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Englbrecht M, Kraft T, Dittel C, Buchleitner A, Giedke G, Kraus B. Indistinguishability of Identical Bosons from a Quantum Information Theory Perspective. Phys Rev Lett 2024; 132:050201. [PMID: 38364122 DOI: 10.1103/physrevlett.132.050201] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024]
Abstract
Using tools from quantum information theory, we present a general theory of indistinguishability of identical bosons in experiments consisting of passive linear optics followed by particle number detection. Our results do neither rely on additional assumptions on the input state of the interferometer, such as, for instance, a fixed mode occupation, nor on any assumption on the degrees of freedom that potentially make the particles distinguishable. We identify the expectation value of the projector onto the N-particle symmetric subspace as an operationally meaningful measure of indistinguishability, and derive tight lower bounds on it that can be efficiently measured in experiments. Moreover, we present a consistent definition of perfect distinguishability and characterize the corresponding set of states. In particular, we show that these states are diagonal in the computational basis up to a permutationally invariant unitary. Moreover, we find that convex combinations of states that describe partially distinguishable and perfectly indistinguishable particles can lead to perfect distinguishability, which itself is not preserved under convex combinations.
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Affiliation(s)
- Matthias Englbrecht
- Department of Physics, QAA, Technical University of Munich, James-Franck-Straße 1, D-85748 Garching, Germany
- Institute for Theoretical Physics, University of Innsbruck, Technikerstraße 21A, 6020 Innsbruck, Austria
| | - Tristan Kraft
- Department of Physics, QAA, Technical University of Munich, James-Franck-Straße 1, D-85748 Garching, Germany
- Institute for Theoretical Physics, University of Innsbruck, Technikerstraße 21A, 6020 Innsbruck, Austria
| | - Christoph Dittel
- Physikalisches Institut, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Straße 3, 79104 Freiburg, Germany
- EUCOR Centre for Quantum Science and Quantum Computing, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Straße 3, D-79104 Freiburg, Germany
- Freiburg Institute for Advanced Studies, Albert-Ludwigs-Universität Freiburg, Albertstraße 19, D-79104 Freiburg, Germany
| | - Andreas Buchleitner
- Physikalisches Institut, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Straße 3, 79104 Freiburg, Germany
- EUCOR Centre for Quantum Science and Quantum Computing, Albert-Ludwigs-Universität Freiburg, Hermann-Herder-Straße 3, D-79104 Freiburg, Germany
| | - Geza Giedke
- Donostia International Physics Center (DIPC), Paseo Manuel de Lardizabal 4, E-20018 San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, E-48009 Bilbao, Spain
| | - Barbara Kraus
- Department of Physics, QAA, Technical University of Munich, James-Franck-Straße 1, D-85748 Garching, Germany
- Institute for Theoretical Physics, University of Innsbruck, Technikerstraße 21A, 6020 Innsbruck, Austria
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DiSantostefano RL, Simons G, Englbrecht M, Humphreys JH, Bruce IN, Bywall KS, Radawski C, Raza K, Falahee M, Veldwijk J. Can the General Public Be a Proxy for an "At-Risk" Group in a Patient Preference Study? A Disease Prevention Example in Rheumatoid Arthritis. Med Decis Making 2024; 44:189-202. [PMID: 38240281 PMCID: PMC10865770 DOI: 10.1177/0272989x231218265] [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: 12/06/2022] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND When selecting samples for patient preference studies, it may be difficult or impractical to recruit participants who are eligible for a particular treatment decision. However, a general public sample may not be an appropriate proxy. OBJECTIVE This study compares preferences for rheumatoid arthritis (RA) preventive treatments between members of the general public and first-degree relatives (FDRs) of confirmed RA patients to assess whether a sample of the general public can be used as a proxy for FDRs. METHODS Participants were asked to imagine they were experiencing arthralgia and had screening tests indicating a 60% chance of developing RA within 2 yrs. Using a discrete choice experiment, participants were offered a series of choices between no treatment and 2 unlabeled hypothetical treatments to reduce the risk of RA. To assess data quality, time to complete survey sections and comprehension questions were assessed. A random parameter logit model was used to obtain attribute-level estimates, which were used to calculate relative importance, maximum acceptable risk (MAR), and market shares of hypothetical preventive treatments. RESULTS The FDR sample (n = 298) spent more time completing the survey and performed better on comprehension questions compared with the general public sample (n = 982). The relative importance ranking was similar between the general public and FDR participant samples; however, other relative preference measures involving weights including MARs and market share differed between groups, with FDRs having numerically higher MARs. CONCLUSION In the context of RA prevention, the general public (average risk) may be a reasonable proxy for a more at-risk sample (FDRs) for overall relative importance ranking but not weights. The rationale for a proxy sample should be clearly justified. HIGHLIGHTS Participants from the general public were compared to first-degree relatives on their preferences for rheumatoid arthritis (RA) preventive treatments using a discrete choice experiment.Preferences were similar between groups in terms of the most important and least important attributes of preventive treatments, with effectiveness being the most important attribute. However, relative weights differed.Attention to the survey and predicted market shares of hypothetical RA preventive treatments differed between the general public and first-degree relatives.The general public may be a reasonable proxy for an at-risk group for patient preferences ranks but not weights in the disease prevention context; however, care should be taken in sample selection for patient preference studies when choosing nonpatients.
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Affiliation(s)
| | - G. Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - M. Englbrecht
- freelance healthcare data scientist, Eckental, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jennifer H. Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian N. Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - C. Radawski
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K. Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M. Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J. Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Veldwijk J, DiSantostefano RL, Janssen E, Simons G, Englbrecht M, Schölin Bywall K, Radawski C, Raza K, Hauber B, Falahee M. Maximum Acceptable Risk Estimation Based on a Discrete Choice Experiment and a Probabilistic Threshold Technique. Patient 2023; 16:641-653. [PMID: 37647010 PMCID: PMC10570171 DOI: 10.1007/s40271-023-00643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE We aimed to empirically compare maximum acceptable risk results estimated using both a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). METHODS Members of the UK general public (n = 982) completed an online survey including a DCE and a PTT (in random order) measuring their preferences for preventative treatment for rheumatoid arthritis. For the DCE, a Bayesian D-efficient design consisting of four blocks of 15 choice tasks was constructed including six attributes with varying levels. The PTT used identical risk and benefit attributes. For the DCE, a panel mixed-logit model was conducted, both mean and individual estimates were used to calculate maximum acceptable risk. For the PTT, interval regression was used to calculate maximum acceptable risk. Perceived complexity of the choice tasks and preference heterogeneity were investigated for both methods. RESULTS Maximum acceptable risk confidence intervals of both methods overlapped for serious infection and serious side effects but not for mild side effects (maximum acceptable risk was 32.7 percent-points lower in the PTT). Although, both DCE and PTT tasks overall were considered easy or very easy to understand and answer, significantly more respondents rated the DCE choice tasks as easier to understand compared with those who rated the PTT as easier (7-percentage point difference; p < 0.05). CONCLUSIONS Maximum acceptable risk estimate confidence intervals based on a DCE and a PTT overlapped for two out of the three included risk attributes. More respondents rated the DCE as easier to understand. This may suggest that the DCE is better suited in studies estimating maximum acceptable risk for multiple risk attributes of differing severity, while the PTT may be better suited when measuring heterogeneity in maximum acceptable risk estimates or when investigating one or more serious adverse events.
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Affiliation(s)
- Jorien Veldwijk
- School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, The Netherlands.
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | | | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Matthias Englbrecht
- Freelance Healthcare Data Scientist, Greven, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Brett Hauber
- Pfizer, Inc., New York, NY, USA
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School or Pharmacy, Seattle, WA, USA
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Simons G, Schölin Bywall K, Englbrecht M, Johansson EC, DiSantostefano RL, Radawski C, Veldwijk J, Raza K, Falahee M. Exploring preferences of at-risk individuals for preventive treatments for rheumatoid arthritis. Scand J Rheumatol 2023; 52:449-459. [PMID: 36178461 DOI: 10.1080/03009742.2022.2116805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Some immunomodulatory drugs have been shown to delay the onset of, or lower the risk of developing, rheumatoid arthritis (RA), if given to individuals at risk. Several trials are ongoing in this area; however, little evidence is currently available about the views of those at risk of RA regarding preventive treatment. METHOD Three focus groups and three interviews explored factors that are relevant to first degree relatives (FDRs) of RA patients and members of the general public when considering taking preventive treatment for RA. The semi-structured qualitative interview prompts explored participant responses to hypothetical attributes of preventive RA medicines. Transcripts of focus group/interview proceedings were inductively coded and analysed using a framework approach. RESULTS Twenty-one individuals (five FDRs, 16 members of the general public) took part in the study. Ten broad themes were identified describing factors that participants felt would influence their decisions about whether to take preventive treatment if they were at increased risk of RA. These related either directly to features of the specific treatment or to other factors, including personal characteristics, attitude towards taking medication, and an individual's actual risk of developing RA. CONCLUSION This research highlights the importance of non-treatment factors in the decision-making process around preventive treatments, and will inform recruitment to clinical trials as well as information to support shared decision making by those considering preventive treatment. Studies of treatment preferences in individuals with a confirmed high risk of RA would further inform clinical trial design.
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Affiliation(s)
- G Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - K Schölin Bywall
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - M Englbrecht
- Freelance Healthcare Data Scientist, Eckental, Germany
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - E C Johansson
- Patient Research Partner, Swedish Rheumatism Association, Stockholm, Sweden
| | | | - C Radawski
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J Veldwijk
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Simons G, Veldwijk J, DiSantostefano RL, Englbrecht M, Radawski C, Bywall KS, Valor Méndez L, Hauber B, Raza K, Falahee M. Preferences for preventive treatments for rheumatoid arthritis: discrete choice survey in the UK, Germany and Romania. Rheumatology (Oxford) 2023; 62:596-605. [PMID: 36068022 PMCID: PMC9891433 DOI: 10.1093/rheumatology/keac397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To quantify preferences for preventive therapies for rheumatoid arthritis (RA) across three countries. METHODS A web-based survey including a discrete choice experiment was administered to adults recruited via survey panels in the UK, Germany and Romania. Participants were asked to assume they were experiencing arthralgia and had a 60% chance of developing RA in the next 2 years and completed 15 choices between no treatment and two hypothetical preventive treatments. Treatments were defined by six attributes (effectiveness, risks and frequency/route of administration) with varying levels. Participants also completed a choice task with fixed profiles reflecting subjective estimates of candidate preventive treatments. Latent class models (LCMs) were conducted and the relative importance of attributes, benefit-risk trade-offs and predicted treatment uptake was subsequently calculated. RESULTS Completed surveys from 2959 participants were included in the analysis. Most participants preferred treatment over no treatment and valued treatment effectiveness to reduce risk more than other attributes. A five-class LCM best fitted the data. Country, perceived risk of RA, health literacy and numeracy predicted class membership probability. Overall, the maximum acceptable risk for a 40% reduction in the chance of getting RA (60% to 20%) was 21.7%, 19.1% and 2.2% for mild side effects, serious infection and serious side effects, respectively. Predicted uptake of profiles reflecting candidate prevention therapies differed across classes. CONCLUSION Effective preventive pharmacological treatments for RA were acceptable to most participants. The relative importance of treatment attributes and likely uptake of fixed treatment profiles were predicted by participant characteristics.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Larissa Valor Méndez
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University (FAU) Erlangen-Nurnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Brett Hauber
- Pfizer, Inc., New York, NY.,Comparative Health Outcomes, Policy, and Economics Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Heiss R, Weber MA, Balbach E, Schmitt R, Rehnitz C, Laqmani A, Sternberg A, Ellermann JJ, Nagel AM, Ladd ME, Englbrecht M, Arkudas A, Horch R, Guermazi A, Uder M, Roemer FW. Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study. Radiology 2023; 307:e220753. [PMID: 36625744 DOI: 10.1148/radiol.220753] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]-weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20-0.64). Conclusion A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Marc-André Weber
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Eva Balbach
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Rainer Schmitt
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Christoph Rehnitz
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Azien Laqmani
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Andreas Sternberg
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Jutta J Ellermann
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Armin M Nagel
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Mark E Ladd
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Matthias Englbrecht
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Andreas Arkudas
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Raymund Horch
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Ali Guermazi
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Michael Uder
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
| | - Frank W Roemer
- Department of Radiology (R. Heiss, E.B., A.M.N., M.U., F.W.R.) and Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine (A.A., R. Horch), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany; Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany (M.A.W.); Department of Radiology, Ludwig Maximilian University of Munich, Munich, Germany (R.S.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.R.); Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.L.); Medizinisches Versorgungszentrum am Rotes Kreuz Krankenhaus, Bremen, Germany (A.S.); University of Minnesota Medical School, Minneapolis, Minnesota (J.J.E.); Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.M.N., M.E.L.); Statscoach, Eckental, Germany (M.E.); VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Boston University School of Medicine, Boston, Mass (M.U., F.W.R.)
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Kleinert S, Schuch F, Rapp P, Ronneberger M, Wendler J, Sternad P, Popp F, Bartz-Bazzanella P, von der Decken C, Karberg K, Gauler G, Wurth P, Späthling-Mestekemper S, Kuhn C, Englbrecht M, Vorbrüggen W, Adler G, Welcker M. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int 2023; 43:89-97. [PMID: 36441274 DOI: 10.1007/s00296-022-05248-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
Spondyloarthritis may contribute to deficits in cognition. The objective of this study was to compare cognitive abilities in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) with matched reference groups. This investigator-initiated, cross-sectional, exploratory study of adults with axSpA or PsA was conducted at two German rheumatology centres (November 2018-September 2019). All data on patient and disease characteristics and cognitive abilities were collected at a single visit. Cognitive function was assessed by the previously validated Memory and Attention Test subscores of selective attention, episodic working memory, and episodic short-term memory and compared with subscores from healthy age-, sex-, and education-matched reference subjects. The mean patient age was 51.1 and 55.8 years in the axSpA (n = 101) and PsA (n = 117) groups, respectively, and mean symptom duration was 13.7 and 10.3 years. Compared with matched reference subjects, axSpA and PsA patients showed significant impairments in selective attention (mean difference of -6.5 and -4.5, respectively, on a 45-point scale; P < 0.001 for both) and no significant differences in episodic working memory. The PsA cohort, but not the axSpA cohort, had significantly better episodic short-term memory subscores compared with matched reference subjects (mean change of 2.0 on a 15-point scale; P < 0.001). Explorative subgroup analyses were unable to identify factors influencing cognitive changes, including disease activity, pain, and function, but may have been underpowered. We conclude that impairments in selective attention may impact the ability of axSpA and PsA patients to process information. These findings warrant additional studies, including longitudinal analyses, in patients with spondyloarthritis.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany.
- Universitätsklinik Würzburg, Med. Klinik 3, Rheumatologie/Klinische Immunologie, Würzburg, Germany.
| | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Praxedis Rapp
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Monika Ronneberger
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Joerg Wendler
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Patrizia Sternad
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | - Florian Popp
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | | | | | - Kirsten Karberg
- Praxis Für Rheumatologie und Innere Medizin, Berlin, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | | | | | | | | | - Georg Adler
- Institut für Studien zur Psychischen Gesundheit (ISPG), Mannheim, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
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8
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Simons G, Janssen EM, Veldwijk J, DiSantostefano RL, Englbrecht M, Radawski C, Valor-Méndez L, Humphreys JH, Bruce IN, Hauber B, Raza K, Falahee M. Acceptable risks of treatments to prevent rheumatoid arthritis among first-degree relatives: demographic and psychological predictors of risk tolerance. RMD Open 2022; 8:rmdopen-2022-002593. [PMID: 36598004 PMCID: PMC9748990 DOI: 10.1136/rmdopen-2022-002593] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To quantify tolerance to risks of preventive treatments among first-degree relatives (FDRs) of patients with rheumatoid arthritis (RA). METHODS Preventive treatments for RA are under investigation. In a preference survey, adult FDRs assumed a 60% chance of developing RA within 2 years and made choices between no treatment and hypothetical preventive treatment options with a fixed level of benefit (reduction in chance of developing RA from 60% to 20%) and varying levels of risks. Using a probabilistic threshold technique, each risk was increased or decreased until participants switched their choice. Perceived risk of RA, health literacy, numeracy, Brief Illness Perception Questionnaire and Beliefs about Medicines Questionnaire-General were also assessed. Maximum acceptable risk (MAR) was summarised using descriptive statistics. Associations between MARs and participants' characteristics were assessed using interval regression with effects coding. RESULTS 289 FDRs (80 male) responded. The mean MAR for a 40% reduction in chance of developing RA was 29.08% risk of mild side effects, 9.09% risk of serious infection and 0.85% risk of a serious side effect. Participants aged over 60 years were less tolerant of serious infection risk (mean MAR ±2.06%) than younger participants. Risk of mild side effects was less acceptable to participants who perceived higher likelihood of developing RA (mean MAR ±3.34%) and more acceptable to those believing that if they developed RA it would last for a long time (mean MAR ±4.44%). CONCLUSIONS Age, perceived chance of developing RA and perceived duration of RA were associated with tolerance to some risks of preventive RA therapy.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ellen M Janssen
- Janssen Research and Development, Titusville, New Jersey, USA
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Larissa Valor-Méndez
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Jennifer H Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Simons G, Janssen E, Veldwijk J, Disantostefano R, Englbrecht M, Radawski C, Valor L, Humphreys J, Bruce IN, Hauber B, Raza K, Falahee M. POS0591 TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS IN FIRST DEGREE RELATIVES: DEMOGRAPHIC AND PSYCHOLOGICAL PREDICTORS OF RISK TOLERANCES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere is a growing research focus on the development of interventions to reduce risk of rheumatoid arthritis (RA) in at-risk groups.(1) RA patients’ first-degree relatives (FDRs) have an elevated risk of developing RA and are potential candidates for preventive interventions. Recent studies have quantified the preferences of at risk groups for preventive treatments.(2-4) Little is known about predictors of preference heterogeneity in this context.ObjectivesAssess the extent to which FDR characteristics and beliefs predict risk tolerances for preventive treatments.MethodsAdult FDRs of patients with confirmed RA in the UK were invited to take part in a web-based survey. FDRs enrolled in a UK prospective cohort (PREVeNT-RA) were also invited. Survey development, including attribute selection and presentation, was informed by qualitative research, ranking surveys, literature review, and expert opinion including patient research partners. Respondents received information about RA, questions to check comprehension, and an introduction to the survey. Participants were asked to imagine they were experiencing arthralgia and had positive autoantibody tests indicating a 60% chance of developing RA within two years. Using a probabilistic threshold technique, participants made choices between no treatment (no benefit and no risks) or a preventive treatment option. Treatment options were defined by a fixed level of benefit (reduction in risk of RA from 60% to 20%) and varying levels of risks (Table 1). For each treatment risk, participants made a series of choices where the risk was systematically increased or decreased until they switched their choice. This procedure was repeated for each of the remaining risks. Participants also completed items assessing demographics, perceived risk of developing RA, health literacy, subjective numeracy, the Brief Illness Perception Questionnaire (IPQ) and the Beliefs about Medicines Questionnaire General (BMQ-G). The maximum acceptable risk (MAR) respondents were willing to accept for a 40% (60% to 20%) point risk reduction in developing RA was summarized across participants using descriptive statistics. Associations between MARs and participants’ characteristics and illness/medication beliefs were assessed using interval regression. Independent variables were dichotomized and effects coded.Table 1.Attributes and levels of treatment optionsTreatment attributeLevels describing no treatment optionLevels describing treatment optionChance of developing RA60%20%Chance of mild side effects0%2%; 4%; 5%; 7% or 10%Chance of a serious infection due to treatment0%1%; 1.5%; 2%; 3% or 5%Chance of a serious side effect that is potentially irreversible0%0.001%; 0.01%; 0.02%; 0.05% or 0.1%Results289 FDRs (80 male) responded. The mean (SE) MAR for mild side effects, serious infection, and serious side effects was 29.08 (1.52), 9.09 (0.60) and 0.85 (0.27), respectively. Participants aged over 60 years were less tolerant of risk of serious infection than average (mean MAR - 2.06 (0.78)) and younger participants were more tolerant of risk of serious infection than average (mean MAR + 2.06 (0.78)). Risk of mild side effects was less acceptable to participants who perceived they were likely/very likely to develop RA (mean MAR - 3.34 (1.55)) than to those who did not (mean MAR + 3.34 (1.55)). Education level, health literacy, numeracy, IPQ and BMQ-G subscales were not predictors of risk tolerance.ConclusionAge and perceived risk of RA had a significant impact on FDRs’ tolerance for specific, but not all, included risks. Cognitive ability and beliefs about RA/medicine did not explain preference heterogeneity. This is informative for drug development and the development of tailored risk communication resources to support preventive approaches.References[1]Mankia et al. Ann Rheum Dis. 2021;80(10):1286-98.[2]Simons et al. Ann Rheum Dis. 2021;80:96-7.[3]Harrison et al. Plos One. 2009; 14(4): e0216075.[4]Finckh et al. Curr Rheumatol Rep. 2016;18: 51.AcknowledgementsOn behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of InterestsGwenda Simons: None declared, Ellen Janssen Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Jorien Veldwijk: None declared, Rachael DiSantostefano Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Matthias Englbrecht Speakers bureau: Abbvie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: Abbvie, Chugai, Roche, Consultant of: Abbvie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly, Employee of: Eli Lilly, Larissa Valor: None declared, Jenny Humphreys: None declared, Ian N. Bruce: None declared, Brett Hauber Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., Karim Raza Consultant of: Abbvie, Sanofi, Grant/research support from: Bristol Myers Squibb, Marie Falahee: None declared.
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Simons G, Veldwijk J, Disantostefano R, Englbrecht M, Radawski C, Valor L, Humphreys J, Bruce IN, Raza K, Falahee M. OP0276 PREFERENCES FOR TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS: DISCRETE CHOICE SURVEY OF RHEUMATOID ARTHRITIS PATIENTS’ FIRST-DEGREE RELATIVES IN THE UNITED KINGDOM AND GERMANY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is a growing research focus on the development of interventions to reduce risk of rheumatoid arthritis (RA) in at-risk individuals.(1) A recent survey of the general population asked to assume a 60% risk of RA established that hypothetical preventive treatments were acceptable to most participants.(2) However the preferences of individuals who actually have an elevated risk of RA, such as first-degree relatives (FDRs) of RA patients, are not well understood.ObjectivesTo quantify FDRs’ preferences for preventive treatments for RA.MethodsAdult FDRs in the UK and Germany were invited to take part in a web-based survey via patients with clinician-confirmed RA either during a rheumatology clinic visit or by mail. In addition, FDRs taking part in a UK-based prospective cohort (PREVeNT-RA) were invited via email. Participants received information about RA followed by questions to check comprehension, and an introduction to the survey including warm-up questions. They were asked to imagine they were experiencing arthralgia and had positive autoantibody tests indicating a 60% chance of developing RA in the next two years. Using a discrete choice experiment, participants were offered a series of 15 choices between no treatment and two unlabeled hypothetical treatments to reduce risk of RA. Treatments were defined by six attributes with varying levels, describing benefits, risks, and frequency/route of administration (Table 1). Attribute selection and presentation was informed by qualitative research, ranking surveys, systematic literature review, and expert opinion. Survey layout was informed by patient research partners and qualitative pre-testing. A two-class latent class analysis was used to estimate preferences and calculate relative importance of treatment attributes and predicted uptake. A panel mixed logit model was used to obtain maximum acceptable risk estimates.Table 1.Treatment attributes and levelsAttributeLevelsChance of developing RA reduced from 60% to10%; 20%; 30%; 40%How the treatment is takenA shallow injection under the skinA drip into the veinOne or two tabletsHow often the medication has to be takenDailyWeeklyMonthlyEvery 6 monthsChance of mild side effects2%; 5%; 10%Chance of a serious infection due to treatment0%; 1%; 5%Chance of a serious side effect that is potentially irreversible1 in 100,000 people20 in 100,000 people100 in 100,000 peopleResults356 FDRs (252 female, 289 in the UK) responded. While treatment effectiveness was the most important attribute in both classes (Figure 1), the importance of other attributes differed between classes, with method and frequency of treatment administration being more important in class 2 and risk of mild side effects only impacting treatment choice in class 1. Perceived risk of developing RA predicted class assignment; those with higher perceived risk were more likely to belong to class 1. On average, the predicted uptake of treatment profiles estimating prevention candidates: abatacept; atorvastatin; hydroxychloroquine; tolerogenic cell-based therapy; and no treatment would be 50%, 15%, 9%, 18% and 0%, respectively. Finally, the maximum acceptable risk participants were willing to accept were 81%, 25% and 3% point increases in risk of mild side effects, serious infection, and serious side effects, respectively, for medicines that would reduce their risk of developing RA in the upcoming two years from 60% to 20%.ConclusionEffective preventive treatments for RA were acceptable to FDRs asked to assume a 60% chance of developing RA. Mode and frequency of treatment administration had a greater impact on treatment choices for participants with a lower perceived risk of RA. These findings are informative for target product profile development, endpoint selection, benefit-risk assessment, regulatory approval, and development of informational resources for those at risk of RA.References[1]Mankia et al. Ann Rheum Dis. 2021;80(10):1286-98.[2]Simons et al. Ann Rheum Dis. 2021;80:96-7.AcknowledgementsOn behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). This abstract and its contents reflect the view of the presenter and not the view of PREFER, IMI, the European Union or EFPIA. K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of InterestsGwenda Simons: None declared, Jorien Veldwijk: None declared, Rachael DiSantostefano Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, Matthias Englbrecht Speakers bureau: Abbvie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Munidpharma, Paid instructor for: Abbvie, Chugai, Roche, Consultant of: Abbvie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Larissa Valor: None declared, Jenny Humphreys: None declared, Ian N. Bruce: None declared, Karim Raza Consultant of: Abbvie, Sanofi, Grant/research support from: Bristol Myers Squibb, Marie Falahee: None declared
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Simons G, Caplan J, DiSantostefano RL, Veldwijk J, Englbrecht M, Bywall KS, Kihlbom U, Raza K, Falahee M. Systematic review of quantitative preference studies of treatments for rheumatoid arthritis among patients and at-risk populations. Arthritis Res Ther 2022; 24:55. [PMID: 35193653 PMCID: PMC8862509 DOI: 10.1186/s13075-021-02707-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
Treatments used for rheumatoid arthritis (RA) are under investigation for their efficacy to prevent RA in at risk groups. It is therefore important to understand treatment preferences of those at risk. We systematically reviewed quantitative preference studies of drugs to treat, or prevent RA, to inform the design of further studies and trials of RA prevention. Stated preference studies for RA treatment or prevention were identified through a search of five databases. Study characteristics and results were extracted, and the relative importance of different types of treatment attributes was compared across populations. Twenty three studies were included 20 of RA treatments (18 of patients; 2 of the general public) and 3 prevention studies with first-degree relatives (FDRs). Benefits, risks, administration method and cost (when included) were important determinants of treatment choice. A benefit was more important than a risk attribute in half of the studies of RA treatment that included a benefit attribute and 2/3 studies of RA prevention. There was variability in the relative importance of attributes across the few prevention studies. In studies with non-patient participants, attributes describing confidence in treatment effectiveness/safety were more important determinants of choice than in studies with patients. Most preference studies relating to RA are of treatments for established RA. Few studies examine preferences for treatments to prevent RA. Given intense research focus on RA prevention, additional preference studies in this context are needed. Variation in treatment preferences across different populations is not well understood and direct comparisons are needed.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.
| | - Joshua Caplan
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK
| | | | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Julius Center for Health and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Karin Schölin Bywall
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK
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Englbrecht M, Bartz-Bazzanella P, von der Decken C, Gauler G, Wurth P, Aries P, Karberg K, Kuhn C, Schuch F, Späthling-Mestekemper S, Vorbrüggen W, Wendler J, Welcker M, Kleinert S. Prevalence of Depressive Symptoms in Patients With Psoriatic Arthritis: Have Numbers Changed During the COVID-19 Pandemic? Front Med (Lausanne) 2021; 8:748262. [PMID: 34790678 PMCID: PMC8591045 DOI: 10.3389/fmed.2021.748262] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
This longitudinal analysis compares the prevalence of depressive symptoms in patients with psoriatic arthritis in the context of the COVID-19 pandemic. Data from a national patient register in Germany were analyzed regarding the Patient Health Questionnaire 2 (PHQ-2) to identify cases suspicious for depression at two time points, i.e., before and during the COVID-19 pandemic. Only patients with complete concurrent information on the Disease Activity in Psoriatic Arthritis Score (DAPSA) were included in the analysis. The frequency of depressive symptoms in psoriatic arthritis patients during the COVID-19 pandemic did not differ from the prevalence rates measured before. In addition, prevalence rates for depressive symptoms did not differ when stratifying the patient sample for DAPSA levels of disease activity measured before the pandemic. These results were confirmed further in a sensitivity analysis, limiting the second PHQ-2 assessment to lockdown periods only. However, longitudinal data on the prevalence of depressive symptoms in patients with rheumatic diseases, in general, and psoriatic arthritis, in particular, are scarce in the context of the COVID-19 pandemic. For a sensible comparison of prevalence rates for depressive symptoms in the future, underlying SARS-CoV-2 infection rates and resulting local healthcare disruptions need to be taken into account, besides the potential use of different depression screening tools to evaluate resulting numbers sensibly and draw corresponding conclusions for patient care.
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Affiliation(s)
| | | | - Cay von der Decken
- Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Germany
| | | | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
| | | | | | - Jörg Wendler
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
| | - Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany.,Medizinische Klinik 3, Rheumatology/Immunology, Universitätsklinik Würzburg, Würzburg, Germany
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13
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Tascilar K, Hagen M, Kleyer A, Simon D, Reiser M, Hueber AJ, Manger B, Englbrecht M, Finzel S, Tony HP, Schuch F, Kleinert S, Wendler J, Ronneberger M, Figueiredo CP, Cobra JF, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Kruger K, Henes J, Schett G, Rech J. Treatment tapering and stopping in patients with rheumatoid arthritis in stable remission (RETRO): a multicentre, randomised, controlled, open-label, phase 3 trial. Lancet Rheumatol 2021; 3:e767-e777. [PMID: 38297524 DOI: 10.1016/s2665-9913(21)00220-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 02/02/2024]
Abstract
BACKGROUND Owing to increasing remission rates, the management of patients with rheumatoid arthritis in sustained remission is of growing interest. The Rheumatoid Arthritis in Ongoing Remission (RETRO) study investigated tapering and withdrawal of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis in stable remission to test whether remission could be retained without the need to take DMARD therapy despite an absence of symptoms. METHODS RETRO was an investigator-initiated, multicentre, prospective, randomised, controlled, open-label, parallel-group phase 3 trial in patients aged at least 18 years with rheumatoid arthritis for at least 12 months before randomisation who were in sustained Disease Activity Score using 28 joints with erythrocyte sedimentation rate (ESR) remission (score <2·6 units). Eligible patients were recruited consecutively from 14 German hospitals or rheumatology practices and randomly assigned (1:1:1) without stratification and regardless of baseline treatment, using a sequence that was computer-generated by the study statistician, to continue 100% dose DMARD (continue group), taper to 50% dose DMARD (taper group), or 50% dose DMARD for 6 months before stopping DMARDs (stop group). Neither patients nor investigators were masked to the treatment assignment. Patients were assessed every 3 months and screened for disease activity and relapse. The primary endpoint was the proportion of patients in sustained DAS28-ESR remission without relapse at 12 months, analysed using a log-rank test of trend and Cox regression. Analysis by a trained statistician of the primary outcome and safety was done in a modified intention-to-treat population that included participants with non-missing baseline data. This study is completed and closed to new participants and is registered with ClinicalTrials.gov (NCT02779114). FINDINGS Between May 26, 2010, and May 29, 2018, 303 patients were enrolled and allocated to continue (n=100), taper (n=102), or stop DMARDs (n=101). 282 (93%) of 303 patients were analysed (93 [93%] of 100 for continue, 93 [91%] of 102 for taper, and 96 [95%] of 101 for stop). Remission was maintained at 12 months by 81·2% (95% CI 73·3-90·0) in the continue group, 58·6% (49·2-70·0) in the taper group, and 43·3% (34·6-55·5) in the stop group (p=0·0005 with log-rank test for trend). Hazard ratios for relapse were 3·02 (1·69-5·40; p=0.0003) for the taper group and 4·34 (2·48-7·60; p<0.0001)) for the stop group, in comparison with the continue group. The majority of patients who relapsed regained remission after reintroduction of 100% dose DMARDs. Serious adverse events occurred in ten of 93 (11%) patients in the continue group, seven of 93 (8%) patients in taper group, and 13 of 96 (14%) patients in the stop group. None were considered to be related to the intervention. The most frequent type of serious adverse event was injuries or procedural complications (n=9). INTERPRETATION Reducing antirheumatic drugs in patients with rheumatoid arthritis in stable remission is feasible, with maintenance of remission occurring in about half of the patients. Because relapse rates were significantly higher in patients who tapered or stopped antirheumatic drugs than in patients who continued with a 100% dose, such approaches will require tight monitoring of disease activity. However, remission was regained after reintroduction of antirheumatic treatments in most of those who relapsed in this study. These results might help to prevent overtreatment in a substantial number of patients with rheumatoid arthritis. FUNDING None.
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Affiliation(s)
- Koray Tascilar
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Michaela Reiser
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany; Rheumatology Section, Sozialstiftung Bamberg, Bamberg, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University of Freiburg, Freiburg, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine 2, University of Wuerzburg, Wuerzburg, Germany
| | | | - Stefan Kleinert
- Department of Internal Medicine 2, University of Wuerzburg, Wuerzburg, Germany; Rheumatology Practice, Erlangen, Germany
| | | | | | - Camille P Figueiredo
- Division of Rheumatology, Faculty of Medicine, Sao Paulo University, Sao Paulo, Brazil
| | | | - Martin Feuchtenberger
- Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen, Germany
| | - Martin Fleck
- Department of Internal Medicine I, University of Regensburg, Regensburg, Germany; Asklepios Medical Center Bad Abbach, Bad Abbach, Germany
| | | | | | | | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Division of Rheumatology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Joerg Henes
- Department of Internal Medicine 2, University of Tubingen, Tubingen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany.
| | - Juergen Rech
- Department of Internal Medicine 3 and Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
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14
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Kleinert S, Rapp P, Schuch F, Ronneberger M, Wendler J, Sternad P, Popp F, Bartz-Bazzanella P, Von der Decken CB, Karberg K, Gauler G, Wurth P, Spaethling-Mestekemper S, Kuhn C, Englbrecht M, Vorbrüggen W, Adler G, Welcker M. AB0494 COGNITIVE IMPAIRMENT IN AXIAL SPONDYLOARTHRITIS? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is some evidence that neuropsychiatric changes occur in systemic lupus(1) and rheumatoid arthritis(2). However, little is known regarding a possible disease-related impairment of cognitive abilities in axial spondyloarthritis (axSpA).Objectives:To evaluate patients with axSpA regarding cognitive impairments.Methods:Patients with axSpA attending two rheumatology practices were routinely evaluated by rheumatologists and underwent a computer-based memory and attention test (MAT) (3, 4) with subscale scores ranging from 0 (worst) to 15 (best). The results of short-term memory and working memory were compared to an age-, sex- and education-matched control group of healthy subjects. Descriptive results are presented as median (IQR) for interval data and n (%) for nominal data if not stated otherwise. Two-tailed Wilcoxon signed-rank tests including Bonferroni-Holm adjustment for multiple tests were conducted to investigate the magnitude of potential differences in cognitive abilities.Results:101 consecutive patients were tested (Table 1). After multiple testing adjustment for two subscales, Wilcoxon signed-rank tests returned significant findings for working memory (V = 539.5, p = 0.006, |r| = 0.204) but not for short-term memory (V = 1075, p = 0.351, |r| = 0.078). Regarding the scales’ anchors, descriptive results on pairwise differences suggested axSpA patients to have working memory scores that are on average 10.7% lower compared to control participants (mean Δ= -1.64, SD Δ= 5.95).Table 1.Patients and disease characteristicsn%MeanSDMedian25% Quantile75% QuantileAge10110051.111.6524260Age (female)4847.552.611.75444.561Age (male)5352.549.811.5514157< 13 years formal education4746.5≥ 13 years formal education5453.5HLA B27 positive n/N64/9263.4Disease duration (years)10110013.711.712421Disease duration (female, years)4847.511.69.99417.2Disease duration (male, years)5352.515.512.915523BASDAI9291.13.71.73.82.45BASFI9190.132.42.31.24.5BASMI7574.31.92.3103ASDAS98972.30.82.31.82.8Conclusion:The MAT computerized testing is a feasible test and was well accepted by patients. Results regarding working memory suggest that cognitive abilities needed to accomplish everyday tasks may be impaired in axSpA patients. Further work is needed to characterise possible causes of or associations with this cognitive impairment.References:[1]Zabala A, Salgueiro M, Saez-Atxukarro O, Ballesteros J, Ruiz-Irastorza G, Segarra R. Cognitive Impairment in Patients With Neuropsychiatric and Non-neuropsychiatric Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis. J Int Neuropsychol Soc. 2018:1-11.[2]Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis. J Clin Neurosci. 2019;69:81-7.[3]Adler G, Bektas M, Feger M, Lembach Y. [Computer-based assessment of memory and attention: evaluation of the memory and attention test (MAT)]. Psychiatr Prax. 2012;39(2):79-83.[4]Adler G, Lembach Y. Memory and selective attention in multiple sclerosis: cross-sectional computer-based assessment in a large outpatient sample. Eur Arch Psychiatry Clin Neurosci. 2015;265(5):439-43.Acknowledgements:This study was funded by the RHADAR GbR (A Network of Rheumatologists), Bahnhofstr. 32, 82152 Planegg, Germany. RHADAR GbR has received a grant for this study from Novartis Pharma GmbH.Disclosure of Interests:Stefan Kleinert Consultant of: Novartis, Abbvie, Grant/research support from: Novartis, Praxedis Rapp: None declared., Florian Schuch Speakers bureau: Novartis, Abbvie, Gilead, Consultant of: Novartis, Abbvie, Gilead, Monika Ronneberger: None declared., Joerg Wendler Speakers bureau: Roche, Pharma, JanssenCilag, Novartis, Abbvie, Consultant of: JanssenCilag, Patrizia Sternad: None declared., Florian Popp: None declared., Peter Bartz-Bazzanella: None declared., Cay-Benedict von der Decken: None declared., Kirsten Karberg Speakers bureau: Roche, Sanofi, Abbvie, Lilly, Georg Gauler Speakers bureau: Abbvie, Gilead, Novartis, Lilly, Consultant of: Lilly, Gilead, Abbvie, Patrick Wurth Speakers bureau: Abbvie, Lilly, UCB, Medac, Susanna Spaethling-Mestekemper Speakers bureau: Abbvie, BMS, Celgene, Gilead, GSK, Hexal, Lilly, MSD, Novartis, Pfizer, Sanofi, UCB, Christoph Kuhn: None declared., Matthias Englbrecht Speakers bureau: AbbVie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: AbbVie, Chugai, Roche, Consultant of: AbbVie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Wolfgang Vorbrüggen: None declared., Georg Adler: None declared., Martin Welcker Speakers bureau: Abbvie, Actelion, Amgen, Biogen,BMS, Berlin Chemie, Celgene, Galapagos, Gilead, GSK, Hexal, Janssen, Medac, MSD, Mundipharma, Mylan, Novartis, Pfizer, Roche, Sanofi, SOBI, UCB, Grant/research support from: Novartis, Abbvie.
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Kleinert S, Bartz-Bazzanella P, von der Decken C, Knitza J, Witte T, Fekete SP, Konitzny M, Zink A, Gauler G, Wurth P, Aries P, Karberg K, Kuhn C, Schuch F, Späthling-Mestekemper S, Vorbrüggen W, Englbrecht M, Welcker M. A Real-World Rheumatology Registry and Research Consortium: The German RheumaDatenRhePort (RHADAR) Registry. J Med Internet Res 2021; 23:e28164. [PMID: 34014170 PMCID: PMC8176344 DOI: 10.2196/28164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
Real-world data are crucial to continuously improve the management of patients with rheumatic and musculoskeletal diseases (RMDs). The German RheumaDatenRhePort (RHADAR) registry encompasses a network of rheumatologists and researchers in Germany providing pseudonymized real-world patient data and allowing timely and continuous improvement in the care of RMD patients. The RHADAR modules allow automated anamnesis and adaptive coordination of appointments regarding individual urgency levels. Further modules focus on the collection and integration of electronic patient-reported outcomes in between consultations. The digital RHADAR modules ultimately allow a patient-centered adaptive approach to integrated medical care starting as early as possible in the disease course. Such a closed-loop system consisting of various modules along the whole patient pathway enables comprehensive and timely patient management in an unprecedented manner.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany.,Medizinische Klinik 3, Rheumatology/Immunology, Universitätsklinik Würzburg, Würzburg, Germany
| | | | - Cay von der Decken
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany.,Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hanover Medical School, Hanover, Germany
| | - Sándor P Fekete
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Matthias Konitzny
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Germany
| | | | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
| | | | | | | | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
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Simons G, Veldwijk J, DI Santostefano R, Englbrecht M, Radawski C, Valor L, Raza K, Falahee M. OP0160-HPR PREFERENCES FOR TREATMENTS TO PREVENT RHEUMATOID ARTHRITIS: DISCRETE CHOICE SURVEY OF GENERAL POPULATIONS IN UNITED KINGDOM, GERMANY, AND ROMANIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is increasing research focus on intervention for rheumatoid arthritis (RA) at the earliest stages of disease development, including treatment to prevent RA in at-risk groups. Novel cellular therapies are in development, and the effectiveness of existing immunomodulatory agents to prevent RA in those at risk is under investigation. Quantitative evidence of likely uptake of preventive treatments, and preferences for benefits and risks of such treatments is limited.Objectives:To quantify preferences for preventive therapies for RA.Methods:A web-based survey (n = 2959) was administered to an age- and gender- stratified sample of adults in the general population from online survey panels in the UK, Germany, and Romania. After receiving information about RA, questions to check comprehension of background information, an introduction to the survey tasks and warm-up questions, participants were asked to imagine that they were experiencing arthralgia (without swelling) and had positive autoantibody tests indicating a 60% chance of developing RA in the next two years. Using a discrete choice experiment with a Bayesian D-efficient design, participants were offered a series of 15 choices between no treatment and two unlabeled hypothetical treatments to lower risk of RA development. Treatments were defined by six attributes with varying levels including benefits, risks, and frequency/route of administration (Table 1). One choice task with fixed levels described treatments representative of those under investigation for RA prevention (abatacept, hydroxychloroquine, atorvastatin and tolerogenic cell-based therapy). Attribute selection and presentation was informed by previous qualitative research, ranking surveys, systematic literature review, and expert opinion. Survey design was informed by patient research partners. The survey was pre-tested during qualitative interviews and revised. A pilot of the final survey with 100 respondents was conducted to obtain priors for the final experimental design. Random parameters logit (RPL) models were used to estimate relative importance of treatment attributes and likely treatment uptake rates in each country.Table 1.Treatment attributes and levelsAttributeLevelsChance of developing RA reduced from 60% to10%; 20%; 30%; 40%How the treatment is takenA shallow injection under the skinA drip into the veinOne or two tabletsHow often the medication has to be takenDailyWeeklyMonthlyEvery 6 monthsChance of mild side effects2%; 5%; 10%Chance of a serious infection due to treatment0%; 1%; 5%Chance of a serious side effect that is potentially irreversible1 in 100,000 people20 in 100,000 people100 in 100,000 peopleResults:Across all three countries, effectiveness was the treatment attribute that had most impact on treatment choice (Figure 1). Method of administration was second most important for respondents from the UK and Romania but less important for German respondents. Risks of serious infection and serious side effects were more important determinants of treatment choice for respondents in Romania than they were in the UK and Germany. Percentage choice of fixed profiles reflecting abatacept, atorvastatin, hydroxychloroquine, tolerogenic cell-based therapy and no treatment differed across countries (χ2=78.90; p<0.001): 28.3%, 20.6%, 22.2% 18.5% and 10.4% respectively in the UK; 31.3%, 18.8%, 11.2%, 23.4% and 15.3% in Germany; and 27.6%, 20.5%, 15.8%, 21.7% and 14.4% in Romania.Conclusion:This study suggests that effective preventive treatments for RA are acceptable to members of the general population told to assume up a 60% chance of developing RA. The relative importance of treatment attributes and likely uptake of fixed treatment profiles differed across countries. These findings are informative for the design of prevention trials, and the development of informational resources and efficient preventive strategies for those at risk of developing RA.Acknowledgements:On behalf of the PREFER project. PREFER received funding from the IMI 2 Joint Undertaking (grant No. 115966), which receives support from the EU’s Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations (EFPIA). K. Raza is supported by the NIHR Birmingham Biomedical Research Centre.Disclosure of Interests:Gwenda Simons: None declared, Jorien Veldwijk: None declared, Rachael Di Santostefano Shareholder of: Johnson & Johnson, Employee of: Janssen R&D (of Johnson & Johnson), Matthias Englbrecht Speakers bureau: AbbVie, Chugai, Eli Lilly, Novartis, Roche, Sanofi, Mundipharma, Paid instructor for: AbbVie, Chugai, Roche, Consultant of: AbbVie, Novartis, Roche, Sanofi, Grant/research support from: Roche, Chugai, Christine Radawski Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Larissa Valor: None declared, Karim Raza Consultant of: Personal fees from Abbvie, Pfizer, Sanofi, Lilly, Bristol Myers Squibb, UCB, Janssen, and Roche Chugai, Grant/research support from: Abbvie and Pfizer, M. Falahee: None declared
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Knitza J, Mohn J, Bergmann C, Kampylafka E, Hagen M, Bohr D, Morf H, Araujo E, Englbrecht M, Simon D, Kleyer A, Meinderink T, Vorbrüggen W, von der Decken CB, Kleinert S, Ramming A, Distler JHW, Vuillerme N, Fricker A, Bartz-Bazzanella P, Schett G, Hueber AJ, Welcker M. Accuracy, patient-perceived usability, and acceptance of two symptom checkers (Ada and Rheport) in rheumatology: interim results from a randomized controlled crossover trial. Arthritis Res Ther 2021; 23:112. [PMID: 33849654 PMCID: PMC8042673 DOI: 10.1186/s13075-021-02498-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Timely diagnosis and treatment are essential in the effective management of inflammatory rheumatic diseases (IRDs). Symptom checkers (SCs) promise to accelerate diagnosis, reduce misdiagnoses, and guide patients more effectively through the health care system. Although SCs are increasingly used, there exists little supporting evidence. OBJECTIVE To assess the diagnostic accuracy, patient-perceived usability, and acceptance of two SCs: (1) Ada and (2) Rheport. METHODS Patients newly presenting to a German secondary rheumatology outpatient clinic were randomly assigned in a 1:1 ratio to complete Ada or Rheport and consecutively the respective other SCs in a prospective non-blinded controlled randomized crossover trial. The primary outcome was the accuracy of the SCs regarding the diagnosis of an IRD compared to the physicians' diagnosis as the gold standard. The secondary outcomes were patient-perceived usability, acceptance, and time to complete the SC. RESULTS In this interim analysis, the first 164 patients who completed the study were analyzed. 32.9% (54/164) of the study subjects were diagnosed with an IRD. Rheport showed a sensitivity of 53.7% and a specificity of 51.8% for IRDs. Ada's top 1 (D1) and top 5 disease suggestions (D5) showed a sensitivity of 42.6% and 53.7% and a specificity of 63.6% and 54.5% concerning IRDs, respectively. The correct diagnosis of the IRD patients was within the Ada D1 and D5 suggestions in 16.7% (9/54) and 25.9% (14/54), respectively. The median System Usability Scale (SUS) score of Ada and Rheport was 75.0/100 and 77.5/100, respectively. The median completion time for both Ada and Rheport was 7.0 and 8.5 min, respectively. Sixty-four percent and 67.1% would recommend using Ada and Rheport to friends and other patients, respectively. CONCLUSIONS While SCs are well accepted among patients, their diagnostic accuracy is limited to date. TRIAL REGISTRATION DRKS.de, DRKS00017642 . Registered on 23 July 2019.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- Université Grenoble Alpes, AGEIS, Grenoble, France.
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eleni Kampylafka
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniela Bohr
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elizabeth Araujo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Timo Meinderink
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany
- RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Cay Benedikt von der Decken
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Stefan Kleinert
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Rheumatologische Schwerpunktpraxis, Drs. Kleinert, Rapp, Ronneberger, Schuch U. Wendler, Rheumatology, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Institut Universitaire de France, Paris, France
- LabCom Telecom4Health, University of Grenoble Alpes & Orange Labs, Grenoble, France
| | | | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Martin Welcker
- RheumaDatenRhePort (rhadar), Planegg, Germany
- MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
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Falahee M, Simons G, DiSantostefano RL, Valor Méndez L, Radawski C, Englbrecht M, Schölin Bywall K, Tcherny-Lessenot S, Kihlbom U, Hauber B, Veldwijk J, Raza K. Treatment preferences for preventive interventions for rheumatoid arthritis: protocol of a mixed methods case study for the Innovative Medicines Initiative PREFER project. BMJ Open 2021; 11:e045851. [PMID: 36916312 PMCID: PMC8039213 DOI: 10.1136/bmjopen-2020-045851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Amidst growing consensus that stakeholder decision-making during drug development should be informed by an understanding of patient preferences, the Innovative Medicines Initiative project 'Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle' (PREFER) is developing evidence-based recommendations about how and when patient preferences should be integrated into the drug life cycle. This protocol describes a PREFER clinical case study which compares two preference elicitation methodologies across several populations and provides information about benefit-risk trade-offs by those at risk of rheumatoid arthritis (RA) for preventive interventions. METHODS AND ANALYSIS This mixed methods study will be conducted in three countries (UK, Germany, Romania) to assess preferences of (1) first-degree relatives (FDRs) of patients with RA and (2) members of the public. Focus groups using nominal group techniques (UK) and ranking surveys (Germany and Romania) will identify and rank key treatment attributes. Focus group transcripts will be analysed thematically using the framework method and average rank orders calculated. These results will inform the treatment attributes to be assessed in a survey including a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). The survey will also include measures of sociodemographic variables, health literacy, numeracy, illness perceptions and beliefs about medicines. The survey will be administered to (1) 400 FDRs of patients with RA (UK); (2) 100 FDRs of patients with RA (Germany); and (3) 1000 members of the public in each of UK, Germany and Romania. Logit-based approaches will be used to analyse the DCE and imputation and interval regression for the PTT. ETHICS AND DISSEMINATION This study has been approved by the London-Hampstead Research Ethics Committee (19/LO/0407) and the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (92_17 B). The protocol has been approved by the PREFER expert review board. The results will be disseminated widely and will inform the PREFER recommendations.
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Affiliation(s)
- Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Larissa Valor Méndez
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | | | | | | | | | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Brett Hauber
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, USA
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Jorien Veldwijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Karg MV, Alber B, Kuhn C, Bohlinger K, Englbrecht M, Dormann H. [SARS-CoV-2, influenza and norovirus infection : A direct epidemiologic comparison]. Med Klin Intensivmed Notfmed 2021; 117:209-217. [PMID: 33559700 PMCID: PMC7871315 DOI: 10.1007/s00063-021-00783-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/21/2020] [Revised: 11/19/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Hospitalisierungsraten, Notaufnahmeprävalenzen und Fallsterblichkeiten (CFP) stationärer SARS-CoV-2-Patienten und wie sich diese von anderen pandemischen oder saisonalen Viruserkrankungen, wie Influenza A/B oder Norovirusinfektionen unterscheiden, wurden bisher nicht untersucht. Diese Arbeit gibt einen Überblick aus einer Kommune darüber und vergleicht diesen auch mit den negativ getesteten stationären Verdachtsfällen. Methoden Im Rahmen retrospektiver Kohortenanalysen von 67.000 Krankenhausfällen eines Klinikums mit umfassender Notfallversorgung und Meldedaten des regionalen Gesundheitsamts wurden für die Virusinfektionen SARS-CoV‑2, Influenza A/B und Norovirus Genotyp 1/2 Hospitalisierungsraten, Notaufnahmeprävalenzen und CFP berechnet. Ergebnisse In Fürth (Stadt‑/Landkreis) wurden 0,34 % der Bevölkerung, 824 Personen, bis 07.05.2020 positiv auf SARS-CoV‑2 getestet, wovon 162 (19,7 %) stationär behandelt wurden. 91 der Infizierten verstarben (CFP 11,0 %), davon 48 stationär. In der aktuellen Grippe‑/Norovirussaison wurden 992 Einwohner als influenzapositiv und 135 als noroviruspositiv gemeldet, davon 202 (20,3 %) bzw. 125 (91,9 %) stationär behandelt. Die Notaufnahmeprävalenzen waren 4,1 %, 2,0 % und 0,6 %. Die CFP der SARS-CoV-2-, influenza- und noroviruspositiven Krankenhauspopulationen betrugen 29,1 %, 3,0 % und 1,6 %, die der testnegativen Verdachtsfälle 5,9 %, 4,8 % und 6,9 % bei einer Krankenhausmortalität von 2,1 % für 2020. Schlussfolgerungen Bei gleichen Hospitalisierungsraten von SARS-CoV-2- und Influenzapatienten unterschieden sich die CFP massiv, während die CFP der testnegativen Verdachtsfälle aller 3 Infektionserkrankungen sich nicht signifikant unterschieden.
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Affiliation(s)
- M V Karg
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
| | - B Alber
- Institut für Labormedizin, Klinikum Fürth, Fürth, Deutschland
| | - C Kuhn
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | - K Bohlinger
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | | | - H Dormann
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
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Pecherstorfer C, Simon D, Unbehend S, Ellmann H, Englbrecht M, Hartmann F, Figueiredo C, Hueber A, Haschka J, Kocijan R, Kleyer A, Schett G, Rech J, Bayat S. A Detailed Analysis of the Association between Urate Deposition and Erosions and Osteophytes in Gout. ACR Open Rheumatol 2020; 2:565-572. [PMID: 32955167 PMCID: PMC7571395 DOI: 10.1002/acr2.11172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize in detail the structural bone changes associated with the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout. METHODS Twenty patients with tophaceous gout and involvement of the MTP1 joint received both dual-energy computed tomography (DECT) of the feet for the detection of tophi and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet for the detection of bone erosions and osteophytes. Demographic and clinical data were collected. Tophi in DECT and erosions and osteophytes in HR-pQCT were overlayed to define their anatomical relation. In addition, the feet of 20 sex- and age-matched healthy controls were scanned to define the normal architecture of the MTP1 joint. RESULTS Patients with gout had an increased number and extent of bone erosions and osteophytes compared with their healthy counterparts (erosions: 5 [0-17] vs 1 [1-2], 45.32 mm3 [7.26-550.32] vs 0.82 mm3 [0.15-21.8]; osteophytes: 10.5 [0-26] vs 1 [0-10], 4.93 mm [0.77-7.19 mm] vs 0.93 mm [0.05-7.61 mm]; all P < 0.001). The median tophi volume detected by DECT (0.12 mm3 [0.01-2.53]) was highly associated with the total volume of erosions (r = 0.597, P = 0.005). CONCLUSION Gout patients show increased changes in their bone microarchitecture. The extent of uric acid deposition is positively correlated with the extent of bone loss at the MTP1 joint, highlighting the strong cohesion of inflammation and erosive changes.
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Affiliation(s)
- Caroline Pecherstorfer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Unbehend
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hanna Ellmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Hartmann
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Camille Figueiredo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel Hueber
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Vienna, Austria and Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria, and Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Bayat
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany and Universitätsklinikum Erlangen, Erlangen, Germany
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Müller HHO, Lücke C, Englbrecht M, Wiesener MS, Siller T, Eckardt KU, Kornhuber J, Maler JM. Kidney-transplant patients receiving living- or dead-donor organs have similar psychological outcomes (findings from the PI-KT study). Ment Illn 2020; 12:17-22. [PMID: 32742627 PMCID: PMC7370952 DOI: 10.1108/mij-10-2019-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Kidney transplantation (KT) is the treatment of choice for end-stage chronic kidney disease (CKD) and is well known to improve the clinical outcome of patients. However, the impact of KT on comorbid psychological symptoms, particularly depression and anxiety, is less clear, and recipients of living-donor (LD) organs may have a different psychological outcome from recipients of dead-donor (DD) organs. Design/methodology/approach In total, 152 patients were included and analyzed using a cross-sectional design. Of these patients, 25 were pre-KT, 13 were post-KT with a LD transplant and 114 were post-KT with a DD transplant. The patients were tested for a variety of psychometric outcomes using the Hospital Anxiety and Depression Scale, the 12-Item Short Form Health Survey (assessing physical and mental health-related quality of life), the Resilience Scale, the Coping Self-Questionnaire and the Social Support Questionnaire. Findings The mean age of the patients was 51.25 years and 40 per cent of the patients were female. As expected, the post-KT patients had significantly better scores on the physical component of the Short Form Health Survey than the pre-KT patients, and there were no significant differences between the two post-KT groups. There were no significant differences among the groups in any of the other psychometric outcome parameters tested, including anxiety, depression and the mental component of health-related quality of life. Research limitations/implications KT and the origin of the donor organ do not appear to have a significant impact on the psychological well-being of transplant patients with CKD. Although the diagnosis and early treatment of psychological symptoms, such as depression and anxiety, remain important for these patients, decisions regarding KT, including the mode of transplantation, should not be fundamentally influenced by concerns about psychological impairments at the population level. Originality/value CKD is a serious condition involving profound impairment of the physical and psychological well-being of patients. KT is considered the treatment of choice for most of these patients. KT has notable advantages over dialysis with regard to the long-term physical functioning of the renal and cardiovascular system and increases the life expectancy of patients. However, the data on the improvement of psychological impairments after KT are less conclusive.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Department of Medical Psychology, University Hospital Bonn, Bonn, Germany and Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Department of Medical Psychology, University Hospital Bonn, Bonn, Germany and Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Rheumatology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Michael S Wiesener
- Department of Nephrology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Teresa Siller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Kai Uwe Eckardt
- Department of Nephrology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - J Manuel Maler
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
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Mosor E, Stoffer-Marx M, Steiner G, Raza K, Stack RJ, Simons G, Falahee M, Skingle D, Dobrin M, Schett G, Englbrecht M, Smolen JS, Kjeken I, Hueber AJ, Stamm TA. I Would Never Take Preventive Medication! Perspectives and Information Needs of People Who Underwent Predictive Tests for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:360-368. [PMID: 30710453 PMCID: PMC7064954 DOI: 10.1002/acr.23841] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Little is known about the experiences, values, and needs of people without arthritis who undergo predictive biomarker testing for the development of rheumatoid arthritis (RA). Our study aimed to explore the perspectives of these individuals and describe their information needs. METHODS A qualitative, multicenter interview study with a thematic analysis was conducted in Austria, Germany and the UK. Individuals were interviewed who underwent predictive biomarker testing for RA and had a positive test result but no diagnosis of any inflammatory joint disease. Participants included patients with arthralgia and asymptomatic individuals. Information and education needs were developed from the qualitative codes and themes using the Arthritis Educational Needs Assessment Tool as a frame of reference. RESULTS Thematic saturation was reached in 34 individuals (76% female, 24 [71%] with arthralgia, and 10 [29%] asymptomatic individuals). Thirty-seven codes were summarized into 4 themes: 1) decision-making around whether to undergo initial predictive testing, 2) willingness to consider further predictive tests, and/or 3) preventive interventions, including medication, and 4) varying reactions after receiving a positive test result. Individuals with arthralgia were more likely to be willing to take preventive action, undergo further testing, and experience psychological distress than asymptomatic individuals. All participants expressed the need for tailored, patient-understandable information. CONCLUSION Individuals at risk of RA are currently the subjects of research aimed at developing better predictive strategies and preventive approaches. Their perceptions and needs should be addressed to inform the future development of interventions combined with education.
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Affiliation(s)
- Erika Mosor
- Medical University of Vienna, Vienna, Austria
| | | | - Günter Steiner
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
| | - Karim Raza
- University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | | | - Mircia Dobrin
- The Romanian League Against Rheumatism, Timisoara, Romania
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Ingvild Kjeken
- Oslo Metropolitan University and Diakonhjemmet Hospital, Oslo, Norway
| | - Axel J Hueber
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja A Stamm
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
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Bayat S, Simon D, Pecherstorfer C, Ellmann H, Figueiredo C, Englbrecht M, Hueber A, Kleyer A, Rech J, Schett G. SAT0556 FINE STRUCTURE ANALYSIS OF THE INTER-RELATION BETWEEN TOPHUS DEPOSITION AND BONE LESIONS IN GOUT USING A COMBINATION OF DUAL ENERGY AND HIGH-RESOLUTION CT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Deposition of uric acid crystals cause an inflammatory reaction, which can lead to structural bone changes, if such deposits form adjacent to cortical bone [1, 2]. Both erosions and bony spurs can form in conjunction with tophus deposition. The exact spatial inter-relation between tophi and structural bone lesions in humans in vivo is not fully characterized.Objectives:To spatially relate structural bone changes (erosions, osteophytes) to the deposition of monosodium urate crystals in the first metatarsophalangeal (MTP1) joint in patients with tophaceous gout.Methods:Tophaceous gout patients with clinically detected tophi at the MTP1 joint underwent simultaneous dual energy computed tomography (DECT) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the feet. Tophi detected by DECT and erosions and osteophytes detected by HR-pQCT were overlayed to define their exact anatomical relation. Furthermore, feet of sex- and age-matched healthy controls (HC) were scanned to define the normal architecture of the MTP1 joint.Results:Gout patients (N=20) had significantly higher numbers (5 (0–17 vs. 1 (1– 2)) and volumes (45.32 mm3(7.26–550.32) vs. 0.82 mm3(0.15–21.8)) of bone erosions as well as significantly higher numbers (10.5 (0-26) vs. 1 (0-10)) and sizes of osteophytes (4.93 mm (0.77-7.19 mm vs. 0.93 mm (0.05-7.61 mm))than healthy controls (N=20). Erosions were in direct spatial relation to bone erosions, while osteophytic responses were more widespread and affected bone regions on the MTP1, which were not directly adjacent to tophi. Median tophus volume detected by DECT (0.12 mm3(0.01–2.53)) was associated with the total volume of erosions (r=0.597, p=0.005).Conclusion:This study demonstrates that bone changes in gout are substantial and not only include erosions but also widespread architectural bone remodeling associated osteophyte formation. While there is a direct spatial relation between tophi and bone erosions the anabolic bone responses in gout are more widespread.References:[1]Dalbeth, N. et al. Ann Rheum Dis. 2015 Jun;74(6):1030-6.[2]Dalbeth, N. et al. Arthritis Res Ther. 2012; 14(4): R165.Data are based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal joints I in gout patients (grey boxplots) and healthy controls (white boxplots). (A) number of bone erosions, (B) volume of bone erosions, (C) number of osteophytes and (D) size of osteophytes. Data are shown as medians and inter-quartile ranges (boxes).Distribution of (A) tophi based on dual-energy computed tomography (DECT) as well as (B) bone erosions and (C) osteophytes based on high-resolution peripheral quantitative computed tomography (HR-pQCT) of metatarsophalangeal (MTP) I head in gout patients. Data are shown for the different regions of the MTPI head including the plantar, medial, dorsal and lateral region of the metatarsal head, as well as the medial and lateral sesamoid bones. Data indicate percentage of patients with tophi, erosions and osteophytes in respective region.Disclosure of Interests:Sara Bayat Speakers bureau: Novartis, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Caroline Pecherstorfer: None declared, Hanna Ellmann: None declared, Camille Figueiredo: None declared, Matthias Englbrecht: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Jürgen Rech Consultant of: BMS, Celgene, Novartis, Roche, Chugai, Speakers bureau: AbbVie, Biogen, BMS, Celgene, MSD, Novartis, Roche, Chugai, Pfizer, Lilly, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB
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Knitza J, Mohn J, Bergmann C, Kampylafka E, Hagen M, Bohr D, Araujo E, Englbrecht M, Simon D, Kleyer A, Meinderink T, Vorbrüggen W, Von der Decken CB, Kleinert S, Ramming A, Distler J, Bartz-Bazzanella P, Schett G, Hueber A, Welcker M. AB1346-HPR REAL-WORLD EFFECTIVENESS AND PERCEIVED USEFULNESS OF SYMPTOM CHECKERS IN RHEUMATOLOGY: INTERIM REPORT FROM THE PROSPECTIVE MULTICENTER BETTER STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Symptom checkers (SC) promise to reduce diagnostic delay, misdiagnosis and effectively guide patients through healthcare systems. They are increasingly used, however little evidence exists about their real-life effectiveness.Objectives:The aim of this study was to evaluate the diagnostic accuracy, usage time, usability and perceived usefulness of two promising SC, ADA (www.ada.com) and Rheport (www.rheport.de). Furthermore, symptom duration and previous symptom checking was recorded.Methods:Cross-sectional interim clinical data from the first of three recruiting centers from the prospective, real-world, multicenter bETTeR-study (DKRS DRKS00017642) was used. Patients newly presenting to a secondary rheumatology outpatient clinic between September and December 2019 completed the ADA and Rheport SC. The time and answers were recorded and compared to the patient’s actual diagnosis. ADA provides up to 5 disease suggestions, Rheport calculates a risk score for rheumatic musculoskeletal diseases (RMDs) (≥1=RMD). For both SC the sensitivity, specificity was calculated regarding RMDs. Furthermore, patients completed a survey evaluating the SC usability using the system usability scale (SUS), perceived usefulness, previous symptom checking and symptom duration.Results:Of the 129 consecutive patients approached, 97 agreed to participate. 38% (37/97) of the presenting patients presented with an RMD (Figure 1). Mean symptom duration was 146 weeks and a mean number of 10 physician contacts occurred previously, to evaluate current symptoms. 56% (54/96) had previously checked their symptoms on the internet using search engines, spending a mean of 6 hours. Rheport showed a sensitivity of 49% (18/37) and specificity of 58% (35/60) concerning RMDs. ADA’s top 1 and top 5 disease suggestions concerning RMD showed a sensitivity of 43% (16/37) and 54% (20/37) and a specificity of 58% (35/60) and 52% (31/60), respectively. ADA listed the correct diagnosis of the patients with RMDs first or within the first 5 disease suggestions in 19% (7/37) and 30% (11/37), respectively. The average perceived usefulness for checking symptoms using ADA, internet search engines and Rheport was 3.0, 3.5 and 3.1 on a visual analog scale from 1-5 (5=very useful). 61% (59/96) and 64% (61/96) would recommend using ADA and Rheport, respectively. The mean SUS score of ADA and Rheport was 72/100 and 73/100. The mean usage time for ADA and Rheport was 8 and 9 minutes, respectively.Conclusion:This is the first prospective, real-world, multicenter study evaluating the diagnostic accuracy and other features of two currently used SC in rheumatology. These interim results suggest that diagnostic accuracy is limited, however SC are well accepted among patients and in some cases, correct diagnosis can be provided out of the pocket within few minutes, saving valuable time.Figure:Acknowledgments:This study was supported by an unrestricted research grant from Novartis.Disclosure of Interests:Johannes Knitza Grant/research support from: Research Grant: Novartis, Jacob Mohn: None declared, Christina Bergmann: None declared, Eleni Kampylafka Speakers bureau: Novartis, BMS, Janssen, Melanie Hagen: None declared, Daniela Bohr: None declared, Elizabeth Araujo Speakers bureau: Novartis, Lilly, Abbott, Matthias Englbrecht Grant/research support from: Roche Pharma, Chugai Pharma Europe, Consultant of: AbbVie, Roche Pharma, RheumaDatenRhePort GbR, Speakers bureau: AbbVie, Celgene, Chugai Pharma Europe, Lilly, Mundipharma, Novartis, Pfizer, Roche Pharma, UCB, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Timo Meinderink: None declared, Wolfgang Vorbrüggen: None declared, Cay-Benedict von der Decken: None declared, Stefan Kleinert Shareholder of: Morphosys, Grant/research support from: Novartis, Consultant of: Novartis, Speakers bureau: Abbvie, Novartis, Celgene, Roche, Chugai, Janssen, Andreas Ramming Grant/research support from: Pfizer, Novartis, Consultant of: Boehringer Ingelheim, Novartis, Gilead, Pfizer, Speakers bureau: Boehringer Ingelheim, Roche, Janssen, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Peter Bartz-Bazzanella: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Martin Welcker Grant/research support from: Abbvie, Novartis, UCB, Hexal, BMS, Lilly, Roche, Celgene, Sanofi, Consultant of: Abbvie, Actelion, Aescu, Amgen, Celgene, Hexal, Janssen, Medac, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: Abbvie, Aescu, Amgen, Biogen, Berlin Chemie, Celgene, GSK, Hexal, Mylan, Novartis, Pfizer, UCB
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Freier D, Englbrecht M, Höhne-Zimmer V, Detert J, Burmester GR. [Higher prevalence of depressive and anxiety symptoms in early arthritis patients in comparison to the normal population]. Z Rheumatol 2019; 78:820-831. [PMID: 30511171 DOI: 10.1007/s00393-018-0571-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many studies and registry data confirm that depression, often associated with anxiety disorders is very often found in patients with rheumatoid arthritis (RA). To what extent these psychiatric disorders are already relevant at a very early stage of the disease, has currently not been adequately investigated. METHODS In this study 176 patients with early joint symptoms (<1 year) were surveyed in an early arthritis consultation (EAC). The hospital anxiety and depression scale (HADS) was completed by the patients to examine the prevalence of depressive and anxiety symptoms. The results were compared to normative data of the general German population and between the diagnosis groups. RESULTS With 47.7% the prevalence of global distress for EA patients was almost twice as high compared to the corresponding group from the general population. This was also confirmed for depressive and anxiety symptoms. The EA patients without confirmed evidence of musculoskeletal inflammatory rheumatic disease (RD) showed nearly the same point prevalence as patients with confirmed RD. In multiple logistic regression the health assessment questionnaire (HAQ) was positively associated with global distress (odds ratio, OR 3.63) while the visual analogue scale (VAS) for global disease activity was positively associated with symptoms of depression (OR 1.03). Female EA patients (OR 5.45) appear to have a higher probability for experiencing corresponding symptoms, whereas patients over 60 years old appear to have less anxiety than younger patients (OR 0.11). CONCLUSION The high prevalence of symptoms of depression and anxiety in EA patients compared to the general population is a challenge for rheumatologists, orthopedists and general practitioners, particularly with respect to the differentiation of possible psychosomatic components in noninflammatory joint complaints. The results suggest that screening for psychiatric problems in patients with rheumatism should be evaluated as soon as possible as these can have a great impact on the perception of pain and physical functional status from the very beginning.
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Affiliation(s)
- D Freier
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Englbrecht
- Medizinische Klink 3 - Rheumatologie und Immunologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) und Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - V Höhne-Zimmer
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Detert
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - G-R Burmester
- Klinik für Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Janssens R, Russo S, van Overbeeke E, Whichello C, Harding S, Kübler J, Juhaeri J, Bywall KS, Comanescu A, Hueber A, Englbrecht M, Nikolenko N, Pravettoni G, Simoens S, Stevens H, Hermann R, Levitan B, Cleemput I, de Bekker-Grob E, Veldwijk J, Huys I. Patient Preferences in the Medical Product Life Cycle: What do Stakeholders Think? Semi-Structured Qualitative Interviews in Europe and the USA. Patient 2019; 12:513-526. [PMID: 31222436 PMCID: PMC6697755 DOI: 10.1007/s40271-019-00367-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, payers, industry, patients, physicians, and regulators. However, the use of PP in decisions along the medical product lifecycle remains limited. As the adoption of PP heavily relies on these stakeholders, knowledge of their perceptions of PP is critical. OBJECTIVE This study aimed to characterize stakeholders' attitudes, needs, and concerns with respect to PP in decision making along the medical product lifecycle. METHODS Semi-structured interviews (n = 143) were conducted with academics (n = 24), health technology assessment/payer representatives (n = 24), industry representatives (n = 24), patients, caregivers and patient representatives (n = 24), physicians (n = 24), and regulators (n = 23) from seven European countries and the USA. Interviews were conducted between April and August 2017. The framework method was used to organize the data and identify themes and key findings in each interviewed stakeholder group. RESULTS Interviewees reported being unfamiliar (43%), moderately familiar (42%), or very familiar (15%) with preference methods and studies. Interviewees across stakeholder groups generally supported the idea of using PP in the medical product lifecycle but expressed mixed opinions about the feasibility and impact of using PP in decision making. Interviewees from all stakeholder groups stressed the importance of increasing stakeholders' understanding of the concept of PP and preference methods and ensuring patients' understanding of the questions asked in PP studies. Key concerns and needs in each interviewed stakeholder group were as follows: (1) academics: investigating the validity, reliability, reproducibility, and generalizability of preference methods; (2) health technology assessment/payer representatives: developing quality criteria for evaluating PP studies and gaining insights into how to weigh them in reimbursement/payer decision making; (3) industry representatives: obtaining guidance on PP studies and recognition on the importance of PP from decision makers; (4) patients, caregivers, and patient representatives: providing an incentive and adequate information towards patients when participating in PP studies; (5) physicians: avoiding bias as a result of commercial agendas in PP studies and clarifying how to deal with subjective and emotional elements when measuring PP; and (6) regulators: avoiding the misuse of PP study results to overrule the traditional efficacy and safety criteria used for marketing authorization and obtaining robust PP study results. CONCLUSIONS Despite the interest all interviewed stakeholder groups reported in PP, the effective use of PP in decision making across the medical product lifecycle is currently hampered by a lack of standardization and consensus on how to both measure and use PP.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
| | - Selena Russo
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, via Giuseppe Ripamonti 435, 20141, Milan, Italy
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, High St, Kensington, NSW, 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - Eline van Overbeeke
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Sarah Harding
- Takeda International, UK Branch, 61 Aldwych, London, WC2B 4AE, UK
| | | | | | - Karin Schölin Bywall
- Centre for Research Ethics & Bioethics, Uppsala University, Husargatan 3, Box 564, 752 37, Uppsala, Sweden
| | - Alina Comanescu
- Community Health Association Romania, 4 Camil Ressu Boulevard, Bucharest, Romania
| | - Axel Hueber
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle Upon Tyne, UK
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology, via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium
| | - Hilde Stevens
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | | | - Bennett Levitan
- Global R&D Epidemiology, Janssen Research & Development, 1125 Trenton-Harbourton Road, PO Box 200, Titusville, NJ, 08560, USA
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium
| | - Esther de Bekker-Grob
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium
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Whichello C, van Overbeeke E, Janssens R, Schölin Bywall K, Russo S, Veldwijk J, Cleemput I, Juhaeri J, Levitan B, Kübler J, Smith M, Hermann R, Englbrecht M, Hueber AJ, Comanescu A, Harding S, Simoens S, Huys I, de Bekker-Grob EW. Factors and Situations Affecting the Value of Patient Preference Studies: Semi-Structured Interviews in Europe and the US. Front Pharmacol 2019; 10:1009. [PMID: 31619989 PMCID: PMC6759933 DOI: 10.3389/fphar.2019.01009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/08/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representatives, regulators, HTA/payer representatives, and a combined group of patients, caregivers, and patient representatives) from seven European countries (the United Kingdom, Sweden, Italy, Romania, Germany, France, and the Netherlands) and the United States. Framework analysis was performed using NVivo 11 software. Results: Fifteen factors affecting the value of PPS in the MPLC were identified. These are related to: study organization (expertise, financial resources, study duration, ethics and good practices, patient centeredness), study design (examining patient and/or other preferences, ensuring representativeness, matching method to research question, matching method to MPLC stage, validity and reliability, cognitive burden, patient education, attribute development), and study conduct (patients’ ability/willingness to participate and preference heterogeneity). Three types of situations affecting the use of PPS results were identified (stakeholder acceptance, market situations, and clinical situations). Conclusion: The factors and situation types affecting the value of PPS, as identified in this study, need to be considered when designing and conducting PPS in order to promote the integration of PPI into decision-making along the MPLC.
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Affiliation(s)
- Chiara Whichello
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
| | - Eline van Overbeeke
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | | | - Selena Russo
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
| | | | | | - Bennett Levitan
- Global R&D Epidemiology, Janssen Research & Development, Titusville, United States
| | - Jürgen Kübler
- Quantitative Scientific Consulting, Marburg, Germany
| | - Meredith Smith
- Global Patient Safety and Labeling, Amgen Inc., Thousand Oaks, CA, United States
| | | | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Sarah Harding
- Global Patient Safety, Takeda, London, United Kingdom
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, Netherlands
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Kampylafka E, Simon D, d'Oliveira I, Linz C, Lerchen V, Englbrecht M, Rech J, Kleyer A, Sticherling M, Schett G, Hueber AJ. Disease interception with interleukin-17 inhibition in high-risk psoriasis patients with subclinical joint inflammation-data from the prospective IVEPSA study. Arthritis Res Ther 2019; 21:178. [PMID: 31349876 PMCID: PMC6659205 DOI: 10.1186/s13075-019-1957-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 03/06/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A specific subset of psoriasis patients is characterized by subclinical inflammatory changes. These patients frequently present with arthralgia and have a higher risk to develop psoriatic arthritis (PsA). We hypothesized that IL-17A inhibition in this subset of patients can intercept the link between skin and joint disease and resolves pain and inflammatory changes. METHODS Psoriasis, but no PsA, patients were included in the open prospective exploratory Interception in very early PsA (IVEPSA) study. Patients had to have nail or scalp involvement or a high psoriasis area severity index (PASI) (> 6) as well as inflammatory or erosive changes in MRI or CT. Patients received treatment with the anti-interleukin (IL)-17A antibody secukinumab over 24 weeks. Clinical assessments of skin and joint disease were done at baseline and after 12 and 24 weeks, MRI and CT at baseline and after 24 weeks. RESULTS Twenty patients were included, 85% of them reporting arthralgia and 40% had tender joints at the examination. Eighty-three percent had at least one inflammatory lesion in the MRI, most of them synovitis/enthesitis. Skin disease (PASI: p < 0.002; BSA: p < 0.003) and arthralgia (VAS pain: p < 0.003) significantly improved after 24 weeks. Total PsAMRIS (p = 0.005) and synovitis subscore (p = 0.008) also significantly improved. Erosions and enthesiophytes did not progress, while bone mass in the distal radius significantly (p = 0.020) increased after 24 weeks. CONCLUSIONS These data suggest that very early disease interception in PsA is possible leading to a comprehensive decline in skin symptoms, pain, and subclinical inflammation. IVEPSA therefore provides rationale for future early interventions with the concept to prevent the onset of PsA in high-risk individuals. TRIAL REGISTRATION Trial registry name PSARTROS; trial registry number: NCT02483234; June 26, 2015.
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Affiliation(s)
- Eleni Kampylafka
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Isabelle d'Oliveira
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christina Linz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Veronika Lerchen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Sektion Rheumatologie, Sozialstiftung Bamberg, Bamberg, Germany
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Hagen M, Englbrecht M, Haschka J, Reiser M, Kleyer A, Hueber A, Manger B, Figueiredo C, Cobra JF, Tony HP, Finzel S, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Lorenz HM, Nüsslein H, Alten R, Henes J, Krüger K, Schett G, Rech J. Cost-effective Tapering Algorithm in Patients with Rheumatoid Arthritis: Combination of Multibiomarker Disease Activity Score and Autoantibody Status. J Rheumatol 2018; 46:460-466. [PMID: 30504510 DOI: 10.3899/jrheum.180028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze the effect of a risk-stratified disease-modifying antirheumatic drug (DMARD)-tapering algorithm based on multibiomarker disease activity (MBDA) score and anticitrullinated protein antibodies (ACPA) on direct treatment costs for patients with rheumatoid arthritis (RA) in sustained remission. METHODS The study was a posthoc retrospective analysis of direct treatment costs for 146 patients with RA in sustained remission tapering and stopping DMARD treatment, in the prospective randomized RETRO study. MBDA scores and ACPA status were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and direct treatment costs were evaluated every 3 months. MBDA and ACPA status were used as predictors creating a risk-stratified tapering algorithm based on relapse rates. RESULTS RA patients with a low MBDA score (< 30 units) and negative ACPA showed the lowest relapse risk (19%), while double-positive patients showed high relapse risk (61%). In ACPA-negative and MBDA-negative (< 30 units), and ACPA or MBDA single-positive (> 30 units) groups, DMARD tapering appears feasible. Considering only patients without flare, direct costs for synthetic and biologic DMARD in the ACPA/MBDA-negative and single positive groups (n = 41) would have been €372,245.16 for full-dose treatment over 1 year. Tapering and stopping DMARD in this low-risk relapse group allowed a reduction of €219,712.03 of DMARD costs. Average reduction of DMARD costs per patient was €5358.83. CONCLUSION Combining MBDA score and ACPA status at baseline may allow risk stratification for successful DMARD tapering and cost-effective use of biologic DMARD in patients in deep remission as defined by the 28-joint count Disease Activity Score using erythrocyte sedimentation rate.
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Affiliation(s)
- Melanie Hagen
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Matthias Englbrecht
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Judith Haschka
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Michaela Reiser
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Arnd Kleyer
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Axel Hueber
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Bernhard Manger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Camille Figueiredo
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jayme Fogagnolo Cobra
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hans-Peter Tony
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Stephanie Finzel
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Stefan Kleinert
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jörg Wendler
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Florian Schuch
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Monika Ronneberger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Martin Feuchtenberger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Martin Fleck
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Karin Manger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Wolfgang Ochs
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hans-Martin Lorenz
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Hubert Nüsslein
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Rieke Alten
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jörg Henes
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Klaus Krüger
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Georg Schett
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany.,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen
| | - Jürgen Rech
- From the Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany; St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna, Vienna, Austria; Institutio de Rheumatologia, São Paolo, Brazil; University of Würzburg, Internal Medicine 2, Würzburg; University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg; Rheumatology Clinical Practice Erlangen, Erlangen; Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen; Asklepios Medical Center, Department of Rheumatology and clinical Immunology, Bad Abbach; Rheumatology Practice Bamberg, Bamberg; Rheumatology Practice Bayreuth, Bayreuth; University of Heidelberg, Medicine 5, Heidelberg; Rheumatology Practice Nuremberg, Nuremberg; Schlosspark Klinik, Internal Medicine/Rheumatology, Berlin; University of Tübingen, Centre for Interdisciplinary Clinical Immunology, Tübingen; Praxiszentrum St. Bonifatius, Munich, Germany. .,M. Hagen, BSc, CandMed, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; M. Englbrecht, PhD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Haschka, MD, St. Vincent Hospital, Vinforce Study Group, Medical University of Vienna; M. Reiser, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Kleyer, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; A. Hueber, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; B. Manger, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; C. Figueiredo, MD, Institutio de Rheumatologia; J. Fogagnolo Cobra, MD, Institutio de Rheumatologia; H.P. Tony, MD, University of Würzburg, Internal Medicine 2; S. Finzel, MD, University Medical Center Freiburg, Rheumatology and Clinical Immunology; S. Kleinert, MD, Rheumatology Clinical Practice Erlangen; J. Wendler, MD, Rheumatology Clinical Practice Erlangen; F. Schuch, MD, Rheumatology Clinical Practice Erlangen; M. Ronneberger, MD, Rheumatology Clinical Practice Erlangen; M. Feuchtenberger, MD, Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen; M. Fleck, MD, Asklepios Medical Center, Department of Rheumatology and clinical Immunology; K. Manger, MD, Rheumatology Practice Bamberg; W. Ochs, MD, Rheumatology Practice Bayreuth; H.M. Lorenz, MD, University of Heidelberg, Medicine 5; H. Nüsslein, MD, Rheumatology Practice Nuremberg; R. Alten, MD, Schlosspark Klinik, Internal Medicine/Rheumatology; J. Henes, MD, University of Tübingen, Centre for Interdisciplinary Clinical Immunology; K. Krüger, MD, Praxiszentrum St. Bonifatius; G. Schett, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen; J. Rech, MD, FAU, Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen.
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Simons G, Stack RJ, Stoffer-Marx M, Englbrecht M, Mosor E, Buckley CD, Kumar K, Hansson M, Hueber A, Stamm T, Falahee M, Raza K. Perceptions of first-degree relatives of patients with rheumatoid arthritis about lifestyle modifications and pharmacological interventions to reduce the risk of rheumatoid arthritis development: a qualitative interview study. BMC Rheumatol 2018; 2:31. [PMID: 30886981 PMCID: PMC6390593 DOI: 10.1186/s41927-018-0038-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/24/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is increasing interest in the identification of people at risk of rheumatoid arthritis (RA) to monitor the emergence of early symptoms (and thus allow early therapy), offer lifestyle advice to reduce the impact of environmental risk factors and potentially offer preventive pharmacological treatment for those at high risk. Close biological relatives of people with RA are at an increased risk of developing RA and are therefore potential candidates for research studies, screening initiatives and preventive interventions. To ensure the success of approaches of this kind, a greater understanding of the perceptions of this group relating to preventive measures is needed. METHODS Twenty-four first-degree relatives of patients with an existing diagnosis of RA from the UK, three from Germany and seven from Austria (age: 21-67 years) took part in semi-structured interviews exploring their perceptions of RA risk, preventive medicine and lifestyle changes to reduce RA risk. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Many first-degree relatives indicated that they anticipated being happy to make lifestyle changes such as losing weight or changing their diet to modify their risk of developing RA. Participants further indicated that in order to make any lifestyle changes it would be useful to know their personal risk of developing RA. Others implied they would not contemplate making lifestyle changes, including stopping smoking, unless this would significantly reduce or eliminate their risk of developing RA. Many first-degree relatives had more negative perceptions about taking preventive medication to reduce their risk of RA, and listed concerns about potential side effects as one of the reasons for not wanting to take preventive medicines. Others would be more willing to consider drug interventions although some indicated that they would wish to wait until symptoms developed. CONCLUSIONS Information targeted at those considered to be at risk of RA should contain information about RA, the extent to which risk can be quantified at an individual level and how risk levels may differ depending on whether early symptoms are present. The benefits (and risks) of lifestyle changes and pharmacological interventions as potential preventive measures should be clearly described.
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Affiliation(s)
- Gwenda Simons
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Rebecca J Stack
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Psychology, Nottingham Trent University, 50 Shakespeare St, Nottingham, NG1 4FQ UK
| | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- University of Applied Sciences FH Campus Wien, Vienna, 1100 Austria
| | - Matthias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Internistisches Zentrum (INZ), Ulmenweg 18, 91054 Erlangen, Germany
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christopher D Buckley
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research and NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kanta Kumar
- The Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL UK
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden
| | - Axel Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Internistisches Zentrum (INZ), Ulmenweg 18, 91054 Erlangen, Germany
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marie Falahee
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Karim Raza
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research and NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Simon D, Kleyer A, Englbrecht M, Stemmler F, Simon C, Berlin A, Kocijan R, Haschka J, Hirschmann S, Atreya R, Neurath MF, Sticherling M, Rech J, Hueber AJ, Engelke K, Schett G. A comparative analysis of articular bone in large cohort of patients with chronic inflammatory diseases of the joints, the gut and the skin. Bone 2018; 116:87-93. [PMID: 30048820 DOI: 10.1016/j.bone.2018.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/12/2018] [Accepted: 07/22/2018] [Indexed: 12/23/2022]
Abstract
Chronic inflammatory diseases are associated with bone loss. While the occurrence of systemic bone loss is well described in chronic inflammatory diseases, the impact of these conditions on articular bone has not been systematically investigated. Recent refinements in high-resolution CT assessment of the joints now allow the accurate measure of articular bone composition. In this study 476 subjects comprising healthy individuals and patients with anticitrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA), ACPA-negative RA, Crohn's disease (CD), ulcerative colitis (UC), psoriasis (PsO) and psoriatic arthritis (PsA) were subjected to high-resolution quantitative computed tomography (HR-pQCT) of the hand. Metacarpal heads were assessed for total, trabecular and cortical volumetric bone mineral density (vBMD). Only ACPA+RA, but not the remaining inflammatory diseases (ACPA-RA, CD, UC, PsO, PsA) showed significant (p < 0.001) loss of articular bone affecting both the trabecular and the cortical compartments. Age and body mass index were also associated with articular bone changes, the former with lower, the latter with higher articular bone mass. In multivariate models, presence of ACPA+RA was an independent factor for articular bone loss. Among chronic inflammatory diseases ACPA+RA is the most potent precipitator for articular bone loss pointing out the role of autoimmunity in the development of articular bone disease in the context of chronic inflammatory disease.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Simon Hirschmann
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Raja Atreya
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
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Simon D, Kleyer A, Faustini F, Englbrecht M, Haschka J, Berlin A, Kraus S, Hueber AJ, Kocijan R, Sticherling M, Rech J, Schett G. Simultaneous quantification of bone erosions and enthesiophytes in the joints of patients with psoriasis or psoriatic arthritis - effects of age and disease duration. Arthritis Res Ther 2018; 20:203. [PMID: 30170626 PMCID: PMC6117875 DOI: 10.1186/s13075-018-1691-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/31/2018] [Indexed: 12/25/2022] Open
Abstract
Background Comprehensive simultaneous quantification of bone erosion and enthesiophytes in the joints of patients with psoriatic arthritis (PsA) has not been performed. Herein, we aimed to compare the extent of bone erosion and enthesiophytes in patients with PsA, psoriasis (PSO) and healthy controls, assess the influence of age and disease duration on the development of erosions and enthesiophytes and define their impact on physical function. Methods Patients with PsA or with PSO and controls were analysed by high-resolution peripheral quantitative computed tomography (HR-pQCT). The extent of bone erosions and enthesiophytes was assessed and plotted according to different categories of age, duration of PSO and duration of PsA, respectively. In addition, demographic and disease-specific data, including physical function (health assessment questionnaire) were collected. Results A total of 203 patients were analysed; 101 had PsA, 55 had PSO and 47 were healthy individuals. Patients with PsA had significantly more and larger erosions (p = 0.002/p = 0.003) and enthesiophytes (p < 0.001) compared to patients with PSO and healthy controls. Patients with PSO and healthy controls did not differ in erosions, while enthesiophytes were more frequent in patients with PSO than in healthy controls. Bone erosions, but not enthesiophytes, showed strong age-dependency in all three groups. In contrast, enthesiophytes were mostly influenced by the duration of PSO and PsA and, in contrast to bone erosions, were associated with poorer physical function. Conclusions Bone erosions are age-dependent, enhanced in PsA and increase with disease duration. Enthesiophytes are less age-dependent, are enhanced in both PSO and PsA and strongly influenced by disease duration. Enthesiophytes impact physical function in PsA suggesting the need for early therapeutic interventions to prevent damage.
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Affiliation(s)
- David Simon
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Francesca Faustini
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Judith Haschka
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.,St. Vincent Hospital, Medical Department II, the VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Andreas Berlin
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Sebastian Kraus
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Axel J Hueber
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - Roland Kocijan
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.,St. Vincent Hospital, Medical Department II, the VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Michael Sticherling
- Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Juergen Rech
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
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Neumann A, Haschka J, Kleyer A, Schuster L, Englbrecht M, Berlin A, Figueiredo CP, Simon D, Muschitz C, Kocijan R, Resch H, Rech J, Schett G. Cortical bone loss is an early feature of nonradiographic axial spondyloarthritis. Arthritis Res Ther 2018; 20:202. [PMID: 30165891 PMCID: PMC6117894 DOI: 10.1186/s13075-018-1620-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
Abstract
Background In the present study, we investigated bone geometry, microstructure, and volumetric bone mineral density (vBMD) in a cohort of patients with nonradiographic axial spondyloarthritis (nr-axSpA) in order to define the early bone changes occurring in axial spondyloarthritis (axSpA) and to define potential factors for deterioration of bone microstructure. Methods Patients with axSpA (n = 107) and healthy control subjects (n = 50) of similar age and sex were assessed for geometric, volumetric, and microstructural parameters of bone using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius. Additionally, demographic and disease-specific characteristics of patients with axSpA were recorded. Results Patients with nr-axSpA and control subjects were comparable in age, sex, and body mass index. Geometric and microstructural analysis by HR-pQCT revealed a significantly reduced cortical area (p = 0.022) and cortical thickness (p = 0.006) in patients with nr-axSpA compared with control subjects. Total and cortical vBMD were significantly reduced in patients with nr-axSpA (p = 0.042 and p = 0.007, respectively), whereas there was no difference in trabecular vBMD. Patients with a short disease duration (< 2 years; n = 46) also showed significant reduction of cortical thickness and cortical area compared with control subjects. Patients with disease duration > 2 years (n = 55) additionally developed a decrease of cortical and total vBMD. Multiple regression models identified male sex to be associated with lower cortical vBMD and female sex to be associated with lower trabecular vBMD. Conclusions Bone microstructure in patients with nr-axSpA is characterized primarily by deterioration of cortical bone. Cortical bone loss starts early and is evident within the first 2 years of the disease. Electronic supplementary material The online version of this article (10.1186/s13075-018-1620-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Neumann
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Louis Schuster
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Camille P Figueiredo
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David Simon
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christian Muschitz
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Roland Kocijan
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Heinrich Resch
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Jürgen Rech
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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Kampylafka E, d'Oliveira I, Linz C, Lerchen V, Stemmler F, Simon D, Englbrecht M, Sticherling M, Rech J, Kleyer A, Schett G, Hueber AJ. Resolution of synovitis and arrest of catabolic and anabolic bone changes in patients with psoriatic arthritis by IL-17A blockade with secukinumab: results from the prospective PSARTROS study. Arthritis Res Ther 2018; 20:153. [PMID: 30053825 PMCID: PMC6063019 DOI: 10.1186/s13075-018-1653-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/27/2018] [Indexed: 01/14/2023] Open
Abstract
Background Although the effects of interleukin-17A (IL-17A) inhibition on the signs and symptoms of psoriatic arthritis (PsA) are well defined, little is known about its impact of local inflammatory and structural changes in the joints. The PSARTROS study was designed to elucidate the effects of IL-17A inhibition on inflammation and bone changes in joints affected by PsA. Methods This was a prospective open-label study in 20 patients with active PsA receiving 24 weeks of treatment with the IL-17A inhibitor secukinumab. Magnetic resonance imaging (MRI), power Doppler ultrasound (PDUS), and high-resolution peripheral quantitative computer tomography (HR-pQCT) of the hands were performed at baseline and after 24 weeks to assess synovitis, periarticular inflammation, bone erosion, enthesiophyte formation, and bone structure. Demographic and clinical measures of joint disease (DAPSA and DAS28-ESR), skin disease (PASI and BSA), and composite measures (minimal disease activity, or MDA) were also recorded. Results Treatment with secukinumab led to significant improvement of signs and symptoms of PsA; 46% reached MDA and 52% DAPSA low disease activity. MRI synovitis (P = 0.034) and signal in PDUS (P = 0.030) significantly decreased after 24 weeks of treatment. Bone erosions in MRI and HR-pQCT and enthesiophytes in the HR-pQCT did not show any progression, and structural integrity and functional bone strength remained stable. Conclusions IL-17 inhibition by secukinumab over 24 weeks led to a significant decrease of synovial inflammation and no progression of catabolic and anabolic bone changes in the joints of patients with PsA. Trial registration ClinicalTrials.gov Identifier: NCT02483234, June 26, 2015; retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13075-018-1653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleni Kampylafka
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Isabelle d'Oliveira
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christina Linz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Veronika Lerchen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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Hewlett S, Kirwan J, Bode C, Cramp F, Carmona L, Dures E, Englbrecht M, Fransen J, Greenwood R, Hagel S, van de Laar M, Molto A, Nicklin J, Petersson IF, Redondo M, Schett G, Gossec L. The revised Bristol Rheumatoid Arthritis Fatigue measures and the Rheumatoid Arthritis Impact of Disease scale: validation in six countries. Rheumatology (Oxford) 2018; 57:300-308. [PMID: 29087507 PMCID: PMC5850460 DOI: 10.1093/rheumatology/kex370] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To evaluate the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), the revised Bristol Rheumatoid Arthritis Numerical Rating Scales (BRAF-NRS V2) and the Rheumatoid Arthritis Impact of Disease (RAID) scale in six countries. Methods We surveyed RA patients in France, Germany, The Netherlands, Spain, Sweden and the UK, including the HAQ, 36-item Short Form Health Survey (SF-36) and potential revisions of the BRAF-NRS coping and Spanish RAID coping items. Factor structure and internal consistency were examined by factor analysis and Cronbach’s α and construct validity by Spearman’s correlation. Results A total of 1276 patients participated (76% female, 25% with a disease duration <5 years, median HAQ 1.0). The original BRAF-MDQ four-factor structure and RAID single-factor structure were confirmed in every country with ⩾66% of variation in items explained by each factor and all item factor loadings of 0.71–0.98. Internal consistency for the BRAF-MDQ total and subscales was a Cronbach’s α of 0.75–0.96 and for RAID, 0.93–0.96. Fatigue construct validity was shown for the BRAF-MDQ and BRAF-NRS severity and effect scales, correlated internally with SF-36 vitality and with RAID fatigue (r = 0.63–0.93). Broader construct validity for the BRAFs and RAID was shown by correlation with each other, HAQ and SF-36 domains (r = 0.46–0.82), with similar patterns in individual countries. The revised BRAF-NRS V2 Coping item had stronger validity than the original in all analyses. The revised Spanish RAID coping item performed as well as the original. Conclusion Across six European countries, the BRAF-MDQ identifies the same four aspects of fatigue, and along with the RAID, shows strong factor structure and internal consistency and moderate–good construct validity. The revised BRAF-NRS V2 shows improved construct validity and replaces the original.
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Affiliation(s)
- Sarah Hewlett
- Nursing & Midwifery, University of the West of England, Bristol, UK
| | - John Kirwan
- Musculoskeletal Research, Bristol University, Bristol, UK
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Twente, The Netherlands, Madrid, Spain
| | - Fiona Cramp
- Nursing & Midwifery, University of the West of England, Bristol, UK
| | | | - Emma Dures
- Nursing & Midwifery, University of the West of England, Bristol, UK
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jaap Fransen
- Rheumatology Department, Radboud University, Nijmegen, The Netherlands
| | - Rosemary Greenwood
- Department of Research and Innovation, Bristol Royal Infirmary, Bristol, UK
| | - Sofia Hagel
- Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Maart van de Laar
- Department of Psychology, Health and Technology, University of Twente, Twente, The Netherlands, Madrid, Spain
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Joanna Nicklin
- Department of Research and Innovation, Bristol Royal Infirmary, Bristol, UK
| | | | - Marta Redondo
- Department of Psychology, Universidad Camilo José Cela, Madrid, Spain
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Laure Gossec
- Rheumatology Department, Sorbonne Universites, UPMC Univ Paris 06, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
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Haberland K, Ackermann JA, Ipseiz N, Culemann S, Pracht K, Englbrecht M, Jäck HM, Schett G, Schuh W, Krönke G. Eosinophils are not essential for maintenance of murine plasma cells in the bone marrow. Eur J Immunol 2018; 48:822-828. [PMID: 29442374 DOI: 10.1002/eji.201747227] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/12/2017] [Revised: 01/02/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
Eosinophils were reported to serve as an essential component of the plasma cell niche within the bone marrow. As the potential contribution of eosinophils to humoral immunity has remained incompletely understood, we aimed to further characterize their role during antibody responses and to additionally investigate their role in autoimmune disease. Contrary to our expectations and the currently prevailing paradigm, we found that eosinophils are fully dispensable for the survival of murine bone marrow plasma cells and accordingly do not contribute to antibody production and autoantibody-mediated disease. Littermate wild type and eosinophil-deficient ΔdblGATA-1 animals showed similar numbers and frequencies of plasma cells and did not differ in steady state levels of immunoglobulins or their ability to raise antigen-specific antibody responses. Eosinophils were likewise dispensable for autoantibody production or autoantibody-induced disease in a mouse model of systemic lupus erythematosus. Our findings thus argue against a role of eosinophils during the maintenance of the plasma cell pool and challenge the hitherto postulated concept of an eosinophil-sustained bone marrow niche.
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Affiliation(s)
- Konrad Haberland
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jochen A Ackermann
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Natacha Ipseiz
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Culemann
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Pracht
- Division of Molecular Immunology, Department of Internal Medicine III, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hans-Martin Jäck
- Division of Molecular Immunology, Department of Internal Medicine III, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Schuh
- Division of Molecular Immunology, Department of Internal Medicine III, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,Nikolaus Fiebiger Center of Molecular Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
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Stemmler F, Simon D, Liphardt AM, Englbrecht M, Rech J, Hueber AJ, Engelke K, Schett G, Kleyer A. Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures. Ann Rheum Dis 2018; 77:973-980. [PMID: 29475856 PMCID: PMC6029639 DOI: 10.1136/annrheumdis-2017-212404] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Bone loss is a well-established consequence of rheumatoid arthritis (RA). To date, bone disease in RA is exclusively characterised by bone density measurements, while the functional properties of bone in RA are undefined. This study aimed to define the impact of RA on the functional properties of bone, such as failure load and stiffness. METHODS Micro-finite element analysis (µFEA) was carried out to measure failure load and stiffness of bone based on high-resolution peripheral quantitative CT data from the distal radius of anti-citrullinated protein antibody (ACPA)-positive RA (RA+), ACPA-negative RA (RA-) and healthy controls (HC). In addition, total, trabecular and cortical bone densities as well as microstructural parameters of bone were recorded. Correlations and multivariate models were used to determine the role of demographic, disease-specific and structural data of bone strength as well as its relation to prevalent fractures. RESULTS 276 individuals were analysed. Failure load and stiffness (both P<0.001) of bone were decreased in RA+, but not RA-, compared with HC. Lower bone strength affected both female and male patients with RA+, was related to longer disease duration and significantly (stiffness P=0.020; failure load P=0.012) associated with the occurrence of osteoporotic fractures. Impaired bone strength was correlated with altered bone density and microstructural parameters, which were all decreased in RA+. Multivariate models showed that ACPA status (P=0.007) and sex (P<0.001) were independently associated with reduced biomechanical properties of bone in RA. CONCLUSION In summary, µFEA showed that bone strength is significantly decreased in RA+ and associated with fractures.
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Affiliation(s)
- Fabian Stemmler
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna-Maria Liphardt
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
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Schönau V, Vogel K, Englbrecht M, Wacker J, Schmidt D, Manger B, Kuwert T, Schett G. The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis 2017; 77:70-77. [PMID: 28928271 DOI: 10.1136/annrheumdis-2017-211687] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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: 04/22/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are diagnostically challenging conditions. Diagnosis of underlying disease may be improved by 18F-fluorodesoxyglucose positron emission tomography (18F-FDG-PET). METHODS Prospective study to test diagnostic utility of 18F-FDG-PET/CT in a large cohort of patients with FUO or IUO and to define parameters that increase the likelihood of diagnostic 18F-FDG-PET/CT. Patients with FUO or IUO received 18F-FDG-PET/CT scanning in addition to standard diagnostic work-up. 18F-FDG-PET/CT results were classified as helpful or non-helpful in establishing final diagnosis. Binary logistic regression was used to identify clinical parameters associated with a diagnostic 18F-FDG-PET/CT. RESULTS 240 patients were enrolled, 72 with FUO, 142 with IUO and 26 had FUO or IUO previously (exFUO/IUO). Diagnosis was established in 190 patients (79.2%). The leading diagnoses were adult-onset Still's disease (15.3%) in the FUO group, large vessel vasculitis (21.1%) and polymyalgia rheumatica (18.3%) in the IUO group and IgG4-related disease (15.4%) in the exFUO/IUO group. In 136 patients (56.7% of all patients and 71.6% of patients with a diagnosis), 18F-FDG-PET/CT was positive and helpful in finding the diagnosis. Predictive markers for a diagnostic 18F-FDG-PET/CT were age over 50 years (p=0.019), C-reactive protein (CRP) level over 30 mg/L (p=0.002) and absence of fever (p=0.001). CONCLUSION 18F-FDG-PET/CT scanning is helpful in ascertaining the correct diagnosis in more than 50% of the cases presenting with FUO and IUO. Absence of intermittent fever, higher age and elevated CRP level increase the likelihood for a diagnostic 18F-FDG-PET/CT.
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Affiliation(s)
- Verena Schönau
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Kristin Vogel
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Jochen Wacker
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Daniela Schmidt
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
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Werner D, Simon D, Englbrecht M, Stemmler F, Simon C, Berlin A, Haschka J, Renner N, Buder T, Engelke K, Hueber AJ, Rech J, Schett G, Kleyer A. Early Changes of the Cortical Micro-Channel System in the Bare Area of the Joints of Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2017; 69:1580-1587. [PMID: 28493323 DOI: 10.1002/art.40148] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/04/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To characterize the specific structural properties of the erosion-prone bare area of the human joint, and to search for early microstructural changes in this region during rheumatoid arthritis (RA). METHODS In the initial part of the study, human cadaveric hand joints were examined for exact localization of the bare area of the metacarpal heads, followed by detection of cortical micro-channels (CoMiCs) in this region by high-resolution peripheral quantitative computed tomography (HR-pQCT) and, after anatomic dissection, validation of the presence of CoMiCs by micro-computed tomography (micro-CT). In the second part of the study, the number and distribution of CoMiCs were analyzed in 107 RA patients compared to 105 healthy individuals of similar age and sex distribution. RESULTS Investigation by HR-pQCT combined with adaptive thresholding allowed the detection of CoMiCs in the bare area of human cadaveric joints. The existence of CoMiCs in the bare area was additionally validated by micro-CT. In healthy individuals, the number of CoMiCs increased with age. RA patients showed significantly more CoMiCs compared to healthy individuals (mean ± SD 112.9 ± 54.7/joint versus 75.2 ± 41.9/joint; P < 0.001), with 20-49-year-old RA patients exhibiting similar numbers of CoMiCs as observed in healthy individuals older than age 65 years. Importantly, CoMiCs were already found in RA patients very early in their disease course, with enrichment in the erosion-prone radial side of the joint. CONCLUSION CoMiCs represent a new form of structural change in the joints of patients with RA. Although the number of CoMiCs increases with age, RA patients develop CoMiCs much earlier in life, and such changes can even occur at the onset of the disease. CoMiCs therefore represent an interesting new opportunity to assess structural changes in RA.
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Affiliation(s)
- David Werner
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Stemmler
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christoph Simon
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Berlin
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | - Nina Renner
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thomas Buder
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich-Alexander University Erlangen-Nuernberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Simon D, Kleyer A, Stemmler F, Simon C, Berlin A, Hueber AJ, Haschka J, Renner N, Figueiredo C, Neuhuber W, Buder T, Englbrecht M, Rech J, Engelke K, Schett G. Age- and Sex-Dependent Changes of Intra-articular Cortical and Trabecular Bone Structure and the Effects of Rheumatoid Arthritis. J Bone Miner Res 2017; 32:722-730. [PMID: 27787923 DOI: 10.1002/jbmr.3025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 12/22/2022]
Abstract
The objective of this cross-sectional study was to define normal sex- and age-dependent values of intra-articular bone mass and microstructures in the metacarpal heads of healthy individuals by high-resolution peripheral quantitative computed tomography (HR-pQCT) and test the effect of rheumatoid arthritis (RA) on these parameters. Human cadaveric metacarpal heads were used to exactly define intra-articular bone. Healthy individuals of different sex and age categories and RA patients with similar age and sex distribution received HR-pQCT scans of the second metacarpal head and the radius. Total, cortical, and trabecular bone densities as well as microstructural parameters were compared between 1) the different ages and sexes in healthy individuals; 2) between metacarpal heads and the radius; and 3) between healthy individuals and RA patients. The cadaveric study allowed exact definition of the intra-articular (intracapsular) bone margins. These data were applied in measuring intra-articular and radial bone parameters in 214 women and men (108 healthy individuals, 106 RA patients). Correlations between intra-articular and radial bone parameters were good (r = 0.51 to 0.62, p < 0.001). In contrast to radial bone, intra-articular bone remained stable until age 60 years (between 297 and 312 mg HA/cm3 ) but decreased significantly (p < 0.001) in women thereafter (237.5 ± 44.3) with loss of both cortical and trabecular bone. Similarly, RA patients showed significant (p < 0.001) loss of intra-articular total (263.0 ± 44.8), trabecular (171.2 ± 35.6), and cortical bone (610.2 ± 62.0) compared with sex- and age-adjusted controls. Standard sex- and age-dependent values for physiological intra-articular bone were defined. Postmenopausal state and RA led to significant decrease of intra-articular bone. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Nina Renner
- Department of Trauma and Orthopaedic Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Camille Figueiredo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.,Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Winfried Neuhuber
- Institute of Anatomy, Department I, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Buder
- Institute of Anatomy, Department I, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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Kleyer A, Beyer L, Simon C, Stemmler F, Englbrecht M, Beyer C, Rech J, Manger B, Krönke G, Schett G, Hueber AJ. Development of three-dimensional prints of arthritic joints for supporting patients' awareness to structural damage. Arthritis Res Ther 2017; 19:34. [PMID: 28187783 PMCID: PMC5303254 DOI: 10.1186/s13075-017-1234-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/18/2016] [Accepted: 01/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) result in severe joint destruction and functional disability if left untreated. We aim to develop tools that help patients with RA and PsA to understand and experience the impact of inflammatory joint disease on the integrity of their (juxta-articular) bone and increase adherence to medical treatment. In this study, we used high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop 3D prototypes of patients’ finger joints. Methods HR-pQCT (XtremeCT, Scanco) measurements were performed in healthy individuals and patients with inflammatory joint disease, followed by a 3D print using the objet30 printer. Healthy participants (n = 10), and patients (n = 15 with RA and 15 with PsA) underwent a detailed, standardized interview with demonstration of printed joints. Results Utilizing HR-pQCT images of metacarpophalangeal (MCP) heads, high quality and exact 3D prints as prototypes were created. Erosions in different sizes and the trabecular network printed in detail were visualized, demonstrating structural reduction in arthritic vs. healthy bone. After demonstration of 3D prints (healthy vs. erosive joint, visual and haptic) 26/39 (66%) participants (including healthy volunteers) were deeply affected, often quoting “shock”. Of the patients with RA and PsA, 13/15 (86%) and 11/15 (73%), respectively, stated that they would rethink their attitude to medication adherence. More importantly, 21/24 patients with RA or PsA (87.5%) expressed that they would have wished to see such 3D prints during their first disease-specific conversations. Conclusion Using arthro-haptic 3D printed prototypes of joints may help to better understand the impact of inflammatory arthritides on bone integrity and long-term damage. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1234-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Laura Beyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christian Beyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 90154, Erlangen, Germany.
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Hirschmann S, Atreya R, Englbrecht M, Neurath MF. Safety and efficacy of intravenous cyclophosphamide pulse therapy in therapy refractory Crohn's disease patients. J Physiol Pharmacol 2017; 68:57-67. [PMID: 28456770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/24/2017] [Indexed: 06/07/2023]
Abstract
A major challenge in the management of persistently active Crohn's disease patient's refractory to treatment regimen following the current guidelines is the induction of remission, which is a prerequisite for subsequent maintenance therapy. The aim of this study was to evaluate both the clinical and endoscopic benefit of intravenous cyclophosphamide pulse therapy in patients with active and therapy refractory Crohn's disease. Nine patients with acute moderate to severe Crohn's disease, not responding to conventional as well as biological therapy regimen received 3 - 9 cycles of monthly treatments with intravenous cyclophosphamide (680 - 1000 mg) in an uncontrolled setting and were retrospectively analyzed. Eight of nine patients (88.9%) had a clinical response (measured by a decrease in the Harvey-Bradshaw index, HBI ≥ 3) and two of nine patients (22.2%) achieved clinical remission (HBI ≤ 4) at week 8 after two applications of intravenous cyclophosphamide therapy. These response and remission rates remained unchanged after individual completion of cyclophosphamide therapy. Median HBI decreased from 18 (7 - 25) at the beginning of therapy to 7 (3 - 18) at week 8. 5 of 9 patients (56%) showed endoscopic response (defined by a reduction of ulcers) and one patient (11%) reached endoscopic remission (defined by the absence of ulcers) after the last application of cyclophosphamide. Arthralgia, which was present in 4 of 9 (44%) patients, was unchanged in most patients after cyclophosphamide therapy, although one patient described a marked reduction in joint pain. Cyclophosphamide pulse therapy was well tolerated during the whole treatment course in all subjects. One patient with long-standing Crohn's disease was diagnosed with a high-grade intraepithelial neoplasia in the rectum and underwent surgical intervention, where the diagnosis of an early stage adenocarcinoma was made. We concluded that intravenous cyclophosphamide pulse therapy was well tolerated by most patients and effective for inducing clinical and endoscopic response and remission in patients with therapy refractory Crohn's disease. In patients who are unresponsive to available therapies, including available biological treatment options, cyclophosphamide therefore represents a potential option to induce therapeutic response, which must then be maintained by other treatment modalities.
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Affiliation(s)
- S Hirschmann
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - R Atreya
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - M Englbrecht
- Medical Clinic 3, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany
| | - M F Neurath
- Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nurnberg, Germany.
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Englbrecht M, Alten R, Aringer M, Baerwald CG, Burkhardt H, Eby N, Fliedner G, Gauger B, Henkemeier U, Hofmann MW, Kleinert S, Kneitz C, Krueger K, Pohl C, Roske AE, Schett G, Schmalzing M, Tausche AK, Peter Tony H, Wendler J. Validation of Standardized Questionnaires Evaluating Symptoms of Depression in Rheumatoid Arthritis Patients: Approaches to Screening for a Frequent Yet Underrated Challenge. Arthritis Care Res (Hoboken) 2016; 69:58-66. [DOI: 10.1002/acr.23002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/08/2016] [Accepted: 07/26/2016] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Martin Aringer
- University Clinical Center Carl Gustav Carus, Technical University of Dresden; Dresden Germany
| | | | - Harald Burkhardt
- Johann Wolfgang Goethe University Frankfurt am Main; Frankfurt Germany
| | - Nancy Eby
- AMS Advanced Medical Services GmbH; Mannheim Germany
| | | | | | - Ulf Henkemeier
- University Hospital Frankfurt am Main Goethe-University; Frankfurt Germany
| | | | | | - Christian Kneitz
- Klinikum Suedstadt Rostock, Klinik für Innere Medizin II; Rostock Germany
| | | | | | | | - Georg Schett
- University of Erlangen-Nuremberg; Erlangen Germany
| | | | - Anne-Kathrin Tausche
- University Clinical Center Carl Gustav Carus, Technical University of Dresden; Dresden Germany
| | | | - Joerg Wendler
- Rheumatologische Schwerpunktpraxis; Erlangen Germany
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Figueiredo CP, Simon D, Englbrecht M, Haschka J, Kleyer A, Bayat S, Hueber A, Pereira RMR, Rech J, Schett G. Quantification and Impact of Secondary Osteoarthritis in Patients With Anti-Citrullinated Protein Antibody-Positive Rheumatoid Arthritis. Arthritis Rheumatol 2016; 68:2114-21. [DOI: 10.1002/art.39698] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/24/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Camille P. Figueiredo
- University of Erlangen-Nuremberg, Erlangen, Germany, and Universidade de São Paulo; São Paulo Brazil
| | - David Simon
- University of Erlangen-Nuremberg; Erlangen Germany
| | | | - Judith Haschka
- University of Erlangen-Nuremberg, Erlangen, Germany, and St. Vincent Hospital; Vienna Austria
| | - Arnd Kleyer
- University of Erlangen-Nuremberg; Erlangen Germany
| | - Sara Bayat
- University of Erlangen-Nuremberg; Erlangen Germany
| | - Axel Hueber
- University of Erlangen-Nuremberg; Erlangen Germany
| | | | - Juergen Rech
- University of Erlangen-Nuremberg; Erlangen Germany
| | - Georg Schett
- University of Erlangen-Nuremberg; Erlangen Germany
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Englbrecht M, Alten R, Aringer M, Baerwald C, Burkhardt H, Eby N, Flacke JP, Fliedner G, Gauger B, Henkemeier U, Hofmann M, Kleinert S, Kneitz C, Krüger K, Lüthje R, Pohl C, Schett G, Schmalzing M, Tausche AK, Tony H, Wendler J. FRI0142 High Prevalence of Depression in Patients with Rheumatoid Arthritis - Data from The Large Cross-Sectional Vadera II Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Figueiredo CP, Bang H, Cobra JF, Englbrecht M, Hueber AJ, Haschka J, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Wendler J, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Rech J, Schett G. Antimodified protein antibody response pattern influences the risk for disease relapse in patients with rheumatoid arthritis tapering disease modifying antirheumatic drugs. Ann Rheum Dis 2016; 76:399-407. [PMID: 27323772 DOI: 10.1136/annrheumdis-2016-209297] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 01/31/2016] [Revised: 04/26/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To perform a detailed analysis of the autoantibody response against post-translationally modified proteins in patients with rheumatoid arthritis (RA) in sustained remission and to explore whether its composition influences the risk for disease relapse when tapering disease modifying antirheumatic drug (DMARD) therapy. METHODS Immune responses against 10 citrullinated, homocitrullinated/carbamylated and acetylated peptides, as well as unmodified vimentin (control) and cyclic citrullinated peptide 2 (CCP2) were tested in baseline serum samples from 94 patients of the RETRO study. Patients were classified according to the number of autoantibody reactivities (0-1/10, 2-5/10 and >5/10) or specificity groups (citrullination, carbamylation and acetylation; 0-3) and tested for their risk to develop relapses after DMARD tapering. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining the role of autoantibodies in predicting relapse. RESULTS Patients varied in their antimodified protein antibody response with the extremes from recognition of no (0/10) to all antigens (10/10). Antibodies against citrullinated vimentin (51%), acetylated ornithine (46%) and acetylated lysine (37%) were the most frequently observed subspecificities. Relapse risk significantly (p=0.011) increased from 18% (0-1/10 reactivities) to 34% (2-5/10) and 55% (>5/10). With respect to specificity groups (0-3), relapse risk significantly (p=0.021) increased from 18% (no reactivity) to 28%, 36% and finally to 52% with one, two or three antibody specificity groups, respectively. CONCLUSIONS The data suggest that the pattern of antimodified protein antibody response determines the risk of disease relapse in patients with RA tapering DMARD therapy. TRIAL REGISTRATION NUMBER 2009-015740-42; Results.
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Affiliation(s)
- Camille P Figueiredo
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.,Division of Rheumatology, Universidade des Sao Paulo, Sao Paulo, Brazil
| | | | | | - Matthias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 2, The Vinforce Study Group, Saint Vincent Hospital, Vienna, Austria
| | - Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michaela Reiser
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Finzel
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine 2, University of Wurzburg, Wurzburg, Germany
| | | | | | | | | | - Martin Feuchtenberger
- Rheumatology Practice and Department of Internal Medicine 2, Clinic Burghausen, Burghausen, Germany
| | - Martin Fleck
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Germany
| | | | | | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,ACURA Center for Rheumatic Diseases Baden-Baden, Baden-Baden, Germany
| | | | | | - Joerg Henes
- Department of Internal Medicine 2, University of Tubingen, Tubingen, Germany
| | | | - Jürgen Rech
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
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Faustini F, Simon D, Oliveira I, Kleyer A, Haschka J, Englbrecht M, Cavalcante A, Kraus S, Tabosa T, Figueiredo C, Hueber A, Kocijan R, Cavallaro A, Schett G, Sticherling M, Rech J. THU0372 Subclinical Joint Inflammation in Psoriasis Patients without Concomitant Psoriatic Arthritis- A Cross-Sectional and Longitudinal Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simon D, Nas K, Faustini F, Kleyer A, Haschka J, Englbrecht M, Hueber A, Kocijan R, Sticherling M, Schett G, Rech J. AB0946 S100A8 but Not S100A9 Level Is Related To The Extent of Erosive Bone Damage in Psoriatic Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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Hagen M, Figueiredo C, Cobra J, Reiser M, Haschka J, Englbrecht M, Hueber A, Manger B, Kleyer A, Finzel S, Tony HP, Wendler J, Kleinert S, Schuch F, Ronneberger M, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Lorenz HM, Nuesslein H, Alten R, Henes J, Krueger K, Schett G, Rech J. SAT0065 Effects of Dmard Tapering on Treatment Costs in Rheumatoid Arthritis Patients- An Analysis from The Prospective Randomized Controlled Retro- Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Simon D, Kleyer A, Stemmler F, Simon C, Hueber A, Kampylafka E, Englbrecht M, Figueiredo C, Engelke K, Berlin A, Haschka J, Rech J, Schett G. SAT0543 Accurate Determination of Periarticular Bone Composition in Healthy Individuals and Comparison To Acpa-Positive Rheumatoid Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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