESR and ASDAS-CRP disease activity states to a relevant degree. Our findings did not provide evidence to reject the established cut-off values for ASDAS-ESR.
Collapse
Affiliation(s)
- Stylianos Georgiadis
- S. Georgiadis, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lykke Midtbøll Ørnbjerg
- L. M. Ørnbjerg, MD, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Research Unit, Sørlandet Hospital, Kristiansand, Norway and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Tore K Kvien
- T. K. Kvien, MD, PhD, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Daniela Di Giuseppe
- D. Di Giuseppe, PhD, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- J. K. Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jakub Závada
- J. Závada (0000-0002-9802-6545), MD, PhD, Institute of Rheumatology, Prague, Czech Republic and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sella A Provan
- S. A. Provan, MD, PhD, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Public Health Section, Inland Norway; University of Applied Sciences, Elverum, Norway
| | - Eirik Klami Kristianslund
- E. K. Kristianslund, MD, PhD, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ana Maria Rodrigues
- A. M. Rodrigues, MD, PhD, EpiDoC Unit, CEDOC, Nova Medical School, Lisbon, Portugal and Rheumatology Unit, Hospital dos Lusíadas, Lisbon, Portugal
| | - Maria José Santos
- M. J. Santos, MD, PhD, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal and Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Žiga Rotar
- Ž. Rotar, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Perdan Pirkmajer
- K. Perdan Pirkmajer, MD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dan Nordström
- D. Nordström, MD, PhD, Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Gary J Macfarlane
- G. J. Macfarlane, MD, PhD, Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, United Kingdom
| | - Gareth T Jones
- G. T. Jones, PhD, Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, United Kingdom
| | | | - Pasoon Hellamand
- P. Hellamand, MD, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands and Amsterdam Rheumatology Immunology Center, Reade and Amsterdam UMC, Amsterdam, Netherlands
| | - Mikkel Østergaard
- M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- M. L. Hetland, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Hellamand P, van de Sande MGH, Ørnbjerg LM, Klausch T, Eklund KK, Relas H, Santos MJ, Vieira-Sousa E, Loft AG, Glintborg B, Østergaard M, Lindström U, Wallman JK, Michelsen B, Fagerli KM, Castrejón I, Gudbjornsson B, Love TJ, Vencovský J, Nekvindová L, Rotar Ž, Tomšič M, Díaz-González F, Kenar G, Tuğsal HY, Iannone F, Ramonda R, Codreanu C, Mogosan C, Nissen MJ, Möller B, Hetland ML, van der Horst-Bruinsma IE. Sex Differences in the Effectiveness of First-Line Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis: Results From the European Spondyloarthritis Research Collaboration Network. Arthritis Rheumatol 2024; 76:587-598. [PMID: 37975166 DOI: 10.1002/art.42758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Women with psoriatic arthritis (PsA) may have reduced tumor necrosis factor inhibitor (TNFi) effectiveness compared to men. We examined sex differences in treatment response and retention rates during 24 months of follow-up among patients with PsA initiating their first TNFi. METHODS Data from patients with PsA across 13 European Spondyloarthritis Research Collaboration Network registries starting their first TNFi were pooled. Logistic regression was used to analyze the association between sex and treatment response using low disease activity (LDA) according to the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP) (<3.2) at six months as the primary outcome. Analyses were adjusted for age, country, conventional synthetic disease-modifying antirheumatic drug treatment, and TNFi start year. Retention rates were explored using the Kaplan-Meier estimator. RESULTS We analyzed the treatment response of 7,679 patients with PsA (50% women) with available data on LDA at six months. At baseline, women and men had similar characteristics, including mean DAS28-CRP (women vs men, 4.4 [SD 1.2] vs 4.2 [SD 1.2]), though patient-reported outcome measures were worse in women. At six months, 64% of women and 78% of men had LDA (relative risk [RR] 0.82; 95% confidence interval [CI] 0.80-0.84). This difference was similar after adjustment (RR 0.83; 95% CI 0.81-0.85). TNFi retention rates were evaluated in 17,842 patients with PsA. Women had significantly lower retention rates than men at all time points (women 79%, 64%, and 50% vs men 88%, 77%, and 64% at 6, 12, and 24 months, respectively). CONCLUSION Despite comparable disease characteristics at baseline, women with PsA have reduced treatment response and retention rates to their first TNFi, highlighting the need to consider sex differences in PsA research and management.
Collapse
Affiliation(s)
- Pasoon Hellamand
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Thomas Klausch
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kari K Eklund
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Relas
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | | | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulf Lindström
- Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Brigitte Michelsen
- Diakonhjemmet Hospital, Oslo and Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Bjorn Gudbjornsson
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Thorvardur J Love
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Jiří Vencovský
- Institute of Rheumatology and Charles University, Prague, Czech Republic
| | | | - Žiga Rotar
- University Medical Centre Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Gökçe Kenar
- Dokuz Eylul University School of Medicine, Izmir, Turkey
| | | | | | | | | | | | | | - Burkhard Möller
- Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Merete L Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
4
|
Ørnbjerg LM, Rugbjerg K, Georgiadis S, Rasmussen SH, Jacobsson L, Loft AG, Iannone F, Fagerli KM, Vencovsky J, Santos MJ, Möller B, Pombo-Suarez M, Rotar Z, Gudbjornsson B, Cefle A, Eklund K, Codreanu C, Jones G, van der Sande M, Wallman JK, Sebastiani M, Michelsen B, Závada J, Nissen MJ, Sanchez-Piedra C, Tomšič M, Love TJ, Relas H, Mogosan C, Hetland ML, Østergaard M. Patient-Reported Outcomes (PROs) and PRO Remission Rates in 12,262 Biologic-Naïve Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitors in Routine Care. J Rheumatol 2024; 51:378-389. [PMID: 38224992 DOI: 10.3899/jrheum.2023-0764] [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: 12/07/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset. METHODS Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment. RESULTS For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years. CONCLUSION In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.
Collapse
Affiliation(s)
- Lykke M Ørnbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark;
| | - Kathrine Rugbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- L. Jacobsson, MD, PhD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne G Loft
- A.G. Loft, MD, PhD, The DANBIO registry and Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Florenzo Iannone
- F. Iannone, MD, PhD, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Karen M Fagerli
- K.M. Fagerli, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jiri Vencovsky
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria J Santos
- M.J. Santos, MD, PhD, Rheumatology Department, Hospital Garcia de Orta, Rheumatology Research Unit, Faculdade de Medicina, Lisboa, and Reuma.pt, Portugal
| | - Burkhard Möller
- B. Möller, MD, Department for Rheumatology and Immunology, Inselspital - University Hospital Bern, University of Bern, Bern, Switzerland
| | - Manuel Pombo-Suarez
- M. Pombo-Suarez, MD, PhD, Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ziga Rotar
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- B. Gudbjornsson, MD, PhD, Centre for Rheumatology Research, Landspitali University Hospital (ICEBIO), and the Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ayse Cefle
- A. Cefle, MD, TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kari Eklund
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Catalin Codreanu
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Gareth Jones
- G. Jones, PhD, BSRBR-AS and Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marleen van der Sande
- M. van der Sande, MD, PhD, Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology, and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - Johan K Wallman
- J.K. Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marco Sebastiani
- M. Sebastiani, MD, PhD, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and Research Unit, Sørlandet Hospital, Kristiansand, Norway, and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Jakub Závada
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- M.J. Nissen, MD, PhD, Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Carlos Sanchez-Piedra
- C. Sanchez-Piedra, MD, PhD, Spanish Agency of Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain
| | - Matija Tomšič
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur J Love
- T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, and Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Heikki Relas
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Corina Mogosan
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Merete L Hetland
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Exarchou S, Di Giuseppe D, Klingberg E, Sigurdardottir V, Wedrén S, Lindström U, Turesson C, Jacobsson LTH, Askling J, Wallman JK. Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study. Ann Rheum Dis 2024; 83:446-456. [PMID: 38049985 DOI: 10.1136/ard-2023-224965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES To compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden. METHODS Adults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0-M07.3) from outpatient rheumatology/internal medicine departments 2001-2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case's first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described. RESULTS All-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40-59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes. CONCLUSIONS Mortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.
Collapse
Affiliation(s)
- Sofia Exarchou
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Daniela Di Giuseppe
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valgerdur Sigurdardottir
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
- Department of Rheumatology, Falun Hospital, Falun, Sweden
| | - Sara Wedrén
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital Malmö, Malmö, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital Lund, Lund, Sweden
| |
Collapse
|
6
|
Roseman C, Wallman JK, Jöud A, Schelin M, Einarsson JT, Lindqvist E, Lampa J, Kapetanovic MC, Olofsson T. Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: what is the role of inflammation control? Scand J Rheumatol 2024; 53:94-103. [PMID: 38031733 DOI: 10.1080/03009742.2023.2258644] [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: 02/16/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE While considerable focus has been placed on pain due to inflammation in psoriatic arthritis (PsA), less is reported on pain despite inflammation control. Here, we aimed to investigate the occurrence/predictors of persistent pain, including non-inflammatory components, after starting anti-tumour necrosis factor (anti-TNF) therapy. METHOD Bionaïve PsA patients starting a first anti-TNF therapy 2004-2010 were identified (South Swedish Arthritis Treatment Group register; N = 351). Outcomes included unacceptable pain [visual analogue scale (VAS) pain > 40 mm], and unacceptable pain despite inflammation control (refractory pain; VAS pain > 40 mm + C-reactive protein < 10 mg/L + ≤ 1 swollen joint of 28), assessed at 0, 3, 6, and 12 months. Baseline predictors were estimated by logistic regression. RESULTS Upon starting anti-TNF therapy, 85% of patients reported unacceptable pain, falling to 43% at 3 months and then remaining stable. After 12 months, refractory pain constituted 63% of all unacceptable pain. Higher baseline VAS pain/global, worse physical function and lower health-related quality-of-life were associated with a higher risk of unacceptable/refractory pain at 12 months. More swollen joints and higher evaluator's global assessment were associated with a lower risk of 12-month refractory pain. CONCLUSIONS A substantial proportion of PsA patients reported unacceptable pain throughout the first anti-TNF treatment year. At 12 months, refractory pain constituted about two-thirds of this remaining pain load. More objective signs of inflammation at anti-TNF initiation were associated with less future refractory pain. This highlights insufficient effect of biologics in patients with inflammation-independent pain, warranting alternative treatments.
Collapse
Affiliation(s)
- C Roseman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - J K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - A Jöud
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Mec Schelin
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
- Department of Research and Development, Skåne University Hospital, Lund, Sweden
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - J T Einarsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - E Lindqvist
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - J Lampa
- Karolinska Institute, Department of Medicine Solna, Rheumatology Unit, Center of Molecular Medicine (CMM), Stockholm, Sweden
| | - M C Kapetanovic
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - T Olofsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Linde L, Ørnbjerg LM, Georgiadis S, H. Rasmussen S, Lindström U, Askling J, Michelsen B, Di Giuseppe D, Wallman JK, Gudbjornsson B, Love TJ, Nordström DC, Yli-Kerttula T, Nekvindová L, Vencovský J, Iannone F, Cauli A, Loft AG, Glintborg B, Laas K, Rotar Z, Tomšič M, Macfarlane GJ, Möller B, van de Sande M, Codreanu C, Nissen MJ, Birlik M, Erten S, Santos MJ, Vieira-Sousa E, Hetland ML, Østergaard M. Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries. Rheumatology (Oxford) 2024; 63:751-764. [PMID: 37314967 PMCID: PMC10907817 DOI: 10.1093/rheumatology/kead284] [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: 01/04/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries. METHODS Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors. RESULTS In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99). CONCLUSION Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.
Collapse
Affiliation(s)
- Louise Linde
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Lykke M Ørnbjerg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H. Rasmussen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department for Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - Lucie Nekvindová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital, University Hospital Bern, on behalf of the Swiss Clinical Quality Management for Rheumatic Diseases, SCQM, Zürich, Switzerland
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sukran Erten
- Department of Rheumatology, Ankara Yıldırım Beyazıt University Ankara City Hospital, Ankara, Turkey
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology, Hospital de Santa Maria, CHULN, Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Merete L Hetland
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Lindström U, di Giuseppe D, Exarchou S, Alenius GM, Olofsson T, Klingberg E, Jacobsson L, Askling J, Wallman JK. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: an observational nationwide study. RMD Open 2023; 9:rmdopen-2022-002883. [PMID: 37173095 DOI: 10.1136/rmdopen-2022-002883] [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: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION We aimed to compare the proportions of patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) remaining on methotrexate (regardless of other disease-modifying antirheumatic drug (DMARD)-changes), and proportions not having started another DMARD (regardless of methotrexate discontinuation), within 2 years of starting methotrexate, as well as methotrexate effectiveness. METHODS Patients with DMARD-naïve, newly diagnosed PsA, starting methotrexate 2011-2019, were identified from high-quality national Swedish registers and matched 1:1 to comparable patients with RA. Proportions remaining on methotrexate and not starting another DMARD were calculated. For patients with disease activity data at baseline and 6 months, response to methotrexate monotherapy was compared through logistic regression, applying non-responder imputation. RESULTS In total, 3642/3642 patients with PsA/RA were included. Baseline patient-reported pain and global health were similar, whereas patients with RA had higher 28-joint scores and evaluator-assessed disease activity. Two years after methotrexate start, 71% of PsA vs 76% of patients with RA remained on methotrexate, 66% vs 60% had not started any other DMARD, and 77% vs 74% had not started specifically a biological or targeted synthetic DMARD. At 6 months, the proportions of patients with PsA versus RA achieving pain-scores ≤15 mm were 26% vs 36%; global health ≤20 mm: 32% vs 42%; evaluator-assessed 'remission': 20% vs 27%, with corresponding adjusted ORs (PsA vs RA) of 0.63 (95% CI 0.47 to 0.85); 0.57 (95% CI 0.42 to 0.76) and 0.54 (95% CI 0.39 to 0.75). DISCUSSION In Swedish clinical practice, methotrexate use is similar in PsA and RA, both regarding initiation of other DMARDs and methotrexate retention. On a group level, disease activity improved during methotrexate monotherapy in both diseases, although more so in RA.
Collapse
Affiliation(s)
- Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniela di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Exarchou
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gerd-Marie Alenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Tor Olofsson
- Department of Clinical Sciences, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| |
Collapse
|
9
|
Exarchou S, Wallman JK, Di Giuseppe D, Klingberg E, Sigurdardottir V, Wedrén S, Lindström U, Turesson C, Jacobsson LTH, Askling J. The National Prevalence of Clinically Diagnosed Psoriatic Arthritis in Sweden 2017. J Rheumatol 2023:jrheum.221139. [PMID: 36858434 DOI: 10.3899/jrheum.221139] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) prevalence estimates vary across studies; studies based on national data are few. We aimed to estimate the prevalence of clinically diagnosed PsA in Sweden in 2017, overall and stratified by sex/age/education/geography, and to quantify disease-modifying anti-rheumatic drug (DMARD) use among those in contact with specialized rheumatology care 2015-2017. METHODS Individuals, 18-79 years (y), alive, residing in Sweden on December 31, 2017, with a prior PsA diagnosis were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). The PsA prevalence was estimated according to a base case (BC) definition (≥1 main PsA ICD-code from rheumatology or internal medicine departments in NPR, or a PsA diagnosis in SRQ), four sensitivity analysis definitions, and for those seen in specialized rheumatology care 2015-2017. In the latter group, DMARD use during 2017 was also assessed. Data for stratifications were retrieved from national registers. RESULTS The crude national prevalence of PsA (18-79y) was estimated at 0.39% (BC), 0.34% after accounting for diagnostic misclassification and 0.32-0.50% across all sensitivity analyses. The prevalence was lower in males and in those with higher level of education. The prevalence for those seen in specialized rheumatology care 2015-2017 was estimated at 0.24%. In this population, 32% received biologic or targeted synthetic DMARDs, and 41% conventional synthetic DMARDs only, during 2017. CONCLUSION The prevalence of clinically diagnosed PsA (18-79y) in Sweden in 2017 was around 0.35%. Among PsA cases in recent contact with specialized rheumatology care, almost 3/4 received DMARD therapy in 2017.
Collapse
Affiliation(s)
- Sofia Exarchou
- SE, Exarchou, MD, PhD, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Johan K Wallman
- JKW, Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden and Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Daniela Di Giuseppe
- DDiG, Di Giuseppe, PhD, Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Eva Klingberg
- EK, Klingberg, MD, PhD, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valgerdur Sigurdardottir
- VS, Sigurdardottir, MD, Center for Clinical Research (CKF) Dalarna, Uppsala University, Falun, Sweden and Department of Rheumatology, Falun Hospital, Falun, Sweden
| | - Sara Wedrén
- SW, Wedrén, MD, PhD, Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Lindström
- UL, Lindström, MD, PhD, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Turesson
- CT, Turesson, Prof., Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden and Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Lennart T H Jacobsson
- LTHJ, Jacobsson, Prof., Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- JA, Askling, Prof., Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Glintborg B, Di Giuseppe D, Wallman JK, Provan SA, Nordström D, Hokkanen AM, Österlund J, Kristianslund E, Kvien TK, Gudbjornsson B, Hetland ML, Michelsen B, Jacobsson L, Askling J, Lindström U. Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries. Rheumatology (Oxford) 2023; 62:647-658. [PMID: 35723604 PMCID: PMC9891432 DOI: 10.1093/rheumatology/keac358] [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: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi). METHODS Patients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication. RESULTS Among 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaïve) and 1948 with secukinumab (11% bionaïve). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant. CONCLUSION When used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.
Collapse
Affiliation(s)
| | | | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Sella A Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dan Nordström
- Department of Medicine and Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki
| | | | - Jenny Österlund
- Division of Medicine, Helsinki University, Helsinki, Finland
| | | | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brigitte Michelsen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Ulf Lindström
- Correspondence to: Ulf Lindström, Department of Rheumatology and Inflammation Research, University of Gothenburg, Box 115, Gothenburg, Sweden. E-mail:
| |
Collapse
|
11
|
Ørnbjerg LM, Linde L, Georgiadis S, Rasmussen SH, Lindström U, Askling J, Michelsen B, Giuseppe DD, Wallman JK, Pavelka K, Závada J, Nissen MJ, Jones GT, Relas H, Pirilä L, Tomšič M, Rotar Z, Geirsson AJ, Gudbjornsson B, Kristianslund EK, van der Horst-Bruinsma I, Loft AG, Laas K, Iannone F, Corrado A, Ciurea A, Santos MJ, Santos H, Codreanu C, Akkoc N, Gunduz OS, Glintborg B, Østergaard M, Hetland ML. Corrigendum to 'Predictors of ASDAS-CRP inactive disease in axial spondyloarthritis during treatment with TNF-inhibitors: data from the EuroSpA collaboration' [Seminars in Arthritis and Rheumatism 56 (2022) 1-13/152081]. Semin Arthritis Rheum 2023; 58:152141. [PMID: 36463635 DOI: 10.1016/j.semarthrit.2022.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark
| | - Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark.
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway; Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Závada
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Heikki Relas
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Pirilä
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland; Department of Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | | | - Addolorata Corrado
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal; Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Helena Santos
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Instituto Português de Reumatologia, Lisbon, Portugal; EpiDoc Unit, Nova Medical School, Lisbon, Portugal
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Nurullah Akkoc
- Division of Rheumatology, Department of Medicine, Celal Bayar University Hospital, Manisa Turkey
| | - Ozgul S Gunduz
- Division of Rheumatology, Department of Medicine, Celal Bayar University Hospital, Manisa Turkey
| | - Bente Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Hamberg V, Wallman JK, Mogard E, Lindqvist E, Olofsson T, Andréasson K. Elevated fecal levels of the inflammatory biomarker calprotectin in early systemic sclerosis. Rheumatol Int 2022; 43:961-967. [PMID: 36566433 PMCID: PMC10073054 DOI: 10.1007/s00296-022-05264-4] [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: 10/12/2022] [Accepted: 12/17/2022] [Indexed: 12/26/2022]
Abstract
Knowledge on gastrointestinal manifestations in early systemic sclerosis (SSc) is limited. We have investigated gastrointestinal inflammation in SSc at the time of diagnosis using the inflammatory biomarker Fecal calprotectin (F-cal). Consecutive patients with suspected SSc were characterized in relation to the 2013 classification criteria for SSc and classified as SSc or SSc-like disease. F-cal levels were measured with a polyclonal ELISA (Calpro A/S, Lysaker, Norway) and levels above 50 µg/g were considered elevated. F-cal levels were compared to those of control subjects without rheumatic disease. Of 137 patients with suspected SSc, 92 were classified as SSc and 45 as SSc-like disease. Median (interquartile range) disease duration among the SSc participants was 2.5 (1.2, 4.6) years. A substantial proportion of participants classified as SSc (35/92, 38%) and SSc-like disease (14/45, 31%) exhibited elevated F-cal compared to the control group (3/41, 7.3%; p < 0.001 and p = 0.007, respectively). Elevated F-cal was associated with proton pump inhibitor usage (OR 7.14; 95% CI 2.56-29.93; p < 0.001). We conclude that elevated F-cal is present in a subgroup of patients with SSc at the time of diagnosis, suggesting that that GI inflammation may be present in this patient group early in the disease course. F-cal did not exhibit potential to differentiate SSc from SSc-like disease.
Collapse
Affiliation(s)
- Viggo Hamberg
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden.
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - Elisabeth Mogard
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - Elisabet Lindqvist
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - Tor Olofsson
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - Kristofer Andréasson
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| |
Collapse
|
13
|
Lindqvist E, Olofsson T, Jöud A, Geijer M, Wallman JK, Mogard E. How good is the agreement between clinical diagnoses and classification criteria fulfilment in axial spondyloarthritis? Results from the SPARTAKUS cohort. Scand J Rheumatol 2022:1-10. [PMID: 35695036 DOI: 10.1080/03009742.2022.2064183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To study the agreement between clinical axial spondyloarthritis (axSpA) diagnoses and fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) axSpA and modified New York (mNY) classification criteria, and to compare disease/health status between axSpA subtypes. METHOD Patients with prevalent, clinical axSpA attending a rheumatology clinic were enrolled in a cross-sectional study. Assessments included physical evaluation, laboratory testing, questionnaires, and appropriate imaging, allowing classification. Standard axSpA outcome measures were compared between patients fulfilling mNY/radiographic versus non-radiographic axSpA (r-axSpA/nr-axSpA) criteria. RESULTS Of 239 consecutively included patients, 141 fulfilled ASAS r-axSpA and/or mNY criteria, while 57 fulfilled nr-axSpA criteria. The agreement between r-axSpA and mNY criteria fulfilment was 94%. The positive predictive value (PPV) of a clinical ankylosing spondylitis (AS) diagnosis for mNY criteria fulfilment was 71%; the PPV of an undifferentiated axSpA (u-axSpA) diagnosis for fulfilment of nr-axSpA criteria was 30% and 40% for mNY criteria. Patients with r-axSpA/AS were older, more often men, and had longer disease duration, more uveitis, and worse spinal mobility than nr-axSpA patients, who had more enthesitis and dactylitis. CONCLUSION We found an overall good concordance between clinical axSpA diagnoses and classification criteria fulfilment, with 83% fulfilling ASAS axSpA and/or mNY criteria. Regarding axSpA subtypes, the concordance was weaker, and although the ICD-10 code for AS correctly identified patients meeting mNY criteria in 71% of cases, one-third of mNY-positive patients lacked an AS diagnosis. Moreover, clinical u-axSpA diagnoses could not serve as a proxy to identify nr-axSpA, highlighting the importance of thorough classification in research on axSpA subtypes.
Collapse
Affiliation(s)
- Elisabet Lindqvist
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Anna Jöud
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Mats Geijer
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan K Wallman
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| | - Elisabeth Mogard
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, lägg till a Sweden
| |
Collapse
|
14
|
Wallman JK, Alenius GM, Klingberg E, Sigurdardottir V, Wedrén S, Exarchou S, Lindström U, Di Giuseppe D, Askling J, Jacobsson L. Validity of clinical psoriatic arthritis diagnoses made by rheumatologists in the Swedish National Patient Register. Scand J Rheumatol 2022:1-11. [PMID: 35659437 DOI: 10.1080/03009742.2022.2066807] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES : Knowledge of the correspondence between clinical ICD diagnoses and classification criteria fulfilment is crucial to interpret studies identifying cases via ICD codes. We assessed the degree to which patients registered with ICD-10 diagnoses of psoriatic arthritis (PsA) in the Swedish National Patient Register (NPR) fulfil established PsA classification criteria. METHOD Four hundred patients with at least one outpatient visit to one of five rheumatology or internal medicine departments (three university/two county departments across Sweden) in 2013-2015, with a main ICD-10 diagnosis of PsA (L40.5-M07.3), were randomly selected (80 cases/site). Through a structured medical record review, positive predictive values (PPVs) for fulfilment of the following classification criteria were assessed: CASPAR, Moll and Wright, Vasey and Espinoza, and modified ESSG criteria for PsA. A subset analysis regarding CASPAR fulfilment was also performed among cases with available rheumatoid factor and peripheral X-ray status (central CASPAR items; n = 227). RESULTS Of the 400 patients with a main ICD-10 diagnosis of PsA, 343 (86%) fulfilled at least one of the four PsA classification criteria. PPVs for the different criteria were: CASPAR 69% (82% in the subset analysis), Moll and Wright 51%, Vasey and Espinoza 76%, and modified ESSG 64%. Overall, only 6.5% of the 400 PsA diagnoses were judged as clearly incorrect by the medical record reviewers. CONCLUSION The validity of rheumatologist-made, clinical ICD-10 diagnoses for PsA in the Swedish NPR is good, with PPVs of 69-82% for CASPAR fulfilment and 86% for meeting any established PsA classification criteria.
Collapse
Affiliation(s)
- J K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - G-M Alenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V Sigurdardottir
- Center for Clinical Research (CKF) Dalarna, Uppsala University, Falun, Sweden.,Department of Rheumatology, Falun Hospital, Falun, Sweden
| | - S Wedrén
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - S Exarchou
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Di Giuseppe
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - J Askling
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Lth Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
15
|
Sagard J, Olofsson T, Mogard E, Marsal J, Andréasson K, Geijer M, Kristensen LE, Lindqvist E, Wallman JK. Gut dysbiosis associated with worse disease activity and physical function in axial spondyloarthritis. Arthritis Res Ther 2022; 24:42. [PMID: 35151357 PMCID: PMC8840679 DOI: 10.1186/s13075-022-02733-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity. The objective of this study was to compare gut dysbiosis frequency between controls, non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) patients and investigate whether gut dysbiosis is cross-sectionally associated with axSpA disease activity, physical function, mobility, or pain. Methods Gut dysbiosis was assessed by 16SrRNA analysis of feces from 44/88 nr-axSpA/AS patients (ASAS/mNY criteria) without inflammatory bowel disease (IBD) and 46 controls without IBD or rheumatic disease. The GA-map™ Dysbiosis Test was used, grading gut microbiota aberrations on a 1-5 scale, where ≥3 denotes dysbiosis. Proportions with dysbiosis were compared between the groups. Furthermore, standard axSpA measures of disease activity, function, mobility, and pain were compared between patients (nr-axSpA and AS combined) with and without dysbiosis, univariately, and adjusted for relevant confounders (ANCOVA). Results Gut dysbiosis was more frequent in AS than controls (36% versus 17%, p=0.023), while nr-axSpA (25% dysbiosis) did not differ significantly from either AS or controls. Univariately, most axSpA measures were significantly worse in patients with dysbiosis versus those without: ASDAS-CRP between-group difference 0.6 (95% CI 0.2–0.9); BASDAI 1.6 (0.8–2.4); evaluator’s global disease activity assessment (Likert scale 0–4) 0.3 (0.1–0.5), BASFI 1.5 (0.6–2.4), and VAS pain (cm) 1.3 (0.4–2.2). Differences remained significant after adjustment for demographics, lifestyle factors, treatments, gut inflammation (fecal calprotectin ≥50 mg/kg), and gut symptoms, except for VAS pain. BASMI and CRP were not associated with dysbiosis. Conclusion Gut dysbiosis, more frequent in AS patients than controls, is associated with worse axSpA disease activity and physical function, seemingly irrespective of both gut inflammation and treatments. This provides further evidence for an important link between disturbances in gastrointestinal homeostasis and axSpA. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02733-w.
Collapse
|
16
|
Olofsson T, Wallman JK, Jöud A, Schelin MEC, Ernestam S, van Vollenhoven R, Saevarsdottir S, Lampa J. Pain Over Two Years After Start of Biologic Versus Conventional Combination Treatment in Early Rheumatoid Arthritis: Results From a Swedish Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2021; 73:1312-1321. [PMID: 32433827 DOI: 10.1002/acr.24264] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/12/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the pain course between methotrexate (MTX)-refractory early rheumatoid arthritis (RA) patients randomized to infliximab (IFX) versus sulfasalazine (SSZ) plus hydroxychloroquine (HCQ). METHODS The randomized, controlled, open-label Swedish Pharmacotherapy (SWEFOT) trial enrolled new-onset RA patients from October 2002 to December 2005. After 3 months of receiving MTX, patients not reaching low disease activity (Disease Activity Score in 28 joints score ≤3.2) were randomized to adding IFX (n = 128) or SSZ plus HCQ (n = 130) and followed for 21 months. Here, outcomes included area under the curve (AUC) for visual analog scale (VAS) scores for pain, unacceptable pain (VAS pain score >40 mm [range 0-100]), and unacceptable pain despite inflammation control (refractory pain; VAS pain score >40 plus C-reactive protein level <10 mg/liter). Between-group differences were analyzed with multivariate regression models. RESULTS Overall, 50% of randomized patients (n = 258) in the crude setting reported unacceptable pain at randomization, declining to 29% at 21 months (P < 0.001), when refractory pain constituted 82% of all unacceptable pain. Comparing randomized arms (intent-to-treat analysis), the AUC for VAS pain was lower in the MTX plus IFX group (P = 0.01), and at 21 months, 32% of patients receiving MTX plus IFX and 45% receiving MTX plus SSZ plus HCQ had unacceptable pain (adjusted relative risk 0.68 [95% confidence interval 0.51, 0.90]; P = 0.008). Regarding refractory pain, no between-group differences were observed. CONCLUSION Despite active combination treatment, almost one-third of new-onset RA patients reported unacceptable pain after 21 months, and refractory pain constituted more than 4/5 of this pain load. Adding IFX versus SSZ plus HCQ to MTX reduced both cumulative pain and unacceptable pain at 21 months, suggesting less long-term pain for the biologic therapy. These results display insufficient effects of current treatment strategies on inflammation-independent pain components, warranting alternative approaches in affected patients.
Collapse
Affiliation(s)
- Tor Olofsson
- Lund University, Skåne University Hospital, Lund, Sweden
| | | | | | | | - Sofia Ernestam
- Academic Specialist Centre, Stockholm Health Services and Karolinska Institutet, Stockholm, Sweden
| | | | - Saedis Saevarsdottir
- Karolinska Institutet, Stockholm, Sweden, and University of Iceland and deCODE genetics, Reykjavik, Iceland
| | - Jon Lampa
- Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
17
|
Lindström U, Glintborg B, Di Giuseppe D, Schjødt Jørgensen T, Gudbjornsson B, Lederballe Grøn K, Aarrestad Provan S, Michelsen B, Lund Hetland M, Wallman JK, Nordström D, Trokovic N, Love TJ, Krogh NS, Askling J, Jacobsson LTH, Kristensen LE. Comparison of treatment retention and response to secukinumab versus tumour necrosis factor inhibitors in psoriatic arthritis. Rheumatology (Oxford) 2021; 60:3635-3645. [PMID: 33367900 DOI: 10.1093/rheumatology/keaa825] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare treatment retention and response to secukinumab vs adalimumab, including the other four TNF inhibitors (TNFi) as comparators, in PsA. METHODS All patients with PsA starting secukinumab or a TNFi in 2015-2018 were identified in the biologic registers of the Nordic countries. Data on comorbidities were linked from national registers. One-year treatment retention and hazard ratios (HRs) for treatment discontinuation were calculated. The proportion achieving a 6 month 28-joint Disease Activity Index for Psoriatic Arthritis (DAPSA28) remission was determined together with odds ratios (ORs) for remission (logistic regression). Both HRs and ORs were calculated with adalimumab as the reference and adjusted for baseline characteristics and concurrent comorbidities. All analyses were stratified by the line of biologic treatment (first, second, third+). RESULTS We identified 6143 patients contributing 8307 treatment courses (secukinumab, 1227; adalimumab, 1367). Secukinumab was rarely used as the first biologic, otherwise baseline characteristics were similar. No clinically significant differences in treatment retention or response rates were observed for secukinumab vs adalimumab. The adjusted HRs for discontinuation per the first, second and third line of treatment were 0.98 (95% CI 0.68, 1.41), 0.94 (0.70, 1.26) and 1.07 (0.84, 1.36), respectively. The ORs for DAPSA28 remission in the first, second and third line of treatment were 0.62 (95% CI 0.30, 1.28), 0.85 (0.41, 1.78) and 0.74 (0.36, 1.51), respectively. In the subset of patients previously failing a TNFi due to ineffectiveness, the results were similar. CONCLUSION No significant differences in treatment retention or response were observed between secukinumab and adalimumab, regardless of the line of treatment. This suggests that even in patients who have failed a TNFi, choosing either another TNFi or secukinumab may be equally effective.
Collapse
Affiliation(s)
- Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Schjødt Jørgensen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kathrine Lederballe Grøn
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
| | | | - Brigitte Michelsen
- Department of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dan Nordström
- Department of Medicine and rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | | | - Thorvardur Jon Love
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars Erik Kristensen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
18
|
Miller H, Wallman JK, Petersson IF, Saevarsdottir S, Söderling J, Ernestam S, Askling J, van Vollenhoven R, Neovius M. Mortality over 14 years in MTX-refractory patients randomized to a strategy of addition of infliximab or sulfasalazine and hydroxychloroquine. Rheumatology (Oxford) 2021; 60:2217-2222. [PMID: 33179071 DOI: 10.1093/rheumatology/keaa553] [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: 05/03/2020] [Revised: 07/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare mortality risk over up to 14 years of follow-up in methotrexate-refractory patients with early RA randomized to a strategy starting with addition of infliximab vs addition of SSZ and HCQ. METHODS Data was from the two-arm, parallel, randomized, active-controlled, open-label Swefot trial in which patients with early RA (symptom duration <1 y) were recruited from 15 rheumatology clinics in Sweden (2002-2005). Patients who did not achieve low disease activity after 3-4 months of MTX were randomized to addition of infliximab (n = 128) or SSZ and HCQ (n = 130). Participants were followed until death, emigration, or end of follow-up, whichever came first. Analyses were by intention-to-treat. RESULTS Over an average follow-up of 13 years, there were 13 and 16 deaths, respectively [8.8 vs 10.6 deaths per 1000 person-years; mortality hazard ratio 1.2 (95% CI: 0.6, 2.5); P =0.62]. The 1-year mortality was 0.8% in both treatment arms, the 5-year mortality was 2.3% for the infliximab arm compared with 1.5% for the conventional combination treatment arm, while the 10-year mortality was 7.8% and 7.7%, respectively. After 5 years, ∼50% of patients in the conventional combination therapy arm had switched to biologic treatment, and 50% in the biologic arm had discontinued treatment with a biologic DMARD. CONCLUSION No difference in mortality risk could be observed over up to 14 years of follow-up between treatment strategy groups. At 5 years (3 years after trial cessation), 50% of patients remained on their assigned therapy, reflecting that DMARD combination is an adequate treatment strategy in 50% of patients. TRIAL REGISTRATION clinicaltrials.gov, identifier: NCT00764725.
Collapse
Affiliation(s)
- Heather Miller
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | | | - Ingemar F Petersson
- Department of Orthopedics, Lund University.,Skåne University Hospital, Lund, Sweden
| | - Saedis Saevarsdottir
- Department of Medicine Solna, Karolinska Institutet, Stockholm.,School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jonas Söderling
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Sofia Ernestam
- Department of Medicine Solna, Karolinska Institutet, Stockholm.,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Ronald van Vollenhoven
- Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Neovius
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| |
Collapse
|
19
|
Lund Hansen R, Schoedt Jørgensen T, Dreyer L, Hetland ML, Glintborg B, Askling J, Di Giuseppe D, Jacobsson LTH, Wallman JK, Nordstrom D, Aaltonen K, Kristianslund EK, Kvien TK, Provan SA, Gudbjornsson B, Love TJ, Kristensen LE. Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: a Nordic population-based cohort study. Rheumatology (Oxford) 2021; 60:140-146. [PMID: 32591790 DOI: 10.1093/rheumatology/keaa237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries. METHODS PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment. RESULTS A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association. CONCLUSION Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype.
Collapse
Affiliation(s)
- Rebekka Lund Hansen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen
| | | | - Lene Dreyer
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen.,Department of Rheumatology, Aalborg University Hospital, Aalborg
| | - Merete L Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), 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, Denmark
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), 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, Denmark
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Lennart T H Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Dan Nordstrom
- ROB-FIN, Division of Medicine, Helsinki University Hospital and Helsinki University
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital, Faculty of Medicine, University of Iceland
| | - Thorvadur J Love
- University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - L E Kristensen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen
| |
Collapse
|
20
|
Michelsen B, Georgiadis S, Di Giuseppe D, Loft AG, Nissen MJ, Iannone F, Pombo‐Suarez M, Mann H, Rotar Z, Eklund KK, Kvien TK, Santos MJ, Gudbjornsson B, Codreanu C, Yilmaz S, Wallman JK, Brahe CH, Möller B, Favalli EG, Sánchez‐Piedra C, Nekvindova L, Tomsic M, Trokovic N, Kristianslund EK, Santos H, Löve TJ, Ionescu R, Pehlivan Y, Jones GT, van der Horst‐Bruinsma I, Ørnbjerg LM, Østergaard M, Hetland ML. Real‐world 6 and 12‐month Drug Retention, Remission and Response Rates of Secukinumab in 2,017 Psoriatic Arthritis patients in 13 European Countries. Arthritis Care Res (Hoboken) 2021; 74:1205-1218. [DOI: 10.1002/acr.24560] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/18/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Division of Rheumatology Department of Medicine Hospital of Southern Norway Trust Kristiansand Norway
- Department of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Anne G Loft
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Rheumatology Aarhus University Hospital Aarhus Denmark
| | - Michael J Nissen
- Department of Rheumatology Geneva University Hospital Geneva Switzerland
| | - Florenzo Iannone
- GISEA registry Rheumatology Unit – DETO University of Bari Italy
| | - Manuel Pombo‐Suarez
- Rheumatology Service Hospital Clinico Universitario Santiago de Compostela Spain
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic
| | - Ziga Rotar
- biorx. si Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Kari K Eklund
- Inflammation Center Department of Rheumatology Helsinki University Hospital, Helsinki, Finland and ORTON Orthopaedic Hospital of the Orton Foundation Helsinki Finland
| | - Tore K Kvien
- Department of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
| | - Maria J Santos
- Reuma.pt registry and Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO) University Hospital Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Catalin Codreanu
- University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Sema Yilmaz
- Division of Rheumatology Selcuk University School of Medicine Selcuklu, Konya Turkey
| | - Johan K Wallman
- Department of Clinical Sciences Lund Rheumatology Lund University Skåne University Hospital Lund Sweden
| | - Cecilie H Brahe
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Burkhard Möller
- Universitätsklinik für Rheumatologie Immunologie und Allergologie Inselspital Bern Switzerland
| | - Ennio G Favalli
- Division of Clinical Rheumatology ASST Gaetano Pini‐CTO Institute Milan Italy
| | | | - Lucie Nekvindova
- Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic
- Institute of Biostatistics and Analyses, Ltd spinoff company of the Masaryk University Brno Czech Republic
| | - Matija Tomsic
- biorx. si Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Nina Trokovic
- Inflammation Center Department of Rheumatology Helsinki University Hospital, Helsinki, Finland and ORTON Orthopaedic Hospital of the Orton Foundation Helsinki Finland
| | | | - Helena Santos
- Reuma.pt registry and Portuguese Institute of Rheumatology Lisbon Portugal
| | - Thorvardur J Löve
- University of Iceland, Faculty of Medicine, and Department of Science and Research, Landspitali University Hospital Reykjavik Iceland
| | - Ruxandra Ionescu
- University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Yavuz Pehlivan
- Rheumatology Department Faculty of Medicine Uludağ University Bursa Turkey
| | - Gareth T Jones
- Epidemiology Group Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen United Kingdom
| | - Irene van der Horst‐Bruinsma
- Amsterdam University Medical Centres location VU University medical centre Department Rheumatology & Immunology Center (ARC) Amsterdam the Netherlands
| | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
21
|
Mogard E, Olofsson T, Bergman S, Bremander A, Kristensen LE, Olsen JK, Wallman JK, Lindqvist E. Chronic Pain and Assessment of Pain Sensitivity in Patients With Axial Spondyloarthritis: Results From the SPARTAKUS Cohort. J Rheumatol 2020; 48:1672-1679. [PMID: 33323532 DOI: 10.3899/jrheum.200872] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study differences in pain reports between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA), and to assess how pain sensitivity measures associate with disease and health outcomes. METHODS Consecutive patients with axial SpA (axSpA) were enrolled in the population-based SPARTAKUS cohort (2015-2017) and classified as AS (n = 120) or nr-axSpA (n = 55). Pain was assessed with questionnaires (intensity/duration/distribution) and computerized cuff pressure algometry to measure pain sensitivity (pain threshold/pain tolerance/temporal summation of pain). Linear regression models were used to compare pain measures between patients with AS and nr-axSpA, and to assess associations between pain sensitivity measures and disease and health outcomes. RESULTS Of 175 patients with axSpA, 43% reported chronic widespread pain, with no significant differences in any questionnaire-derived or algometry-assessed pain measures between patients with AS and nr-axSpA. Lower pain tolerance was associated with longer symptom duration, worse Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index (BASMI), more pain regions, unacceptable pain, worse Maastricht AS Enthesitis Score (MASES), fatigue, anxiety, and health-related quality of life. Further, lower pain threshold was associated with worse ASDAS-CRP and MASES, whereas higher temporal summation was associated with longer symptom duration, unacceptable pain, and worse BASMI. CONCLUSION Chronic pain is common in axSpA, with no observed differences in any pain measures between patients with AS and nr-axSpA. Further, higher pain sensitivity is associated with having worse disease and health outcomes. The results indicate that patients with AS and nr-axSpA, in line with most clinical characteristics, have a similar pain burden, and they highlight large unmet needs regarding individualized pain management, regardless of axSpA subgroup.
Collapse
Affiliation(s)
- Elisabeth Mogard
- E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden;
| | - Tor Olofsson
- E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden
| | - Stefan Bergman
- S. Bergman, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Spenshult Research and Development Centre, Halmstad, Sweden
| | - Ann Bremander
- A. Bremander, PT, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Spenshult Research and Development Centre, Halmstad, Sweden, Department of Regional Health Research, University of Southern Denmark, Odense, and Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Lars Erik Kristensen
- L.E. Kristensen, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden, and The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | - Jack Kvistgaard Olsen
- J. Kvistgaard Olsen, BSc, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | - Johan K Wallman
- E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden
| | - Elisabet Lindqvist
- E. Mogard, PT, PhD, T. Olofsson, MD, PhD, J.K. Wallman, MD, PhD, E. Lindqvist, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, and Skåne University Hospital, Department of Rheumatology, Lund, Sweden
| |
Collapse
|
22
|
Olofsson T, Söderling JK, Gülfe A, Kristensen LE, Wallman JK. Patient-Reported Outcomes Are More Important Than Objective Inflammatory Markers for Sick Leave in Biologics-Treated Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1712-1716. [PMID: 29885037 DOI: 10.1002/acr.23619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/05/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the impact of common noncomposite disease activity measures on sick leave in biologics-treated patients with rheumatoid arthritis (RA). METHODS Data from study visits by biologics-treated RA patients of working age (<65 years) in the observational South Swedish Arthritis Treatment Group Register between 2005 and 2011, were included (5,118 visits by 941 patients). We performed association analyses between various noncomposite disease activity measures at each visit and the number of days of sick leave during the subsequent month; this information was retrieved from the Social Insurance Agency. Adjusted separate generalized estimating equation regression models were used, and analyses were stratified according to sick leave status for the month preceding each visit (no, partial, or full sick leave). Results are presented as standardized beta coefficients for comparability. RESULTS Among modifiable noncomposite disease activity measures, patient's assessment of pain and disease activity scored on a visual analog scale (VAS) were most strongly associated with subsequent sick leave, irrespective of baseline sick leave status. Generally, measures that were more objective (swollen joint count, erythrocyte sedimentation rate, and C-reactive protein) had less impact on sick leave compared with variables that were more subjective (patient's pain and global scores on a VAS, evaluator's global assessment of disease activity on a 5-grade Likert scale, and tender joint count). CONCLUSION Measures of disease activity that are more subjective have a greater impact on sick leave in biologics-treated patients with RA compared with variables that are more objective, suggesting a stronger focus on subjective measures when targeting work loss or intervening to reduce it.
Collapse
Affiliation(s)
- Tor Olofsson
- Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Anders Gülfe
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Lars-Erik Kristensen
- Lund University, Lund, Sweden, and the Parker Institute, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | | |
Collapse
|
23
|
Hambardzumyan K, Hermanrud C, Marits P, Vivar N, Ernestam S, Wallman JK, van Vollenhoven RF, Fogdell-Hahn A, Saevarsdottir S. Association of female sex and positive rheumatoid factor with low serum infliximab and anti-drug antibodies, related to treatment failure in early rheumatoid arthritis: results from the SWEFOT trial population. Scand J Rheumatol 2019; 48:362-366. [PMID: 31244356 DOI: 10.1080/03009742.2019.1602670] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: Infliximab-treated patients with rheumatoid arthritis (RA) may respond insufficiently due to low serum infliximab (sIFX) levels, caused by anti-drug antibodies (ADAs). However, monitoring of sIFX and ADAs is not routinely implemented, and levels for optimal outcome have not been validated. We searched for predictors for sIFX < 0.2 μg/mL and ADA development in a randomized setting. Methods: In the SWEFOT trial, of 128 patients randomized to methotrexate + IFX therapy, 101 had serum samples at 3, 9, and 21 months that were analysed for sIFX [enzyme-linked immunosorbent assay (ELISA)] and ADAs [ELISA, and precipitation and acid dissociation (PandA) when sIFX > 0.2 μg/mL]. The primary and secondary outcome measures were low disease activity [LDA = 28-joint Disease Activity Score (DAS28) ≤ 3.2] and remission (DAS28 < 2.6). Baseline characteristics were assessed as potential predictors of sIFX < 0.2 μg/mL or ADA positivity, using logistic regression. Results: Categorization of sIFX levels into < 0.2, 0.2-2.9, 3.0-7.0, and > 7.0 μg/mL showed a dose-response association with LDA (30%, 64%, 67%, and 79%, respectively, p = 0.008) and remission (10%, 45%, 39%, and 66%, p = 0.004) at trial cessation (21 months). Female patients had sIFX < 0.2 μg/mL more often than males (35% vs 7%, p = 0.006), with a similar trend for rheumatoid factor (RF)-positive vs RF-negative patients (34% vs 16%, p = 0.059). ADA positivity showed similar patterns, also after adjustment for potential confounders (female sex: p = 0.050; RF positivity: p = 0.067). PandA captured four highly ADA-reactive patients with sIFX > 0.2 μg/mL, of whom three were ADA positive at other time-points, all with high DAS28 at follow-up. Conclusion: In early RA patients receiving IFX as a second-line agent, sIFX < 0.2 μg/mL and ADA development were associated with treatment failure and were more common in females, with a similar trend for RF positivity. Our findings support the use of therapeutic drug monitoring, and PandA in ADA-negative non-responders. Trial registration: SWEFOT NCT00764725 ( https://clinicaltrials.gov/ct2/show/NCT00764725 ).
Collapse
Affiliation(s)
- K Hambardzumyan
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden
| | - C Hermanrud
- Clinical Neuroimmunology, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - P Marits
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital , Stockholm , Sweden
| | - N Vivar
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden
| | - S Ernestam
- Academic Specialist Centre, Stockholm Health Services , Stockholm , Sweden
| | - J K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University , Lund , Sweden
| | - R F van Vollenhoven
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden.,Amsterdam Rheumatology and Immunology Center , Amsterdam , The Netherlands
| | - A Fogdell-Hahn
- Clinical Neuroimmunology, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - S Saevarsdottir
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden.,Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | | |
Collapse
|
24
|
Verstappen SMM, Lacaille D, Boonen A, Escorpizo R, Hofstetter C, Bosworth A, Leong A, Leggett S, Gignac MAM, Wallman JK, Ter Wee MM, Berghea F, Agaliotis M, Tugwell P, Beaton D. Considerations for Evaluating and Recommending Worker Productivity Outcome Measures: An Update from the OMERACT Worker Productivity Group. J Rheumatol 2019; 46:1401-1405. [PMID: 30936275 DOI: 10.3899/jrheum.181201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Worker Productivity Group continues efforts to assess psychometric properties of measures of presenteeism. METHODS Psychometric properties of single-item and dual answer multiitem scales were assessed, as well as methods to evaluate thresholds of meaning. RESULTS Test-retest reliability and construct validity of single item global measures was moderate to good. The value of measuring both degree of difficulty and amount of time with difficulty in multiitems questionnaires was confirmed. Thresholds of meaning vary depending on methods and external anchors applied. CONCLUSION We have advanced our understanding of the performance of presenteeism measures and have developed approaches to describing thresholds of meaning.
Collapse
Affiliation(s)
- Suzanne M M Verstappen
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia. .,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto.
| | - Diane Lacaille
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Annelies Boonen
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Reuben Escorpizo
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Catherine Hofstetter
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Ailsa Bosworth
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Amye Leong
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Sarah Leggett
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Monique A M Gignac
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Johan K Wallman
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Marieke M Ter Wee
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Florian Berghea
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Maria Agaliotis
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Peter Tugwell
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| | - Dorcas Beaton
- From the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester; Arthritis Research UK/Medical Research Council (MRC) Centre for Musculoskeletal Health and Work, University of Southampton, Southampton; National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK; Department of Medicine, and the Division of Rheumatology, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; Institute for Work & Health; University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Rheumatology, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA; Swiss Paraplegic Research, Nottwil, Switzerland; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Carol Davila University of Medicine, Bucharest, Romania; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,S.M. Verstappen, PhD, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton; D. Lacaille, MDCM, FRCPC, MHSc, Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, and Arthritis Research Canada; A. Boonen, MD, PhD, Division of Rheumatology, Maastricht University Medical Center, CAPHRI; R. Escorpizo, BSc, MSc, DPT, Department of Rehabilitation and Movement Science, University of Vermont, and Swiss Paraplegic Research; C. Hofstetter, OMERACT Patient Research Partner; A. Bosworth, MBE, OMERACT Patient Research Partner, NRAS; A. Leong, OMERACT Patient Research Partner; S. Leggett, MSc, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; M.A. Gignac, PhD, Institute for Work & Health, and University of Toronto; J.K. Wallman, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology; M.M. Ter Wee, PhD, MSc, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, and Department of Rheumatology, Amsterdam Infection and Immunity Institute, Amsterdam Public Health; F. Berghea, MD, PhD, Carol Davila University of Medicine; M. Agaliotis, PhD, MSc, Australian Institute of Health Management Services, University of Tasmania; P. Tugwell, MD, MSc, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; D. Beaton, PhD, Institute for Work & Health, and University of Toronto
| |
Collapse
|
25
|
McInnes IB, Wallman JK, Schett G, Quebe-Fehling E, Rasouliyan L, Pricop L, Fasth AE, Gaillez C. 254 Impact of secukinumab treatment on psoriatic arthritis patients with or without enthesitis at baseline: pooled data from FUTURE 2 AND FUTURE 3 Phase 3 studies. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez107.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, SWEDEN
| | - Georg Schett
- Department of Medicine – Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, GERMANY
| | - Erhard Quebe-Fehling
- Global Medical Affairs Biostatistics in Global Drug Development, Novartis Pharma AG, Basel, SWITZERLAND
| | | | - Luminita Pricop
- Immunology Hepatology and Dermatology Franchise, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andreas E Fasth
- Novartis Nordics Medical Affairs, Novartis Sverige AB, Täby, SWEDEN
| | - Corine Gaillez
- Novartis Global Medical Affairs department, Novartis Pharma AG, Basel, SWITZERLAND
| |
Collapse
|
26
|
Hambardzumyan K, Bolce RJ, Wallman JK, van Vollenhoven RF, Saevarsdottir S. Serum Biomarkers for Prediction of Response to Methotrexate Monotherapy in Early Rheumatoid Arthritis: Results from the SWEFOT Trial. J Rheumatol 2019; 46:555-563. [PMID: 30709958 DOI: 10.3899/jrheum.180537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate baseline levels of 12 serum biomarkers that constitute a multibiomarker disease activity test, as predictors of response to methotrexate (MTX) in patients with early rheumatoid arthritis (eRA). METHODS In 298 patients from the Swedish Pharmacotherapy (SWEFOT) clinical trial, baseline serum levels of 12 proteins were analyzed for association with disease activity based on the 28-joint count Disease Activity Score (DAS28) after 3 months of MTX monotherapy using uni-/multivariate logistic regression. Primary outcome was low disease activity (LDA; DAS28 ≤ 3.2). RESULTS Of 298 patients, 104 achieved LDA after 3 months on MTX. Four of the 12 biomarkers [C-reactive protein (CRP), leptin, tumor necrosis factor receptor I (TNF-RI), and vascular cell adhesion molecule 1 (VCAM-1)] significantly predicted LDA based on stepwise logistic regression analysis. Dichotomization of patients using receiver-operating characteristic curve analysis-based cutoffs for these biomarkers showed significantly higher proportions with LDA among patients with lower versus higher levels of CRP or leptin (40% vs 23%, p = 0.004, and 40% vs 25%, p = 0.011, respectively), as well as among those with higher versus lower levels of TNF-RI or VCAM-1 (43% vs 27%, p = 0.004, and 41% vs 25%, p = 0.004, respectively). Combined score based on these biomarkers, adjusted for known predictors of LDA (smoking, sex, and age), associated with decreased chance of LDA (adjusted OR 0.45, 95% CI 0.32-0.62). CONCLUSION Low baseline levels of CRP and leptin, and high baseline levels of TNF-RI and VCAM-1 were associated with LDA after 3 months of MTX therapy in patients with eRA. Combination of these 4 biomarkers increased accuracy of prediction. [Trial registration number: NCT00764725].
Collapse
Affiliation(s)
- Karen Hambardzumyan
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Rebecca J Bolce
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Johan K Wallman
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Ronald F van Vollenhoven
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - Saedis Saevarsdottir
- From the Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Crescendo Bioscience, South San Francisco, California, USA; Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands; Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden. .,K. Hambardzumyan, MSc, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital; R.J. Bolce, MSN, Crescendo Bioscience; J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; R.F. van Vollenhoven, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, and Amsterdam Rheumatology and Immunology Center; S. Saevarsdottir, MD, PhD, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, and Unit of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet.
| |
Collapse
|
27
|
Olofsson T, Lindqvist E, Mogard E, Andréasson K, Marsal J, Geijer M, Kristensen LE, Wallman JK. Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis: results from the SPARTAKUS cohort. Rheumatology (Oxford) 2019; 58:1176-1187. [DOI: 10.1093/rheumatology/key427] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 11/17/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Tor Olofsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, Skåne University Hospital, Lund
| | - Elisabet Lindqvist
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, Skåne University Hospital, Lund
| | - Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, Skåne University Hospital, Lund
| | - Kristofer Andréasson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, Skåne University Hospital, Lund
| | - Jan Marsal
- Department of Clinical Sciences Lund, Gastroenterology, Lund University, Lund
- Department of Gastroenterology, Skåne University Hospital, Lund
| | - Mats Geijer
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund
- Department of Radiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lars Erik Kristensen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund
- Department of Rheumatology, Skåne University Hospital, Lund
| |
Collapse
|
28
|
Wallman JK, Jöud A, Olofsson T, Jacobsson LTH, Bliddal H, Kristensen LE. Work disability in non-radiographic axial spondyloarthritis patients before and after start of anti-TNF therapy: a population-based regional cohort study from southern Sweden. Rheumatology (Oxford) 2017; 56:716-724. [PMID: 28064208 DOI: 10.1093/rheumatology/kew473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Indexed: 01/22/2023] Open
Abstract
Objective The aim was to assess work-loss days before and after commencement of anti-TNF treatment in patients with non-radiographic axial spondylarthritis (nr-axSpA). Methods Bionaïve nr-axSpA patients (n = 75), aged 17-62 years, fulfilling the Assessment of SpondyloArthritis international Society criteria for axial spondyloarthritis and starting anti-TNF treatment during 2004-11, were retrieved from the observational South Swedish Arthritis Treatment Group study. Patient information was linked to Swedish Social Insurance Agency data on sick leave and disability pension from 1 year before to 2 years after anti-TNF initiation. Matched population references were included for comparison and to adjust for secular trends. Results The nr-axSpA patients had a median age of 35 years and disease duration of 6 years at the start of treatment. During the 2 years after anti-TNF initiation, mean work-loss days (including both sick leave and disability pension) in the nr-axSpA group decreased significantly from 3.4 to 1.9 times more than among the population references. The effect was seen on sick leave, whereas disability pension levels remained similar in both groups throughout. Conclusion Anti-TNF therapy in nr-axSpA was associated with a significant and sustained improvement of work disability over 2 years. However, the proportion of work-loss days remained almost twice as high as in the general population at the end of follow-up.
Collapse
Affiliation(s)
- Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Tor Olofsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | | | - Henning Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Denmark
| | - Lars E Kristensen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.,The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Denmark
| |
Collapse
|
29
|
Eriksson JK, Wallman JK, Miller H, Petersson IF, Ernestam S, Vivar N, van Vollenhoven RF, Neovius M. Infliximab Versus Conventional Combination Treatment and Seven-Year Work Loss in Early Rheumatoid Arthritis: Results of a Randomized Swedish Trial. Arthritis Care Res (Hoboken) 2017; 68:1758-1766. [PMID: 27015295 PMCID: PMC6767553 DOI: 10.1002/acr.22899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/02/2015] [Revised: 03/13/2016] [Accepted: 03/22/2016] [Indexed: 01/23/2023]
Abstract
Objective To compare long‐term work loss in methotrexate‐refractory early rheumatoid arthritis (RA) patients randomized to the addition of infliximab or conventional combination treatment. Methods This study was a multicenter, 2‐arm, parallel, randomized, active‐controlled, open‐label trial. RA patients with <1‐year symptom duration were recruited from 15 rheumatology clinics in Sweden between 2002–2005. Patients who did not achieve low disease activity after 3–4 months of methotrexate therapy were randomized to the addition of infliximab or conventional combination treatment with sulfasalazine plus hydroxychloroquine. Yearly sick leave and disability pension days >7 years after randomization were retrieved from nationwide registers kept by the Swedish Social Insurance Agency. Results Of 210 working‐age patients, 109 were randomized to infliximab (mean age 48.4 years, 73% women) and 101 to conventional treatment (mean age 48.7 years, 77% women). The year before randomization, the mean number of annual work days lost was 127 in the infliximab arm and 118 in the conventional treatment group (mean difference 9 [95% confidence interval (95% CI) −23, 39]). Compared to the year before randomization, the mean changes at 7 years were −25 days in the infliximab and −26 days in the conventional treatment group (adjusted mean difference 10 [95% CI −25, 46]). The cumulative mean for work‐loss days was 846 in the infliximab group and 701 in the conventional treatment group (adjusted mean difference 104 [95% CI −56, 284]). Conclusion Long‐term work loss improved significantly in early RA patients randomized to infliximab plus methotrexate or conventional combination therapy. No difference was detected between strategies, and the level of work‐loss days remained twice that observed in the general population.
Collapse
|
30
|
Hambardzumyan K, Saevarsdottir S, Forslind K, Petersson IF, Wallman JK, Ernestam S, Bolce RJ, van Vollenhoven RF. A Multi-Biomarker Disease Activity Score and the Choice of Second-Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure. Arthritis Rheumatol 2017; 69:953-963. [PMID: 27992691 PMCID: PMC5516230 DOI: 10.1002/art.40019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
Objective To investigate whether the Multi‐Biomarker Disease Activity (MBDA) score predicts optimal add‐on treatment in patients with early rheumatoid arthritis (RA) who were inadequate responders to MTX (MTX‐IRs). Methods We analyzed data from 157 MTX‐IRs (with a Disease Activity Score using the erythrocyte sedimentation rate [DAS28‐ESR] >3.2) from the Swedish Pharmacotherapy (SWEFOT) trial who were randomized to receive triple therapy (MTX plus sulfasalazine plus hydroxychloroquine) versus MTX plus infliximab. The MBDA score as a predictor of the subsequent DAS28‐based response to each second‐line treatment was analyzed at randomization with the Breslow‐Day test for 2 × 2 groups, using both validated categories (low [<30], moderate [30–44], and high [>44]) and dichotomized categories (lower [≤38] versus higher [>38]). Results Among the 157 patients, 12% had a low MBDA score, 32% moderate, and 56% high. Of those with a low MBDA score, 88% responded to subsequent triple therapy, and 18% responded to MTX plus infliximab (P = 0.006); for those with a high MBDA score, the response rates were 35% and 58%, respectively (P = 0.040). When using 38 as a cutoff for the MBDA score (29% patients with lower scores versus 71% with higher scores), the differential associations with response to triple therapy versus MTX plus infliximab were 79% versus 44% and 36% versus 58%, respectively (P = 0.001). Clinical and inflammatory markers had poorer predictive capacity for response to triple therapy or MTX plus infliximab. Conclusion In patients with RA who had an inadequate response to MTX, the MBDA score categories were differentially associated with response to subsequent therapies. Thus, patients with post‐MTX biochemical improvements (lower MBDA scores) were more likely to respond to triple therapy than to MTX plus infliximab. If confirmed, these results may help to improve treatment in RA.
Collapse
Affiliation(s)
| | | | | | | | | | - Sofia Ernestam
- Institution LIME Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
31
|
Wallman JK, Eriksson JK, Nilsson JÅ, Olofsson T, Kristensen LE, Neovius M, Geborek P. Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis: Observational Data from Southern Sweden. J Rheumatol 2016; 43:1292-9. [DOI: 10.3899/jrheum.150617] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/22/2022]
Abstract
Objective.To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA).Methods.Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005–2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs.Results.Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15–0.27), 0.16 (0.11–0.21), and –0.15 (−0.21 to −0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39–0.48), 0.27 (0.23–0.32), and −0.34 (−0.38 to −0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28).Conclusion.Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.
Collapse
|
32
|
Cooper A, Wallman JK, Gülfe A. What PASSes for good? Experience-based Swedish and hypothetical British EuroQol 5-Dimensions preference sets yield markedly different point estimates and patient acceptable symptom state cut-off values in chronic arthritis patients on TNF blockade. Scand J Rheumatol 2016; 45:470-473. [PMID: 27025702 DOI: 10.3109/03009742.2016.1143965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Health utilities derived from answers to generic health-related quality of life (HRQoL) questionnaires such as the EuroQol 5-Dimensions (EQ-5D) are often used in cost-utility analyses (CUAs) of new and expensive treatments. Different preference sets (tariffs) used in the computation of utility values and quality-adjusted life-years (QALYs) from questionnaire responses (health states) yield varying results, potentially affecting decisions of resource allocation. The objective of the present study was to compare British (UK), hypothetical, and Swedish (SE), experience-based, EQ-5D utilities using data from clinical practice. METHOD UK and SE EQ-5D utilities were computed in an observational cohort of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) treated with tumour necrosis factor (TNF) blockers, comparing point estimates and patient acceptable symptom state (PASS) cut-off levels. RESULTS SE utilities were found to be consistently higher than UK utilities, and PASS cut-offs were essentially stable over time. CONCLUSIONS With higher baseline utilities, there may be less room for improvement after an intervention and thus less accumulation of QALYs in CUAs applying the SE, as opposed to the UK, EQ-5D tariff.
Collapse
Affiliation(s)
- A Cooper
- a Section of Rheumatology, Department of Clinical Sciences , Lund University , Lund , Sweden
| | - J K Wallman
- a Section of Rheumatology, Department of Clinical Sciences , Lund University , Lund , Sweden
| | - A Gülfe
- a Section of Rheumatology, Department of Clinical Sciences , Lund University , Lund , Sweden
| |
Collapse
|
33
|
Hambardzumyan K, Bolce RJ, Saevarsdottir S, Forslind K, Wallman JK, Cruickshank SE, Sasso EH, Chernoff D, van Vollenhoven RF. Association of a multibiomarker disease activity score at multiple time-points with radiographic progression in rheumatoid arthritis: results from the SWEFOT trial. RMD Open 2016; 2:e000197. [PMID: 26958364 PMCID: PMC4780313 DOI: 10.1136/rmdopen-2015-000197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/18/2016] [Accepted: 01/31/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In rheumatoid arthritis (RA), predictive biomarkers for subsequent radiographic progression (RP) could improve therapeutic choices for individual patients. We previously showed that the multibiomarker disease activity (MBDA) score in patients with newly diagnosed RA identified patients at risk for RP. We evaluated the MBDA score at multiple time-points as a predictor of RP during 2 years of follow-up. METHODS A subset of patients with RA (N=220) from the Swedish Farmacotherapy (SWEFOT) trial were analysed for MBDA score, disease activity score of 28 joints (DAS28), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at baseline (BL), month 3 and year 1, for predicting RP based on modified Sharp/van der Heijde scores at BL, year 1 and year 2. RESULTS Patients with persistently low MBDA (<30) scores or those with a decrease from moderate (30-44) to low MBDA scores, did not develop RP during 2 years of follow-up. The highest risk for RP during 2 years of follow-up (42%) was observed among patients with persistently high (>44) MBDA scores. Among methotrexate non-responders with a high MBDA score at BL or month 3, significantly more of those who received triple therapy had RP at year 2 compared with those who received antitumour necrosis factor therapy. CONCLUSIONS Measuring the MBDA score both before and during treatment in RA was useful for the assessment of individual patient risk for RP during 2 years of follow-up. In comparison with low CRP, ESR or DAS28, a low MBDA score at any time-point was associated with numerically lower proportions of RP. TRIAL REGISTRATION NUMBER NCT00764725.
Collapse
Affiliation(s)
- Karen Hambardzumyan
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Rebecca J Bolce
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - Saedis Saevarsdottir
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kristina Forslind
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Helsingborg, Sweden; Section of Rheumatology, Department of Medicine, Helsingborg's Lasarett, Helsingborg, Sweden
| | - Johan K Wallman
- Section of Rheumatology, Department of Clinical Sciences , Lund University , Lund , Sweden
| | | | - Eric H Sasso
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - David Chernoff
- Crescendo Bioscience Inc , South San Francisco, California , USA
| | - Ronald F van Vollenhoven
- Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| |
Collapse
|
34
|
Gülfe A, Wallman JK, Kristensen LE. EuroQol-5 dimensions utility gain according to British and Swedish preference sets in rheumatoid arthritis treated with abatacept, rituximab, tocilizumab, or tumour necrosis factor inhibitors: a prospective cohort study from southern Sweden. Arthritis Res Ther 2016; 18:51. [PMID: 26892115 PMCID: PMC4759951 DOI: 10.1186/s13075-016-0950-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/05/2015] [Accepted: 02/08/2016] [Indexed: 11/20/2022] Open
Abstract
Background The development of EuroQol-5 dimensions (EQ-5D) utility over time in rheumatoid arthritis (RA) patients, treated with biologics other than tumour necrosis factor inhibitors (TNFi), based on the standard British (UK) and the new Swedish (SE) EQ-5D preference sets, has not been previously described. Methods Demographics, core set data, EQ-5D utility, and treatment characteristics for patients with established RA, receiving biologics in southern Sweden from January 2006 to March 2014, were retrieved from observational databases. Theoretical, UK, and experience-based, SE, EQ-5D mean utilities were plotted over time. Results Data regarding 2418 treatment courses with abatacept (ABA, n = 100), rituximab (RTX, n = 230), tocilizumab (TOC, n = 121), or TNFi (n = 1967) were included in the analysis. Patients starting TNFi treatment, as expected, had shorter disease duration and less previous biologics. Baseline utilities of patients commencing ABA and TOC, but not RTX, were also lower than in the TNFi group. Following treatment initiation, rapid utility improvements were seen with all therapies, reaching plateaus after approximately 1.5 months, and then remaining fairly stable throughout follow-up in patients adhering to therapy. SE utilities were consistently higher than UK, with baseline values at around 0.7 leaving little room for improvement. Conclusions ABA, RTX, TOC, and TNFi treatments were all associated with favourable EQ-5D utility developments in RA patients adhering to therapy. The compression of the experience-based SE preference set towards higher utilities may compromise its ability to detect between-group differences in quality-adjusted life-years, thus making cost-effectiveness harder to demonstrate in cost-utility analyses applying this preference set, rather than the standard UK.
Collapse
Affiliation(s)
- Anders Gülfe
- Department of Clinical Sciences Lund, Rheumatology Section, Lund University, 221 84, Lund, Sweden. .,Department of Rheumatology, Skåne University Hospital, 221 85, Lund, Sweden.
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology Section, Lund University, 221 84, Lund, Sweden. .,Department of Rheumatology, Skåne University Hospital, 221 85, Lund, Sweden.
| | - Lars Erik Kristensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2000, Copenhagen, Denmark.
| |
Collapse
|
35
|
Wallman JK, Kapetanovic MC, Petersson IF, Geborek P, Kristensen LE. Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice. Arthritis Res Ther 2015; 17:378. [PMID: 26703005 PMCID: PMC4718030 DOI: 10.1186/s13075-015-0897-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 08/28/2015] [Accepted: 12/10/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence between nr-axSpA and AS patients during three years of anti-TNF (tumor necrosis factor) therapy in clinical practice, and to explore the impact of inflammatory activity measured by CRP (C-reactive protein) at treatment initiation. METHODS Nr-axSpA and AS patients (n = 86/238) in southern Sweden, commencing anti-TNF therapy 1999-2011, were followed during three years. Anti-TNF cessation was defined as stopping therapy, without restarting another anti-TNF agent within three months. Differences in the three year developments of patient's visual analogue scale (VAS) scores for global health and pain, EuroQol 5-Dimensions utility, evaluator's global disease activity assessment, CRP, and ESR (erythrocyte sedimentation rate) were assessed by repeated ANOVA. Anti-TNF adherence was compared by Log rank test and Cox regression. In a subanalysis, the same outcomes were studied after splitting both groups into patients with/without baseline CRP elevation. RESULTS Nr-axSpA patients were more often female and had lower acute phase reactants at baseline. Apart from CRP, which remained lower in the nr-axSpA group throughout follow-up (p = 0.004), no between-group differences were detected regarding clinical developments (p >0.1 for all comparisons) or anti-TNF adherence (hazard ratio: 1.1 (95% CI 0.7 to 1.8) for the nr-axSpA vs. AS group) during three years. Elevated baseline CRP was similarly associated with superior clinical outcomes and treatment adherence in both groups. CONCLUSIONS With the exception of constantly lower CRP levels in the nr-axSpA group, three years anti-TNF therapy resulted in similar clinical outcomes and treatment adherence in nr-axSpA and AS patients, thus strengthening the hypothesis that these diagnoses represent different aspects/phases of the same disease.
Collapse
Affiliation(s)
- Johan K Wallman
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. .,Reumatologiska kliniken, Skånes Universitetssjukhus Lund, Kioskgatan 3, 22185, Lund, Sweden.
| | - Meliha C Kapetanovic
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Ingemar F Petersson
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. .,Section of Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Pierre Geborek
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Lars Erik Kristensen
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. .,The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Denmark.
| |
Collapse
|
36
|
Lorenzo AV, Jolesz FA, Wallman JK, Ruenzel PW. Proton magnetic resonance studies of triethyltin-induced edema during perinatal brain development in rabbits. J Neurosurg 1989; 70:432-40. [PMID: 2915251 DOI: 10.3171/jns.1989.70.3.0432] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 01/03/2023]
Abstract
To better understand the role of myelin-associated water in the differentiation of white and gray matter in magnetic resonance (MR) imaging, changes in MR relaxation processes were studied in rabbits during myelination and after induction of cytotoxic edema with triethyltin (TET). Normal rabbits were killed at various age intervals ranging from premature (28 days' gestation) to adult, and changes in MR relaxation times (T1 and T2) and in water and electrolyte content were determined for various areas of brain and muscle. Similar measurements were made in rabbits of comparable age exposed to TET. Light and electron microscopy and MR imaging were used to follow myelin development and morphological changes induced by TET. During the first 30 postnatal days, both T1 and T2 declined by 50% in normal rabbits, a fall that paralleled the loss in brain water and sodium that occurred during the same period. Exposure to TET prolonged T1 and T2 in white but not gray matter, reflecting the accumulation of sodium and water (edema fluid) in white matter areas. Multiexponential analysis revealed a second, longer component in T2 magnetization decay of TET-exposed white matter, presumably attributable to accumulation of non-ordered water within intramyelinic vacuoles, a supposition consistent with electron microscopic and MR imaging findings. In contrast to reports by others, changes in T1 (but not T2) closely correlated with alterations in brain water (r = 0.93, df = 39). The absence of tissue disruption in the animals in the present study may account for these differences, but further studies will be required both to resolve this question and to fully understand MR images of white matter edema in mature and immature brain.
Collapse
Affiliation(s)
- A V Lorenzo
- Department of Neurosurgery, Children's Hospital, Boston, Massachusetts
| | | | | | | |
Collapse
|
37
|
Bartynski WS, Barnes PD, Wallman JK. Cranial CT of autosomal recessive osteopetrosis. AJNR Am J Neuroradiol 1989; 10:543-50. [PMID: 2501985 PMCID: PMC8334514] [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] [Indexed: 01/01/2023]
Abstract
Eight infants with radiographic and bone biopsy evidence of autosomal recessive osteopetrosis were evaluated by cranial CT. The clinical presentations and CT characteristics support the theory that this disorder exhibits severe and mild variants. At an early stage the severe variant demonstrates small optic canals, small orbits with proptosis, and a small nasoethmoid complex without significant bone thickening. The paranasal sinuses show bud formation but no pneumatization. The temporal bone retains a fetal appearance with trumpet-shaped internal auditory canals, prominent subarcuate fossae, and no mastoid pneumatization. The ventricles and subarachnoid spaces are enlarged. Bone thickness increases with age, leading to further orbital encroachment. Similar but less severe features are present in the mild variant. Underdevelopment of the orbits, nasoethmoid complex, and temporal bone suggests that delayed maturation is the primary morphologic abnormality of the skull base in osteopetrosis, and that bone thickening is a secondary manifestation caused by reduced bone turnover.
Collapse
Affiliation(s)
- W S Bartynski
- Department of Radiology, Children's Hospital, Boston, MA 02115
| | | | | |
Collapse
|
38
|
Abstract
A child was seen because of encephalopathy and metabolic ketoacidosis at 19 months. She was found to have a cobalamin-responsive form of methylmalonic acidemia of the cbl A complementation group. However, after treatment with cyanocobalamin and a protein-restricted diet, with recovery from the encephalopathy, she was found to have a tremor and bilateral dystonic posturing in association with lucencies in the globus pallidi shown by computed tomographic scan.
Collapse
|
39
|
Abstract
Clinically apparent cerebral edema is a rare and often fatal complication of diabetic ketoacidosis. To determine whether subclinical brain swelling occurs more commonly, we obtained cranial CT scans in six children with diabetic ketoacidosis treated with fluid resuscitation and continuous low-dose insulin therapy. Control scans were obtained before hospital discharge. Compared with the scans during convalescence, the early scans of all six children showed a narrowing of the brain's ventricular system, compatible with brain swelling. Average changes in diameter were 1.3 +/- 0.1 mm for the third ventricle and 3.7 +/- 0.8 mm for the lateral ventricles (P less than 0.01). In addition, a narrowing of the subarachnoid spaces was subjectively noted during a blind reading of the early scans. Although no single scan was overtly indicative of cerebral edema, the data suggest that subclinical brain swelling may be a common occurrence during treatment of diabetic ketoacidosis in children. Sequential CT scans of the brain may provide a means of evaluating modifications of standard therapy aimed at preventing cerebral edema.
Collapse
|
40
|
Abstract
✓ A new, simple, accurate, and inexpensive device for monitoring intracranial pressure, the Pressure Indicating Bag, is described. It is adaptable to both manual and automatic use.
Collapse
|