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Zampaloni C, Mattei P, Bleicher K, Winther L, Thäte C, Bucher C, Adam JM, Alanine A, Amrein KE, Baidin V, Bieniossek C, Bissantz C, Boess F, Cantrill C, Clairfeuille T, Dey F, Di Giorgio P, du Castel P, Dylus D, Dzygiel P, Felici A, García-Alcalde F, Haldimann A, Leipner M, Leyn S, Louvel S, Misson P, Osterman A, Pahil K, Rigo S, Schäublin A, Scharf S, Schmitz P, Stoll T, Trauner A, Zoffmann S, Kahne D, Young JAT, Lobritz MA, Bradley KA. A novel antibiotic class targeting the lipopolysaccharide transporter. Nature 2024; 625:566-571. [PMID: 38172634 PMCID: PMC10794144 DOI: 10.1038/s41586-023-06873-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/20/2022] [Accepted: 11/16/2023] [Indexed: 01/05/2024]
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major global pathogen with limited treatment options1. No new antibiotic chemical class with activity against A. baumannii has reached patients in over 50 years1. Here we report the identification and optimization of tethered macrocyclic peptide (MCP) antibiotics with potent antibacterial activity against CRAB. The mechanism of action of this molecule class involves blocking the transport of bacterial lipopolysaccharide from the inner membrane to its destination on the outer membrane, through inhibition of the LptB2FGC complex. A clinical candidate derived from the MCP class, zosurabalpin (RG6006), effectively treats highly drug-resistant contemporary isolates of CRAB both in vitro and in mouse models of infection, overcoming existing antibiotic resistance mechanisms. This chemical class represents a promising treatment paradigm for patients with invasive infections due to CRAB, for whom current treatment options are inadequate, and additionally identifies LptB2FGC as a tractable target for antimicrobial drug development.
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Affiliation(s)
- Claudia Zampaloni
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Patrizio Mattei
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Konrad Bleicher
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- SixPeaks Bio, Basel, Switzerland
| | - Lotte Winther
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Claudia Thäte
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- Preclinical Sciences and Translational Safety, Janssen Pharmaceutica, Beerse, Belgium
| | - Christian Bucher
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Jean-Michel Adam
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- AutoChem R&D, Mettler-Toledo International, Greifensee, Switzerland
| | - Alexander Alanine
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- Independent consultant, Cambridge, Great Britain
| | - Kurt E Amrein
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Vadim Baidin
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Christoph Bieniossek
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Caterina Bissantz
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Franziska Boess
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Carina Cantrill
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Thomas Clairfeuille
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Fabian Dey
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Patrick Di Giorgio
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Pauline du Castel
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - David Dylus
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Pawel Dzygiel
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Antonio Felici
- Discovery Microbiology, Aptuit (Verona) Srl, an Evotec Company, Verona, Italy
| | - Fernando García-Alcalde
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Andreas Haldimann
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Matthew Leipner
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Semen Leyn
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Séverine Louvel
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Pauline Misson
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Andrei Osterman
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Karanbir Pahil
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Sébastien Rigo
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Adrian Schäublin
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- SixPeaks Bio, Basel, Switzerland
| | - Sebastian Scharf
- Roche Pharma Research and Early Development, Informatics, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Petra Schmitz
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Theodor Stoll
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Andrej Trauner
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Sannah Zoffmann
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
- Therapeutics Discovery, Janssen Pharmaceutica, Beerse, Belgium
| | - Daniel Kahne
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - John A T Young
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Michael A Lobritz
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland.
| | - Kenneth A Bradley
- Roche Pharma Research and Early Development, Immunology, Infectious Disease and Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland.
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Richter K, Rufer AC, Muller M, Burger D, Casagrande F, Grossenbacher T, Huber S, Hug MN, Koldewey P, D'Osualdo A, Schlatter D, Stoll T, Rudolph MG. Reply to Alarcon and Borroto: Small molecule AX-024 reduces T cell proliferation independently of CD3ε-Nck1 interaction at SH3.1. J Biol Chem 2020; 295:10077. [PMID: 32680972 DOI: 10.1074/jbc.rl120.014441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kirsten Richter
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Arne C Rufer
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Magali Muller
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Dominique Burger
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Fabio Casagrande
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Tabea Grossenbacher
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Sylwia Huber
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Melanie N Hug
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Philipp Koldewey
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Andrea D'Osualdo
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Daniel Schlatter
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Theodor Stoll
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Markus G Rudolph
- pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Richter K, Rufer AC, Muller M, Burger D, Casagrande F, Grossenbacher T, Huber S, Hug MN, Koldewey P, D'Osualdo A, Schlatter D, Stoll T, Rudolph MG. Small molecule AX-024 reduces T cell proliferation independently of CD3ϵ/Nck1 interaction, which is governed by a domain swap in the Nck1-SH3.1 domain. J Biol Chem 2020; 295:7849-7864. [PMID: 32317279 PMCID: PMC7278359 DOI: 10.1074/jbc.ra120.012788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Activation of the T cell receptor (TCR) results in binding of the adapter protein Nck (noncatalytic region of tyrosine kinase) to the CD3ϵ subunit of the TCR. The interaction was suggested to be important for the amplification of TCR signals and is governed by a proline-rich sequence (PRS) in CD3ϵ that binds to the first Src homology 3 (SH3) domain of Nck (Nck-SH3.1). Inhibition of this protein/protein interaction ameliorated inflammatory symptoms in mouse models of multiple sclerosis, psoriasis, and asthma. A small molecule, AX-024, was reported to inhibit the Nck/CD3ϵ interaction by physically binding to the Nck1-SH3.1 domain, suggesting a route to develop an inhibitor of the Nck1/CD3ϵ interaction for modulating TCR activity in autoimmune and inflammatory diseases. We show here that AX-024 reduces T cell proliferation upon weak TCR stimulation but does not significantly affect phosphorylation of Zap70 (ζ chain of T cell receptor–associated protein kinase 70). We also find that AX-024 is likely not involved in modulating the Nck/TCR interaction but probably has other targets in T cells. An array of biophysical techniques did not detect a direct interaction between AX-024 and Nck-SH3.1 in vitro. Crystal structures of the Nck-SH3.1 domain revealed its binding mode to the PRS in CD3ϵ. The SH3 domain tends to generate homodimers through a domain swap. Domain swaps observed previously in other SH3 domains indicate a general propensity of this protein fold to exchange structural elements. The swapped form of Nck-SH3.1 is unable to bind CD3ϵ, possibly representing an inactive form of Nck in cells.
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Affiliation(s)
- Kirsten Richter
- I2O Disease Translational Area, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Arne C Rufer
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Magali Muller
- I2O Disease Translational Area, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Dominique Burger
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Fabio Casagrande
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Tabea Grossenbacher
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Sylwia Huber
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Melanie N Hug
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Philipp Koldewey
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Andrea D'Osualdo
- I2O Disease Translational Area, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Daniel Schlatter
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Theodor Stoll
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Markus G Rudolph
- Therapeutic Modalities, Lead Discovery and Medicinal Chemistry, pRED Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
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Stoll T, Zafeiropoulos G, Dogan I, Genuit H, Lavrijsen R, Koopmans B, Tsampas M. Visible-light-promoted gas-phase water splitting using porous WO 3 /BiVO 4 photoanodes. Electrochem commun 2017. [DOI: 10.1016/j.elecom.2017.07.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jarrett JW, Yi C, Stoll T, Rehault J, Oriana A, Branchi F, Cerullo G, Knappenberger KL. Dissecting charge relaxation pathways in CdSe/CdS nanocrystals using femtosecond two-dimensional electronic spectroscopy. Nanoscale 2017; 9:4572-4577. [PMID: 28321446 DOI: 10.1039/c7nr00654c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Exciton relaxation dynamics of CdSe and quasi-type-II CdSe/CdS core/shell nanocrystals were examined using femtosecond two-dimensional electronic spectroscopy (2DES). The use of 2DES allowed for determination of structure-specific and state-resolved carrier dynamics for CdSe nanocrystals formed with five, or fewer, CdS passivation monolayers (ML). For CdSe and CdSe/CdS nanocrystals formed with one through three MLs of CdS, excitation using broad bandwidth femtosecond visible laser pulses generated electron-hole pairs among the |X1〉 = 2.14 eV and |X2〉 = 2.27 eV exciton states. For both excitations, the electron is promoted to the lowest energy excited (1Se) conduction-band state and the hole is in the 1S3/2 (X1) or 2S3/2 (X2) valence-band state. Therefore, the relaxation dynamics of the hot hole were isolated by monitoring the-time-dependent amplitude of 2DES cross peaks. The time constant for hot hole relaxation within the CdSe valence band was 150 ± 45 fs. Upon passivation by CdS, this hole relaxation time constant increased to 170 ± 30 fs (CdSe/CdS-3ML). This small increase was attributed to the formation of a graded, or alloyed, interfacial region that precedes the growth of a uniform CdS capping layer. The small increase in hole relaxation time reflects the larger nanocrystal volume of the CdSe/CdS system with respect to the CdSe nanocrystal core. In contrast, the dynamics of larger core/shell nanocrystals (≥4ML CdS) exhibited a picosecond buildup in 2DES cross-peak amplitude. This time-dependent response was attributed to interfacial hole transfer from CdS to CdSe valence-band states. Importantly, the 2DES data distinguish CdSe exciton relaxation from interfacial carrier transfer dynamics. In combination, isolation of structurally well-defined nanocrystals and state-resolved 2DES can be used to examine directly the influence of nanoscale structural modifications on electronic carrier dynamics, which are critical for developing nanocluster-based photonic devices.
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Affiliation(s)
- J W Jarrett
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306-4390, USA.
| | - C Yi
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306-4390, USA.
| | - T Stoll
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - J Rehault
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy and Paul Scherrer Institute, CH-4232 Villigen PSI, Switzerland
| | - A Oriana
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy and Laboratoire de Spectroscopie Ultrarapide, EPFL, CH-1015 Lausanne, Switzerland
| | - F Branchi
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - G Cerullo
- IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - K L Knappenberger
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306-4390, USA. and IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy and National High Magnetic Field Laboratory, 1800 E. Paul Dirac Drive, Tallahassee, Florida 32310-4005, USA
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Urowitz MB, Gladman D, Ibañez D, Fortin P, Sanchez-Guerrero J, Bae S, Clarke A, Bernatsky S, Gordon C, Hanly J, Wallace D, Isenberg D, Ginzler E, Merrill J, Alarcon G, Steinsson K, Petri M, Dooley MA, Bruce I, Manzi S, Khamashta M, Ramsey-Goldman R, Zoma A, Sturfelt G, Nived O, Maddison P, Font J, van Vollenhoven R, Aranow C, Kalunian K, Stoll T, Buyon J. Clinical manifestations and coronary artery disease risk factors at diagnosis of systemic lupus erythematosus: data from an international inception cohort. Lupus 2016; 16:731-5. [PMID: 17728367 DOI: 10.1177/0961203307081113] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic Lupus International Collaborating Clinics (SLICC) comprises 27 centres from 11 countries. An inception cohort of 918 SLE patients has been assembled according to a standardized protocol between 2000 and 2006. Clinical features, classic coronary artery disease (CAD) risk factors, as well as other potential risk factors were collected. Of the 918 patients 89% were females, and of multi racial origin. Less than half the patients were living in a permanent relationship, 58% had post secondary education and 51% were employed. Eight percent had family history of SLE. At enrolment, with at mean age of diagnosis of 34.5 years, a significant number of patients already had CAD risk factors, such as hypertension (33%) and hypercholesterolemia (36%). Only 15% of the patients were postmenopausal, 16% were current smokers and 3.6% had diabetes at entry to the SLICC-RAS (Registry for Atherosclerosis). A number of patients in this multi-racial, multi-ethnic inception cohort of lupus patients have classic CAD risk factors within a mean of 5.4 months from diagnosis. This cohort will be increased to 1500 patients to be followed yearly for 10 years. This will provide a unique opportunity to evaluate risk factors for accelerated atherosclerosis in SLE. Lupus (2007) 16, 731—735.
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Affiliation(s)
- M B Urowitz
- SLICC Registry for Atherosclerosis Coordinating Centre, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada
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7
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Urowitz MB, Gladman DD, Anderson NM, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke A, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg D, Rahman A, Merrill J, Ginzler E, Alarcón GS, Fessler BF, Petri M, Bruce IN, Khamashta M, Aranow C, Dooley M, Manzi S, Ramsey-Goldman R, Sturfelt G, Nived O, Steinsson K, Zoma A, Ruiz-Irastorza G, Lim S, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken C, Askanase A, Stoll T. Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort. Lupus Sci Med 2016; 3:e000143. [PMID: 27099765 PMCID: PMC4836282 DOI: 10.1136/lupus-2015-000143] [Citation(s) in RCA: 40] [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: 12/18/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 01/07/2023]
Abstract
Objective To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up. Methods The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used. Results 31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors. Conclusions In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.
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Affiliation(s)
- M B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada
| | - D D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada
| | - N M Anderson
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada
| | - J Su
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada
| | - J Romero-Diaz
- Instituto Nacional de Ciencias Medicas y Nutrición , Mexico City , Mexico
| | - S C Bae
- Department of Rheumatology , Hanyang University Hospital for Rheumatic Diseases , Seoul , Korea
| | - P R Fortin
- Division of Rheumatology , Centre Hospitalier Universitaire de Québec et Université Laval , Quebec City , Canada
| | - J Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto , Toronto Ontario , Canada
| | - A Clarke
- Division of Rheumatology , Cumming School of Medicine University of Calgary , Calgary, Alberta , Canada
| | - S Bernatsky
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology , Montreal General Hospital, McGill University Health Centre , Montreal, Quebec , Canada
| | - C Gordon
- Rheumatology Research Group , School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - J G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology , Queen Elizabeth II Health Sciences Centre and Dalhousie University , Halifax, Nova Scotia , Canada
| | - D J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA , Los Angeles, California , USA
| | - D Isenberg
- Centre for Rheumatology Research, University College , London , UK
| | - A Rahman
- Centre for Rheumatology Research, University College , London , UK
| | - J Merrill
- Department of Clinical Pharmacology , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA
| | - E Ginzler
- Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - B F Fessler
- Department of Medicine, Division of Clinical Immunology and Rheumatology , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - M Petri
- Department of Rheumatology , Johns Hopkins University School of Medicine , Baltimore, Maryland , USA
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, London, UK
| | - M Khamashta
- Lupus Research Unit , The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine , London , UK
| | - C Aranow
- Feinstein Institute for Medical Research , Manhasset, New York , USA
| | - M Dooley
- Division of Rheumatology and Immunology, Department of Medicine , University of North Carolina , Chapel Hill, North Carolina , USA
| | - S Manzi
- Department of Medicine , West Penn Allegheny , Pittsburgh, Pennsylvania , USA
| | - R Ramsey-Goldman
- Northwestern University and Feinberg School of Medicine , Chicago, Illinois , USA
| | - G Sturfelt
- Department of Rheumatology , University Hospital Lund , Lund , Sweden
| | - O Nived
- Department of Rheumatology , University Hospital Lund , Lund , Sweden
| | - K Steinsson
- Department of Rheumatology , Center for Rheumatology Research Fossvogur Landspitali University Hospital , Reyjkavik , Iceland
| | - A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital , East Kilbride, Scotland , UK
| | - G Ruiz-Irastorza
- Autoimmune Disease Unit, Department of Internal Medicine , Hospital Universitario Cruces., University of the Basque Country , Barakaldo , Spain
| | - S Lim
- Division of Rheumatology, Emory University School of Medicine , Atlanta, Georgia , USA
| | - K C Kalunian
- UCSD School of Medicine , La Jolla, California , USA
| | - M Ỉnanç
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty , Istanbul University , Istanbul , Turkey
| | - R van Vollenhoven
- Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute , Stockholm , Sweden
| | - M Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases , Hospital Clínic , Barcelona , Spain
| | - D L Kamen
- Division of Rheumatology, Medical University of South Carolina , Charleston, South Carolina , USA
| | - S Jacobsen
- Department of Rheumatology Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark
| | - C Peschken
- Department of Medicine and Community Health Sciences, University of Manitoba , Winnipeg, Manitoba , Canada
| | - A Askanase
- Division of Rheumatology, Columbia University Medical Center , New York , USA
| | - T Stoll
- Department of Rheumatology , Kantousspital , Schaffhausen , Switzerland
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Chaigne B, Chizzolini C, Perneger T, Trendelenburg M, Huyun-Do U, Dayer E, Otto P, Stoll T, von Kempis J, Ribi C. FRI0390 Health-Related Quality of Life in Swiss Patients with Systemic Lupus Erythematosus – A Cross-Sectional Analysis Within the Swiss Systemic Lupus Erythematosus Cohort Study (SSCS). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2577] [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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Jaeschke G, Kolczewski S, Spooren W, Vieira E, Bitter-Stoll N, Boissin P, Borroni E, Büttelmann B, Ceccarelli S, Clemann N, David B, Funk C, Guba W, Harrison A, Hartung T, Honer M, Huwyler J, Kuratli M, Niederhauser U, Pähler A, Peters JU, Petersen A, Prinssen E, Ricci A, Rueher D, Rueher M, Schneider M, Spurr P, Stoll T, Tännler D, Wichmann J, Porter RH, Wettstein JG, Lindemann L. Metabotropic Glutamate Receptor 5 Negative Allosteric Modulators: Discovery of 2-Chloro-4-[1-(4-fluorophenyl)-2,5-dimethyl-1H-imidazol-4-ylethynyl]pyridine (Basimglurant, RO4917523), a Promising Novel Medicine for Psychiatric Diseases. J Med Chem 2015; 58:1358-71. [DOI: 10.1021/jm501642c] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jörg Huwyler
- Pharmaceutical
Technology, Pharmacenter, University of Basel, , Klingelbergstrasse
50, CH-4056 Basel, Switzerland
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10
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Urowitz M, Gladman DD, Ibañez D, Sanchez-Guerrero J, Bae SC, Gordon C, Fortin PR, Clarke A, Bernatsky S, Hanly JG, Wallace DJ, Isenberg D, Rahman A, Merrill J, Ginzler E, Alarcón GS, Fessler B, Khamashta M, Steinsson K, Petri M, Dooley M, Bruce IN, Manzi S, Sturfelt G, Nived O, Ramsey-Goldman R, Zoma A, Maddison P, Kalunian K, van Vollenhoven R, Aranow C, Romero Diaz J, Stoll T. Changes in Quality of Life in the First 5 Years of Disease in a Multicenter Cohort of Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2014; 66:1374-9. [DOI: 10.1002/acr.22299] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/28/2014] [Indexed: 11/06/2022]
Affiliation(s)
- M. Urowitz
- Toronto Western Hospital; Toronto, Ontario Canada
| | | | - D. Ibañez
- Toronto Western Hospital; Toronto, Ontario Canada
| | | | - S. C. Bae
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - C. Gordon
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - P. R. Fortin
- Toronto Western Hospital; Toronto, Ontario Canada
| | - A. Clarke
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - S. Bernatsky
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - J. G. Hanly
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - D. J. Wallace
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - D. Isenberg
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - A. Rahman
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - J. Merrill
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - E. Ginzler
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - G. S. Alarcón
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - B. Fessler
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - M. Khamashta
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - K. Steinsson
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - M. Petri
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - M. Dooley
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - I. N. Bruce
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - S. Manzi
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - G. Sturfelt
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - O. Nived
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - R. Ramsey-Goldman
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - A. Zoma
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - P. Maddison
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - K. Kalunian
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - R. van Vollenhoven
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - C. Aranow
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - J. Romero Diaz
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
| | - T. Stoll
- Systemic Lupus International Collaborating Clinics; Toronto, Ontario Canada
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11
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Orbai AM, Truedsson L, Sturfelt G, Nived O, Fang H, Alarcón GS, Gordon C, Merrill J, Fortin PR, Bruce IN, Isenberg DA, Wallace DJ, Ramsey-Goldman R, Bae SC, Hanly JG, Sanchez-Guerrero J, Clarke AE, Aranow CB, Manzi S, Urowitz MB, Gladman DD, Kalunian KC, Costner MI, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, Van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Pham N, Brey R, Weisman MH, McGwin G, Magder LS, Petri M. Anti-C1q antibodies in systemic lupus erythematosus. Lupus 2014; 24:42-9. [PMID: 25124676 DOI: 10.1177/0961203314547791] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study. METHODS Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA. RESULTS Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01). CONCLUSIONS Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis.
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Affiliation(s)
- A-M Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Truedsson
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
| | - G Sturfelt
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - O Nived
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - H Fang
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Gordon
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK
| | - Jt Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - P R Fortin
- Division of Rheumatology, Department of Medicine, Centre Hospitalier Universitaire (CHU) de Québec Axe Maladies Infectieuses et Immunitaires, CRCHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - D A Isenberg
- Centre for Rheumatology, Research Division of Medicine, London, UK
| | - D J Wallace
- Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - R Ramsey-Goldman
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S-C Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - J G Hanly
- Division of Rheumatology, Departments of Medicine and Pathology Capital Health and Dalhousie University, Halifax, Nova Scotia, Canada
| | - J Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - A E Clarke
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - C B Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - S Manzi
- Department of Medicine, Division of Rheumatology, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - M B Urowitz
- Toronto Western Hospital Toronto, Ontario, Canada
| | - D D Gladman
- Toronto Western Hospital Toronto, Ontario, Canada
| | - K C Kalunian
- Division of Rheumatology, Allergy and Immunology, UCSD School of Medicine, La Jolla, CA, USA
| | - M I Costner
- North Dallas Dermatology Associates, Dallas, TX, USA
| | - V P Werth
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA, USA
| | - A Zoma
- Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK
| | - S Bernatsky
- Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - G Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Hospital Universitario Cruces Universidad del Pais Vasco, Barakaldo, Spain
| | | | - S Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J P Buyon
- New York University, New York, NY, USA
| | | | - M A Dooley
- University of North Carolina, Chapel Hill, NC, USA
| | | | - E Ginzler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - T Stoll
- Kantonsspital Schaffhausen, Schaffhausen, Switzerland
| | - C Peschken
- University of Manitoba Winnipeg, Manitoba, Canada
| | - J L Jorizzo
- Wake Forest University, Winston-Salem, NC, USA
| | - J P Callen
- University of Louisville, Louisville, KY, USA
| | - S S Lim
- Emory University, Atlanta, GA, USA
| | - B J Fessler
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - D L Kamen
- Medical University of South Carolina, Charleston, SC, USA
| | - A Rahman
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - K Steinsson
- Landspitali University Hospital, Reykjavik, Iceland
| | | | - L Sigler
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Hameed
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Pham
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Brey
- University of Texas Health Science Center, San Antonio, TX, USA
| | - M H Weisman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G McGwin
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L S Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - M Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Urowitz MB, Gladman DD, Ibañez D, Fortin PR, Bae SC, Gordon C, Clarke A, Bernatsky S, Hanly JG, Isenberg D, Rahman A, Sanchez-Guerrero J, Wallace DJ, Ginzler E, Alarcón GS, Merrill JT, Bruce IN, Sturfelt G, Nived O, Steinsson K, Khamashta M, Petri M, Manzi S, Ramsey-Goldman R, Dooley MA, van Vollenhoven RF, Ramos M, Stoll T, Zoma A, Kalunian K, Aranow C. Evolution of disease burden over five years in a multicenter inception systemic lupus erythematosus cohort. Arthritis Care Res (Hoboken) 2011; 64:132-7. [DOI: 10.1002/acr.20648] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Aringer M, Burkhardt H, Burmester GR, Fischer-Betz R, Fleck M, Graninger W, Hiepe F, Jacobi AM, Kötter I, Lakomek HJ, Lorenz HM, Manger B, Schett G, Schmidt RE, Schneider M, Schulze-Koops H, Smolen JS, Specker C, Stoll T, Strangfeld A, Tony HP, Villiger PM, Voll R, Witte T, Dörner T. Current state of evidence on 'off-label' therapeutic options for systemic lupus erythematosus, including biological immunosuppressive agents, in Germany, Austria and Switzerland--a consensus report. Lupus 2011; 21:386-401. [PMID: 22072024 DOI: 10.1177/0961203311426569] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Systemic lupus erythematosus (SLE) can be a severe and potentially life-threatening disease that often represents a therapeutic challenge because of its heterogeneous organ manifestations. Only glucocorticoids, chloroquine and hydroxychloroquine, azathioprine, cyclophosphamide and very recently belimumab have been approved for SLE therapy in Germany, Austria and Switzerland. Dependence on glucocorticoids and resistance to the approved therapeutic agents, as well as substantial toxicity, are frequent. Therefore, treatment considerations will include 'off-label' use of medication approved for other indications. In this consensus approach, an effort has been undertaken to delineate the limits of the current evidence on therapeutic options for SLE organ disease, and to agree on common practice. This has been based on the best available evidence obtained by a rigorous literature review and the authors' own experience with available drugs derived under very similar health care conditions. Preparation of this consensus document included an initial meeting to agree upon the core agenda, a systematic literature review with subsequent formulation of a consensus and determination of the evidence level followed by collecting the level of agreement from the panel members. In addition to overarching principles, the panel have focused on the treatment of major SLE organ manifestations (lupus nephritis, arthritis, lung disease, neuropsychiatric and haematological manifestations, antiphospholipid syndrome and serositis). This consensus report is intended to support clinicians involved in the care of patients with difficult courses of SLE not responding to standard therapies by providing up-to-date information on the best available evidence.
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Affiliation(s)
- M Aringer
- Rheumatology, Medicine III, University Medical Center TU Dresden, Germany.
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14
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Ippolito A, Wallace DJ, Gladman D, Fortin PR, Urowitz M, Werth V, Costner M, Gordon C, Alarcón GS, Ramsey-Goldman R, Maddison P, Clarke A, Bernatsky S, Manzi S, Bae SC, Merrill JT, Ginzler E, Hanly JG, Nived O, Sturfelt G, Sanchez-Guerrero J, Bruce I, Aranow C, Isenberg D, Zoma A, Magder LS, Buyon J, Kalunian K, Dooley MA, Steinsson K, van Vollenhoven RF, Stoll T, Weisman M, Petri M. Autoantibodies in systemic lupus erythematosus: comparison of historical and current assessment of seropositivity. Lupus 2011; 20:250-5. [PMID: 21362750 DOI: 10.1177/0961203310385738] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13%). However, 6/11 (55%) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20% more patients with anti-RNP and 18% more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57% to 97%). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18% and 39%, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials.
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Affiliation(s)
- A Ippolito
- Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21205, USA.
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15
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Verrier S, Meury TR, Kupcsik L, Heini P, Stoll T, Alini M, Alini M. Platelet-released supernatant induces osteoblastic differentiation of human mesenchymal stem cells: potential role of BMP-2. Eur Cell Mater 2010; 20:403-14. [PMID: 21154246 DOI: 10.22203/ecm.v020a33] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Platelet-rich preparations have recently gained popularity in maxillofacial and dental surgery, but their beneficial effect is still under debate. Furthermore, very little is known about the effect of platelet preparations at the cellular level, and the underlying mechanisms. In this study, we tested the effect of platelet-released supernatant (PRS) on human mesenchymal stem cell (MSC) differentiation towards an osteoblastic phenotype in vitro. Cultures of MSC were supplemented with PRS and typical osteoblastic markers were assessed at up to 28 days post-confluence. PRS showed an osteoinductive effect on MSC, as shown by an increased expression of typical osteoblastic marker genes such as collagen Ialpha1, bone sialoprotein II, BMP-2 and MMP-13, as well as by increased ⁴⁵Ca²+ incorporation. Our results suggest that the effect of PRS on human MSC could be at least partially mediated by BMP-2. Activated autologous PRS could therefore provide an alternative to agents like recombinant bone growth factors by increasing osteoblastic differentiation of bone precursor cells at bone repair sites, although further studies are needed to fully support our observations.
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Affiliation(s)
- S Verrier
- AO Research Institute, CH-7270 Davos, Switzerland
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16
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Urowitz MB, Gladman D, Ibañez D, Bae SC, Sanchez-Guerrero J, Gordon C, Clarke A, Bernatsky S, Fortin PR, Hanly JG, Wallace DJ, Isenberg D, Rahman A, Alarcón GS, Merrill JT, Ginzler E, Khamashta M, Nived O, Sturfelt G, Bruce IN, Steinsson K, Manzi S, Ramsey-Goldman R, Dooley MA, Zoma A, Kalunian K, Ramos M, Van Vollenhoven RF, Aranow C, Stoll T, Petri M, Maddison P. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:881-7. [PMID: 20535799 DOI: 10.1002/acr.20122] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe vascular events during an 8-year followup in a multicenter systemic lupus erythematosus (SLE) inception cohort and their attribution to atherosclerosis. METHODS Clinical data, including comorbidities, were recorded yearly. Vascular events were recorded and attributed to atherosclerosis or not. All of the events met standard clinical criteria. Factors associated with atherosclerotic vascular events were analyzed using descriptive statistics, t-tests, and chi-square tests. Stepwise multivariate logistic regression was used to assess the association of factors with vascular events attributed to atherosclerosis. RESULTS Since 2000, 1,249 patients have been entered into the cohort. There have been 97 vascular events in 72 patients, including: myocardial infarction (n = 13), angina (n = 15), congestive heart failure (n = 24), peripheral vascular disease (n = 8), transient ischemic attack (n = 13), stroke (n = 23), and pacemaker insertion (n = 1). Fifty of the events were attributed to active lupus, 31 events in 22 patients were attributed to atherosclerosis, and 16 events were attributed to other causes. The mean +/- SD time from diagnosis to the first atherosclerotic event was 2.0 +/- 1.5 years. Compared with patients followed for 2 years without atherosclerotic events (n = 615), at enrollment, patients with atherosclerotic vascular events were more frequently white, men, older at diagnosis of SLE, obese, smokers, hypertensive, and had a family history of coronary artery disease. On multivariate analysis, only male sex and older age at diagnosis were associated factors. CONCLUSION In an inception cohort with SLE followed for up to 8 years, there were 97 vascular events, but only 31 were attributable to atherosclerosis. Patients with atherosclerotic events were more likely to be men and to be older at diagnosis of SLE.
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Affiliation(s)
- M B Urowitz
- Toronto Western Hospital, Toronto, Ontario, Canada.
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Urowitz MB, Gladman D, Ibañez D, Fortin P, Sanchez-Guerrero J, Bae S, Clarke A, Bernatsky S, Gordon C, Hanly J, Wallace D, Isenberg D, Ginzler E, Merrill J, Alarcón GS, Steinsson K, Petri M, Dooley MA, Bruce I, Manzi S, Khamashta M, Ramsey-Goldman R, Zoma A, Sturfelt G, Nived O, Maddison P, Font J, van Vollenhoven R, Aranow C, Kalunian K, Stoll T. Accumulation of coronary artery disease risk factors over three years: Data from an international inception cohort. ACTA ACUST UNITED AC 2008; 59:176-80. [DOI: 10.1002/art.23353] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marx C, Mörgeli HP, Büchi S, Stoll T. [Are there associations of health status, disease activity and damage in SLE patients?---Results of a study of a cohort of a Swiss specialized outpatient clinic]. Praxis (Bern 1994) 2007; 96:895-9. [PMID: 17601244 DOI: 10.1024/1661-8157.96.22.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM To study the relationship between self assessed health status of patients with Systemic Lupus Erythematosus (SLE), lupus activity, damage, patients' age and disease duration in a cohort of a Swiss specialized outpatient clinic. PATIENTS AND METHODS A cross sectional study of 38 patients fulfilling the classification criteria for SLE. The patients visited a rheumatology outpatient clinic in Switzerland between January 2002 and December 2004. The last assessment during this period was used for the study. The assessment included, besides demographic data, the measurement of disease activity using the BILAG index, the measurement of disease damage using the SLICC/ACR damage index (SDI), as well as the patient's self assessed health status using the patient's questionnaire Medical Outcome Survey Short Form 36 (SF-36). RESULTS A total of 36 women and 2 men were included in the study (median age: 43 yrs, median disease duration: 11 yrs). Increased disease activity (total BILAG) was shown to be significantly correlated with reduced physical function. A greater damage (total SDI) correlated significantly with reduced role function due to emotional limitations. Neither age nor disease duration showed any significant correlation with health status in this study. CONCLUSION The present study, which is based on internationally accepted assessment tools for SLE patients, shows a significant relationship between increased disease activity and reduced physical function. This result emphasizes the importance of optimizing treatment aiming at reducing disease activity.
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Affiliation(s)
- C Marx
- Psychiatrische Poliklinik, Universitätsspital Zürich
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Kühn F, Fehr S, Stoll T. [Back pain and acne conglobata: SAPHO syndrome]. Praxis (Bern 1994) 2007; 96:591-5. [PMID: 17506389 DOI: 10.1024/1661-8157.96.15.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We report on a young woman suffering from SAPHO syndrome with back pain and arthritis of the sternoclavicular joints. This inflammatory disorder of the osteoarticular system (synovitis, osteitis, and hyperostosis) is associated with severe acne or palmoplantar pustulosis. The patient was treated with pamidronate, NSAID and physiotherapy which improved the musculoskeletal symptoms completely. The acne was treated with isotretinoin.
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Affiliation(s)
- F Kühn
- Abteilung Rheumatologie, Kantonsspital Schaffhausen
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20
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Jaschko G, Brühlmann P, Altwegg M, Stoll T. [The role of PCR for the diagnosis of Lyme arthritis]. Praxis (Bern 1994) 2005; 94:1301-5. [PMID: 16173127 DOI: 10.1024/0369-8394.94.34.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE, PATIENTS AND METHODS We studied retrospectively four patients with Lyme arthritis of the knee, the role of PCR for the detection of B. burgdorferi DNA and its influence on further therapeutic decisions. RESULTS All four patients with Lyme arthritis suffered from knee pain and effusions. None of them remembered having had a tick bite or an erythema migrans. The diagnosis was confirmed by positive serology and in three cases by detection of B. burgdorferi DNA by PCR analysis of the joint fluid. In one patient, PCR was also positive in the synovial tissue. Because of persistent symptoms after adequate antibiotic therapy, PCR was repeated in the joint fluid of two patients. In one patient a positive PCR suggested an ongoing infection. Thus, the antibiotic treatment was changed. A further PCR was negative. Symptoms resolved slowly in all patients over a time of two to seven months after the end of the antibiotic treatment. CONCLUSION PCR to detect B. burgdorferi DNA in synovial fluid or tissue respectively is a helpful tool for the diagnosis of Lyme arthritis. Moreover, in patients with refractory Lyme arthritis PCR may be helpful in monitoring the course of the disease.
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Affiliation(s)
- G Jaschko
- Rheumaklinik und Institut für Medizinische Mikrobiologie Universitätsspital Zürich
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Stoll T, Sutcliffe N, Mach J, Klaghofer R, Isenberg DA. Analysis of the relationship between disease activity and damage in patients with systemic lupus erythematosus--a 5-yr prospective study. Rheumatology (Oxford) 2004; 43:1039-44. [PMID: 15161983 DOI: 10.1093/rheumatology/keh238] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether initial damage, disease duration, age, initial health status, average disease activity over the 5 yr or an average medication score covering the follow-up period would predict an increase in damage in patients with systemic lupus erythematosus (SLE) within the next 5 yr. METHODS A 5-yr prospective longitudinal study of a cohort of 141 consecutive patients with SLE attending a specialist lupus out-patient clinic in London from their first assessment between July 1994 and February 1995. Disease activity was assessed using the BILAG system, initial health status by the Medical Outcome Survey Short Form 20 with an extra question about fatigue (SF-20+) and damage by the SLICC/ACR Damage Index (SDI). Damage was reassessed 5 yr later. Statistical analysis was carried out using multiple logistic regression analysis (logXact). RESULTS One hundred and thirty-three female and eight male SLE patients (97 Caucasians, 16 Afro-Caribbeans, 22 Asians and 6 others) were included, their age at inclusion was 41.1 +/- 12.5 yr and their disease duration 10.2 +/- 6.3 yr. The mean measures at inclusion were: total BILAG 5.2 (range 0-17), total SDI 1.2 (0-7) and medication score 1.2 (0-3). Six patients were lost to follow-up because they had moved. Of the remaining 135 patients total damage had increased in 40 patients and 10 patients had died. At the end of the study, at 4.63 +/- 0.19 yr, the total SDI had increased to 1.6 +/- 1.7. Multiple logistic regression analysis revealed that death and increase in damage were strongly predicted by a high total disease activity over the entire study period (P<0.001) as we had hypothesized. When the total BILAG score was replaced by the average number of A-flares the prediction of accrual of damage during the study period was again highly significant (P = 0.004). CONCLUSIONS In this first prospective study of its type a highly significant impact of total disease activity, as measured over 5 yr using the BILAG system, on the development of total damage was revealed. Moreover, these results provide further proof of the validity of the SDI and support the BILAG concept of the A-flares.
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Affiliation(s)
- T Stoll
- aarReha, Badstrasse 55, CH-5116 Schinznach-Bad, Switzerland.
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22
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Hilgers K, Stoll T, Skakun Y, Coenen HH, Qaim SM. Cross-section measurements of the nuclear reactions natZn(d,x)64Cu, 66Zn(d,alpha)64Cu and 68Zn(p,alphan)64Cu for production of 64Cu and technical developments for small-scale production of 67Cu via the 70Zn(p,alpha)67Cu process. Appl Radiat Isot 2004; 59:343-51. [PMID: 14622933 DOI: 10.1016/s0969-8043(03)00199-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The radionuclides 64Cu (T1/2=12.7h) and 67Cu (T1/2=61.9h) are useful in internal therapy. In connection with production of 64Cu, excitation functions of the reactions natZn(d,x)64Cu, 66Zn(d,alpha)64Cu and 68Zn(p,alphan)64Cu were measured radiochemically using the stacked-foil technique. From the measured data, the thick target yields of 64Cu were calculated and compared with experimental data available in the literature. The three investigated processes are discussed in comparison to the commonly used 64Ni(p,n)64Cu reaction for the production of 64Cu. As regards 67Cu production, the technical feasibility of the 70Zn(p,alpha)67Cu process was investigated. An electroplated isotopically enriched 70Zn target was developed which can withstand slanting beams of 20MeV protons of currents up to 20 microA. Methods for chemical separation of 67Cu and efficient recovery of the enriched target material were worked out. The method is suitable only for small-scale production of 67Cu.
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Affiliation(s)
- K Hilgers
- Institut für Nuklearchemie, Forschungszentrum Jülich GmbH, D-52425 Jülich, Germany
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23
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Abstract
OBJECTIVES The BILAG index is a clinical measure of lupus disease activity. It is valid, reliable and sensitive to change. Scoring in the BILAG index is based upon the physician's intention to treat. A flare of active lupus is defined as a new A or B score in at least one system. The main aim of this study was to determine whether patients with a lupus flare are treated as expected from the principles upon which the scoring system was devised. Secondly we wanted to establish whether patients with a new B score preceded by a C should be considered to have flared, as with patients scoring B following a D or E score. METHODS Over a 12-month period, 250 patients regularly attending lupus clinics in Birmingham and London were assessed using the BILAG index at each visit. RESULTS A new A or B score was observed in 154 (61.6%) patients. An A flare was observed in 26 (10.4%) patients. A B flare (in which the B score was preceded by a D or E score) was observed in 65 (26.0%) patients. There were 63 (25.2%) patients in whom there was a B score in a system in which a C score was previously recorded. Steroids were started or increased in 20 (77%) patients with an A flare. Almost all (92%) patients with a new A score had some increase in therapy. For the patients with new B scores, 53 (41%) had some increase in therapy, but multiple reasons were found for no change in therapy in 75 (59%) of these patients. There was no difference in the treatment of new B scores arising after a previous C score compared with previous D or E scores. Non-Caucasians were more likely to have a lupus flare than Caucasians. CONCLUSIONS These results are consistent with the principles upon which the BILAG index was devised and suggest that a moderate disease flare can be defined as a new B score following a C, D or E score according to the BILAG index.
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Affiliation(s)
- C Gordon
- Department of Rheumatology, University of Birmingham, Edgbaston, Birmingham, UK.
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Alini M, Roughley PJ, Antoniou J, Stoll T, Aebi M. A biological approach to treating disc degeneration: not for today, but maybe for tomorrow. Eur Spine J 2002; 11 Suppl 2:S215-20. [PMID: 12384747 PMCID: PMC3611567 DOI: 10.1007/s00586-002-0485-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2002] [Accepted: 07/12/2002] [Indexed: 02/07/2023]
Abstract
The intervertebral disc unites the vertebrae in the spine, providing the flexibility required for bending and twisting and resisting the compression inflicted by gravity when in an upright posture. The discs have a complex structure, with the outer annulus fibrosus having lamellae of organized collagen fibrils and the inner nucleus pulposus having a more random collagen organization and an abundance of aggregating proteoglycans. This composite nature endows the disc with both the tension-resisting properties of a ligament and the compression-resisting properties of articular cartilage. Unfortunately, disc structure and function does not remain optimal throughout life, but undergoes progressive degeneration, commencing in the young adult, and is particularly evident in the nucleus pulposus. With time, disc degeneration may result in clinical symptoms, such as low back pain, and require medical intervention. Such treatment may involve removal of the offending disc by surgery rather than its repair, which would be the preferred course of action. In the near future, current bioengineering techniques may offer the possibility of repairing the damaged disc, if an engineered tissue with the appropriate functional properties can be generated to augment the ailing disc. In this report, we summarized our recent results, in which disc cells were implanted into a scaffold of collagen and hyaluronan, or entrapped into a chitosan gel, and growth factors were used to modulate matrix synthesis in an attempt to produce a tissue with a similar molecular composition to native nucleus pulposus tissue.
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Affiliation(s)
- M Alini
- Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Canada.
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Muschik M, Ludwig R, Halbhübner S, Bursche K, Stoll T. Beta-tricalcium phosphate as a bone substitute for dorsal spinal fusion in adolescent idiopathic scoliosis: preliminary results of a prospective clinical study. Eur Spine J 2001; 10 Suppl 2:S178-84. [PMID: 11716016 PMCID: PMC3611545 DOI: 10.1007/s005860100271] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study is to evaluate the ability of beta-tricalcium phosphate (TCP) in granular form to achieve dorsal spondylodesis in adolescent idiopathic scoliosis (AIS). Twenty-eight patients underwent surgical correction and were followed up for 13+/-8 (range 6-33) months. Posterolateral grafting was performed, using either autograft bone mixed with allograft bone (n=19; "bone group") or autograft bone mixed with 25 g TCP (n=9; "TCP group"). Patients were followed by clinical examination, X-rays and computed tomographic (CT) scans to measure bone mineral density. Fusion involved 12+/-1 (range 10-14) vertebrae. The segments were fused after 6+/-1 months in both groups according to the radiographs. No pseudarthrosis was observed. Bone mineral density was 430+/-111 (range 273-629) mg/cm3 in the TCP group versus 337+/-134 (range 130-669) mg/cm3 in the bone group. Resorption of TCP was complete on the radiographs after 8+/-2 (range 6-10) months. Based upon the results of this small preliminary study, the use of TCP appears to be a valuable alternative to allografts for application in the spine, even when large amounts of bone are needed.
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Affiliation(s)
- M Muschik
- Orthopädische Klinik der Charité, Humboldt-Universität, Berlin, Germany.
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Steffen T, Stoll T, Arvinte T, Schenk RK. Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery. Eur Spine J 2001; 10 Suppl 2:S132-40. [PMID: 11716010 PMCID: PMC3611547 DOI: 10.1007/s005860100325] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Harvesting autologous bone graft from the iliac crest is associated with considerable secondary morbidity. Bone graft substitutes such as porous ceramics are increasingly used for spinal surgery. This paper presents the results of an animal study in which beta-tricalcium phosphate (beta-TCP) bone substitutes were used for anterior spinal surgery in sheep and baboons. The presented baboon study also investigated the effect of impregnating the ceramic material with transforming growth factor (TGF). In the first study, using the sheep model, a stand-alone instrumented anterior fusion was performed. The animals were randomized into three treatment groups: autologous bone, beta-TCP granules, and sham group. The results were analyzed biomechanically and histologically at three survival intervals: 8, 16 and 32 weeks. An additional animal group was added later, with ceramic pre-filled implants. In the second study, a baboon model was used to assess the osteointegration of a 15-mm-diameter porous beta-TCP block into the vertebral body. The experiment was partially motivated by a new surgical procedure proposed for local bone graft harvest. Three treatment groups were used: beta-TCP plug, beta-TCP plug impregnated with TGF-beta3, and a sham group with empty defect. The evaluation for all animals included computer tomograms at 3 and 6 months, as well as histology at 6 months. In the sheep model, the mechanical evaluation failed to demonstrate differences between treatment groups. This was because massive anterior bone bridges formed in almost all the animals, masking the effects of individual treatments. Histologically, beta-TCP was shown to be a good osteoconductor. While multiple signs of implant micromotion were documented, pre-filling the cages markedly improved the histological fusion outcomes. In the baboon study, the beta-TCP plugs were completely osteointegrated at 6 months. For the group that used ceramic plugs impregnated with TGF-beta3, no incremental advantage was seen as a result of this particular application. However, TGF-beta3 is a potent growth factor at a very low dose. Not only does it speed up the ceramic material resorption, but it is also responsible for massive regional new bone formation. More experiments are required to better understand the biological effects of this growth factor in relation to bone formation, and to be able to take clinical advantage of them.
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Affiliation(s)
- T Steffen
- Royal Victoria Hospital, Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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Abstract
Physiotherapy is the treatment of choice in patients with symptoms caused by a lumbar disc herniation. In clinical practice a broad range of physiotherapeutic modalities has been revealed to be helpful. During the acute stage the efficacy of the McKenzie-concept, mobilisation therapies and traction has been demonstrated in randomized controlled trials with a blind assessor. In addition, pain reducing physical therapies such as cold or electrotherapy and non-steroidal anti-inflammatory drugs, analgesics and/or muscle relaxants are sensible initial accompanying treatments. The effectiveness of active physiotherapies such as training of local strength endurance of back and abdominal muscles has been proven in patients during the chronic stage. The indications for a in-patient rehabilitation programme, for surgery and the danger of developing chronic low back pain are discussed.
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Affiliation(s)
- T Stoll
- aarReha Schinznach, Fachklinik für Rehabilitation, Rheumatologie und Osteoporose, Schinznach.
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Stoll T, Kauer Y, Büchi S, Klaghofer R, Sensky T, Villiger PM. Prediction of depression in systemic lupus erythematosus patients using SF-36 Mental Health scores. Rheumatology (Oxford) 2001; 40:695-8. [PMID: 11426030 DOI: 10.1093/rheumatology/40.6.695] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE As depression is common in systemic lupus erythematosus (SLE) patients, we investigated whether and how the Medical Outcome Survey Short Form 36 (SF-36) scores, routinely used in the assessment of SLE patients, would indicate the absence or presence of depression. METHODS The Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) and the SF-36 were applied in a cross-sectional cohort of 60 SLE patients [mean age 45 (S.D. 15) yr, disease duration 11 (9) yr, 90% female, 100% Caucasians]. The SF-36 domain score with the closest association with HADS-D was used for further analysis. On the basis of HADS-D scores, the patients were split into two groups: one without depression (score<8) and the other with possible depression (score > or =8). RESULTS The SF-36 Mental Health score was most closely correlated to the depression score (rho=-0.69, P<0.0005). The calculated Mental Health score cut-off value which significantly differentiated possibly depressed from non-depressed SLE patients was 61. Its sensitivity for the detection of possible depression was 89%, its specificity 77% and its negative predictive value 97%. CONCLUSIONS The present study contributes to knowledge of means of excluding depression and the prevention of underdiagnosis and undertreatment of depression in SLE patients.
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Affiliation(s)
- T Stoll
- Rheuma- und Rehabilitationsklinik, Schinznach, Division of Psychosocial Medicine, University Hospital, Zürich, Switzerland
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Stoll T, Sutcliffe N, Klaghofer R, Isenberg DA. Do present damage and health perception in patients with systemic lupus erythematosus predict extent of future damage?: a prospective study. Ann Rheum Dis 2000; 59:832-5. [PMID: 11005787 PMCID: PMC1753012 DOI: 10.1136/ard.59.10.832] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study whether either initial damage, disease activity, disease duration, age, a drug score, or health status would predict an increase in damage in patients with systemic lupus erythematosus (SLE) within the next three years. METHODS A three year prospective longitudinal study of a cohort of 141 consecutive patients with SLE attending a specialist lupus outpatient clinic from their first assessment between July 1994 and February 1995. Disease activity was assessed using the BILAG system, health status by the Medical Outcome Survey Short Form 20 with an extra question about fatigue (SF-20+), and damage by the SLICC/ACR Damage Index (SDI). Damage was reassessed three years later. Statistical analysis was carried out using logistic regression analysis (logXact). RESULTS 133 female and 8 male patients with SLE (97 white subjects, 16 Afro-Caribbeans, 22 Asians, and 6 others) were included. Their mean (SD) age at inclusion was 41.1 (12.5) years and their disease duration 10.2 (6. 3) years. The mean measures at inclusion were: total BILAG 5.2 (range 0-17), total SDI 1.2 (0-7), drug score 1.2 (0-3); SF-20+: physical 58 (0-100), role 54 (0-100), social functioning 71 (0-100), mental health 64 (16-100), health perception 44 (0-100), pain 53 (0-100), fatigue 59 (0-100). Four patients were lost to follow up because they had moved. At three years in 33 patients the total SDI had increased to a mean of 1.5 (0-7) (n=130). Moreover, seven patients had the maximum damage as they had died during the follow up period. The only variables with an independent and significant contribution in predicting damage at three years were the total damage score (odds ratio (OR)=1.46; 95% CI 1.04 to 2.05), and health perception (OR=0.96; 95% CI 0.93 to 0.99) at inclusion. CONCLUSIONS Of all the variables at inclusion only the total damage score and SF-20+: health perception, significantly predicted an increase in damage, for patients with SLE, three years later.
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Affiliation(s)
- T Stoll
- Rheuma- und Rehabilitationsklinik, CH-5116 Schinznach-Bad, Switzerland.
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Büchi S, Villiger P, Kauer Y, Klaghofer R, Sensky T, Stoll T. PRISM (Pictorial Representation of Illness and Self Measure)- a novel visual method to assess the global burden of illness in patients with systemic lupus erythematosus. Lupus 2000; 9:368-73. [PMID: 10878730 DOI: 10.1191/096120300678828479] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE For patients with chronic illnesses the global burden of illness is a crucial health measure hitherto neglected in research studies and clinical practice. We tested the application and validity of PRISM (Pictorial Representation of Illness and Self-Measure), a novel visual method for assessing the burden of illness, in patients with systemic lupus erythematosus (SLE). METHOD PRISM was applied in a cross sectional sample of 60 patients with SLE. Correlations were assessed between a quantitative measure derived from PRISM (Self-Illness Separation-SIS) and sociodemographic factors, measures of disease activity, damage, physical and psychological disability variables, as well as coping resources. RESULTS The PRISM task was understood by all but one patient, and was in every instance completed in less than 3 minutes. SIS correlated with SF-36 physical health, coping resources as assessed by Sense of Coherence (SOC), and age, but not with disease activity or damage. In multiple regression analyses, independent contributions to SIS were observed for SF-36 physical component scale (contributing 12% of the variance). SOC (10%) and age (14%). CONCLUSION PRISM is a new non-verbal measure to assess burden of illness. As in previous studies, PRISM was well accepted and understood by patients with SLE, quick to complete, and yielded meaningful information consistent with that in earlier research work.
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Affiliation(s)
- S Büchi
- Division of Psychosocial Medicine, University Hospital, Zürich, Switzerland.
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Abstract
To date, there have been very few studies on the age dependence of maximal isometric muscle strength (MIMS) in healthy subjects aged 20-80 years, based upon measurements of a large number of functional muscle groups (FMGs). Using a hand-held pull gauge it is possible to measure MIMS of nearly every FMG. The objectives of this study were to obtain normative values for MIMS, to evaluate differences in MIMS in relation to gender and body side and to compare the age dependence of muscle strength between women and men. In a convenience sample of 290 healthy women (aged 20-82 years) and 253 men (aged 21-79 years), MIMS of 51 FMGs was measured. For each FMG the age dependence of MIMS was depicted, side and gender specific, as percentile curves and was analysed using linear quantile regression analysis. MIMS was found to be significantly higher in men than in women and higher on the right than on the left side. A biphasic model with linear equations for strength medians was derived for each gender. The age at transition from phase 1 to phase 2 was 55 years (SD 8) for women and 49 years (SD 13) for men. During phase 1, MIMS did not decrease significantly. During phase 2, MIMS decreased in all FMGs in both genders with a steeper slope in women (-0.92) than in men (-0.63). The age dependence of MIMS differed significantly between women and men. The present study gives gender-specific equations which enable one to calculate normative values for MIMS, as measured with a pull gauge, based upon age. These normative values will allow an objective assessment of patients with diminished muscle strength as, for example, in myositis, rheumatoid arthritis and nerve root compression syndromes or in the elderly.
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Affiliation(s)
- T Stoll
- Rheuma- und Rehabilitationsklinik, Schinznach-Bad, Switzerland
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Gardner TN, Stoll T, Marks L, Mishra S, Knothe Tate M. The influence of mechanical stimulus on the pattern of tissue differentiation in a long bone fracture--an FEM study. J Biomech 2000; 33:415-25. [PMID: 10768390 DOI: 10.1016/s0021-9290(99)00189-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
2D, coronal plane, finite elements models (FEMs) were developed from orthogonal radiographs of a diaphyseal tibial fracture and its reparative tissue at four different time points during healing. Each callus was separated into regions of common tissue histology by computerised radiographic analysis. Starting point values of tissue material properties from the literature were refined by the model to simulate exactly the mechanical behaviour of the subject's callus and bone during loading. This was achieved by matching measured inter-fragmentary displacements with calculated inter-fragmentary forces. Stress and strain distributions in the callus and bone were calculated from peak inter-fragmentary displacements measured during natural walking activity, and were correlated with the subsequently observed pattern of tissue differentiation and maturation of the callus. The growth and stiffening of the external callus progressively reduced the inter-fragmentary gap strain. Partial maturation of the gap tissue was apparent only one week before fixator removal. Principal stresses in the callus were compared with 'yield stresses' in corresponding tissue from the literature. This indicated the presence of stress concentrations medial and lateral to the fracture gap, which probably caused tissue damage during normal activity levels. Tissue damage may also have precipitated partial structural failure of the callus, both of which were believed to have delayed healing during the middle third of the fixation period. Had the fixation device provided greater inter-fragmentary support during early healing, this may have prevented callus failure and the consequent delay in healing. A further benefit of this would have been the reduction of the initially high intra-gap tissue strains to a magnitude more conducive to earlier maturation of the bridging tissue that united the bone.
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Affiliation(s)
- T N Gardner
- Oxford Orthopaedic Engineering Centre, University of Oxford, Headington, UK.
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Gardner TN, Stoll T, Marks L, Knothe-Tate M, Mishra S, Evans M, Simpson H, Hardy J, Kenwright J. A finite element model of a human tibial fracture stress concentrations and mechanical failure in healing callus. J Biomech 1998. [DOI: 10.1016/s0021-9290(98)80022-5] [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: 11/29/2022]
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Büchi S, Sensky T, Allard S, Stoll T, Schnyder U, Klaghofer R, Buddeberg C. Sense of coherence--a protective factor for depression in rheumatoid arthritis. J Rheumatol 1998; 25:869-75. [PMID: 9598882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A stress-vulnerability model of depression was investigated in patients with rheumatoid arthritis (RA). Antonovsky's Sense of Coherence (SOC) was examined as a factor protecting against depression. METHOD Relationships between sociodemographic factors, disease activity, functional impairment, pain, depression, and SOC were assessed using multivariate methods in a cross sectional sample of 89 consecutive outpatients with RA. RESULTS Increased prevalence of depression was associated with low SOC and high self-rated pain levels, but not with other factors assessed. By multiple regression analysis, independent contributions to depression were observed for SOC (23% of variance) and for pain (24% of variance), but not functional impairment or disease activity. CONCLUSION Comprehensive models of adjustment in RA need to include protective factors such as SOC, in addition to pain and other pathological variables. SOC may be helpful in identifying individuals with RA who are particularly vulnerable to depression, who may be helped by focused psychological interventions such as cognitive therapy.
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Affiliation(s)
- S Büchi
- Department of Psychiatry, Imperial College School of Medicine, West Middlesex University Hospital, London, UK
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Villringer K, Kurth R, Repenthin J, Stoll T, Curio G, Schwiemann J, Wolf KJ, Villringer A. FMRI Mapping of Digital and Facial Sites in Human Brodmann Area 3b. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31236-9] [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: 10/28/2022] Open
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Wuttke M, Meyer M, Varga Z, Stoll T. [Immobilizing muscle weakness accentuated in leg and proximal muscles]. Praxis (Bern 1994) 1998; 87:630-635. [PMID: 9623335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 54 year old waiter was referred to the hospital because of proximal muscle weakness, most pronounced in his legs, which progressed to an inability to stand or walk within weeks. Myopathy was diagnosed based on the muscle biopsy findings and myositis was ruled out by laboratory and biopsy results. Further investigations led us to exclude an endocrine cause, hypovitaminosis D, infectious myopathy or a paraneoplastic syndrome. Heteroanamnesis revealed severe alcoholism, lasting for more than 30 years. The presumed alcohol induced hepatopathy was confirmed by liver biopsy. There were no signs of an acute alcoholic myopathy, as the weakness had developed rather insidiously, there was no elevation of the CK serum level nor myoglobinuria and a type 2 fibre atrophy was found by muscle biopsy. As expected the weakness improved under abstention. Thus the final diagnosis of a chronic alcohol induced myopathy was established.
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Affiliation(s)
- M Wuttke
- Medizinische Klinik, Stadtspital Waid, Zürich
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Sutcliffe N, Stoll T, Pyke S, Isenberg DA. Functional disability and end organ damage in patients with systemic lupus erythematosus (SLE), SLE and Sjögren's syndrome (SS), and primary SS. J Rheumatol Suppl 1998; 25:63-8. [PMID: 9458204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the accumulated end organ damage and health status in patients with SS and to compare with patients with SLE (with or without SS). METHODS Thirty-seven patients with primary SS were studied and compared with 120 patients with SLE and 21 patients with SLE and SS. The Medical Outcome Survey Short Form 20 with an additional question for fatigue was used to assess health status. The SLICC/ACR damage index with a supplementary oral section was used to assess end organ damage. For statistical analysis, logistic regression analysis, Fisher's exact test, and Kruskal-Wallis rank tests were applied. RESULTS Patients in all 3 groups had reduced quality of life with respect to all aspects of functional status and well being. There was no difference between the groups. In the primary SS group, the greatest damage was in the oral section (62% of patients). The patients with SLE and SS had the greatest renal, peripheral vascular, and musculoskeletal damage (24, 19, 38% of patients, respectively) followed by the SLE group. Ocular damage was more common in the primary SS group, but that was due to older age in this group. Malignancy was most common in the primary SS group (11%). Other organ damage scores did not differ between groups. CONCLUSION End organ damage is uncommon in primary SS (with the exception of oral damage), but the degree of functional ability is as great as in SLE.
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Affiliation(s)
- N Sutcliffe
- Department of Medicine, University College, London, UK
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Stoll T, Gordon C, Seifert B, Richardson K, Malik J, Bacon PA, Isenberg DA. Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus. J Rheumatol Suppl 1997; 24:1608-14. [PMID: 9263159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the metric properties and validity of the assessment of quality of life by the MOS Short Form 36 (SF-36) in patients with systemic lupus erythematosus (SLE) and to examine the effect of disease on quality of life. METHODS Cross sectional study of 150 patients with SLE (age: mean 39.7 yrs, SD 11.4 yrs; 95% female) attending 2 specialist lupus clinics between November 1994 and April 1995. Shortly before or after the consultation patients completed the SF-36 and the MOS SF-20 with an additional question about fatigue (SF-20+) in random order. Disease activity was measured by the British Isles Lupus Activity Group System (BILAG), disease damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SLICC). RESULTS SF-36 domains were shown to be internally consistent (Cronbach's coefficient alpha > or = 0.71). Significant associations of the SF-36 domains with the corresponding domains of the SF-20+ and with global disease activity measured by BILAG were observed. SF-36 scores in patients with SLE were significantly lower than in controls. Different disease activity levels were significantly associated with different quality of life scores, with excellent ability to record the continuum from good health to serious illness by the SF-36. Disease activity had greater effect on quality of life than age, cumulative damage, or disease duration. CONCLUSION This study shows the SF-36 is internally consistent and proves construct, discriminatory, and criterion validity for the SF-36 and construct validity for the SF-20+ in patients with SLE. The SF-36 is preferred because of its broader scope of questions, its widespread use, and previous international validation for a wide variety of diseases.
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Affiliation(s)
- T Stoll
- Bloomsbury Rheumatology Unit/Division of Rheumatology, Department of Medicine, University College of London, UK
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Stoll T. Patients and caregivers benefit from transplantation classes. Oncol Nurs Forum 1997; 24:803. [PMID: 9244867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Stoll T, Stucki G, Malik J, Pyke S, Isenberg DA. Association of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index with measures of disease activity and health status in patients with systemic lupus erythematosus. J Rheumatol Suppl 1997; 24:309-13. [PMID: 9034988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the internal consistency and validity of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) with respect to disease activity, health status, and medication score. METHODS A prospective cross sectional study of patients with systemic lupus erythematosus (SLE) attending a specialist lupus outpatient clinic between July 1994 and February 1995. The internal consistency of the SDI components was examined using Cronbach's coefficient alpha. The associations of the SDI components with disease activity measured by the British Isles Lupus Assessment Group (BILAG) index, health status measured by the Medical Outcomes Study (MOS) Short Form 20, and with a medication score were analyzed using Spearman's rank correlation coefficient (p). RESULTS 133 women and 8 men ranging in age from 20.1 to 88.7 years (mean 41.1, SD 12.5) were studied. With few exceptions, the components of the SDI that reflect damage in different organ systems were not associated with each other. We found a significant although weak relationship between some related SDI and BILAG components (p 0.25 to 0.28; p < 0.01). While damage to the musculoskeletal system was associated with limitations in physical functioning measured with the MOS Short Form 20 (p-0.30; p < 0.01) and renal damage inversely with fatigue (p-0.23; p < 0.01) there was no significant relationship of other SDI components with the MOS Short Form 20. Renal and neuropsychiatric damage were associated significantly with the medication score (p 0.27 and 0.23; p < 0.01). CONCLUSION The components of the SDI are valid in that they are associated with disease activity in the respective organ systems and some of them with a medication score. However, damage in different organ systems in SLE does not follow a common pattern. It is thus suggested that the SDI profile be used in addition to the SDI total score as an endpoint in clinical and epidemiological studies.
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Affiliation(s)
- T Stoll
- Department of Medicine, University College of London, UK
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Stoll T, Stucki G, Malik J, Pyke S, Isenberg DA. Further validation of the BILAG disease activity index in patients with systemic lupus erythematosus. Ann Rheum Dis 1996; 55:756-60. [PMID: 8984942 PMCID: PMC1010295 DOI: 10.1136/ard.55.10.756] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association among the BILAG disease activity index components and their relations with global assessments, health status, and laboratory tests with regard to the validity of the BILAG index. METHODS A cross sectional study of consecutive patients with systemic lupus erythematosus (SLE) attending a specialist lupus outpatient clinic between July 1994 and February 1995. The internal consistency of the British Isles Lupus Assessment Group (BILAG) index-a disease activity assessment system for SLE patients, based on the principle of the physician's intention to treat-was examined using Cronbach's coefficient alpha. The association of the components of the BILAG index with health status as measured with the MOS Short Form 20 (SF-20), with patients' and doctors' global assessments of patient wellbeing and with laboratory tests was analysed with Spearman rank correlations. RESULTS 133 female and eight male patients, age 20.1 to 88.7 years (mean 41.1, SD 12.5), were included. With few exceptions, the components of the BILAG index which reflect disease activity in different organ systems were not associated with each other. With the exception of the mucocutaneous component, we found a significant relation between all components of BILAG and global assessment of patient wellbeing, health status, erythrocyte sedimentation rate, or serum C3 level. CONCLUSIONS The study confirms the validity of all but the mucocutaneous component of the BILAG index. However, disease activity in different organ systems in SLE does not follow a common pattern. Thus the individual BILAG components should be used rather than the total BILAG score as a primary endpoint in clinical and epidemiological studies. To capture the total effect of SLE on an individual measures of disease activity, damage, and health status are all needed.
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Affiliation(s)
- T Stoll
- Department of Medicine, University College of London, United Kingdom
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Stoll T, Stucki G, Brühlmann P, Vogt M, Gschwend N, Michel BA. Infection of a total knee joint prosthesis by peptostreptococcus micros and propionibacterium acnes in an elderly RA patient: implant salvage with longterm antibiotics and needle aspiration/irrigation. Clin Rheumatol 1996; 15:399-402. [PMID: 8853177 DOI: 10.1007/bf02230366] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe the favourable long-term outcome after late total knee joint prosthesis infection in an elderly RA patient. Peptostreptococcus micros and Propionibacterium acnes were cultured from the synovial fluid, and the finding of a coexistent abscess at the root of a wisdom tooth suggested a dental origin to the joint infection. Long-term antibiotics in conjunction with aspiration/irrigation resulted in salvage of the implant and an excellent functional outcome.
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Affiliation(s)
- T Stoll
- Department of Rheumatology and Physical Medicine, University Hospital, Zürich, Switzerland
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Stucki G, Brühlmann P, Stoll T, Stucki S, Willer B, Michel BA. Low serum creatine kinase activity is associated with muscle weakness in patients with rheumatoid arthritis. J Rheumatol 1996; 23:603-8. [PMID: 8730112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In rheumatoid arthritis (RA) serum creatine kinase (CK) is reduced in association with inflammatory response variables. Our objective was to examine whether low CK is associated with muscle weakness and to what extent the hypothesized relationship between CK and muscle weakness can be explained by anthropometric and sociodemographic variables and/or disease variables. METHODS Cross sectional and longitudinal retrospective analyses of clinical, radiological, and biochemical data of a prospective cohort of consecutive patients with RA. Isometric muscle strength was measured with a validated muscle strength index (MSI); CK was measured with an enzymatic assay (N-acetyl-cysteine, 37 degrees C). RESULTS 65 patients were enrolled in the study and we obtained complete one year followup data from 47. In cross sectional analysis, CK was a significant, moderate correlate of the MSI (r = 0.43, p < 0.01). CK remained a significant explanatory variable of the MSI in multivariate models that controlled for demographic variables and lean body mass, corticosteroid use, and biochemical, clinical, and radiological disease variables. In longitudinal dichotomous analyses, worsening in CK was weakly but significantly associated with decreased muscle strength, whereas in linear analyses the association did not reach significance. CONCLUSION In patients with RA, low CK activity is associated with muscle weakness. Demographic, anthropometric, and disease variables related to muscle mass or muscle atrophy explain only part of this association. Our findings support the hypothesis that muscle weakness may be partly caused by a disease related reduction of CK activity independent of muscle atrophy.
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Affiliation(s)
- G Stucki
- Department of Rheumatology and Physical Medicine, University Hospital Zürich, Switzerland
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Stoll T, Seifert B, Isenberg DA. SLICC/ACR Damage Index is valid, and renal and pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus. Br J Rheumatol 1996; 35:248-54. [PMID: 8620300 DOI: 10.1093/rheumatology/35.3.248] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigated the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index as a predictor of severe outcome and an indicator of morbidity in different ethnic groups, and in regard to its validity. We retrospectively studied disease course within 10 yr of diagnosis in an inception cohort of 80 patients with systemic lupus erythematosus (SLE). The mean renal damage score (DS) at 1 yr after diagnosis was a significant predictor of endstage renal failure and the mean pulmonary DS at 1 yr significantly predicted death within 10 yr of diagnosis. Compared to Caucasians, Afro-Caribbeans and Asians had significantly higher mean total DS at 5 and 10 yr, and higher mean renal DS at 10 yr. At 5 yr, the mean renal DS in Afro-Caribbeans and the mean neuropsychiatric DS in Asians were significantly higher than in Caucasians. The rate of endstage renal failure in Caucasians was significantly lower than in the other ethnic groups. Our results confirm the validity of the SLICC/ACR Damage Index.
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Affiliation(s)
- T Stoll
- Bloomsbury Rheumatology Unit/Division of Rheumatology, Department of Medicine, University College of London, UK
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Stucki G, Stoll T, Brühlmann P, Michel BA. Construct validation of the ACR 1991 revised criteria for global functional status in rheumatoid arthritis. Clin Exp Rheumatol 1995; 13:349-52. [PMID: 7554563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In order to assess the construct and discriminatory validity of the 1991 ACR functional status criteria for rheumatoid arthritis (RA), a cross-sectional analysis of 62 consecutive patients with RA (according to the American Rheumatism Association 1987 revised criteria) who were attending the outpatient clinic of rheumatology, University Hospital Zürich, was carried out. A moderate-to-strong association of the ACR criteria with pain (r = 0.54), the tender (r = 0.54) and swollen joint count (r = 0.31), grip strength (r = -0.49), C-reactive protein (r = 0.35), the HAQ disability index (r = 0.76), self-perceived global health (r = 0.58), and the Larsen radiological score (r = 0.32) was found. The mean scores of most disease parameters and all 8 domains of the health assessment questionnaire were significantly different between, and increased regularly across, the 4 classes. We conclude that the ACR 1991 functional status criteria for RA are a valid measure of the consequences of impairment and discriminate well the physical functional status.
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Affiliation(s)
- G Stucki
- Department of Rheumatology and Physical Medicine, University Hospital, Zurich, Switzerland
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Stoll T. [More cardiovascular sports participation! Cognitive approach as important as physical training]. Fortschr Med 1995; 113:86. [PMID: 7750889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- T Stoll
- Forschungsstelle Allgemeinmedizin, Universtät Ulm
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Stoll T, Brühlmann P, Stucki G, Seifert B, Michel BA. Muscle strength assessment in polymyositis and dermatomyositis evaluation of the reliability and clinical use of a new, quantitative, easily applicable method. J Rheumatol 1995; 22:473-7. [PMID: 7783064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the feasibility and the reliability of a quantitative method of maximal isometric strength measurement for the assessment of patients with myositis in clinical practice and research. METHODS Three observers independently examined the strength of 13 muscle groups of 7 patients with stable polymyositis and dermatomyositis (PM/DM) using a handheld pull-gauge. Reliability was assessed following a balanced random 3-way cross classification with interactions and using the analysis of variance method. Serial followup strength data for 2 patients were compared to change in creatinine kinase (CK) levels. RESULTS All measurements could be performed without causing pain to the patients. One single test including 13 muscle groups was done in 7 min or less. Both intra and interobserver correlations were strong and significant for all muscle groups. The intraobserver reliability ranged from 0.88 for elbow extensors to 0.98 for knee extensors and cervical spine flexors. The interobserver reliability ranged from 0.81 for elbow flexors to 0.98 for knee extensors and cervical spine flexors. The followup of 2 cases yielded moderate to strong correlations of serial strength measurements with CK levels. CONCLUSION Serial measurement of isometric muscle strength with a handheld pull-gauge is a feasible, inexpensive, time efficient and reliable method and may provide additional quantitative information in the clinical assessment of patients with myositis.
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Affiliation(s)
- T Stoll
- Clinic of Rheumatology and the Institute of Physical Medicine, University Hospital, Zürich, Switzerland
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